Supplemental Nutrition Assistance Program Participation and Emergency Food Pantry Use.

OBJECTIVE: To determine the association between Supplemental Nutrition Assistance Program (SNAP) participation and pantry use. DESIGN: A pretest-posttest design that compared pantry use at program enrollment and after 6 months of participation while controlling for household, economic, and geographic characteristics. SETTING: Supplemental Nutrition Assistance Program Food Security Survey: a national telephone survey of SNAP new-entrant households conducted in 2011-2012. PARTICIPANTS: A total of 3,191 households that completed baseline interviews and were still participating in SNAP approximately 6 months later. MAIN OUTCOME MEASURE: Received emergency food from pantries in the past 30 days. ANALYSIS: Logistic regression analysis of pantry use with SNAP participation and time-varying household characteristics as independent variables. Statistical significance was assessed using t tests. The authors applied a Bonferroni adjustment to account for multiple comparisons performed. RESULTS: Participating in SNAP for 6 months was associated with a decrease in pantry use by 5.2 percentage points (P < .001), representing a 24% reduction (from 21.8% to 16.6%). CONCLUSIONS AND IMPLICATIONS: Supplemental Nutrition Assistance Program benefit allotments are sufficient for some households, but 76% of SNAP households that enter the program while using pantries continue to do so about 6 months later, which underscores the need to assess the adequacy of SNAP benefit allotments in ensuring access to sufficient food for a healthy, active life.

Supplemental nutrition assistance program participation and child food security.

OBJECTIVE: This article investigates the association between Supplemental Nutrition Assistance Program (SNAP) participation and child food security by using data from the largest national survey of the food security of SNAP participants to date. METHODS: The analysis used a survey of nearly 3000 households with children and a quasi-experimental research design that consisted of 2 sets of comparisons. Using a cross-sectional sample, we compared information collected from SNAP households within days of program entry with information collected from a contemporaneous sample of SNAP households that had participated for ∼6 months. Next, by using a longitudinal sample, we compared baseline information collected from new-entrant SNAP households with information from those same households 6 months later. Multivariate logistic regression analysis was used to estimate associations between SNAP and child food security. RESULTS: SNAP participation was associated with an approximately one-third decrease in the odds of children being food insecure in both samples. In the cross-sectional analysis only, SNAP was also associated with a decrease in the odds of children experiencing severe food insecurity (designated very low food security). Findings were qualitatively robust to different empirical specifications. CONCLUSIONS: After controlling for other possible confounders, we found children in households that had participated in SNAP for 6 months experienced improvements in food security. On the basis of these findings, we conclude SNAP serves a vital role in improving the health and well-being of low-income children by increasing food security. Future research is needed to determine whether specific groups of children experience differential improvements in food security.

Relationship quality and burden among caregivers for late-stage cancer patients.

OBJECTIVE: This study explores how caregiver relationship quality with family, patient, and patient's health care provider (HCP) is associated with subjective caregiver burden during the early treatment phase for late-stage cancer. METHOD: Burden and relationship quality were assessed in telephone interviews with family caregivers (FCGs) of advanced cancer patients. The five subscales of the Caregiver Reaction Assessment measured burden, while relationships were measured with the Family Relationship Index, the Family Inventory of Needs subscale of met needs, and a scale assessing family discord in cancer communication. RESULTS: Multiple linear regression analyses in SPSS (v16) of 420 FCGs showed that higher quality relationship with family was associated with lower burden in FCG abandonment, health, scheduling (p < 0.001) and finances (p < 0.01). Higher quality relationship with patients' HCPs was associated with lower burden in FCG abandonment (p < 0.05), health, and finances (p < 0.001). More discordant communication in patient relationship was associated with lower financial burden (p < 0.05). Relationship quality was not associated with caregiver self-esteem. CONCLUSIONS: Findings demonstrate that caregiver relationship quality with family and with HCP are important factors in understanding caregiver burden during the early treatment phase of late-stage cancer care.

Costs and risks in the management of patients with gastric acid hypersecretion.

GOALS: To define both risks and costs of optimal care of patients with gastric acid hypersecretion. BACKGROUND: The management of Zollinger-Ellison syndrome and other gastric acid hypersecretory disorders remains challenging. The optimal strategy for follow-up including gastric acid analysis, laboratory studies, and endoscopy is unknown but important given the potential complications from uncontrolled acid secretion. STUDY: Over the last 18 years, patients with gastric acid hypersecretory disorders have been followed prospectively with gastric acid analysis and endoscopy titrating oral lansoprazole and evaluating for complications. Protocol driven charges were calculated using the most recent information available. RESULTS: After 1 year of treatment optimization, 19 of 67 patients had 43 relapses, (once only in 10 patients). Risk markers for relapse included: (1) antrectomy, 67% relapsed versus 21% in unoperated patients; (2) basal acid output >5 mmol/h (risk=5.17); and (3) poor compliance. On treatment, 79% of 58 intact patients (excluding antrectomy) were lesion-free; 11% had only 1 relapse. Thus 90% were well managed with optimized lansoprazole alone. Protocol driven charges exceeded $25,000 the first year and $7000 annually thereafter. CONCLUSIONS: Relapse is infrequent and generally mild with acid secreting status closely monitored. The ideal strategy to balance costs and testing awaits further study.

