Persistently mentally ill residents of psychiatric facilities express clear preferences about key aspects of community-based care when they are asked, and these preferences often reflect different views from those expressed by either family members or clinical care providers.

Vitamin A (retinol) status was determined in two groups living in the northern part of Canada: native (Indian and Inuit) and non-native (Caucasian). The dietary intake of vitamin A and its plasma concentration were measured prenatally, at delivery and postnatally in mothers. Plasma concentrations were also measured at birth and postnatally in their infants. The mean vitamin A intake of native mothers was significantly lower than that of non-native mothers, 661 ± 485 versus 1,377 ± 1,418 retinol equivalents (p < 0.00005), with a higher risk of deficiency without supplementation, 35% versus 8%. Plasma retinol concentrations, although not in the deficient range, were significantly lower in native than non-native mothers prenatally and postnatally. Infant mean plasma retinol concentrations at birth averaged only 52% of those of their mothers and were significantly lower among native than non-native infants although no clinical evidence of vitamin A deficiency was noted. We speculate that vitamin A supplementation in native Northern Canadian mothers during pregnancy and in their neonates during infancy may have a role to play in the prevention of vitamin A deficiency. We also postulate that plasma retinol concentrations of 50-60% of maternal levels and between 0.7 and 2.5 µmol/l represent a ‘normal’ range for newborn infants.

Seven deaf children attended a bilingual-bicultural (bi-bi) prekindergarten, kindergarten, and first grade from 1993 to 1996 in an east-central Texas public school. The children had diverse backgrounds (African American, Hispanic, White) and various intellectual, cognitive, and linguistic abilities. We detail the backgrounds of the seven children and their families and describe three bi-bi classrooms. We present standardized test scores on cognition (Bracken Test of Basic Concepts) and academic achievement (Stanford Achievement Test, 9th edition, and Woodcock-Johnson Psycho-Educational Battery). When, with one exception, the children completed first grade, they all tested at grade level. (The exception was a younger child who had only completed kindergarten but who nonetheless tested at the first-grade level). We interpret our findings in light of theories of first- and second-language acquisition and discuss the feasibility of establishing bi-bi programs in areas where no large Deaf community exists. We also note our plans to evaluate the seven children again, at the end of second grade in spring 1997.

Results support a phased-in approach to hospital downsizing and the need for considerable transitional funding. Because hospital downsizing is unlikely to save dollars, at least in the short term, reforms must remain guided by humanitarian motivations to improve quality of life for persons with severe and persistent mental illnesses.

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