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Purpose: This paper examines the prevalence of long COVID across different demographic groups in the US and the extent to which workers with impairments associated with long COVID have engaged in pandemic-related remote work. Methods: We use the US Household Pulse Survey to evaluate the proportion of all adults who self-reported to (1) have had long COVID, and (2) have activity limitations due to long COVID. We also use data from the US Current Population Survey to estimate linear probability regressions for the likelihood of pandemic-related remote work among workers with and without disabilities. Results: Findings indicate that women, Hispanic people, sexual and gender minorities, individuals without 4-year college degrees, and people with preexisting disabilities are more likely to have long COVID and to have activity limitations from long COVID. Remote work is a reasonable arrangement for people with such activity limitations and may be an unintentional accommodation for some people who have undisclosed disabilities. However, this study shows that people with disabilities were less likely than people without disabilities to perform pandemic-related remote work. Conclusion: The data suggest this disparity persists because people with disabilities are clustered in jobs that are not amenable to remote work. Employers need to consider other accommodations, especially shorter workdays and flexible scheduling, to hire and retain employees who are struggling with the impacts of long COVID. [ABSTRACT FROM AUTHOR]

This paper presents a method that uses observed data from an age-period table to set bounds on the age, period, and cohort effects in an age-period-cohort multiple classification (APCMC) model. The rationale is that with enough periods over a long time span the age distributions within periods on the dependent variable will be affected by different sets of cohorts for each of the periods. This is likely to result in different trends in these separate period age distributions such that the trends in the age distributions will encompass the trend in the age effects that generated the dependent variable values. This approach can help to identify bounds that likely encompass the age, period, cohort parameters that generated the data. The data used in this papers are estimated homicide arrests by single years for those aged 15–64 for the periods 1964 to 2019 in the United States. I utilize the observed trends in the age-distributions for each of the 56 periods as different constraints on the trends for the age effects in the APCMC fixed effects model. These estimates are used to form bounds on the age effects, period effects, and cohort effects. [ABSTRACT FROM AUTHOR]

There is limited literature examining the longitudinal stability of depressive symptoms for individuals with asthma, or how religiosity/spirituality relates to depressive symptoms across time. The present study aimed to identify the stability of and the longitudinal associations between depressive symptoms and R/S across multiple developmental periods for adolesents with asthma (N = 998) within the United States. Depressive symptoms (βrange 0.33 − 0.60) and R/S (βrange 0.26 − 0.73) were stable across time, with some variability. A cross-lagged association demonstrated that use of R/S in young adulthood (Wave 3) was associated with decreased depressive symptoms in adulthood (β = -0.17, p <.001, CI − 0.25 - − 0.09, SE = 0.04). Use of R/S in adolescence (Wave 2) was predictive of increased depression in adulthood (β = 0.13, p <.001, CI 0.05 − 0.20, SE = 0.04). Results demonstrated differential relations between R/S and depressive symptoms across development, and highlight the potential importance of integrating conversations focused on R/S within healthcare settings, especially as R/S during young adulthood may buffer against or reduce depressive symptoms in adulthood. [ABSTRACT FROM AUTHOR]

Background: There is an epidemic of firearm injuries in the United States since the mid-2000s. Thus, we sought to examine whether hospitalization from firearm injuries have increased over time, and to examine temporal changes in patient demographics, firearm injury intent, and injury severity. Methods: This was a multicenter, retrospective, observational cohort study of patients hospitalized with a traumatic injury to six US level I trauma centers between 1/1/2016 and 6/30/2022. ICD-10-CM cause codes were used to identify and describe firearm injuries. Temporal trends were compared for demographics (age, sex, race, insured status), intent (assault, unintentional, self-harm, legal intervention, and undetermined), and severity (death, ICU admission, severe injury (injury severity score ≥ 16), receipt of blood transfusion, mechanical ventilation, and hospital and ICU LOS (days). Temporal trends were examined over 13 six-month intervals (H1, January–June; H2, July–December) using joinpoint regression and reported as semi-annual percent change (SPC); significance was p < 0.05. Results: Firearm injuries accounted for 2.6% (1908 of 72,474) of trauma hospitalizations. The rate of firearm injuries initially declined from 2016-H1 to 2018-H2 (SPC = − 4.0%, p = 0.002), followed by increased rates from 2018-H2 to 2020-H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the greatest hospitalization rate from firearm injuries (14.0%) and were the only group to demonstrate a temporal increase (SPC = 6.3%, p < 0.001). The proportion of uninsured patients increased (SPC = 2.3%, p = 0.02) but there were no temporal changes by age or sex. ICU admission rates declined (SPC = − 2.2%, p < 0.001), but ICU LOS increased (SPC = 2.8%, p = 0.04). There were no significant changes over time in rates of death (SPC = 0.3%), severe injury (SPC = 1.6%), blood transfusion (SPC = 0.6%), and mechanical ventilation (SPC = 0.6%). When examined by intent, self-harm injuries declined over time (SPC = − 4.1%, p < 0.001), assaults declined through 2019-H2 (SPC = − 5.6%, p = 0.01) before increasing through 2022-H1 (SPC = 6.5%, p = 0.01), while undetermined injuries increased through 2019-H1 (SPC = 24.1%, p = 0.01) then stabilized (SPC = − 4.5%, p = 0.39); there were no temporal changes in unintentional injuries or legal intervention. Conclusions: Hospitalizations from firearm injuries are increasing following a period of declines, driven by increases among NH Black patients. Trauma systems need to consider these changing trends to best address the needs of the injured population. [ABSTRACT FROM AUTHOR]

Background: Youth who face adversity are at a disproportionate risk for poor sleep health across the life course. Identifying whether the association between adversity and poor sleep varies based upon age and sex is needed. This study aims to explore sex and age as moderators between social risk and sleep in a sample of U.S. youth. Methods: This study analyzed data of 32,212 U.S. youth (6–17 years) whose primary caregiver participated in the 2017–2018 National Survey of Children's Health. A social cumulative risk index (SCRI) score was calculated from 10 parental, family, and community risk indicators. Nighttime sleep duration was the number of hours the child slept during the past week. Weeknight sleep irregularity was operationalized as whether the child sometimes/rarely/never went to bed at the same time. Generalized logistic regression models estimated associations between SCRI and sleep duration/irregularity, with age and sex as moderators. Results: Age moderated the association between SCRI and short sleep (OR = 1.12, p < 0.001), such that the magnitude of the SCRI-sleep relationship was 12% greater in school-age children. Sex was not a significant moderator. In stratified models by age group, age was positively associated with short sleep in both groups, with a greater magnitude in school-age children. Female school-age children were less likely to have short sleep than males. Conclusions: Younger children with greater social cumulative risk factors may be more vulnerable to short sleep duration. Further research into the mechanisms underlying the relationships between social risk and sleep health in school-age children is needed. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations. [ABSTRACT FROM AUTHOR]

