Mental Health Services for Nursing Home Residents: What Will It Cost?

The Nursing Home Reform Act of 1987 requires nursing homes to provide basic mental health services for all residents and to give active mental health treatment, a set of specialized mental health services, to those residents who are admitted with a serious mental illness. This article examines the potential size of the nursing home population who will require mental health services, its demographic composition, and the facilities in which these individuals reside using the Institutional Population Component of the National Medical Expenditure Survey. Estimates of the potential costs of providing monthly psychotherapy and pharmacological management to this population in nursing homes indicate that the mandate will have significant financial effects on nursing facilities. Conclusions about how the requirements for maintaining the mental and psychosocial well-being of nursing home residents may affect the future of nursing home care and mental health care are considered.

Will International Pursuit of the Millenium Development Goals Alleviate Poverty in Mountains?

Since September 2000, when world leaders agreed on time-bound, measurable goals to reduce extreme poverty, hunger, illiteracy, and disease while fostering gender equality and ensuring environmental sustainability, the Millennium Development Goals (MDGs) have increasingly come to dominate the policy objectives of many states and development agencies. The concern has been raised that the tight timeframe and financial restrictions might force governments to invest in the more productive sectors, thus compromising the quality and sustainability of development efforts. In the long term, this may lead to even greater inequality, especially between geographical regions and social strata. Hence people living in marginal areas, for example in remote mountain regions, and minority peoples risk being disadvantaged by this internationally agreed agenda. Strategies to overcome hunger and poverty in their different dimensions in mountain areas need to focus on strengthening the economy of small-scale farmers, while also fostering the sustainable use of natural resources, taking into consideration their multifunctionality.

[Will type I diabetes mellitus be treated with immunosuppressive drugs in the future?]

Even if the pathogenesis of type-I (insulin-dependent) diabetes mellitus is still not clarified in every detail, there is general agreement that this form of diabetes is induced by autoimmune mechanisms leading to beta-cell destruction. Therefore, it should theoretically be feasible to suppress the mechanism leading to type-I diabetes with appropriate and early immunotherapy. The current clinical data clearly document that the rate and duration of remissions in patients with newly diagnosed type-I diabetes can be increased significantly using appropriate immunosuppressive regimens. However, before these therapies can become standard therapy of type-I diabetes, the following important clinical requirements have to be fulfilled: the toxicity (especially to kidneys and beta-cells) has to be reduced, the patients should be diagnosed and treated in 'pre-diabetic' states, more selective immunosuppressive regimens have to be available in order to reduce the occurrence of treatment-associated lymphomas and neoplasias. Since accurate detection of 'pre-diabetic' patients is difficult and presents an immense logistic problem, it may take a long time before large-scale immunosuppressive therapies of type-I diabetes are feasible.

Will Whole-Tree Harvest of Jack Pine (Pinus banksiana) deplete soil nutrients in low-productivity sand soils?

In 2009 and 2010 a study was conducted on the Hiawatha National Forest (HNF) to determine if whole-tree harvest (WTH) of jack pine would deplete the soil nutrients in the very coarse-textured Rubicon soil. WTH is restricted on Rubicon sand in order to preserve the soil fertility, but the increasing construction of biomass-fueled power plants is expected to increase the demand for forest biomass. The specific objectives of this study were to estimate biomass and nutrient content of above- and below-ground tree components in mature jack pine (Pinus banksiana) stands growing on a coarse-textured, low-productivity soil, determine pools of total C and N and exchangeable soil cations in Rubicon sand, and to compare the possible impacts of conventional stem-only harvest (CH) and WTH on soil nutrient pools and the implications for productivity of subsequent rotations. Four even-aged jack pine stands on Rubicon soil were studied. Allometric equations were used to estimate above-ground biomass and nutrients, and soil samples from each stand were taken for physical and chemical analysis. Results indicate that WTH will result in cation deficits in all stands, with exceptionally large Ca deficits occurring in two stands. Where a deficit does not occur, the cation surplus is small and, chemical weathering and atmospheric deposition is not anticipated to replace the removed cations. CH will result in a surplus of cations, and will likely not result in productivity declines during the first rotation. However even under CH, the surplus is small, and chemical weathering and atmospheric deposition will not supply enough cations for the second rotation.