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Rossi states that these gaps are often a result of unreliable tools or methods to measure nutrition risk, along with a lack of clarity in the definition of risk. In the study, Rossi took what are called "street-level bureaucrats" and applied them for WIC. These people were either at marginal or no nutrition risk, yet they were accepted easily into the WIC program.

This practice essentially turns eligibility into solely a matter of income. The second eligibility standard for participation in the WIC program—income level—also allows for much subjectivity. While this definition seems straight forward, Besharov and Germanis describe many instances in which WIC participants with incomes above this level still received services. This could be due to the rapid growth of WIC in the past 30 years. Many WIC staff members have reported that because of the rise in funding, local income testing procedures have become less thorough Besharov and Germanis aren't the only ones who have noticed discrepancies in the WIC income eligibility requirement.

A USDA study demonstrated that 5. General Accounting Office , Because of this evidence, the USDA believes that WIC can reduce funding and still meet the needs of those who truly are in need of assistance [21]. Conversely, the same report explained that some members of the USDA have concluded that the current method for estimating eligibility is flawed and reports a much lower number of eligible citizens than actually exists.

The method is flawed because it measures income on an annual basis instead of a monthly basis. When the researchers compared monthly income to annual income, they found that the number of income-eligible people increased dramatically a monthly evaluation level.

No mention of the effect on mothers was mentioned. They concluded that if income were measured monthly, then a larger number of families would be eligible to participate in WIC [21]. Other research suggests that instead of redefining WIC eligibility requirements, policymakers should better advertise how lenient the requirements are. In a study published in , Craig Gundersen, a professor in the Department of Nutritional Science at the University of Illinois at Urbana-Champaign, found that many parents stop using WIC funds to care for their children after their children reach the age of one year.

Only one in nine non-participating children nationwide are ineligible for WIC aid. To combat this phenomenon, Gundersen suggests that if policymakers want to reach those most in need, they need to target this group of people who were once on WIC and left, not new recipients. Eligibility for participation in the WIC program has been affected by a number of federal programs and policy changes since the s.

The federal government has gradually increased its control over WIC program policies, which has resulted in a move away from state program control. For instance, the nutritional risk criteria that had previously been instituted by the state cutoffs were standardized by the federal government in Allowing these groups to be eligible, in effect, raised the income eligibility threshold for WIC services. Research has identified an increase in health benefits among WIC program participants that could offset the additional costs of Medicaid in the future.

Changes in welfare benefits are also estimated to increase the adjunctive eligibility rate. A state was allowed to match federal funds for meals in private schools. Requirements to use certain WIC funds for the costs of nutrition services and administration were extended [24]. WIC program participation can be affected by an introduction of new programs or changes to existing policy of programs that affect women, infants, and children.

If services increase under the TANF program, a specific segment of participants in the WIC program, such as infants, showed a decrease in participation. Implementation of the TANF program accounts for a 9. In addition to current programs that affect eligibility and participation in the WIC program, many states distribute waivers that extend program rules, change work requirements, and extend program timelines that affect eligibility and participation in WIC.

WIC's impact is affected by internal programs. Some scholars assert that the spending structure needs to be adjusted so a greater number of eligible individuals can receive WIC services. Transferring some spending to other parts of the program is under consideration. Besharov and Germanis argue that a sustained effort to make the program more effective should begin with a policy debate about WIC's role and impacts.

Opportunities for improving the Nutritional Status of Women, Infants, and Children , authors Fox, McManus, and Schmidt from the George Washington University, say local WIC agencies are required to make nutrition education available to participants at least twice in each six-month certification period. The initial nutritional session is usually conducted during the intake appointment with the individual, and subsequent sessions are typically offered in a group format lasting about 10 to 15 minutes.

These education sessions are optional than mandatory This practice raises questions about the efficiency of WIC spending. People doubt the legitimacy of the minute nutritional education since it is too short to play a part in improving the participant's nutritional status. Therefore, it is reasonable to ask: Would it be more effective and efficient if the spending for this session is transferred to other useful areas? A Cause for Concern? The higher retail value of the WIC food benefit for infants is due to the inclusion of infant formula.