Past research conducted primarily in young adults has demonstrated the utility of cognitive offloading for benefitting performance of memory-based tasks, particularly at high memory loads. At the same time, older adults show declines in a variety of memory abilities, including subtle changes in short-term memory, suggesting that cognitive offloading could also benefit performance of memory-based tasks in this group. To this end, 94 participants (62 young adults, 32 older adults) were tested on a retrospective audiovisual short-term memory task in two blocked conditions. Offloading was permitted in the offloading choice condition but not in the internal memory condition. Performance was improved for both age groups in the offloading choice condition compared to the internal memory condition. Moreover, the choice to use the offloading strategy was similar across age groups at high memory loads, and use of the offloading strategy benefitted performance for young and older adults similarly. These data suggest that older adults can make effective use of cognitive offloading to rescue performance of memory-based activities, and invites future research on the benefits of cognitive offloading for older adults in other, more complex tasks where age-related memory impairment is expected to be more prominent. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a degenerative disease defined by low bone mineral density, has a high prevalence, and causes fractures at multiple sites throughout the body, greatly affecting the quality of patients. α-Klotho is an endocrine factor involved in the regulation of various metabolic processes in humans, and its role in bone metabolism has attracted widespread attention. The relationship between α-klotho and bone mineral density has not been uniformly recognized, and no large-scale correlation analysis has been conducted in the middle-aged and elderly population. Objective: To determine the relationship between α-klotho and bone mineral density in middle-aged and elderly people. Methods: Population data of 3120 individuals aged 40–79 years were obtained from the NHANES database for the period 2011–2016. Regression analysis was performed using a general linear model with serum α-klotho as the independent variable and total bone mineral density, thoracic bone mineral density, lumbar bone mineral density, pelvic bone mineral density, and trunk bone mineral density as the dependent variables, respectively. The generalized additive model was also used for smoothing curve fitting and threshold effect analysis. Results: Serum α-klotho was positively correlated with total bone mineral density at lg (Klotho) < 2.97 and with thoracic bone mineral density at lg (Klotho) > 2.69 (β = 0.05, p = 0.0006), and negatively correlated (β = −0.27, p = 0.0341) with lumbar bone mineral density at lg (Klotho) < 2.69. It also positively correlated with trunk bone mineral density (β = 0.027, p = 0.03657) and had no segmental effect but did not correlate with pelvic bone mineral density. The positive association of serum α-klotho with those aged 40–49 years, female, non-Hispanic White, and without hypertension was clearer. In the population with diabetes, a significantly positive association between total (β = 0.15, p = 0.01), thoracic (β = 0.23, p = 0.0404), and lumbar (β = 0.22, p = 0.0424) bone mineral density and α-klotho was observed. Conclusions: α-Klotho has different relationships with total, thoracic, lumbar, and trunk bone mineral density. Among them, the positive correlation between α-klotho and trunk bone mineral density is more valuable for predicting osteoporosis. The significant effect of α-klotho on bone mineral density in diabetes patients suggests its potential as a predictive marker of diabetes progression. [ABSTRACT FROM AUTHOR]

Background: This study examined the conflicts between different generations working in US emergency departments (ED). We sought to record generational differences involving communication preferences, perceived areas of conflict, work motivations, and attitudes regarding work-life balance. Methods: We developed a survey to assess the physician perspective on generational conflict in the ED. The survey was distributed to members of the American College of Emergency Physicians, a professional organization comprising emergency medicine physicians in the USA. Results: We received 696 completed responses. Men represented 60% of respondents and the largest proportion of respondents were emergency physicians working in community settings (53%); 11% were residents. Generation representation was smallest for Traditionalist (2%) and largest for Gen X (43%). Seventy percent reported observing conflict due to generational communication with the largest frequency being once a week (26%). In the associated open-ended questions, 247 (33%) provided 316 anecdotal descriptions of observed conflict. Responses clustered into seven themes (ordered by frequency): Work Ethic, Treatment Approach, Technology Application, Entitlement, Professionalism, Work Life/Balance, and Communication Style. Comparing Work Ethic responses, 52–70-year-olds reported that younger providers are less interested in "accomplishing anything" while 26–34-year-olds resented that attitude. Respondents completing the open-ended questions regarding preventing and responding to conflict provided some insight into helpful strategies including actions supportive of clear communication and standardized policies and expectations. Only 5% of respondents reported that they had discussed generational communication in department meetings with the odds of a woman reporting conflict being less than males (p =.01). Conclusion: Conflicts in the ED in the USA can be attributed to how an individual views the values of someone from another generation. Understanding the frequency and areas of generational conflict in the ED can help medical leaders find strategies to mitigate negative workplace interactions. [ABSTRACT FROM AUTHOR]

Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify. [ABSTRACT FROM AUTHOR]

The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted based on the PICO-structured question: "What are the intervention options to reduce bruxism in children/adolescents?". No language, year, or study design restrictions were imposed. Studies reporting interventions to reduce bruxism in children (< 10) and adolescents (10 to 19 years old) were included. Reviews and letters to editors were not included. From 2723 records, 17 papers were included. Included studies were primarily randomized clinical trials performed in Brazil (35.3%) and using different criteria for the diagnosis of bruxism. Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medications (hydroxyzine/trazodone/flurazepam), occlusal splints, orthodontic interventions, and psychological and physical therapy interventions. Reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and in orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis-L) have shown inconclusive results.Conclusions: Several intervention options are available to inhibit or reduce bruxism activity. The respective indication, contraindications, and side effects of each treatment option must be assessed individually and carefully, taking into account that bruxism is not considered a disorder in otherwise healthy individuals.What is known• Biological and psychological factors have been strongly correlated to the development of bruxism• Bruxism prevalence ranging from 6 to 50% in childrenWhat is new• Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medication (Hydroxyzine/ Trazodone/ Flurazepam), occlusal splints, orthodontic interventions, psychological, and physical therapy interventions• A reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis L) show inconclusive results in respect of the reduction in bruxism. [ABSTRACT FROM AUTHOR]

The study examined timing of autism spectrum disorder (ASD) identification in education versus health settings for 8-year-old children with ASD identified through records-based surveillance. The study also examined type of ASD symptoms noted within special education evaluations. Results indicated that children with records from only education sources had a median time to identification of ASD over a year later than children with records from health sources. Black children were more likely than White children to have records from only education sources. Restricted and repetitive behaviors were less frequently documented in educational evaluations resulting in developmental delay eligibility compared to specific ASD eligibility among children with ASD. Future research could explore strategies reduce age of identification in educational settings and increase equitable access to health evaluations. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations of healthy dietary patterns with cardiometabolic biomarkers and all-cause mortality among individuals with prediabetes. Methods: This cohort study included 8363 adults with prediabetes from the National Health and Nutrition Examination Survey 1999–2014. Healthy dietary patterns including Alternate Healthy Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet score (AMED), Dietary Approaches to Stop Hypertension score (DASH), and Healthy Eating Index-2015 (HEI-2015) were calculated based on 24-h dietary recall data. Mortality status was obtained by linkage to National Death Index records. Cardiometabolic biomarkers, including blood glucose, insulin, HbA1c, C-reactive protein (CRP), and lipids, were measured at recruitment. Results: During 61,991 person-years of follow-up, 991 deaths occurred. Comparing the extreme quartiles, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were 0.65 (0.49, 0.85) for AHEI-2010 (P-trend = 0.002), 0.68 (0.50, 0.92) for AMED (P-trend = 0.004), 0.72 (0.53, 0.98) for DASH (P-trend = 0.03), and 0.78 (0.58, 1.05) for HEI-2015 (P-trend = 0.08). Besides, the HRs (95% CIs) for all-cause mortality per 20-percentile increment in scores were 0.78 (0.67, 0.90) for AHEI-2010 (P = 0.001), 0.73 (0.62, 0.86) for AMED (P < 0.001), 0.84 (0.69, 1.02) for DASH (P = 0.08), and 0.86 (0.74, 1.00) for HEI-2015 (P = 0.04). In addition, higher dietary scores were associated with favorable blood glucose, insulin, HOMA-IR, blood lipids, and CRP (all P-trend < 0.05). The high-density lipoprotein cholesterol and CRP explained 1.53–9.21% of the associations between dietary patterns and all-cause mortality (P < 0.05). Conclusions: Diets with higher AHEI-2010, AMED, DASH, and HEI-2015 were associated with improved cardiometabolic factors and lower all-cause mortality among individuals with prediabetes. These findings suggest that multiple healthy dietary patterns instead of a one-size-fits-all diet plan might be beneficial and acceptable for individuals with prediabetes. [ABSTRACT FROM AUTHOR]

