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Objectives: Vaccine hesitancy among essential workers remains a significant public health challenge. We examined psychological constructs of perceived susceptibility, threat, and self-efficacy and their associations with COVID-19 vaccine hesitancy among a racially and ethnically diverse essential workforce population. Methods: We performed a cross-sectional survey of essential workers from September-December 2020 at a large Los Angeles safety-net medical center as part of a program offering free COVID-19 serology testing. Program participants completed a standardized survey at the time of phlebotomy. Hierarchical logistic regression was utilized to determine factors independently associated with vaccine hesitancy. Results: Among 1327 persons who had serology testing, 1235 (93%) completed the survey. Of these, 958 (78%) were healthcare workers. Based on expressed intent, 22% were vaccine-hesitant 78% were vaccine acceptors. In our multivariate model, vaccine hesitancy was associated with female gender [aOR = 2.09; 95% CI (1.44-3.05)], African American race [aOR = 4.32; (2.16-8.62)], LatinX ethnicity [aOR = 2.47; 95% CI (1.51-4.05)] and history of not/sometimes receiving influenza vaccination [aOR = 4.39; 95% CI (2.98-6.48)]. Compared to nurses, vaccine hesitancy was lower among physicians [aOR = 0.09; 95% CI (0.04-0.23)], non-nursing/non-physician healthcare workers [aOR = 0.55; 95% CI (0.33-0.92)], and non-healthcare care workers [aOR = 0.53; 95% CI (0.36-0.78)]. Conclusions: Among a racially/ethnically diverse group of safety net medical center essential workers, COVID-19 vaccine hesitancy was associated with racial/ethnic minority groups, employment type, and prior influenza vaccination hesitancy. Interestingly, we found no association with the Health Belief Model construct measures of perceived susceptibility, threat, and self-efficacy. Psychological constructs not assessed may be drivers of vaccine hesitancy in our population. [ABSTRACT FROM AUTHOR]

Background: Limited information exists regarding COVID-19 vaccine hesitancy among healthcare workers (HCWs). Our previous survey analyzed the reasons for HCWs' decisions to accept vaccination, suggesting that a "one-size fits all" approach may not suffice to increase vaccine uptake. Methods: Based on the vaccination acceptance group (acceptor, hesitant, refuser), we examined differences by sociodemographic factors (race/ethnicity, household income, education) from Likert Scale responses to fourteen influences affecting a decision to be vaccinated using the Kruskal–Wallis test and multinomial logistic regression with mutual adjustment for these sociodemographic factors, age, and sex. Results: Non-Hispanic White vaccine acceptors ranked lower confidence in preventing, withstanding, or treating COVID-19, while Non-Hispanic Blacks more highly regarded the motivation of a religious leader, colleague, or family member. Social media was ranked more influential among Non-Hispanic Asians. Acceptors with lower incomes ranked a job requirement influential; conversely, higher income vaccine hesitant HCWs highly rated this reason. More highly educated acceptors ranked being motivated by colleagues, family, and other HCWs higher. Adjustment weakened some but not all the differences between groups. Conclusions: Sociodemographic factors affect HCWs' decisions to be vaccinated against COVID-19. Our findings may help develop more focused and tailored strategies to improve vaccination acceptance. [ABSTRACT FROM AUTHOR]

Abstract: Most plant communities support a diverse assemblage of arbuscular mycorrhizal fungi (AMF). AMF communities have the potential to affect plant community structure and vice versa. We examined AMF sporulation in a 4.5‐ha reconstructed prairie in Eau Claire County, Wisconsin. In fall 2003, the site was planted with varied numbers and combinations of native prairie species from four functional guilds: C3 grasses/sedges, C4 grasses, legume, and nonleguminous forbs. We hypothesized that more diverse plant seeding mixtures would promote AMF diversity. To examine the interaction between plant and fungal communities, plots were divided and subplots treated with the fungicide chlorothalonil to suppress AMF, enriched with ammonium nitrate fertilizer, treated with both fungicide and nitrogen, or remained untreated (control). Soil samples were collected during the summers of 2004, 2006, and 2007 from each subplot. Spores of AMF were extracted, identified to species, and enumerated. Initial plant seeding diversity did not significantly influence spore abundance, fungal diversity, plant productivity, or plant richness 4 years after establishment. Fungal species richness was positively, but weakly, correlated with plant productivity (r2 = 0.11) and plant richness (r2 = 0.09). Fungal community composition changed significantly over time; nitrogen addition, fungicide application, and site characteristics also shaped community composition. After 4 years of treatment, nitrogen and fungicide reduced AMF richness, changed sporulation patterns among AMF taxa, and reduced diversity and productivity in plant communities. Divergence in AMF community is being mirrored by changes in the plant community independent of initial seeding treatments, though causation could not be determined. [ABSTRACT FROM AUTHOR]