Examining the characteristics of unstaged colon and rectal cancer cases.

BACKGROUND: There are only three published studies that have examined unstaged cancers, including breast, prostate and colorectal cancer, but none have specifically examined which aspects of tumor staging were missing. The objective of the study was to identify which stage components were missing, to characterize and to identify predictors of unstaged cancer, and to evaluate prognosis of unstaged in colon and rectal cancer patients. METHODS: Data on all colon and rectal cancer cases diagnosed during 1991 to 2002 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Information included in the analysis encompassed socio-demographics; tumor size (T); number of lymph nodes (N); metastases (M); SEER summary stage; SEER sites; cancer treatment; month and year of diagnosis; and last date known alive. RESULTS: The study included 128,418 colon and 44,616 rectal cancer patients. Overall, 5.1% of colon and 7.8% of rectal cancer patients were unstaged. Compared to staged cases, both unstaged colon and rectal cancer cases were more likely to be older, African American, female, diagnosed in the Northeast and South, and have unknown treatment (all p<0.001). The stage component of M was found to be the factor missing most frequently which attributed most to being unstaged. Survival was significantly higher in unstaged and the overall cohort compared to distant staged colon and rectal cancer patients (both p<0.001) except for patients > or =65 years old (p>0.99). CONCLUSIONS: Given that unstaged cases differ from staged, the findings have methodological implications in accounting for unstaged cases in epidemiological and health services research.

Receipt of standard breast cancer treatment by African American and White women.

OBJECTIVES: Breast cancer mortality is higher among African Americans than for Whites, though their breast cancer incidence is lower. This study examines whether this disparity may be due to differential receipt of treatment defined as "standard of care" or "addition to standard of care" by the National Comprehensive Cancer Network (NCCN). DESIGN: Incident, female breast cancer cases, 2,203 African American and 7,518 White, diagnosed during 1996-2002 were identified from the Alabama Statewide Cancer Registry. Breast cancer treatment was characterized as whether or not a woman received standard of care as defined by the NCCN. For cases characterized as receiving standard of care, addition to standard of care was also evaluated, defined as receiving at least one additional treatment modality according to NCCN guidelines. Logistic models were used to evaluate racial differences in standard and addition to standard of care and to adjust for age, stage at diagnosis, year of diagnosis and area of residence. RESULTS: No racial differences were found for standard (Prevalence Ratio (PR)=1.00) or for addition to standard of care (PR=1.00) after adjustment for confounders. When the adjusted models were examined separately by age, stage, and area of residence, overall no racial differences were found. CONCLUSION: No racial differences in standard of care and addition to standard of care for breast cancer treatment were found. Therefore, both African Americans and Whites received comparable treatment according to NCCN guidelines.

Absence of gastrointestinal infections in a cohort of patients with Zollinger-Ellison syndrome and other acid hypersecretors receiving long-term acid suppression with lansoprazole.

BACKGROUND: The relationship between proton pump inhibitor therapy and other acid suppressing medications and the risk of gastrointestinal infections remains controversial. METHODS: Patients enrolled in a long-term trial of lansoprazole for Zollinger-Ellison syndrome and other acid hypersecretory states had interval histories taken every six months regarding hospitalizations or other intercurrent medical conditions. All medications taken were also reviewed at each visit. In addition, available patients were specifically queried during the study period 2006-2007 regarding the development of any gastrointestinal infections, hospitalizations, and prescriptions for antibiotics. RESULTS: Ninety patients were enrolled in our long-term study and 81 were available for review. The median basal gastric pH for the cohort after stabilization on therapy was 2.9 and ranged from 1.1 - 8.4 with a median pentagastrin stimulated gastric pH of 1.60 (range 1.0 - 8.2). No patient developed a clinically significant gastrointestinal infection during the study. The median patient years of follow-up were 6.25 years. CONCLUSION: In a cohort of patients with gastric acid hypersecretion in whom acid secretion status was monitored on lansoprazole, all were free of significant gastrointestinal infections on long-term follow-up. TRIAL REGISTRATION: NCT00204373.

Magnetic source imaging versus intracranial electroencephalogram in epilepsy surgery: a prospective study.

OBJECTIVE: Noninvasive brain imaging tests can potentially supplement or even replace the use of intracranial electroencephalogram (ICEEG), an invasive, costly procedure used in presurgical epilepsy evaluation. This study prospectively examined the agreement between magnetic source imaging (MSI) and ICEEG localization in epilepsy surgery candidates. METHODS: Patients completing video monitoring with scalp EEG who had intractable partial epilepsy based on ictal electro-clinico-anatomical features were screened. Forty-nine enrolled patients (mean age, 27 years; range, 1-61 years) completed MSI and ICEEG studies. Decisions about ICEEG and surgery were made at a consensus conference where MSI could only influence ICEEG coverage by indicating supplemental coverage to that already planned by an original hypothesis. RESULTS: The positive predictive value of MSI for seizure localization was 82 to 90%, depending on whether computed against ICEEG alone or in combination with surgical outcome. The kappa score of agreement for MSI with ICEEG was 0.2744 (p < 0.01) INTERPRETATION: MSI yields localizing information with a high positive predictive value in epilepsy surgery candidates who typically require ICEEG. This finding suggests that enough clinical validity exists for MSI to potentially replace ICEEG for seizure localization.