Physical function decline due to aging or disease can be assessed with quantitative motion analysis, but this currently requires expensive laboratory equipment. We introduce a self-guided quantitative motion analysis of the widely used five-repetition sit-to-stand test using a smartphone. Across 35 US states, 405 participants recorded a video performing the test in their homes. We found that the quantitative movement parameters extracted from the smartphone videos were related to a diagnosis of osteoarthritis, physical and mental health, body mass index, age, and ethnicity and race. Our findings demonstrate that at-home movement analysis goes beyond established clinical metrics to provide objective and inexpensive digital outcome metrics for nationwide studies. [ABSTRACT FROM AUTHOR]

Fractures associated with intimate partner violence (IPV) are devastating injuries that can have lifelong physical and emotional implications. With exception to the facial region, there are very limited epidemiological reports describing the types and location of IPV-related fractures. The objective of this study is to review a national database and describe trends that are associated with IPV-related fractures. An analysis of all adult (18 years and older) was performed using the National Trauma Data Bank from 2007 through 2014. There were 1352 records identified where the patient was diagnosed with an IPVrelated fracture. Women accounted for 83% of the population and the mean age was 37.5 years. Nearly half of the population sustained fractures to the face. Variances among fracture location were observed across age groups. Facial fractures were recorded more in the younger population (18–39 years) when compared to the other age groups (40–59 years and 60+ years), p < 0.001. Alternatively, rib and femur fractures were more commonly seen among survivors aged 60 years and older when compared to the younger age groups, p < 0.001. The ability to identify and respond to survivors of IPV in the healthcare setting is critically important. While facial fractures are particularly common in the presence of IPV, they are not the only type of fractures that may be seen. In many cases healthcare professionals are the first line of defense in identifying suspected IPV cases. The findings of this paper build upon existing literature while also describing IPV-related fractures across the age spectrum. [ABSTRACT FROM AUTHOR]

Given long waitlists for autism spectrum disorder (ASD) evaluation coupled with the COVID-19 pandemic, it is crucial to triage patients to services they are likely to receive diagnostic clarity (i.e., virtual, in-person evaluation). Participants attended a virtual ASD assessment. A subset also attended in-person evaluation. Results suggest younger children with educational services for ASD may benefit from virtual assessment while older patients with a history of psychiatric conditions may benefit from in-person evaluation. An ASD symptom severity tool related to virtual and in-person diagnostic clarity. Family history of ASD related to in-person diagnosis while other variables (e.g., age, educational services) did not. The study suggests patient characteristics may be used to determine for whom virtual ASD assessment may be appropriate. [ABSTRACT FROM AUTHOR]

Sleep is important for physical and mental health. Latinx individuals are thought to experience worse sleep and associated health outcomes, resulting in health disparities. There is a dearth of research on the factors (e.g., employment status, age at immigration) that predict poor sleep among Latinx immigrants. The present study aimed to (1) examine the link between demographic factors, immigration-related factors, and acculturation stress, and sleep, and (2) identify factors that either attenuate or intensify the link between acculturation stress and sleep among Latinx immigrants in the US South, an immigrant-hostile area that is home to an increasing Latinx population that remains understudied. Hierarchical regressions were used to analyze data from 391 Latinx adult immigrants, examining the link between demographic factors, immigration-related factors, acculturation stress, and two sleep variables (sleep quality, difficulty falling asleep). Employment status and age at immigration were examined as moderators of the link between acculturation stress and sleep. Data were collected through in-person surveys. Regressions showed that acculturation stress was significantly linked to worse sleep quality (β = 0.30, p = 0.001) and more difficulty falling asleep (β = 0.41, p < 0.001), while controlling for participant characteristics. Younger age at immigration (β = − 0.14, p = 0.005) and being unemployed (β = − 0.13, p = 0.006) were associated with more difficulty falling asleep. Age at immigration intensified the relationship between acculturation stress and sleep quality (β = 0.14, p = 0.005), difficulty falling asleep (β = 0.15, p = 0.002). Reducing acculturation stress is a meaningful intervention focus, with important implications for sleep health, particularly for recent Latinx immigrants. Age at immigration and employment status are also important factors to consider when designing targeted interventions. [ABSTRACT FROM AUTHOR]

Purpose: The impact of the COVID-19 pandemic on psychological well-being will likely be long-lasting. Efforts directed towards monitoring the onset and progression of distress and mental health disorders are needed to identify and prioritize at-risk populations. This study assesses the psychological well-being of the United States (US) general population during the early phase of the COVID-19 COVID-19 pandemic using validated patient-reported outcome measures (PROMs). Methods: A cross-sectional study design was used. Adults (18 years or older) who could read and write in English were recruited through Prolific in May 2020. Participants completed a REDCap survey including demographic and health-related questions and three PROMs measuring global health (PROMIS-10 Global Health), anxiety [Generalized Anxiety Disorder Scale-7 (GAD-7)], and depression [Patient Health Questionnaire-9 (PHQ-9)]. A multivariable linear regression was used to identify key factors associated with worse psychological well-being. Results: Mean age of the 2023 participants was 31.92 ± 11.57 years (range, 18–82). Participants were mainly White (64.7%, n = 1309), female (52.2%, n = 1057), working full-time before the pandemic (43.5%, n = 879), and completed a college, trade, or university degree (40.7%, n = 823). Most participants reported mild to severe anxiety (57.3%, n = 1158) and depression (60%, n = 1276) on the GAD-7 and PHQ-9, respectively. Patient characteristics associated with worse psychological well-being included: age ≤ 39 years, non-White, female or gender diverse, BMI ≥ 30, uninsured, annual income ≤ $49,999 (USD), lower educational attainment, and belief that COVID-19 is deadlier than flu. Conclusion: PROMs can be used to assess and monitor psychological well-being during the COVID-19 pandemic and to inform the planning and delivery of targeted public health interventions to support at-risk populations. [ABSTRACT FROM AUTHOR]

Background: Aspirations refer to wishes, ways of defining quality of life (QOL), and life goals. Living with chronic illness likely impacts a person's life aspirations. Duchenne Muscular Dystrophy (DMD) is an inherited disorder characterized by the inevitable and progressive loss of ambulation and independence. The present cross-sectional case–control study investigated how aspirations differed between people with DMD and a stratified comparison group of nationally representative children/adults. Methods: A web-based survey was administered October through December 2020. Recruitment was stratified by age group: 8–12, 13–17, and > = 18, reflecting the DMD disability trajectory. Aspirations were measured using qualitative (open-ended) and quantitative (closed-ended) questions. Qualitative prompts asked participants about wishes, how they would define "QOL"; and goals; answers to the prompts were then coded by six trained raters. Quantitative questions included 29 closed-ended goal-delineation items from the QOL Appraisal Profilev2. These data were analyzed using multivariate models adjusting for propensity scores (demographic differences), and testing for the effects of role (patient or comparison), age, and role-by-age interactions. Results: The study sample of DMD (n = 285) and comparison (n = 292) participants provided open-text data: 577 wishes statements, 283 QOL-definition statements, and 149 goals statements. Inter-rater reliability (kappa = 0.77) reflected good agreement between different raters' codes. Results suggested that people with DMD have aspirations that differ from their peers in several important ways. Both open-text and closed-ended data in both unadjusted and adjusted analyses generally showed that people with DMD were more focused on intrinsic aspirations such as health, healthcare, and independence than their peers. Compared to non-DMD persons, DMD individuals were much less focused on financial or housing concerns, community contributions, or spiritual growth. With age, patients' aspirations focused less on extrinsic aspirations such as careers and work and increasingly emphasized emotion-oriented goals. Patients were markedly less likely to give a direct answer to the open-ended goals question. Conclusion: There were important differences in aspirations between people with DMD and their peers. These findings may be helpful for developing psychosocial interventions. [ABSTRACT FROM AUTHOR]

