IN the 19th century there were two major hypotheses to explain the pathogenesis of atherosclerosis: the "incrustation" hypothesis and the "lipid" hypothesis. The incrustation hypothesis of von Rokitansky,1 proposed in 1852 and modified by Duguid,2 suggested that intimal thickening resulted from fibrin deposition, with subsequent organization by fibroblasts and secondary lipid accumulation. The lipid hypothesis, proposed by Virchow3 in 1856, suggested that lipid in the arterial wall represented a transduction of blood lipid, which subsequently formed complexes with acid mucopolysaccharides; lipid accumulated in arterial walls because mechanisms of lipid deposition predominated over those of removal. The two hypotheses are now . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM199201233260406?articleTools=true

The pathogenesis of coronary artery disease and the acute coronary syndromes (1).

This article presents a narrative of the unfolding of the Second Demographic Transition (SDT) since the theory was first formulated in 1986. The first part recapitulates the foundations of the theory, and documents the spread of the SDT to the point that it now covers most European populations. Also for Europe, it focuses on the relationship between the SDT and the growing heterogeneity in period fertility levels. It is shown that the current positive relationship between SDT and TFR levels is not a violation of the SDT theory, but the outcome of a "split correlation" with different sub-narratives concerning the onset of fertility postponement and the degree of subsequent recuperation in two parts of Europe. The second part of the article addresses the issue of whether the SDT has spread or is currently spreading in industrialized Asian countries. Evidence gathered for Japan, South Korea, Hong Kong, Singapore, and Taiwan is presented. That evidence pertains to both the macro-level (national trends in postponement of marriage and parenthood, rise of cohabitation) and the micro-level (connections between individual values orientations and postponement of parenthood). Strong similarities are found with SDT patterns in Southern Europe, except for the fact that parenthood is still very rare among Asian cohabiting partners.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/79230/j.1728-4457.2010.00328.x.pdf?sequence=1

The Unfolding Story of the Second Demographic Transition

Head Start is a preschool program for disadvantaged children which aims to improve their skills so that they can begin schooling on an equal footing with their more advantaged peers. Begun in 1965 as part of President Johnson’s “War on Poverty,” Head Start now serves over 800,000 children in predominantly part-day programs, almost 50 percent of eligible three and four year-old poor children (Children’s Defense Fund, 2000). Over time, federal funding has increased from $96 million in 1965 to $4.7 billion in 1999. There have been dozens of studies of Head Start and closely related preschool and early school enrichment programs. Some studies involve small-scale model programs, others evaluate large-scale public programs which are generally of somewhat lower quality than the model programs. This paper discusses what is known about these early childhood education programs: what they try to do; the extent to which they work; what can be said about their optimal timing, targeting, and content; and the circumstances in which the benefits of providing these programs—ranging from gains to the children to the value of child care provided to the parents—are likely to outweigh the costs. This review of the evidence concludes that these programs have significant short- and medium-term benefits, and that the effects are often greater for more disadvantaged children. Some of the model programs have produced exciting results in terms of improving educational attainment and earnings and reducing welfare dependency and crime. The jury is still out on Head Start, but a simple cost-benefit analysis suggests that Head Start would pay for itself in terms of

https://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.15.2.213

Early childhood education programs

This study's objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.8 cases per 1000 discharges, with rates increasing by approximately 11% per year. Older age, male gender, and black race were strongly associated (P < 0.0001) with ARF. The overall in-hospital death rate was 4.6% in discharges without ARF, 15.2% in discharges with ARF coded as the principal diagnosis, and 32.6% in discharges with ARF as a secondary diagnosis. In-hospital death rates were 32.9% in discharges with ARF that required renal dialysis and 27.5% in those with ARF that did not require dialysis. Death within 90 d after hospital admission was 13.1% in discharges without ARF, 34.5% in discharges with ARF coded as the principal diagnosis, and 48.6% in discharges with ARF as a secondary diagnosis. Discharges with ARF were more (P < 0.0001) likely to have intensive care and other acute organ dysfunction than those without ARF. For discharges both with and without ARF, rates for death within 90 d after hospital admission showed a declining trend. In conclusion, the incidence rate of ARF in Medicare beneficiaries has been increasing. Those of older age, male gender, and black race are more likely to have ARF. These data show ARF to be a major contributor to morbidity and mortality in hospitalized patients.

