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Aims The atherosclerotic profile and advanced plaque subtype burden in symptomatic patients ≤45 years old have not been established. This study aimed to assess the prevalence and predictors of coronary artery calcium (CAC), plaque subtypes, and plaque burden by coronary computed tomography angiography (CCTA) in symptomatic young patients. Methods and results We included 907 symptomatic young patients (18–45 years) from Montefiore undergoing CCTA for chest pain evaluation. Prevalence and predictors of CAC, plaque subtypes, and burden were evaluated using semi-automated software. In the overall population (55% female and 44% Hispanic), 89% had CAC = 0. The likelihood of CAC or any plaque by CCTA increased with >3 risk factors {RFs, odds ratio [OR] 7.13 (2.14–23.7) and OR 10.26 (3.36–31.2), respectively}. Any plaque by CCTA was present in 137 (15%); the strongest independent predictors were age ≥35 years [OR 3.62 (2.05–6.41)] and family history of premature coronary artery disease (FHx) [OR 2.76 (1.67–4.58)]. Stenosis ≥50% was rare (1.8%), with 31% of those having CAC = 0. Significant non-calcified plaque (NCP, 37.2%) and low-attenuation plaque (LAP, 4.24%) burdens were seen, even in those with non-obstructive stenosis. Among patients with CAC = 0, 5% had plaque, and the only predictor of exclusively NCP was FHx [OR 2.29 (1.08–4.86)]. Conclusion In symptomatic young patients undergoing CCTA, the prevalence of CAC or any coronary atherosclerosis was not negligible, and the likelihood increased with RF burden. The presence of coronary stenosis ≥50% was rare and most often accompanied by CAC >0, but there was a significant burden of NCP and LAP even within the non-obstructive group. [ABSTRACT FROM AUTHOR]

Background: United Network for Organ Sharing (UNOS) allocation criteria changed in 2018 to accommodate the increased prevalence of ventricular assist device use as a bridge to heart transplant, which consequently prioritized sicker patients. We aimed to assess the impact of this new allocation policy on the length of stay following heart transplantation. Secondary outcomes include other risk factors for prolonged hospitalization and its effect on mortality and postoperative complications. Methods: The UNOS Registry was queried to identify patients who underwent isolated heart transplants in the United States between 2001 and 2023. Patients were divided into quartiles according to their respective length of stay. Results: A total of 57 020 patients were included, 15 357 of which were allocated with the new system. The median hospital length of stay was 15 days (mean 22.7 days). Length of stay was longer in the new allocation era (25 ± 30 vs. 22 ± 27 days, p <.001). The longer length of stay was associated with increased 5‐year mortality in the new allocation system (aHR: 1.18; 95% CI: 1.15, 1.20; p‐value: <.001). Conclusion: Longer hospital stays and associated observed increased risk for mortality in the era after the allocation criteria change reflect the rationale of this shift which was to prioritize heart transplants for sicker patients. Further studies are needed to track the progress of surgical and perioperative management of these studies over time. [ABSTRACT FROM AUTHOR]

COVID-19 has disrupted the lives of families across the United States and all over the world. Stress is known to have a negative impact on parent–child feeding interactions; hence, the purpose of this study is to examine how COVID-related parenting stress, which was measured using a newly developed scale, is related to parent mental health, nonresponsive feeding, and children's self-regulation of eating. 119 parents of children ages 2–7 years old filled out questions about COVID-related parenting stress, mental health, nonresponsive feeding behaviors, and children's self-regulation of eating. A series of multiple regressions were run to predict parent anxiety and psychological distress from COVID-related parenting stress. COVID-related parenting stress was found to be a significant predictor of both parent anxiety and psychological distress. When COVID-related parenting stress was further broken down into COVID-Related Job/Financial Security Stress and COVID-Related Family Safety/Stability Stress, COVID-Related Job/Financial Security Stress predicted psychological distress while COVID-Related Family Safety/Stability Stress predicted parent anxiety. Moderation analyses were also run to test the difference across the parents of children under 5 years of age and those of children who were 5 years of age and older regarding the association of COVID-related parenting stress and either parent anxiety or psychological distress. There was no significant difference across age. Lastly, COVID-related parenting stress and nonresponsive feeding practices were simultaneously entered into a multiple regression to predict children's self-regulation of eating, and COVID-related parenting stress and parent distrust in appetite were both found to decrease children's ability to self-regulate energy intake. Based on findings from this study, researchers interested in improving children's self-regulation of eating and long-term health outcomes should continue to target the reduction of nonresponsive parent feeding behaviors, but they should also aim to look beyond specific parent feeding behaviors by attempting to help parents manage stressors in their lives. [ABSTRACT FROM AUTHOR]

In order to find out an alternative to traditional environmental policies in the State of São Paulo (Brazil), which have been mainly focused on legal standard compliance for air and water emissions, as well as in soil contamination, the Environmental Agency of São Paulo State — CETESB — launched a research project entitled Industrial Toxic Substances Use Reduction Programme. The project was launched in 2006 with funding from the United States Trade and Development Agency. Its aim was to propose new policies and strategies to reduce industrial releases of toxic compounds to the environment. Its general steps were the identification of an initial toxic chemical targets list; a review of successful programmes in the United States; the development of key elements and the establishment of alternative combinations of those elements for the implementation of an indigenous programme. Since project completion, CETESB has been discussing the possibility of implementing the results through a pilot project being developed jointly with industry representatives. This pilot project will serve as a model for a broader industrial toxic substances reduction programme to be implemented in São Paulo State. [ABSTRACT FROM AUTHOR]

The article presents a study on the occurrence of the impairment of Jak2-mediated protection in diabetic myocardium through the angiotensin II type 1 (AT1) receptor-mediated machanism in the U.S. The study intends to determine the capability of angiotensin II type 1 receptor to cause impairment of cardioprotective signaling in diabetic hearts. The findings reveal on the role of AT1 receptor mediated upregulation of calcinerium acitivity to diabetic heart's unresponsiveness to protection.

