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At least 19 recordsLinked to original sources
PubMed2000

Retirement plans, personal saving, and saving adequacy.

This Issue Brief addresses three questions raised by recent trends in personal saving: How are national savings measured and what is the meaning of the trends in measured personal saving rates, given what is included and what is not included in those measures? What is the effect of retirement saving programs--in particular, 401(k) plans and individual retirement accounts (IRAs)--on personal saving levels? What are the implications of existing saving behavior for the retirement income security of today's workers? The National Income and Product Accounts (NIPA), the most commonly referenced gauge of personal saving, is a widely misunderstood measure. One could argue that a complete measure of saving would include increases in wealth through capital gains, but NIPA does not factor accrued and realized capital gains on stocks and other assets into the saving rate. By one measure, accounting for capital gains results in an aggregate personal saving rate of 33 percent--more than double the rate of four decades ago. A major policy question is the impact of tax-qualified retirement saving plans (i.e., IRAs and 401(k) plans) on personal saving rates. Empirical analysis of this issue is extremely challenging and findings have been contradictory. These programs now represent an enormous store of retirement-earmarked wealth in tax-deferred vehicles: Combined, such tax-deferred retirement accounts currently have assets of about $4 trillion. Ninety percent of IRA contributions are now the result of "rollovers" as employees leave employer plans, like 401(k) plans. While leakage from the system remains a challenge, the majority of the assets in the system can be expected to be available to fund workers' retirements. One could argue that, from a retirement income security perspective, workers in general are better off because IRA and 401(k) programs exist. Surely, many of the dollars in these programs would have been saved even without the programs; but they would not necessarily have been earmarked for retirement and been available to fund retirement expenses. As rollovers become larger, this "partnership" of employment-based qualified plans and IRAs will grow even more important. The evidence indicates that many groups of American workers appear unlikely to be able to afford a retirement that maintains their current lifestyle (at least not without working more years than currently planned). Consensus does not exist on how many workers are at risk or the typical magnitude of their retirement saving shortfall. There is a consensus, however, that a substantial number of individuals are at risk. This is not surprising--despite the fact that the 70 percent of workers are saving for retirement--since relatively few workers know how much it is that they need to accumulate to fund their retirement.

Adult↗
PubMed1997

Saving lives in the present versus saving lives in the future--is there a framing effect?

This study considers how to compare programs which are designed to save lives. "To estimate the discount rate for lives saved in the future a number of studies have been carried out on the trade-off between saving lives now and in the future. A telephone survey is administered to about 1,700 individuals [in Sweden] to test if the framing of the question affects the estimated trade-off. In one sample the question is framed as saving 100 lives today versus saving x future lives and in one sample the question is framed as saving 100 future lives versus saving y lives today. The result shows that the framing has a major impact on the trade-off."

Demography↗
PubMed1979

Population growth, life-cycle saving, and international differences in steady-state optimal saving rates.

Life-cycle savings theories have been a seminal development in analyses of the relationship between rational savings patterns for individuals and the accumulation of wealth or capital at the level of the society as a whole. Applications of the theories in industrialized countries never investigated the significance of large differences in birth and death rates across societies. The strong demographic components of life-cycle saving analysis are here the center of focus. Illustrative general numerical applications of a modified version of the life-cycle approach suggest that mortality differentials comparable to those presently encountered among nations are consistent with very large differentials in steady-state optimal ratios of wealth-to-income. Specific application to Peru of the model estimated by Tobin for the United States indicates that high levels of mortality, current Peruvian birth rates, and Peruvian age-income profiles imply optimal rational savings rates far below those of the United States.

Birth Rate↗
PubMed2004

Saving President Reagan's life. The need for an organized emergency medical system in the United States to save lives of all casualties.