Incidence and Mortality of Acute Renal Failure in Medicare Beneficiaries, 1992 to 2001

This article compares 14 OECD countries, as of the middle-to-late 1980s, with respect to their provision of policies that support moth ers' employment: parental leave, child care, and the scheduling of public education. Newly gathered data on 18 policy indicators are pre sented. The indicators are then standardized, weighted, and summed into indices. By differ entiating policies that affect maternal employ ment from family policies more generally, these indices reveal dramatic cross-national differences in policy provisions.The empirical results reveal loose clusters of countries that correspond only partially to prevailing welfare-state typologies. For mothers with preschool-aged children, only five of the 14 countries provided reasonably complete and continuous benefits that sup ported their options for combining paid work with family responsibilities. The pattern of cross-national policy variation changed no tably when policies affecting mothers with older children were examined.The indices provide an ...

/pdf/supporting-the-employment-of-mothers-policy-variation-across-sovp4hy7fj.pdf

Supporting the Employment of Mothers: Policy Variation Across Fourteen Welfare States

Young adults in recent cohorts have been leaving the parental home earlier and marrying later now than they did several decades ago resulting in an increased period of independent living. This paper explores the consequences of time spent in non-family living using data from the [U.S.] National Longitudinal Surveys of Young Men and Young Women. We expect that experience in living away from home prior to marriage will cause young adults to change their attitudes values plans and expectations and move them away from a traditional family orientation. The authors find evidence to support this hypothesis in the case of young women. "Those who lived independently became more likely to plan for employment lowered their expected family size became more accepting of employment of mothers and more non-traditional on sex roles in the family than those who lived with their parents. Non-family living had much weaker effects on young men in the few tests that we could perform for them. The paper also addresses the conditions under which living away increases individualism and it discusses the implications of these findings." (EXCERPT)

Nonfamily living and the erosion of traditional family orientations among young adults.

Because of the high rates of employment of mothers, a large and increasing number of preschool children receive regular care from someone else. This article develops and tests hypotheses about the choice of child care arrangements for younger and older preschool children, using data from the National Longitudinal Survey of Young Women. We argue that appropriate care depends on the age of the child. It includes care by the mother or a paid provider in the child’s home for children aged 0–2 and mother care and nursery school or center care for those 3–5. We estimate models of the mother’s employment and choice of child care separately for younger and older preschoolers. Our results show that need for care, presence of substitutes for the mother, financial resources, and preferences all affect both full-time care by the mother and the type of child care chosen by working women, although they affect these two decisions in different ways.

https://www.rand.org/content/dam/rand/pubs/notes/2007/N2855.pdf

Child care for preschoolers: Differences by child’s age

Although most children whose mothers work receive some nonparental care, this “child care” varies tremendously in its characteristics, especially quality. Child development researchers and practitioners have explored in detail the characteristics of child care that provide the best environment for children. However, we know virtually nothing about which parents select “high-quality” care for their children, or which arrangements most often have the features associated with the best outcomes for children. This paper explores these issues, using parents' reports of characteristics of their child's care arrangement from the National Longitudinal Survey of Youth. Results show that on several dimensions care in a home—the child's own, a nonrelative's, or a relative's—provides features linked to quality care. However, in general, parents do not pay more for the features of child care associated with high quality in the child development literature. The implications of these results are discussed.

/pdf/what-parents-pay-for-child-care-characteristics-quality-and-1nyl9zenyk.pdf

What Parents Pay For: Child Care Characteristics, Quality, and Costs

Employment of geriatric nurse practitioners (GNPs) is one strategy to improve nursing home care. The effects of GNPs on costs and profitability of nursing homes and on costs of patient medical service use outside the nursing home are examined. Employment of GNPs does not adversely affect nursing home costs or significantly affect profits. There is some evidence of cost savings in medical service use for newly admitted patients but no evidence of savings for continuing residents. GNPs reduce the use of hospital services for both groups, and the reduction is statistically significant for newly admitted patients.

Assessing cost effects of nursing-home-based geriatric nurse practitioners

Two alternative methods to Medicare Cost Reports that provide information about hospital costs more promptly but less accurately are investigated. Both employ utilization data from current-year bills. The first attaches costs to utilization data using cost-charge ratios from the previous year's cost report; the second uses charges from current year's bills. The first method is the more accurate of the two, but even using it, only 40 percent of hospitals had predicted costs within plus or minus 5 percent of actual costs. The feasibility and cost of obtaining cost reports from a small, fast-track sample of hospitals should be investigated.

Christina Witsberger

Papers

Nonfamily living and the erosion of traditional family orientations among young adults.

Child care for preschoolers: Differences by child’s age

What Parents Pay For: Child Care Characteristics, Quality, and Costs

Assessing cost effects of nursing-home-based geriatric nurse practitioners

Predicting hospital accounting costs.