Using sophisticated methodology, this study suggests that a comprehensive health promotion program can lower the rate of health care cost increases and produce a positive ROI.

This study examines the factor structure, consistency, stability, and validity of children's reports of violence and verbal aggression in the home. Children recruited from clinic and community settings (N = 323) and their parents or guardians were administered the Conflict Tactics Scales to represent different perspectives on the patterns and severity of family violence. Based on children's reports, violence and verbal aggression among family members were quite common and moderately stable over a 2-year period. Children reported considerably higher rates of mother-to-child violence than did mothers, but the opposite pattern occurred for child-to-mother violence. Children's reports of verbal aggression and violence between different dyads predicted forms of children's dysfunction, especially antisocial behavior, at 2-year follow-up. Child reports provided important information not available from parent reports alone. The findings suggest the need for a comprehensive assessment of violence and hostility among family members.

This study provides the first prospective evaluation of the course and predictors of children's involvement with fire over a 2-year period in 268 nonpatient and patient children (ages 6-13 yrs). Selected predictor variables obtained at initial (intake) assessment, which included fire-specific and general psychosocial measures, were examined in each sample using hierarchical logistic regression. Both samples reported heightened involvement in matchplay and firesetting at follow-up, though the frequency of each behavior was nearly four times higher in patients than in nonpatients. Fifty per cent and 59% of the initial firesetters in the nonpatient and patient samples, respectively, became recidivists. In the nonpatient sample, the child's initial involvement in firesetting and level of covert antisocial behavior were the only psychosocial predictors of follow-up firesetting that added incremental variance beyond demographics. In the patient sample, the child's initial involvement in fire-related acts and level of covert antisocial behavior were the only predictors of follow-up firesetting beyond any initial involvement in matchplay. The findings highlight somewhat different risk factors for subsequent firesetting in nonpatient and patient children, especially prior firesetting and matchplay, respectively, and bear implications for the prevention of firesetting recidivism.

This study provides the first prospective evaluation of the course and predictors of children's involvement with fire over a 2-year period in 268 nonpatient and patient children (ages 6-13 yrs). Selected predictor variables obtained at initial (intake) assessment, which included fire-specific and general psychosocial measures, were examined in each sample using hierarchical logistic regression. Both samples reported heightened involvement in matchplay and firesetting at follow-up, though the frequency of each behavior was nearly four times higher in patients than in nonpatients. Fifty per cent and 59% of the initial firesetters in the nonpatient and patient samples, respectively, became recidivists. In the nonpatient sample, the child's initial involvement in firesetting and level of covert antisocial behavior were the only psychosocial predictors of follow-up firesetting that added incremental variance beyond demographics. In the patient sample, the child's initial involvement in fire-related acts and level of covert antisocial behavior were the only predictors of follow-up firesetting beyond any initial involvement in matchplay. The findings highlight somewhat different risk factors for subsequent firesetting in nonpatient and patient children, especially prior firesetting and matchplay, respectively, and bear implications for the prevention of firesetting recidivism.

Objective. To determine factors associated with selecting a high-deductible health plan (HDHP) rather than a preferred provider plan (PPO) and to examine switching and market segmentation after initial selection. Data Sources/Study Setting. Claims and benefit information for 2005-2007 from nine employers in western Pennsylvania first offering HDHP in 2006. Study Design. We examined plan growth over time, used logistic regression to determine factors associated with choosing an HDHP, and examined the distribution of healthy and sick members across plan types. Data Extraction. We linked employees with their dependents to determine family-level variables. We extracted risk scores, covered charges, employee age, and employee gender from claims data. We determined census-level race, education, and income information. Principal Findings. Health status, gender, race, and education influenced the type of individual and family policies chosen. In the second year the HDHP was offered, few employees changed plans. Risk segmentation between HDHPs and PPOs existed, but it did not increase. Conclusions. When given a choice, those who are healthier are more likely to select an HDHP leading to risk segmentation. Risk segmentation did not increase in the second year that HDHPs were offered.Key Words. Consumer-driven health plan, risk segmentation, high-deductible health planIn response to the rising cost of health care, there has been increased interest in making the health care system more responsive to patients/consumers and in making consumers more responsible for the cost of health care. One result has been the growth of ''consumer-directed health care.'' Although consumerdirected health care has been defined many ways, the term commonly applies to an insurance product that has a high deductible with an associated health savings account (HSA) and a limit on out-of-pocket expenditures. This model was formalized under the Medicare and Medicaid Modernization Act and the r Health Research and Educational Trust

Cellular tRNALys-3 serves as the primer for reverse transcription of human immunodeficiency virus, type 1 (HIV-1). tRNALys-3 interacts directly with HIV-1 reverse transcriptase, is packaged into viral particles and anneals to the primer-binding site (PBS) of the HIV-1 genome to initiate reverse transcription. Therefore, the priming step of reverse transcription is a potential target for antiviral strategies. We have developed a mutant tRNALys-3 derivative with mutations in the PBS-binding region such that priming specificity was re-directed to the highly conserved TAR stem-loop region. This mutant tRNA retains high-affinity binding to HIV-1 reverse transcriptase, viral encapsidation, and is able to prime at both the targeted TAR sequence and at the viral PBS. Constitutive expression of mutant tRNA in T-cells results in marked inhibition of HIV-1 replication, as determined by measurements of viral infectivity, syncytium formation, and p24 production. Inhibition of retroviral replication through interference with the normal process of priming constitutes a new anti-retroviral approach and also provides a novel tool for dissecting molecular aspects of priming.

This online intervention showed a favorable and cost-effective impact on health care cost.

The natural ligands for the chemokine receptors CCR5 (RANTES, MIP-1alpha, and MIP-1beta) and CXCR4 (SDF-1) can act as potent inhibitors of infection by the human immunodeficiency virus type 1 (HIV-1) at the level of viral entry. Unlike antibody-mediated inhibition, chemokine-mediated inhibition is broadly effective. Different HIV-1 strains can utilize the same coreceptor(s) for viral entry and, therefore, can be blocked by the same chemokine(s). HIV-1 strains that are highly resistant to neutralization by V3-specific antibodies are sensitive to inhibition by chemokines. Therefore, the use of chemokine-derived molecules constitutes a potential therapeutic approach to prevent infection by HIV-1. We have generated a fusion protein between RANTES and human IgG3 (RANTES-IgG3). The effectiveness of RANTES-IgG3 inhibition of infection by HIV-1 was similar to that of rRANTES. Inhibition of HIV-1 by RANTES-IgG3 was specific for CCR5-dependent but not CXCR4-dependent HIV-1 isolates. Fusion of a chemokine to an IgG moiety offers two desirable properties with respect to the recombinant chemokine alone. First, IgG fusion proteins have extended half-lives in vivo. Second, molecules with IgG heavy chain moieties may be able to cross the placenta and potentially induce fetal protection.