We are describing a heretofore untold narrative description of the emergency medical plan that saved the life of President Reagan on March 30th 1981. In 1976, Dr. Richard Edlich, director of the Emergency Medical Services at the University of Virginia Medical Center, wrote an editorial on the need for an emergency medical plan for the President of the United States. One year later Dr. Edlich enlisted the help of five distinguished experts in emergency medical systems in our nation to develop an emergency medical plan for the President of the United States. This published emergency medical plan was coauthored by Dr. David Boyd, the Director of Emergency Medical Services of the Department of Public Health and Welfare. Dr. Boyd wisely alerted both the Department of Health and Welfare as well as the White House staff, including Secret Service, of this plan. Realizing the importance of immediate emergency care, the Secret Service agent wisely recommended that the wounded President Reagan be immediately transported to the George Washington University Health Center, which has skilled emergency physicians as well as trauma surgeons, who saved the President's life. Realizing the benefits of this emergency medical plan that saved the life of the President of the United States, Drs. Edlich, Britt, and Wish will now be coordinating a medical narrative report that describes the development of emergency medical systems in the United States as well as modern trauma care in our nation.

Emergency Medical Services↗
PubMed1998

Absence of a deleterious effect of calcium channel blockers in patients with left ventricular dysfunction after myocardial infarction: The SAVE Study Experience. SAVE Investigators. Survival and Ventricular Enlargement.

BACKGROUND: As a result of randomized controlled trials with calcium channel blockers after myocardial infarction, concern has developed that these agents are associated with an increased risk of cardiovascular events, particularly in the presence of left ventricular dysfunction. METHODS: To test the hypothesis that calcium channel blockers increase cardiovascular events in such patients, the incidence of all-cause mortality, cardiovascular death, severe heart failure, and recurrent infarction was examined in 940 patients taking calcium channel blockers and 1180 not taking them 24 hours before randomization to placebo or captopril in the Survival and Ventricular Enlargement (SAVE) Trial. All patients had an ejection fraction < or =40%. Relative risks for calcium channel blocker users versus nonusers and the 95% confidence intervals were computed with univariate and multivariate Cox regressions. Adjustments were made for differences in baseline covariates. RESULTS: For all causes of mortality, the relative risk for calcium channel blocker users versus nonusers was 0.96, with the 95% confidence interval of 0.78 to 1.17. In the SAVE placebo and captopril groups, the relative risks for the development of severe heart failure among the calcium channel block users versus nonusers were 0.95 and 1.23, with the 95% confidence interval of 0.72 to 1.25 and 0.88 to 1.71, respectively. A similar neutral result held for patients with and without a history of hypertension. Furthermore, calcium channel blockers did not alter the benefit of the angiotensin converting enzyme inhibitor, captopril. CONCLUSIONS: This analysis of the nonrandomized clinical use of calcium channel blockers in the postmyocardial infarction population with left ventricular dysfunction did not identify either a clinical deterioration or improvement with respect to subsequent cardiovascular events.

Adult↗
PubMed2002

Scientific priorities and strategic planning for resuscitation research and life saving therapy following traumatic injury: report of the PULSE Trauma Work Group. Post Resuscitative and Initial Utility of Life Saving Efforts.

Traumatic injury and its sequelae remains a major, unrecognized, public health problem in North America. It is the principle cause of death in patients aged 1-44 and the overall leading cause of life years lost in the United States. Recognizing this the National Heart, Lung and Blood Institute (NHLBI), in conjunction with other federal agencies, organized a conference in June 2000 to discuss the basic and clinical research projects that could lead to improved outcomes following cardiopulmonary or post-injury resuscitation. The Post Resuscitative and Initial Utility of Life Saving Efforts (PULSE) Workshop resulted and eight workgroups were established to focus on various aspects including organ systems, pharmacology, epidemiology, and trauma. The Trauma Work group recommendations are presented in this manuscript. Despite the recognition of improved survival and outcome through advancements in trauma systems and trauma care, the National Institutes of Health (NIH) support ratio for trauma research is only 0.10 compared to 1.65 for cancer research and a remarkable support ratio of 3.51 for AIDS and HIV infection research. The successful federal HIV research program has significantly decreased the morbidity and mortality over the last ten years at a cost of 1.4 billion dollars per year. A coordinated trauma research program should aim to replicate the success achieved by such programs; however, a centralized federal "home" for trauma research does not exist. Consequently, the existing limited research support is derived from NIH institutes in addition to other federal and state agencies. This report serves to describe some of the obstacles and to outline various strategies and priorities for basic science, clinical and translational trauma resuscitation research.