Aims: Chronic kidney disease (CKD) poses a significant health burden in the United States (US). Although earlier studies investigated income disparities in other chronic diseases, limited research has been carried out for CKD in recent years. We investigated income disparities in the prevalence and trends of CKD among US adults. Subjects and methods: This cross-sectional study analyzed National Health and Nutrition Examination Survey 2003–18 data. Survey periods were grouped as 2003–06, 2007–10, 2011–14, and 2015–18. Using glomerular filtration rate and urinary albumin-creatinine ratio from CKD-epidemiology equation, individuals ≥20-year-old were classified into stages of CKD. Income was derived from family income to poverty ratio and equally stratified as low-, middle-, and high-income. Results: In all periods, a reduction in CKD prevalence was observed as income-level increased. In 2003–06, the prevalence (95% confidence interval [CI]) of CKD was 17.8% (15.6%–20.3%), 14.7% (13.1%–16.4%), and 11.5% (10.3%–12.9%) among low-, middle-, and high-income people, respectively. It remained similar in 2007–10 and 2011–14. In 2015–18, this prevalence (95% CI) was 17.9% (16.5%–19.5%), 15.9% (14.6%–17.2%), and 10.2% (8.8%–11.8%) among low-, middle, and high-income people, respectively. Similar differences were detected across most age, gender, and race/ethnicity categories. Income differences were also observed in prevalence of CKD risk factors, including diabetes, obesity, metabolic syndrome, and smoking. Conclusion: While there was no increase in overall CKD prevalence, there could be an association between CKD and income, and low- or middle-income people had higher prevalence of CKD than high-income people. Lifestyle intervention and chronic disease-related health service provision need to consider the income disparity in CKD burden to improve the health and wellbeing of the US population. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death worldwide. In this study, we assessed factors related to cardiovascular disease risk and outcomes among sexual minorities (SM). Data from multiple waves of the PATH study were used in this analysis. Multivariable regression models were used to assess the association between sexual identity and: tobacco or e-cigarette use, adverse cardiovascular events, and age at first diagnosis of adverse cardiovascular disease events. In our sample (N = 23,205), 1,660 (7.15%) participants identified as SM. SM men, relative to heterosexual men, are more likely to be diagnosed with high blood pressure (aRR = 1.27; 95% CI 1.10, 1.47), high cholesterol (aRR = 1.32; 95% CI: 1.12, 1.55), congestive heart failure (aRR = 2.29; 95% CI 1.13, 4.65), stroke (aRR = 2.39; 95% CI: 1.14, 5.04), heart attack (aRR = 2.40; 95% CI 1.42, 4.04), and other heart conditions (aRR = 1.52; 95% CI: 1.06, 2.18). Although no simple differences were observed among SM women compared to heterosexual women, SM women were more likely to be diagnosed at a younger age for high blood pressure (aRR = -0.69; 95% CI − 1.08, − 0.29), high cholesterol (aRR = -0.77; 95% CI − 1.15, − 0.38), stroke (aRR = − 1.04; 95% CI − 1.94, − 0.13), and heart attack (aRR = − 1.26; 95% CI − 2.42, − 0.10). SM men were only diagnosed at a younger age for stroke (aRR = − 1.18; 95% CI − 2.06, − 0.30). Compared to heterosexuals, sexual minorities are at higher risk for cardiovascular disease, more likely to develop cardiovascular disease at an earlier age, and more likely to use tobacco products. Future research should focus on decreasing cardiovascular risk among sexual minorities including reducing tobacco use and stress. Screening recommendations for sexual minority populations should also be reviewed in light of a growing body of literature suggesting elevated risk from a young age. [ABSTRACT FROM AUTHOR]

Evidence from epidemiological studies suggests that vaccine-preventable disease (VPD) such as influenza or herpes zoster contribute significantly to the increased risk of older adults for cardiovascular, cerebrovascular, neurological, and renal complications in the period after illnesses. However, since the period of elevated risk can persist well beyond the duration of the acute illness, the connection is not always recognized. To obtain insights into the relationship between diagnoses for vaccine-preventable disease and for other conditions, we analyzed principal and secondary diagnoses for 3,127,768 inpatient admissions of adults 50 years and older in the United States, using medical insurance claims drawn from the IBM® MarketScan® Research Databases (Marketscan). The Marketscan data indicated that overall, 3.1% of these hospitalizations had a principal diagnosis of VPD with variation by month of admission, and age. However, hospitalizations with a principal non-VPD diagnosis but secondary VPD diagnoses were 2.8 times more frequent, with particularly high rates in those whose principal diagnoses were non-VPD respiratory or circulatory disease. Hospitalized patients with a secondary VPD diagnosis tended to have poorer discharge outcomes, and longer length of stay in comparison to hospitalized patients without a secondary VPD diagnosis. In total, these data are consistent with suggestions that VPDs play a significant and potentially under-estimated role in hospitalization and outcomes, which may be potentially preventable by improved vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: Quinolones are popular antibiotics that are known for their potency, broad coverage, and reasonable safety. Concerns have been raised about a possible association between quinolones and retinal detachment (RD). Methods: We conducted a nested case–control study using electronic health records (EHR) from the Health Facts® Database. The initial cohort included all patients who were admitted between 2000 and 2016, with no history of eye disease, and had a minimum medical history of one year. Eligible cases comprised inpatients who were first admitted with a primary diagnosis of RD between 2010 and 2015. Each eligible case was matched without replacement to five unique controls by sex, race, age, and period-at-risk. We used conditional logistic regression to calculate RD risk, adjusting for exposure to other medications, and major risk factors. Results: We identified 772 cases and 3860 controls. Whereas our primary analysis of all subjects revealed no quinolone-associated RD risk, elevated but non-significant risks were noted in African Americans (ciprofloxacin and levofloxacin), those aged 56–70 years old (moxifloxacin), and women (ciprofloxacin). Conclusion: Our study did not identify an elevated RD risk within 30 days following systemic administration of quinolone antibiotics. Suggestions of increased risk observed in some population subgroups warrant further investigation. [ABSTRACT FROM AUTHOR]

The cost of ASD in the U.S. is estimated using a forecast model that for the first time accounts for the true historical increase in ASD. Model inputs include ASD prevalence, census population projections, six cost categories, ten age brackets, inflation projections, and three future prevalence scenarios. Future ASD costs increase dramatically: total base-case costs of $223 (175–271) billion/year are estimated in 2020; $589 billion/year in 2030, $1.36 trillion/year in 2040, and $5.54 (4.29–6.78) trillion/year by 2060, with substantial potential savings through ASD prevention. Rising prevalence, the shift from child to adult-dominated costs, the transfer of costs from parents onto government, and the soaring total costs raise pressing policy questions and demand an urgent focus on prevention strategies. [ABSTRACT FROM AUTHOR]

The Eyberg Child Behavior Inventory (ECBI) is one of the most widely used and well-validated parent rating scales for children’s disruptive behavior. This screening instrument is a short, targetted and easy to implement inventory with good psychometric properties and is normed for different countries, among which the United States, Spain, Sweden and Norway. The ECBI has been successfully used for research and clinical purposes, in several countries including The Netherlands. To date, Dutch studies have relied on Scandinavian or US norm scores. However, this may be problematic because of cross-cultural differences in the degree to which certain behaviors are seen as problematic by parents. The main goal of this paper therefore was to obtain norm scores for The Netherlands among 6462 Dutch children aged 4 to 8 years (Mage = 6.37 years; SD = 1.32; 50.6% boys). In line with previous research, we found small differences on the mean sum scores across children of different ages (intensity scale) and gender (intensity and problem scale). Therefore, Dutch norm scores were provided age- and gender specific. Our results showed that disruptive behavior of children in the most rural areas was reported as occurring less frequently and was seen as less problematic by parents compared to the disruptive behavior of children in less rural areas. Finally, we found that Dutch norm scores on the ECBI were significantly lower than US norm scores, and significantly higher on the intensity scale (but not the problem scale) than Norwegian and Swedish norm scores. [ABSTRACT FROM AUTHOR]

