EFFECTS OF EBT CUSTOMER SERVICE WAIVERS ON FOOD STAMP RECIPIENTS: EXECUTIVE SUMMARY

Most State agencies are now using electronic benefits transfer (EBT) systems to issue food stamp benefits. To promote operational efficiency, some States have received waivers of certain rules governing EBT use. An exploratory study was conducted to ascertain the effects of these waivers on food stamp recipients. The results show that two of the waivers-those allowing recipients to select their own personal identification numbers and to receive EBT training by mail rather than in person-cause new food stamp recipients in waiver States to have more difficulties in using the electronic system than new recipients in nonwaiver States. Further, the difficulties are more apparent among the elderly or disabled. However, the problems tend to disappear as new users gain EBT experience. A third waiver, extending time for card replacement via mail, showed mixed benefits for recipients, most of whom prefer to pick up the card at a food stamp office. Perhaps the most important conclusion is that the customer service waivers do not affect recipient satisfaction with the EBT system; the high level of satisfaction that they expressed suggests that most problems with the waivers are either transitory or minor. The full report is available online. See Effects of EBT Customer Service Waivers on Food Stamp Recipients: Final Report, at: http://www.ers.usda.gov/publications/efan02007EBT, new recipients, customer service, vulnerable subgroups, recipient satisfaction, Food Consumption/Nutrition/Food Safety, Food Security and Poverty,

ASSESSMENT OF WIC COST-CONTAINMENT PRACTICES; EXECUTIVE SUMMARY

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides both nutrition education and supplemental foods containing nutrients determined by nutritional research to be lacking in the diets of pregnant, breastfeeding, and postpartum women, infants, and children. State WIC agencies have implemented practices designed to reduce the cost of food packages containing these prescribed foods. For instance, one of the WIC program's primary cost-saving practices is negotiating rebate contracts with manufacturers of infant formula. Additional practices include limiting authorized vendors to stores with lower food prices; limiting approved brands, package sizes, forms, or prices; and negotiating rebates with food manufacturers or suppliers. There is concern that these practices may inadvertently counter the program's goal of providing supplemental foods and nutrition education. Based on a review of cost-containment practices in six States, including interviews with the various stakeholders and analysis of WIC administrative files, the study draws three major conclusions: (1) costcontainment practices reduced average food package costs by 0.2 to 21.4 percent, depending on practices implemented and local conditions; (2) the cost-containment practices had few adverse outcomes for WIC participants; and (3) administrative costs of the practices were low, averaging about 1.5 percent of food package savings. The full report, Assessment of WIC Cost-Containment Practices: Final Report, is available online at http://www.ers.usda.gov/publications/efan03005.WIC Program, cost-containment, food-item restrictions, vendor restrictions, manufacturers' rebates, food package costs, Food Consumption/Nutrition/Food Safety, Food Security and Poverty,

Do supplemental list frames for subpopulations increase subpopulation sampling efficiency? Evidence from the National Household Food Acquisition and Purchase Survey

Multiple-frame sampling has been regarded as a device for increasing efficiency in identifying small subpopulations. However, there has been a lack of empirical evidence in supporting the efficiency of the multiple-frame approach and in guiding best practices. The current study focuses on a special scenario in which two frames were used to recruit sample members. Using paradata from the U.S. National Household Food Acquisition and Purchase Survey (FoodAPS), the current analysis focuses on recruiting households that received Supplementary Nutrition Assistance Program (SNAP) as a sub-goal of the survey sampling. SNAP households account for around one-fifth of the general U.S. population, compared to a survey goal of 30 percent of responding households. Our findings were consistent with theoretical expectations. Having and using additional SNAP list frames improved the efficiency of identifying SNAP households as opposed to screening a general address-based sample frame. This efficiency remained even as the SNAP list frames aged

Comparative neurohormonal responses in patients with preserved and impaired left ventricular ejection fraction: Results of the studies of left ventricular dysfunctions (SOLVD) registry