Animals↗
PubMed2002

Practical issues of platelet glycoprotein IIb/IIIa receptor inhibition: saving lives and saving money.

Abciximab is a monoclonal, human chimeric antibody with unique pharmacodynamics, pharmacokinetics, and receptor-specificity that distinguishes it from the small-molecule platelet glycoprotein IIb/IIIa receptor inhibitors. Abciximab has consistent, well-defined dosing and robust clinical results. Pooled data across abciximab trials comprising 9290 patients at maximum duration of follow-up demonstrates a 19% reduction in the relative risk of mortality (P =.003). There is a misperception of the cost of abciximab that focuses solely on the acquisition price of the drug. Cost-effectiveness analysis models compare the incremental improvement in clinical outcomes related to the increase in cost. Abciximab is extremely cost-effective in cost per life-year saved and is very attractive economically compared to alternative spending of health care dollars.

Cardiovascular Diseases↗
PubMed1997

Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement (SAVE) Study. SAVE Investigators.

OBJECTIVES: This study assessed whether treatment with a beta-adrenergic blocking agent in addition to the use of the angiotensin-converting enzyme (ACE) inhibitor captopril decreases cardiovascular mortality and morbidity in patients with asymptomatic left ventricular dysfunction after myocardial infarction (MI) and whether the presence of neurohumoral activation at the time of hospital discharge predicts the effects of beta-blocker treatment in these patients. BACKGROUND: Both beta-blockers and ACE inhibitors have been shown to have beneficial effects in patients with left ventricular dysfunction but no overt heart failure after MI. These patients often have persistent neurohumoral activation at the time of hospital discharge, and one would expect that patients with activation of the sympathetic nervous system derive the most benefit from treatment with beta-blockers. However, beta-blockers are underutilized in this high risk group of patients, and it is unknown whether their beneficial effects are additive to those of ACE inhibitors. METHODS: We performed a retrospective analysis of data from the Survival and Ventricular Enlargement (SAVE) study and its neurohumoral substudy. The relations between beta-blocker use at the time of randomization and neurohumoral activation and the subsequent development of cardiovascular events were analyzed by use of Cox proportional hazards models controlling for covariates. RESULTS: After adjustment for baseline imbalances, beta-blocker use was associated with a significant reduction in risk of cardiovascular death (30%, 95% confidence interval [CI] 12% to 44%) and development of heart failure (21%, 95% CI 3% to 36%), but the reduction in recurrent MI (11%, 95% CI 13% to 31%) was not significant. These reductions were independent of the use of captopril. Beta-blockers were not found to have a greater effect in patients with neurohumoral activation at the time of hospital discharge. CONCLUSIONS: The beneficial effects of beta-blocker use at the time of hospital discharge in patients with asymptomatic left ventricular dysfunction after MI appear to be additive to those of captopril and other interventions known to improve prognosis. Neurohumoral activation at the time of hospital discharge fails to identify those patients who will derive the greatest benefit from treatment with beta-blockers.

Adrenergic beta-Antagonists↗
PubMed2003

Labor saved, calories lost: the energetic impact of domestic labor-saving devices.