We pooled data from four years (2016–2019) of the National Survey of Children's Health (NSCH) and included a nationally representative sample of 6 to 17 years old US children (N = 94,369; Mean age = 11.53 years, Standard Deviation [SD] = 3.53). Among 6–17-year-old US children, about 48% had a lifelong exposure to at least one of nine Adverse Childhood Experiences (ACEs), and 18.7% had a current diagnosis of at least one of four mental disorders. We examined the association between ACEs, neighborhood support, and mental disorders using several logistic regression models. More types of lifelong ACEs and lower neighborhood support were associated with a higher diagnosis of internalizing (anxiety/depression) and externalizing (ADHD/behavior problems) mental disorders (odds ratio [OR] > 1, and p <.001 for all relationships). After controlling for neighborhood support in the models, the odds ratios for ACEs attenuated but remained significant in all models regardless of mental disorder type or age group. However, the odds ratios for neighborhood support were larger for the association with ADHD/behavior problems than anxiety/depression. Moreover, odds ratios for neighborhood support levels were higher for older children (12–17 years old) compared to younger (6–11 years old) children. Higher neighborhood support appears to mitigate the adverse effects of ACEs on mental disorders, especially externalizing mental disorders (anxiety/depression) among adolescents (12–17 years old). [ABSTRACT FROM AUTHOR]

Purpose: Previous reports of gynecologic cancer rates have adjusted for hysterectomy prevalence with data from the Behavioral Risk Factor Surveillance System (BRFSS) or the National Health Interview Survey (NHIS). We sought to determine if BRFSS and NHIS produce similar estimates of hysterectomy prevalence. Methods: Using data from BRFSS and NHIS, we calculated hysterectomy prevalence for women aged 20–79 years, stratified by 10-year age groups, survey year (2010, 2018), and race/ethnicity (Hispanic, non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, non-Hispanic all other race groups). Results: BRFSS and NHIS produced similar increasing trends in hysterectomy prevalence by age and directional differences by race and ethnicity. Fewer than 2% of women aged 20–29 years and more than 4 out of 10 women aged 70–79 years reported having had a hysterectomy. Conclusion: Our analyses suggest adjustment for hysterectomy prevalence with data from either survey would likely reduce distortion in cervical and uterine cancer rates. BRFSS, a survey which has a larger sample size than NHIS, may better support analyses of hysterectomy estimates for smaller subpopulations. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) and chronic hepatitis B virus (CHB) infection can be prevented with treatment and vaccination, respectively. We reviewed epidemiology and guidelines for TB and CHB to inform strategies for reducing United States (U.S.) burden of both infections. Non-U.S.-born, compared to U.S.-born, persons have a 15-, 6-, and 8-fold higher TB incidence and latent TB infection (LTBI) and CHB prevalence, respectively; all infections disproportionately impact non-U.S.-born Asians. TB and CHB each are associated with ~ 10% mortality that results in 7- and 14-years per life lost, respectively. LTBI and CHB have significant gaps in their care cascade as 40% of LTBI and 20% of CHB patients are diagnosed, and 20% of LTBI and CHB diagnosed patients receive treatment. Reducing TB and CHB burden will require healthcare provider-, system-, and policy-level interventions, and increased funding and collaboration between public health departments and healthcare systems. Institutional Review Board Statement: Since this review article did not include primary data on patients and only focused on reviewing published data, approval by an institutional review board was not needed. [ABSTRACT FROM AUTHOR]

To examine the effect of maternal age on the risk of preterm birth and its phenotypes in foreign-born compared to native-born mothers. The 2014–2017 US Birth and Fetal Death data were analyzed (N = 14,867,880). Log-binomial regression models were used to estimate adjusted prevalence ratios (APR), quantifying the association between mother's nativity and preterm birth and its phenotypes, stratified by maternal age. Foreign-born mothers had a 13% lower probability of preterm birth compared to their native-born counterparts (APR, 0.87 [95% CI 0.86–0.87]). This protective effect persisted across all preterm phenotypes. Stratification by maternal age showed a slightly elevated risk in preterm and moderate-to-late preterm for adolescent mothers. Our study supports the existence of the "foreign-born paradox" whereby foreign-born mothers experienced lower levels of preterm birth despite the disadvantages of living in an alien socio-cultural environment. This favorable birth outcome was present primarily in foreign-born mothers aged ≥ 20 years. [ABSTRACT FROM AUTHOR]

Religious coping is one potential strategy to manage stressors. Positive religious coping has been linked to better physical and mental health outcomes, while negative religious coping has been associated with increased stress and anxiety. The primary objective of this study was to examine individuals' use of religious coping during the COVID-19 pandemic. We examined the relationship between COVID-19 anxiety and religious coping in a national sample of 970 individuals located within the USA recruited via Amazon's Mechanical Turk (MTurk) between September 12, 2020, and September 25, 2020. Findings indicate negative religious coping is most strongly associated with COVID-19 anxiety, as higher levels of negative religious coping were positively related to COVID-19 anxiety. In a moderated multiple regression wherein positive religious coping and negative religious coping were included in an interaction term, only negative religious coping was significantly associated with COVID-19 anxiety. This may have been due, in part, because individual's typical religious engagement was disrupted by social distancing and isolation measures. When accounting for participant age, sex, religious beliefs and behaviors, and negative religious coping, positive religious coping was negatively, although weakly, associated with COVID-19 anxiety. These findings suggest that negative religious coping has a stronger association with COVID-19 anxiety than positive religious coping. [ABSTRACT FROM AUTHOR]

This paper argues that the demographic consequences of the ending of U. S. academic expansion in the 1970s virtually guaranteed a large decline in the total disciplinary effort available to read any given unit of sociological publication. These effects are partly composition effects related to shift from a pyramidal to a columnar age distribution and partly substitution effects related to the switch from a seller's to a buyer's market for academic talent. As buyers raised standards, publication expanded rapidly, which both increased the material to be read and decreased the time available to read it. The crisis in scholarly reading is less a result of changes in individual scholarly propensities to read than in the numbers and ages of scholars and of the newly central role of publication in scholarly careers. Since publication is now a system of excess, the paper closes with an analysis of the various strategies available to handle that excess. [ABSTRACT FROM AUTHOR]

This study examined temporal and social comparisons of physical health status. Participants in two waves of the MIDUS cohort ranging in age from young adult to young-old (N = 2,408) rated current, past, and future physical health, as well as peer health. Past health was generally rated as better than current health (particularly among young adults). Young adults expected better future health; young-old adults expected declining health. All groups recalled their health as better than they reported a decade earlier. Middle-aged and young-old respondents expected more decline than they reported ten years later; young adults' ratings were consistent. The two older groups believed they were healthier than same-age peers, whereas younger respondents believed they were less healthy (though as healthy as the other age groups). The nature and trajectories of temporal and social comparisons of physical health across the lifespan suggest the need to examine their consequences for health behaviors. [ABSTRACT FROM AUTHOR]

