Self-help groups challenge health care systems in the US and UK

Purpose: This research considers how self-help groups (SHGs) and self- help organizations (SHOs) contribute to consumerist trends in two different societies: United States and United Kingdom. How do the health care systems and the voluntary sectors affect the kinds of social changes that SHGs/SHOs make? Methodology/approach: A review of research on the role of SHGs/SHOs in contributing to national health social movements in the UK and US was made. Case studies of the UK and the US compare the characteristics of their health care systems and their voluntary sector. Research reviews of two community level self-help groups in each country describe the kinds of social changes they made. Findings: The research review verified that SHGs/SHOs contribute to national level health social movements for patient consumerism. The case studies showed that community level SHGs/SHOs successfully made the same social changes but on a smaller scale as the national movements, and the health care system affects the kinds of community changes made. Research limitations: A limited number of SHGs/SHOs within only two societies were studied. Additional SHGs/SHOs within a variety of societies need to be studied. Originality/value of chapter Community SHGs/SHOs are often trivialized by social scientists as just inward-oriented support groups, but this chapter shows that local groups contribute to patient consumerism and social changes but in ways that depend on the kind of health care system and societal context

Substituição total do farelo de soja por uréia ou amiréia, em dietas com alto teor de concentrado, sobre a amônia ruminal, os parâmetros sangüíneos e o metabolismo do nitrogênio em bovinos de corte Total replacement of soybean meal by urea or starea in high grain diets on nitrogen metabolism, ruminal ammonia-N concentration and blood parameters in beef cattle

Seis novilhos da raça Nelore, não castrados, com peso médio inicial de 420 kg, distribuídos em delineamento em quadrado latino 3x3 duplicado, foram utilizados para avaliar a substituição total de uma fonte de proteína verdadeira (farelo de soja), em uma dieta deficiente em proteína degradável no rúmen (PDR), por uréia ou amiréia (fontes de nitrogênio não protéico), ambas em uma dieta adequada em PDR. As dietas foram isoprotéicas (13,0%) utilizando-se o bagaço de cana-de-açúcar in natura (BIN) como única fonte de volumoso (20% da MS). Foram avaliados: a concentração de amônia ruminal, nitrogênio uréico plasmático, glicose plasmática e o metabolismo do nitrogênio. Os tratamentos foram: 1) farelo de soja (FS); 2) uréia e 3) amiréia (A-150S). A concentração de nitrogênio amoniacal no fluido ruminal foi superior no tratamento com uréia, comparado ao tratamento com farelo de soja, sendo que o tratamento com amiréia não diferiu dos demais. O tratamento com amiréia apresentou maior perda de N urinário. A retenção de N (g/d e % do consumido) e o valor biológico da proteína (N retido, % do N digerido) foram superiores para o tratamento com uréia, comparado aos demais. A concentração de nitrogênio uréico no plasma e a concentração de glicose plasmática foram similares entre os tratamentos. A substituição total do farelo de soja por uréia, ajustando a PDR na dieta de bovinos de corte, demonstrou ser viável. A uréia na forma convencional apresentou vantagens em relação à amiréia.<br>Six Nellore bulls, with initial body weight of 420 kg, were assigned to a duplicated 3x3 Latin square design to evaluate the effects of replacing a true protein source (soybean meal), of high biological value, in a rumen degradable protein (RDP) deficient diet, by urea or starea (a supposedly slow release nonprotein nitrogen source), both in a RDP adjusted diet. In natura sugarcane bagasse as the only source of forage (20% of DM). Evaluated parameters were: rumen ammonia-N concentration, plasma urea-N, glucose and nitrogen balance. Experimental treatments were: 1) soybean meal (SBM); 2) urea and 3) starea (A-150S). Diets were isonitrogen (13% CP). The rumen ammonia-N concentration was higher in the treatment with urea, compared to the treatment with SBM, and starea showed no difference compared to the others. Starea had higher loss of urinary N. N retention (g/d and % of consumed) and protein biological value (N retention, % of N digestible) were higher for urea treatment, compared to the others. There was no difference on plasma urea-N and glucose concentration among treatments. Total replacement of SBM by urea, adjusting PDR in diets for growing beef cattle, demonstrated to be viable. Conventional urea showed advantage compared to starea