An incidental observation of the fly Philornis downsi parasitizing a Galapagos Flycatcher ( Myiarchus magnirostris) nest has revealed new insights into the searching behavior and biology of this invasive fly parasite and its interactions with endemic landbirds in the Galapagos Islands. Observations suggest that P. downsi relies on olfactory cues, or olfactory cues combined with the activity of adult birds, to locate nests and that flies continue to visit nests when chicks are >3 d old. At least 200 eggs were laid by P. downsi in different parts of the nest and >40 early-instar larvae were found inside the head of one chick, with additional larvae found in the base of the nest. Parasitism was the likely cause of mortality of both chicks found in or near the nest. This description of P. downsi parasitizing chicks of M. magnirostris highlights the vulnerability of this endemic bird species to this invasive fly. [ABSTRACT FROM AUTHOR]

Use of agency-employed supplemental nurses on nursing personnel costs was examined in 19 adult patient care units in a large academic medical center. Results indicated that the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient. In addition, there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California, Data Sources/Study Setting. Longitudinal administrative data on Medical enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties-two long-standing MMC counties and one traditional fee-for-service Medicaid county in California between 1987 and 1992. Study Design. We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medical enrollment prior to delivery, data censoring, arid individual characteristics such as race and age. Principal Findings. Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. Conclusions. MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes. [ABSTRACT FROM AUTHOR]

During the 1980s and 1990s there were great increases in health insurance coverage for poor children through the Children's Health Insurance Program (CHIP) and extended Medicaid eligibility. Problems remain for the small number of children with serious medical conditions whose care is a high proportion of total health care expenditures on children. We report on the adequacy of health insurance coverage for a sample of children with serious and rare illnesses treated at the single tertiary care pediatric hospital in Indiana. One third of privately insured children in our data had inadequate insurance. Compared to families with inadequate health insurance, families with adequate insurance were 50% less likely to delay care for themselves and 67% less likely to delay care for a child. Our research identifies policy-relevant deficiencies in private health coverage for seriously ill children ineligible for either Medicaid or CHIP. [ABSTRACT FROM AUTHOR]

Since health professionals provide frontline care to COVID-19 patients, information on vaccine acceptance among healthcare workers is needed. We developed and implemented an anonymous internet-based cross-sectional survey with direct solicitation among employees of a safety net health system. Items queried demographic and health-related characteristics, experience with and knowledge of COVID-19, and determinants of decisions to vaccinate. COVID-19 vaccine acceptance groups (acceptors, hesitant, refusers) were defined; an adapted version of the WHO vaccine hesitancy scale was included. The survey demonstrated good reliability (Cronbach's alpha = 0.92 for vaccine hesitancy scale; 0.93 for determinants). General linear and logistic regression methods examined factors which were univariately associated with vaccine hesitancy and vaccine acceptance, respectively. Multivariable models were constructed with stepwise model-building procedures. Race/ethnicity, marital status, job classification, immunocompromised status, flu vaccination and childhood vaccination opinions independently predicted hesitancy scale scores. Gender, education, job classification and BMI independently predicted acceptance, hesitancy, and refusal groups. Among hesitant employees, uncertainty was reflected in reports of motivating factors influencing their indecision. Despite a strong employee-support environment and job protection, respondents reported physical and mental health effects. The appreciation of varied reasons for refusing vaccination should lead to culturally sensitive interventions to increase vaccination rates amongst healthcare workers. [ABSTRACT FROM AUTHOR]

Abstract: Claims-based utilization data collected in four Medicaid demonstration programs are used to examine the impact of primary care case management on patterns of reliance on the emergency room as a source of services. The experience of stratified random samples of AFDC (Aid to Families with Dependent Children) adults and children in the demonstration programs is compared with that of ≡ samples from comparison groups in traditional Medicaid programs. Data were analyzed in multivariate models controlling for person characteristics in a pre/post, demonstration/ comparison design. Results indicated large reductions in the proportion of persons with at least one emergency room visit ranging from 27 to 37 per ¢ for children and 30 to 45 per ¢ for adults. Use levels for persons with at least one ER visit are less substantially affected. The findings suggest that gatekeeping designs can alter patterns of enrollee use with respect to the emergency room and some discussion of these implications is presented. [ABSTRACT FROM AUTHOR]

Focuses on breast cancer which is a serious illness while highlighting the issues of how to pay medical expenses for the care and treatment of the disease if the persons has no adequate or no insurance. Presentation of a case for special strategies and action to address the unique problems the some seriously ill people experience with health coverage; Review of current sources of health coverage for the seriously ill.

Studies the practice variation of total knee replacements (KR) in the elderly in the United States. Medicare-funded KRs; Annual rate of increase; Factors influencing the likelihood of receiving KR.