Background: To add context to the impact of medical conditions, it is important to interpret and compare health outcomes across studies and populations. We aimed to determine Dutch reference values for the Patient-Reported Outcomes Measurement Information System Scale v1.2 - Global Health (PROMIS-GH). Methods: The PROMIS-GH, also referred to as PROMIS-10, was completed by 4370 Dutch persons, representative for the 2016 Dutch population. T-scores for the mental health (GMH) and physical health (GPH) subscales, and their shorter two-item subscales, were calculated for the entire population, age groups and gender. T-scores for GMH and GPH were compared to the US reference population, representative for the 2000 US general population. Interpretability thresholds for poor, fair, good, very good and excellent GPH and GMH were calculated based on T-scores of participants, which were categorized into five groups based on their response to item Global01. For each group the mean GPH and GMH T-score was calculated and the midpoint between two adjacent means was identified, resulting in thresholds. Thresholds based on the Dutch data were compared to US thresholds. Results: The Dutch population had a GMH T-score of 44.7 and a GPH T-score of 45.2, both substantially worse than the US reference population T-score of 50. Lower T-scores were also found for age-range and gender subpopulations. Dutch GMH and GPH interpretability thresholds were mostly not substantially different compared to the US thresholds, although the Dutch threshold between fair and poor mental health was considerably higher (29 vs. 38). Conclusions: This study reports reference values for the PROMIS-GH scale for the Dutch general population, including age-range and gender subpopulations. These reference values provide an important tool for healthcare professionals and researchers to better evaluate and interpret patient-reported mental health and physical health. Scores are notably worse than the US reference values. The exact reason for this remains subject for further research, although possibilities for the differences are discussed, including the presence of differential item functioning and the representativeness and recentness of the data. [ABSTRACT FROM AUTHOR]

Prostate-specific antigen (PSA) testing is one of the standard screening methods for prostate cancer (PC); however, a high proportion of men with abnormal PSA findings lack evidence for PC and may undergo unnecessary treatment. Furthermore, little is known about the prevalence of PSA testing for US men, after the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening in 2012. Our objectives were to: (1) examine the self-reported patterns of PSA testing following a change in the USPSTF prostate cancer screening recommendations and (2) to determine the associated socio-demographic factors. Data were from the 2010 and 2015 National Health Interview Surveys. Men were ages ≥ 40 years and responded to the question "Ever had a PSA test?". Multivariable logistic regression was used to examine PSA testing prevalence in 2010 and 2015, and their associated socio-demographic factors. The analytic sample contained 15,372 men. A majority (75.2%) identified as non-Hispanic (NHW) and 14.2% were foreign-born. Those surveyed in 2015 were less likely to report ever having had a PSA test when compared to those in 2010. Compared to US-born and older NHW men, PSA testing was statistically significantly lower among foreign-born men and men belonging to all other racial categories. Fewer men reported PSA testing following the USPSTF 2012 recommendations. Associated socio-demographic factors included nativity, age, race/ethnicity, educational attainment and type of health insurance. Further studies are required to elucidate our findings and their health implications for the US native and foreign-born population. [ABSTRACT FROM AUTHOR]

Today China has the world’s largest older population, defined as aged 65 and over. The size of the older population in the United States is also large, ranking third in the world in 2000. The combined older populations of China and the United States represented 29 percent of the world’s population 65 and older in 2000. The large older populations in these two countries are projected to more than double in size over the next three decades. Although currently China is younger than the United States and many other countries, its aging process will accelerate in the next few decades, with a speed surpassing the experience of many Western European countries and the United States. This paper examines the current and future situation of the older population in China and compares China’s aging with that of the United States, using 2000 and earlier censuses from both countries as well as the population projections data from the U.S. Census Bureau. Growth of the older population, changes in the age distribution in China with comparisons to the United States, and the projections of the older population’s future growth are analyzed and presented. The paper also discusses sources of financial support and living arrangements in China and the United States. Finally, the paper assesses trends in the older population support ratio and the implications for the economic well-being of an aging population. [ABSTRACT FROM AUTHOR]

This paper is an examination of hospital 30-day readmission costs using data from 119 acute care hospitals operated by the U.S. Veterans Administration (VA) in fiscal year 2011. We applied a two-part model that linked readmission probability to readmission cost to obtain patient level estimates of expected readmission cost for VA patients overall, and for patients discharged for three prevalent conditions with relatively high readmission rates. Our focus was on the variable component of direct patient cost. Overall, managers could expect to save $2140 for the average 30-day readmission avoided. For heart attack, heart failure, and pneumonia patients, expected readmission cost estimates were $3432, $2488 and $2278. Patient risk of illness was the dominant driver of readmission cost in all cases. The VA experience has implications for private sector hospitals that treat a high proportion of chronically ill and/or low income patients, or that are contemplating adopting bundled payment mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: Reproductive life planning is an important aspect of OBGYN resident education. Despite learning about declining fertility and the implications associated with delaying pregnancy, OBGYN residents overestimate the age when fertility declines and fertility treatment success rates. Objective: To characterize attitudes towards infertility, pregnancy timing, and fertility preservation among OBGYN residents at academic programs in the United States. Methods: Cross sectional study of female trainees from 27 academic OBGYN residency programs. A voluntary, anonymous online survey was used to assess reproductive experiences and characterize attitudes towards personal family planning and infertility. Results: Of 756 trainees who were sent the survey, 487 opened the email, and 309 participated (63.4% response rate per opened email, 40.9% overall). The majority of residents expressed a desire to have children, but had not started childbearing (75.8%, n = 210) with a planned delay for career/educational reasons (84.5%, n = 196). The majority planned to have children before age 35 (90%, n = 210). Of those not finished with childbearing, 78.5% reported worrying about infertility (n = 205) and 40.8% reported considering fertility preservation (n = 111). If interested in fellowship, trainees were more worried about infertility (p = 0.01, OR 2.74 (95% CI 1.24 –6.04)). Conclusions for Practice: Female OBGYN residents learn to help patients with reproductive planning and many may personally delay family building. To help alleviate anxiety, improve reproductive autonomy, and prevent future regret, OBGYN residents may benefit from counseling regarding declining fertility with age and the advantages and disadvantages of fertility preservation, specifically emphasizing the realistic chance of success with oocyte cryopreservation compared to conception at a young age. [ABSTRACT FROM AUTHOR]

Purpose: Workplace accommodations, vital for employees with disabilities, promote diversity and inclusion efforts in organizations. This article examines who requests accommodations and who is more likely to have requests granted. We investigate the roles of individual characteristics and their intersection, including disability, sexual orientation, gender, race/ethnicity, and age. Methods: Using data from a national survey of U.S. lawyers, we estimate the odds of requesting accommodations and having the requests approved. We also estimate differences in odds according to individual characteristics, adjusting for control variables. Results: Personal identity factors, such as disability status, gender, and age, predict requests for accommodations. Odds of requesting accommodations were higher for women and people with disabilities as compared to men and those without disabilities, but lower for older individuals. Odds of requesting accommodations were higher for an older population segment—older lesbian, gay, bisexual, and queer (LGBQ) lawyers—than for younger lawyers. Accommodations were granted differentially to individuals with multiple marginalized identities. Counter to predictions, being a person with a disability is negatively associated with having an accommodation granted. Older lawyers generally have higher odds of having accommodations granted, but odds for groups such as women and racial/ethnic minorities decline with age. LGBQ lawyers who are racial minorities have lower odds than White LGBQ lawyers of having their accommodations granted. Longer tenure increases the odds of requesting accommodations. Working for a private organization decreases the odds; working for a large organization generally increases the odds. Conclusions: Those most needing accommodations, such as lawyers with disabilities and women, are more likely to request accommodations. Disabled lawyers, older women lawyers, older racial/ethnic minority lawyers, and LGBQ minority lawyers have relatively low odds of having requests granted. The results highlight the need to consider intersectional identities in the accommodation process. [ABSTRACT FROM AUTHOR]