Since the WIC program encourages breast feeding, it raises a question similar to the foregoing: Would it be more effective and efficient if some of the spending on infant formula is transferred to drawing more participation of WIC, making more people eligible for this program? Participants of WIC receive checks, vouchers, or electronic cards to purchase food at participating retail markets each month to supplement their diets.

The program food package is designed to address the specific needs of low-income pregnant, breastfeeding, and postpartum non-breastfeeding women; infants; and children up to five years of age who are nutritionally at risk.

The food purchased with WIC vouchers must be on the approved list of approved foods. Up until , the list of approved foods was meant to help supplement participant's diets to contain the following priority nutrients: Nationwide data showed that WIC participants had inadequate intake of vitamin E, magnesium, calcium, potassium, and fiber while using the original food packages.

Participants also had an excessive intake of saturated fats, sodium, zinc, and preformed vitamin A. In response to the lack of intended program outcomes, the U. Department of Agriculture's Food and Nutrition Service assigned the Institute of Medicine's Committee to assess the effectiveness of the food package content.

This included prioritizing the targeted nutrient intake and offering recommendations for specific changes to the WIC food packages. To do this, the committee was charged with making recommendations that were "culturally suitable, non-burdensome to administration, efficient for nationwide distribution and vendor checkout, and cost-neutral.

This change to the food package was done again in , which put the food package in compliance with the Dietary Guideline for Americans. This change introduced an inclusion of cash-value vouchers for fruits, vegetables, whole-wheat bread, corn or whole-wheat tortillas, brown rice, oats, bulgur, and barley.

Milk purchase options were also altered to only include lower-fat milk for all women and all children over 2 years of age. The adjustment in the food package had a significant effect on participant nutrition. The literature suggested that there has been a significant increase in the overall nutrition of WIC participants as a result of these food package changes.

Participants were surveyed before and after the new food package implementations. The data showed that there was a Currently, WIC food packages include infant cereal, iron-fortified adult cereal, fruit rich in vitamin C, vegetable juice, eggs, milk, cheese, peanut butter, beans, and fish. WIC has recently expanded this list to also include soy-based beverages, tofu, baby foods, whole-wheat bread, and a variety of fruits and vegetables.

The literature painted a clear picture of the improvements that have been made and the effect the food package change has made in increasing the nutrition of WIC participants. WIC has dramatically reduced healthcare costs by a providing prenatal services, and b promoting breastfeeding. Several controlled evaluations have shown that women who receive prenatal WIC services have lower hospital costs for both them and their infants than women who did not receive WIC services.

In , prenatal WIC enrollment was estimated to have reduced first year medical costs for U. Prenatal use of WIC services also decreases the odds of having a low birth-weight newborn by 25 percent and reduces very low birth-weight births by 44 percent. One reason that WIC is known as being cost-effective is explained in a study done in by Debbie Montgomery and Patricia Splett where they showed that promotion of breast-feeding in the WIC program is an effective cost-containment action.

Historically, WIC has been portrayed as an efficient and effective use of taxpayer dollars. Finding or conducting research that conclusively proves that portrayal is somewhat difficult.

Two challenges exist, finding research that encompasses all areas of WIC and conducting scientific research. Research on WIC tends to focus on the help provided to pregnant women and newborns. The research on this part of WIC shows that the help provided is effective and the system is efficient.

These results are then used to determine that all of the WIC programs are effective. Besharov and Germanis [33]. Conducting scientific research on an aid program like WIC is also problematic. First, it is difficult, if not impossible, to establish a control group. To do so would require a researcher to take people asking for aid and then split them into two groups.

Aid would then need to be denied to one of the groups. This would be unethical. Second, it is difficult to account for other variables that could affect infant and children health, in addition to the help provided by WIC. An example would be parental motivation. How do you determine if the results of WIC were because of the program or due to effective parenting?

More effective parents may be more likely to seek WIC help earlier and longer. They are designed to be used as interpersonal communication tools by individuals and frontline workers in giving out important information to women and caregivers.

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