OBJECTIVE: As the prevalence of obesity has increased, so has sedentariness. Progressive sedentariness has been attributed to greater use of labor saving devices, such as washing machines, and less nonexercise walking (e.g., walking to work). However, there is a paucity of data to support this conclusion. In this study, we address the hypothesis that domestic mechanization of daily tasks has resulted in less energy expenditure compared with performing the same tasks manually. RESEARCH METHODS AND PROCEDURES: Energy expenditure was measured in four groups of subjects (122 healthy adult men and women total) from Rochester, Minnesota. Energy expenditure was measured using indirect calorimetry while subjects performed structured tasks such as cleaning dishes and clothes, stair climbing, and work-associated transportation, and these values were compared with the respective mechanized activity. RESULTS: Energy expenditure was significantly greater and numerically substantial when daily domestic tasks were performed without the aid of machines or equipment (clothes washing: 45 +/- 14 vs. 27 +/- 9 kcal/d; dish washing: 80 +/- 28 vs. 54 +/- 19 kcal/d; transportation to work: 83 +/- 17 vs. 25 +/- 3 kcal/d; stair climbing: 11 +/- 7 vs. 3 +/- 1 kcal/d; p < 0.05). The combined impact of domestic mechanization was substantial and equaled 111 kcal/d. DISCUSSION: The magnitude of the energetic impact of the mechanized tasks we studied was sufficiently great to contribute to the positive energy balance associated with weight gain. Efforts focused on reversing sedentariness have the potential to impact obesity.

Adult↗
PubMed1994

Saving enemy children: Save the Children's Russian relief operation, 1921-23.

When the Russian harvest failed in 1921, the economy had been devastated by years of disasters. Appeals were made to the outside world, and Save the Children was one of the main agencies to respond. Despite reservations about supporting the Soviets, a major advertising campaign was launched, raising large sums of money which were used to open feeding centres in the face of adverse climate and a devastated infrastructure. Facing some critical press coverage, the Fund used advanced media techniques to get its message across. By summer 1923, the famine was over and the Fund had succeeded in feeding up to 675,000 people.

Child↗
PubMed2002

Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria.

OBJECTIVE: Little is known about the impact of disease management programs on medical costs for patients with diabetes. This study compared health care costs for patients who fulfilled health employer data and information set (HEDIS) criteria for diabetes and were in a health maintenance organization (HMO)-sponsored disease management program with costs for those not in disease management. RESEARCH DESIGN AND METHODS: We retrospectively examined paid health care claims and other measures of health care use over 2 years among 6,799 continuously enrolled Geisinger Health Plan patients who fulfilled HEDIS criteria for diabetes. Two groups were compared: those who were enrolled in an opt-in disease management program and those who were not enrolled. We also compared HEDIS data on HbA(1c) testing, percent not in control, lipid testing, diabetic eye screening, and kidney disease screening. All HEDIS measures were based on a hybrid method of claims and chart audits, except for percent not in control, which was based on chart audits only. RESULTS: Of 6,799 patients fulfilling HEDIS criteria for the diagnosis of diabetes, 3,118 (45.9%) patients were enrolled in a disease management program (program), and 3,681 (54.1%) were not enrolled (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged 394.62 dollars for program patients compared with 502.48 dollars for nonprogram patients (P < 0.05). This difference was accompanied by lower inpatient health care use in program patients (mean of 0.12 admissions per patient per year and 0.56 inpatient days per patient per year) than in nonprogram patients (0.16 and 0.98, P < 0.05 for both measures). Program patients experienced fewer emergency room visits (0.49 per member per year) than nonprogram patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, P < 0.05 for both measures). Except for emergency room visits, these differences remained statistically significant after controlling for age, sex, HMO enrollment duration, presence of a pharmacy benefit, and insurance type. Program patients also achieved higher HEDIS scores for HbA(1c) testing as well as for lipid, eye, and kidney screenings (96.6, 91.1, 79.1, and 68.5% among program patients versus 83.8, 77.6, 64.9, and 39.3% among nonprogram patients, P < 0.05 for all measures). Among 1,074 patients with HbA(1c) levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level >9.5%, as compared with 79 of 548 (14.4%) nonprogram patients. CONCLUSIONS: In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical costs.

Aged↗
PubMed1994

Street gangs: save yourself while saving a life.

Until the root causes of gang violence--poverty, unemployment, stressed families and lack of education--are addressed on a national level, the number of victims will continue to mount. By having a basic understanding of gang violence and its manifestations, you can try to ensure your own safety while saving lives.

Adolescent↗