Managing access: extending Medicaid to children through school-based HMO coverage.

This study explores how a health maintenance organization's (HMO) capacity and incentives to manage care might be used to improve access. In the early 1990s, the Florida Healthy Kids (FHK) demonstration extended Medicaid-like HMO coverage to indigent children in the public schools of Volusia County, Florida. The study finds that uninsured student months in area public schools were likely reduced by one-half. Utilization and cost levels for these indigent enrollees proved to be indistinguishable from commercial clients; and measures of access, utilization, and satisfaction for enrollees were in line with (and in some cases, superior to) non-enrollees with private insurance. Overall, these results suggest the value of using schools as a medium for providing coverage, and the importance of taking deliberate steps to manage access to reduce non-financial barriers to care.

Influence of creep feeding and weaning on brush border enzyme activities in the piglet small intestine.

The activities of the enterocyte brush border enzymes lactase (beta-D galactoside galactohydrolase, EC 3.2.1.23) and sucrase (sucrose alpha-D glucohydrolase, EC 3.2.1.48) were measured at set percentage lengths along the small intestines of 112 piglets killed between 21 and 32 days of age. The influences on these activities of consumption of creep feed and of weaning were recorded. Weaning at three weeks old resulted in large, rapid reductions in lactase activity at most sites along the small intestine; sucrase activity declined temporarily and then recovered. Minimum values were recorded about four to five days after weaning. Similar changes were observed whether or not creep feed was consumed before weaning. Continued consumption of creep feed by unweaned pigs over the 21 to 32 day period also produced small but significant reductions in lactase activities. The large loss of digestive enzyme activities at brush borders in weaned animals coincided with a reduced ability to absorb xylose and to checks in growth rate in otherwise healthy piglets.

Coliform numbers in the stomach and small intestine of healthy pigs following weaning at three weeks of age.

In 60 weaned and 52 unweaned pigs, aged between 21 and 32 days, the number of coliform organisms in the gastric contents was found to be related to their pH value. The contents were generally more acidic in the weaned animals and contained fewer coliforms. Haemolytic coliform organisms were never identified among selected isolates examined from the gastric contents although in weaned animals the haemolytic enterotoxigenic Escherichia coli serotype 0149: K91, K88a,c (Abbotstown strain) was commonly recovered from the intestines. After weaning, this strain appeared to colonize the anterior small intestine from lower down the tract, and its presence was associated with an increase in the total coliform count at the site from which it was isolated. Rotaviruses were also more commonly detected in the intestinal contents of weaned than unweaned pigs, but their appearance after weaning appeared to be preceded by the proliferation of haemolytic E. coli. The presence of either or both of these potentially enteropathogenic organisms never induced diarrhoea, and although faecal water content increased significantly after weaning, this occurred independently of the presence of both agents.

Radiologic observations of gastric mixing and emptying of food in growing pigs.

The stomachs of 10 Large White x Landrace pigs were examined radiographically from weaning (at 26 to 28 days of age) until 6 or 16 weeks of age. Conventional radiographs were taken and observations were made with a television chain and 35-mm cinecamera linked to an image intensifier. Before radiography, each animal was fed its normal diet that contained a barium sulfate suspension and/or radio-opaque pellets. The basic pattern of motility in the major chamber of the pig's stomach was similar to that described in animals with a simple stomach. Type II peristaltic waves were clearly identified as indentations of the body of the stomach that moved towards the pyloric antrum, which became circular as it filled with digesta. A terminal antral contraction then occurred, the antrum decreased in diameter, and the ingesta and barium sulfate either entered the duodenum or were returned to the body of the stomach. Liquids and finely ground food left the stomach more rapidly than did the radio-opaque pellets that were retained for up to 44 hours. The radio-opaque pellets demonstrated the movement of ingesta within the gastric lumen and showed that ingesta was retropulsed into the body of the stomach by the terminal antral contraction. In 4 pigs, barium and ingesta were present in the 2nd chamber of the stomach, the gastric diverticulum. In 1 pig, a movement of the diverticulum was observed on a single occasion.