AbstractObjectives. The aim of this study was to determine the differences in neurohumoral responses between patients with pulmonary congestion with and without impaired left ventricular ejection fraction.Background. Previous studies have established the presence of neurohumoral activation in patients with congestive heart failure. It is not known whether the activation of these neurohumoral mechanisms is related to the impairment in systolic contractility.Methods. The 898 patients recruited into the Studies of Left Ventricular Dysfunction (SOLVD) Registry substudy were examined to identify those patients with pulmonary congestion on chest X-ray film who had either unpaired (<- 45%, group I) or preserved (> 45%, group II) left ventricular ejection fraction. Plasma norepinephrine, plasma renin activity, arginine vasopressin and atrial natriuretic peptide levels were measured in these two groups of patients and compared with values in matched control subjects,Results. Distribution of the New York Heart Association symptom classification was the same in the two groups of patients. Compared with control subjects, patients in group II with pulmonary congestion and preserved ejection fraction had no activation of the neurohumoral mechanisms, except for a small but statistically significant increase in arginine vasopressin and plasma renin activity. Compared with patients in group II, those in group I with pulmonary congestion and unpaired ejection fraction had significant increases in plasma norepinephrine (p < 0.002), plasma renin activity (p < 0.02) and atrial natriuretic peptide levels (p < 0.0007). When we controlled for baseline differences between groups I and II, the between-group differences in plasma norepinephrine (p < 0.02) and atrial natriuretic peptide (p < 0.002) remained significant. However, plasma renin activity was not significantly different between groups I and II. When the effects of diuretic agents and angiotensinconverting enzyme inhibitors were adjusted, patients with lower ejection fraction were found to have significantly higher plasma norepinephrine and atrial natriuretic peptide levels.Conclusions. The results point to the importance of the decrease in left ventricular ejection fraction as one of the mechanisms for activation of neurohormones in patients with heart failure

Relation of neurohumoral activation to clinical variables and degree of ventricular dysfunction: A report from the registry of studies of left ventricular dysfunction

Objectives. This study examined the relation between neurohumoral activation and severity of left ventricular dysfunction and congestive heart failure in a broad group of patients with depressed left ventricular function who were not recruited on the basis of eligibility for a therapeutic trial. Background. Previous studies have established the presence of neurohumoral activation in patients with severe congestive heart failure. It is not known whether the activation of these neurohumoral mechanisms is related to an impairment in left ventricular function

Value of the First Post-Transplant Biopsy for Predicting Long-Term Cardiac Allograft Vasculopathy (CAV) and Graft Failure in Heart Transplant Patients

BACKGROUND: Cardiac allograft vasculopathy (CAV) is the principal cause of long-term graft failure following heart transplantation. Early identification of patients at risk of CAV is essential to target invasive follow-up procedures more effectively and to establish appropriate therapies. We evaluated the prognostic value of the first heart biopsy (median: 9 days post-transplant) versus all biopsies obtained within the first three months for the prediction of CAV and graft failure due to CAV. METHODS AND FINDINGS: In a prospective cohort study, we developed multivariate regression models evaluating markers of atherothrombosis (fibrin, antithrombin and tissue plasminogen activator [tPA]) and endothelial activation (intercellular adhesion molecule-1) in serial biopsies obtained during the first three months post-transplantation from 172 patients (median follow-up = 6.3 years; min = 0.37 years, max = 16.3 years). Presence of fibrin was the dominant predictor in first-biopsy models (Odds Ratio [OR] for one- and 10-year graft failure due to CAV = 38.70, p = 0.002, 95% CI = 4.00-374.77; and 3.99, p = 0.005, 95% CI = 1.53-10.40) and loss of tPA was predominant in three-month models (OR for one- and 10-year graft failure due to CAV = 1.81, p = 0.025, 95% CI = 1.08-3.03; and 1.31, p = 0.001, 95% CI = 1.12-1.55). First-biopsy and three-month models had similar predictive and discriminative accuracy and were comparable in their capacities to correctly classify patient outcomes, with the exception of 10-year graft failure due to CAV in which the three-month model was more predictive. Both models had particularly high negative predictive values (e.g., First-biopsy vs. three-month models: 99% vs. 100% at 1-year and 96% vs. 95% at 10-years). CONCLUSIONS: Patients with absence of fibrin in the first biopsy and persistence of normal tPA in subsequent biopsies rarely develop CAV or graft failure during the next 10 years and potentially could be monitored less invasively. Presence of early risk markers in the transplanted heart may be secondary to ischemia/reperfusion injury, a potentially modifiable factor