This study examined the long-term effectiveness of the ACCESS (Access to Community Care and Effective Services and Supports) project on service utilization and continuity of care among homeless persons with serious mental illness. A 3-year longitudinal analysis, using Medicaid claims data, tracked behavioral health service utilization among 146 Medicaid-eligible participants in the Pennsylvania ACCESS program. Utilization patterns of inpatient, outpatient, and emergency department services for psychiatric and substance abuse treatment were examined during the year prior to, during, and one year after the implementation of the ACCESS project. Use of psychiatric ambulatory care significantly increased among intervention participants and remained greater following ACCESS intervention. Better continuity of care following hospitalization was achieved during and after the intervention. The number of days spent hospitalized significantly decreased during the intervention. These results suggest that the ACCESS intervention was effective in linking hard-to-reach homeless persons with serious mental illness to the community mental health service system, and that this effect was maintained after termination of the intervention. [ABSTRACT FROM AUTHOR]

A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs. [ABSTRACT FROM AUTHOR]

Reports on the impact of privatization of government entities throughout the United States. How privatization is becoming a tool that states use to save money and provide better service; The issue of privatization as a practical, cost-saving management tool.

This section presents an overview of reports on health care reform in the U.S. as of January 1998.

This article presents the results of the 1995 survey of public retirement systems conducted by the Public Pension Coordinating Council . The result demonstrate the strong funding of public pension plans. This survey obtains in depth information about the current administration, membership, benefits, contributions, funding, investments and reporting of public retirement systems. The Public Pension Coordinating Council was formed in 1990 to assist the public employee retirement community. The council is composed of the Government Finance Officers Association, the National Association of State Retirement Administrators, the National Conference on Public Employee Retirement Systems and the National Council on Teacher Retirement. In the 1995 survey, 310 systems responded to the survey, representing a total of 457 plans and covering 80 percent of the 13.6 million active members reported by the U.S. Bureau of the Census in 1994. State and local retirement systems exist within an administrative framework that is structured by state and local laws and overseen by retirement boards of elected, appointed and ex officio members. Retirement boards generally have substantial authority over the system and are usually involved in decisions regarding investment policy, benefit provision and actuarial assumptions.

This article presents an overview of several publications by the U.S. General Accounting Office (GAO) dealing with the federal budget. How do you capture the complexity and breadth of an entity that spends over $1.5 trillion and employs over 4.5 million people? As an initial step in dealing with the challenges presented by the scope and magnitude of the federal government, the GAO has produced a variety of primarily graphical products based on historical budget information. The topic of the federal debt provokes much confusion among both policy makers and the public. For example, one point that is sometimes overlooked is that even if Congress and the president agree to balance the budget within the next several years, the dollar amount of the federal debt would continue to grow until balance is actually achieved. Once the budget is balanced, although the debt would decline as a share of the economy, its dollar value would essentially remain the same. The only way to reduce the amount of debt is to run a budget surplus. Although many excellent articles, reports and books have been written on the debt and its effects, these discussions tend to be complex and technical. To help provide basic information about the debt in accessible way, the GAO has published an informational report called "Federal Debt: Answers to Frequently Asked Questions" on November 27, 1996.

Background: The proximate cause of donor brain death is not considered a conventional risk factor in modern heart transplantation.Objectives: This study aimed to investigate the effect of the cause of donor brain death on recipients.Methods: Using the United Network for Organ Sharing registry, long-term mortality and allograft failure were compared in recipients who underwent heart transplantation in the United States from 2005 through 2018 between allograft recipients from donors with stroke as the cause of brain death (n = 3,761) vs nonstroke causes (n = 14,677). Inverse probability weighting was used for risk adjustment. Interactions were investigated between the cause of brain death and other conventional donor risk factors for recipient mortality.Results: There was an interaction between the cause of brain death and donor age (Pinteraction = 0.008). When allografts were procured from donors aged 40 years or younger, stroke as the cause of brain death was associated with an increased risk of mortality (23% vs 19% at 5 years; HR: 1.17; 95% CI: 1.02-1.35) and allograft failure (HR: 1.30; 95% CI: 1.04-1.63). When donors were older than 40 years, the cause of brain death was not associated with outcomes.Conclusions: As the cause of donor brain death, stroke had a substantially different effect on recipient and allograft survival depending on donor age. In the case of younger donor ages, stroke was associated with higher recipient mortality and allograft failure than other causes of brain death. The strength of this association decreased with increasing donor age such that the increased hazard was no longer present in donors older than approximately 40 years. [ABSTRACT FROM AUTHOR]

The article presents a survey which assesses the relationship in elderly subjects between free-living daily physical activity and mucosal immunity, especially salivary secretory immunoglobulin A in the U.S. There were eighty volunteers aged 71 participated in this study. Saliva samples were used to identify the said relationship. In conclusion, the study suggested that a free-living daily physical activity level of approximately 7000 steps per day might be regarded as a moderate daily physical activity target for elderly people to improve mucosal immune function.