Participation in social behaviors that enhance group-level fitness may be influenced by mutations that affect patterns of social epistasis in human populations. Mutations that cause individuals to not participate in these behaviors may weaken the ability of members of a group to coordinate and regulate behavior, which may in turn negatively affect fitness. To investigate the possibility that de novo mutations degrade these adaptive social behaviors, we examine the effect of paternal age (as a well-established proxy for de novo mutation load) on one such social behavior, namely religious observance, since religiosity may be a group-level cultural adaptation facilitating enhanced social coordination. Using two large samples (Wisconsin Longitudinal Study and AddHealth), each of a different US birth cohort, paternal age was used to hierarchically predict respondent's level of church attendance after controlling for multiple covariates. The effect is absent in WLS (β =.007, ns, N = 4560); however, it is present in AddHealth (β = −.046, p <.05, N = 4873) increasing the adjusted model R2 by.005. The WLS respondents were (mostly) born in the 1930s, whereas the AddHealth respondents were (mostly) born in the 1970s. This may indicate that social-epistatic regulation of behavior has weakened historically in the USA, which might stem from and enhance the ability for de novo mutations to influence behavior among more recently born cohorts—paralleling the secular rise in the heritability of age at sexual debut after the sexual revolution. [ABSTRACT FROM AUTHOR]

Introduction: Autism mandates are laws that require commercial insurers to cover certain evidence-based treatments for Autism Spectrum Disorder (ASD). The purpose of this study was to review state variability in autism insurance mandates and the benefits they cover and to discuss recommendations for research and policy to improve ASD services across states. Methods: Data were extracted from 2001 to 2020 from all 50 states plus the District of Columbia (N = 51) from policy text. News articles and websites of ASD advocacy organizations were also reviewed to ensure inclusion of the most recent policy changes. Descriptive statistics and heatmaps were used to characterize the autism mandate landscape and visualize variability in benefit parameters across states. Results: Autism mandates vary greatly in benefit parameters across US states, but there is a common set of benefits that most states have adopted. These include coverage of provider-recommended ASD services except for medical equipment, coverage up to an age limit of 18 to 21, an annual dollar limit of $36,000 with no restriction on the number of hours or visits, no lifetime cap on benefits, and requirement of BCBA® certification or its equivalent for providers of ABA. Discussion: There is a need for continued research evaluating the impact of autism mandates and benefit parameters on access to care, service utilization, and clinical outcomes for the ASD population. Stakeholder engagement and understanding the impact of autism mandates on clinical and patient-centered outcomes may provide direction for policy advocacy and public health initiatives. [ABSTRACT FROM AUTHOR]

Summary: We performed a cost-effectiveness analysis comparing 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for US postmenopausal women with hip BMD T-scores between − 2.5 and − 3.5. We found that for most postmenopausal women 5 years of treatment prior to drug holiday is the more effective and cost-effective option. Introduction: We performed a cost-effectiveness analysis to compare 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for postmenopausal osteoporotic women. Methods: We created an individual-level state-transition microsimulation model to compare 3 treatment strategies for US postmenopausal women with osteoporosis and femoral neck BMD T-scores between − 2.5 and − 3.5 at baseline: recurrent periods of 5 years of alendronate followed by 5 years of drug holiday (alendronate 5/5), recurrent periods of 10 years of alendronate followed by 5 years of drug holiday (alendronate 10/5), and no alendronate treatment. Results: Base-case analysis revealed for women initiating treatment at ages 50, 60, and 70, the alendronate 5/5 strategy dominated (was more effective and less costly than) the alendronate 10/5 strategy and no treatment. For women age 80, the alendronate 10/5 strategy dominated. When assuming a lower relative risk of nonvertebral fracture during years 6–10 of alendronate treatment than the base-case assumption, the alendronate 10/5 strategy became the most cost-effective strategy even at younger treatment initiation ages. Probabilistic sensitivity analysis results supported the base-case findings; for treatment initiation ages of 50, 60, and 70, the alendronate 5/5 strategy was favored, whereas for treatment initiation age of 80, the alendronate 10/5 strategy was favored; however, there was uncertainty in these findings. Conclusions: After 5 years of alendronate treatment, younger postmenopausal women (ages 50–70) with osteoporosis would likely benefit from a drug holiday, whereas older women (age 80) are likely to benefit from treatment for 10 years before a drug holiday. [ABSTRACT FROM AUTHOR]

Introduction: Colchicine is currently approved for the treatment of gout and familial Mediterranean fever, among other conditions. Clarithromycin, a strong inhibitor of CYP3A4 and P-glycoprotein, dramatically increases colchicine's half-life, augmenting the risk of a life-threatening adverse reaction when used inadvertently with colchicine.Objectives: The aim of this study was to examine the evidence and clinical implications of concomitant use of colchicine and clarithromycin.Methods: Case reports of colchicine-clarithromycin co-administration were searched using the FDA's Adverse Event Reporting System (FAERS) database. PubMed, EMBASE, and Web of Science electronic databases were also searched from January 2005 through November 2019 for articles reporting colchicine-clarithromycin concomitant use. Individual reports were reviewed to identify consequences of coadministration, dose, days to onset of interaction, symptoms, evidence of renal disease, time to resolution of symptoms, and Drug Interaction Probability Scale (DIPS) rating.Results: The FAERS search identified 58 reported cases, nearly 53% of which were from patients aged between 65 and 85 years. Of 30 reported deaths, 11 occurred in males, and 19 in females. Other frequent complications reported in FAERS included diarrhea (31%), pancytopenia (22%), bone marrow failure (14%), and vomiting (14%). From published literature, we identified 20 case reports of concomitant exposure, 19 of which were rated 'probable' and one 'possible' according to DIPS rating. Of these cases, four 'probable' patients expired. The documented onset of colchicine toxicity occurred within 5 days of starting clarithromycin, and death within 2 weeks of concomitant exposure.Conclusion: Clinical manifestations of colchicine-clarithromycin interaction may resemble other systemic diseases and may be life threatening. Understanding this clinically meaningful interaction can help clinicians avoid unsafe medication combinations. [ABSTRACT FROM AUTHOR]

The potential for the development of psychopathology in aolescent refugees and asylees is high due to the trauma inherent in their experience. Yet, psychopathology rooted in trauma has proven amenable to treatment. Nonetheless, as most clinicians are monolingual, the language difference between clinician and client may be a barrier of desensitization and processing typically characteristic of trauma therapy. Thus, this study aimed to describe qualitative differences in speech production among native and non-native narratives using Linguistic Inquiry and Word Count (LIWC) processing software (Pennebaker et al. 2015) to understand if the current best practice will function similarly in these populations. We compared 10 adolescent immigrants (50% male) who narrated events that provoked their migration to the U.S. in their second language (L2; i.e., English) to 10 age- and gender-matched adolescents narrating in their first language (L1; i.e., Spanish). Results revealed L1 narratives were significantly higher in their use of/talk about anger, cognitive processes, discrepancy, tentativeness, perceptual processes, ingestion, relativity, time, work, and home. L2 narratives were higher in their use of/talk about positive emotions, death, causation, health, motion, space, and fillers. Findings have implications for the efficacy of treatments using discourse to ameliorate symptoms related to trauma in non-native languages. [ABSTRACT FROM AUTHOR]