The level of distribution of carbohydrases in the small intestine mucosa of pigs from 3 weeks of age to maturity.

1. The levels of the brush-border enzymes sucrase (sucrose glucohydrolase, EC 3.2.1.48), isomaltase (oligo-1,6-glucosidase, EC 3.2.1.10), maltases 2 and 3 (glucoamylase, EC 3.2.1.3), lactase (beta-galactosidase, EC 3.2.1.23) and trehalase (EC 3.2.1.28) and adsorbed pancreatic alpha-amylase (EC 3.2.1.1) have been measured at twenty-one positions along the small intestines of eighty-four pigs of different ages ranging from 3 weeks to 4.5 years. The state of dilation of the intestine at the sampling points was noted. 2. The levels of sucrase and isomaltase increased with age throughout the age-range studied. Trehalase and the glucoamylases increased with age up to 200--300 d of age. Lactase decreased with age over the whole age range. 3. For the pigs above 10 weeks of age, the distribution pattern of the brush-border enzymes along the intestine did not change with age. Each enzyme had a characteristic distribution curve, with low values at the proximal and distal ends and a peak which was proximal in the instance of lactase and trehalase and approximately mid-way along the gut with sucrase, isomaltase and the glucoamylases. 4. The pattern of distribution of the brush-border enzymes altered with age in the piglets, but approached the adult pattern by 8 weeks. 5. Piglets weaned at 3 weeks had higher levels of sucrase, isomaltase and glucoamylases at 5 weeks than piglets left on the sow. At 8 weeks of age the piglets weaned at 3 weeks still had higher sucrase and isomaltase levels than those on the sow. 6. There was a very close correlation between the sucrase and isomaltase levels, and between the maltase 2 and maltase 3 levels in all the samples, and a fairly close correlation between all these four enzymes. 7. The level of alpha-amylase increased with age but showed no regular distribution pattern, its irregular fluctuations being related to the presence or absence of dilation of the intestine at the time of slaughter rather than to the position along the intestine.

The quantitative assessment of normal canine small intestinal mucosa.

Quanitative methods of assessing the architecture of small intestinal mucosa have been applied to biopsy material from normal dogs. Mucosal samples taken from four predetermined sites show that there are significant quantitative differences between the various levels of the small bowel. Animals of one year of age and older show no correlation between age or weight and mucosal dimensions. The significance of these findings, in relation to examination of biopsy material from cases of clinical small intestinal disease, is discussed.

The quantitative assessment of mucosa in canine small intestinal malabsorption.

Histological sections from the small intestines of dogs showing clinical signs of small intestinal malabsorption have been examined using morphometric techniques. Weibel graticule measurements appear to be a useful adjunct to the subjective assessment of villus atrophy. Severe clinical signs of small intestinal malabsorption may be associated with a patchy distribution of lesions throughout the small bowel.

The presence and distribution of beta-galactosidases in the small intestinal mucosa of the neonatal dog.

The beta-galactosidase activity of the small intestinal mucosa of the neonatal dog has been studied over the pH range 3-0 - 5-8 using different substrates and in the presence and absence of p-chloromercuribenzoate. Partial separation of two beta-galactosidases has been achieved by gel filtration. The results suggest that three beta-galactosidases, comparable with those in other mammals, exist in canine small intestinal mucosa.

Small intestinal beta-galactosidase activity in the horse.

Two enzymes having lactase activity are present in the equine small intestine. The first, the digestive enzyme, neutral beta-galactosidase, declines in activity from birth to three years, disappearing completely between 3 and 4 years of age. The other, the soluble lysosomal enzyme, acid beta-galactosidase, having affinity for lactose and a synthetic beta-galactoside, shows a decrease in activity in the first three months of life and thereafter varies little in activity and represents the lactase enzyme in the adult horse. This pattern may parallel the development of lactase activity in many other mammals and in the majority of the world's human population.