Purpose: Worldwide breast cancer is the most commonly diagnosed cancer in women and often associated with a profound physiological stress reaction. Mind-body medicine modalities have been proven effective in reducing stress symptoms. This article will cover the prevalence of MBM use in women with and without breast cancer in the US population and detect predictors of MBM use in women diagnosed with breast cancer.Methods: The 2017 National Health Interview Survey (NHIS) was used to study the prevalence of breast cancer and the use of mind-body medicine (MBM) among individuals with breast cancer in the US population. Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of MBM use in women with breast cancer in the past 12 months were identified.Results: The prevalence of breast cancer in women was 3.1%. Among women diagnosed with breast cancer, 25.2% had used MBM in the past 12 months. Spiritual meditation (14.3%), followed by yoga (9.6%), and mindfulness meditation (4.3%) were the most commonly used MBM approaches for women with breast cancer diagnosis. Only higher education independently predicted the use of MBM among them.Conclusions: In this nationally representative sample of the USA, the most common used MBM approach was spiritual meditation, while this approach is much less researched than the evidence based approaches of yoga and mindfulness meditation. Especially stressed individuals worldwide could benefit from MBM the literature suggests. Particularly in the acute survivorship stage, influencing the initial stress reaction could be beneficial. [ABSTRACT FROM AUTHOR]

Birth weight in the United States declined substantially during the 1990s and 2000s. We suggest that the declines were likely due to shifts in gestational age resulting from changes in obstetric practices. Using restricted National Vital Statistics System data linked birth/infant death data for 1990-2013, we analyze trends in obstetric practices, gestational age distributions, and birth weights among first-birth singletons born to U.S. non-Hispanic White, non-Hispanic Black, and Latina women. We use life table techniques to analyze the joint probabilities of gestational age-specific birth and gestational age-specific obstetric intervention (i.e., induced cesarean delivery, induced vaginal delivery, not-induced cesarean delivery, and not-induced vaginal delivery) to fully document trends in obstetric practices by gestational age. We use simulation techniques to estimate counterfactual changes in birth weight distributions if obstetric practices did not change between 1990 and 2013. Results show that between 1990 and 2013, the likelihood of induced labors and cesarean deliveries increased at all gestational ages, and the gestational age distribution of U.S. births significantly shifted. Births became much less likely to occur beyond gestational week 40 and much more likely to occur during weeks 37-39. Overall, nearly 18% of births from not-induced labor and vaginal delivery at later gestational ages were replaced with births occurring at earlier gestational ages from obstetric interventions. Results suggest that if rates of obstetric practices had not changed between 1990 and 2013, then the average U.S. birth weight would have increased over this time. Findings strongly indicate that recent declines in U.S. birth weight were due to increases in induced labor and cesarean delivery at select gestational ages. [ABSTRACT FROM AUTHOR]

This study sought to evaluate the prevalence of blood lead levels (BLL) in refugee children upon arrival to the U.S. and determine whether they received BLL screening and follow-up according to CDC guidelines. 301 refugee children ages 6 months to 16 years were seen at the International Family Medicine Clinic from 2003 to 2016. Data were collected on BLL, treatment, age, gender, English proficiency, native language, anemia, malnutrition, and microcytosis. Bivariate analyses were conducted to determine the association between these variables and BLL. The prevalence of elevated blood lead levels (EBLL), defined as ≥ 10 µg/dL before June 2012 and ≥ 5 µg/dL from June 2012, was observed in 13% (n = 39). Male sex (p = 0.033), young age (p = 0.003), and microcytosis (p = 0.009) were significantly associated with EBLL. Follow-up and treatment for EBLL were lower than the recommended CDC guidelines for BLL and greater education of healthcare providers is needed. [ABSTRACT FROM AUTHOR]

Indoor tanning exposes users to high levels of ultraviolet radiation, increasing skin cancer risk. The risk is greatest for those who begin indoor tanning at a young age. The objective of this study was to assess changes in indoor tanning prevalence over time among U.S. high school students, by sex, age, and race/ethnicity. We used cross-sectional data from the 2009, 2011, 2013, 2015, and 2017 national Youth Risk Behavior Survey to examine changes in indoor tanning prevalence from 2009 to 2017 and from 2015 to 2017. From 2009 to 2017 indoor tanning declined overall (15.6 to 5.6%; p < 0.001), across all age groups, and among white (37.4 to 10.1%; p < 0.001) and Hispanic (10.5 to 3.0%; p < 0.001) female students, and white (7.0 to 2.8%; p < 0.001) and Hispanic (5.8 to 3.4%; p < 0.001) male students. From 2015 to 2017, indoor tanning declined overall (7.3 to 5.6%; p = 0.04) and among white (15.2 to 10.1%; p = 0.03) and Hispanic (5.8 to 3.0%; p = 0.02) female students, and 16-year-old students (7.2 to 4.7%; p = 0.03). Indoor tanning has continued to decrease, particularly among white and Hispanic female students, dropping well below the Healthy People 2020 target for adolescents. However, continued efforts are needed to further reduce and sustain reductions in adolescent indoor tanning and address remaining research gaps. [ABSTRACT FROM AUTHOR]

Immigrant African gay and bisexual men (GBM) are at risk for substance use and adverse mental health outcomes due to negative experiences in home and host countries. Little is known about correlates of substance use and mental health outcomes in this population. We explored pre- and post-migratory factors associated with substance use and depression in recently migrated African GBM. Participants (N = 70) were recruited between July and November 2015 in NYC. Eligible participants were administered a structured questionnaire. Correlates of substance use and depression were identified using bivariate and multivariable analyses. Factors independently associated with current substance use were age, openness about sexual orientation, homophobic experiences in home country, forced sex in home country, current housing instability, and internalized homophobia. Factors independently associated with depression were post-traumatic stress disorder symptoms and alcohol use. Substance use and depression were associated with negative experiences in home and host country. [ABSTRACT FROM AUTHOR]

This study examines the roles of age, period, and cohort in influenza mortality trends over the years 1959-2016 in the United States. First, we use Lexis surfaces based on Serfling models to highlight influenza mortality patterns as well as to identify lingering effects of early-life exposure to specific influenza virus subtypes (e.g., H1N1, H3N2). Second, we use age-period-cohort (APC) methods to explore APC linear trends and identify changes in the slope of these trends (contrasts). Our analyses reveal a series of breakpoints where the magnitude and direction of birth cohort trends significantly change, mostly corresponding to years in which important antigenic drifts or shifts took place (i.e., 1947, 1957, 1968, and 1978). Whereas child, youth, and adult influenza mortality appear to be influenced by a combination of cohort- and period-specific factors, reflecting the interaction between the antigenic experience of the population and the evolution of the influenza virus itself, mortality patterns of the elderly appear to be molded by broader cohort factors. The latter would reflect the processes of physiological capital improvement in successive birth cohorts through secular changes in early-life conditions. Antigenic imprinting, cohort morbidity phenotype, and other mechanisms that can generate the observed cohort effects, including the baby boom, are discussed. [ABSTRACT FROM AUTHOR]

LGBTQ+ (e.g., lesbian, gay, bisexual, transgender, queer) youths' engagement with information and communication technologies (ICTs) allows them to access social support, develop their identities, and increase their well-being in a context of relative safety. However, a significant knowledge gap remains regarding the patterns of LGBTQ+ youths' use of ICTs, how ICT usage varies among LGBTQ+ sub-populations, as well as how LGBTQ+ youths' usage compares to the general youth population. This article investigates the use of ICTs by a geographically diverse, cross-sectional survey sample (n = 6309) of LGBTQ+ youth (ages 14–29) from across the United States and Canada. The sample's use of mobile and non-mobile digital devices, their time spent engaging online, and their participation on a wide variety of social media and other online platforms were studied. A comparison of participants' experiences was also undertaken based upon their sociodemographic characteristics—particularly age, sexual orientation, gender identity, ethno-racial identity, community type, and socioeconomic status. Significant implications for contemporary social work practice with diverse LGBTQ+ youth populations and sub-populations by individual service providers and social service organizations are discussed. [ABSTRACT FROM AUTHOR]