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Introduction: Possibilities Project Plus (PPPlus) is a free assistive device (AD) marketplace and research platform for persons with disabilities. The overall aim of PPPlus is to increase access to ADs through an integration of service, research and education. To maximize positive outcomes and reflect community needs a co-design approach informed by guiding principles of Integrated Knowledge Translation (IKT) was adopted, with examination of methods related to Experience Based Co-design. The integrated nature of PPPlus benefits from the use of specific engagement strategies that align with IKT principles to meet project objectives. The extent to which partnership and engagement strategies are specified in the rehabilitation research literature vary greatly and studies that provide information on specific strategies used to operationalize principles are limited. The objective of this manuscript is to provide a description of the co-design approach and the specific strategies that strive to achieve meaningful user engagement. By reflecting on these processes we also report on limitations and strategies for improvement. Methods: The co-design approach is highlighted through specific project activities including a representative governance structure, ongoing environmental scan and iterative Health Equity Impact Assessments (HEIA). The inherent engagement strategies that align with IKT and co-design principles are described. Discussion: The most impactful engagement strategies included early engagement of partners throughout all phases, ensuring project relevance across partners through alignment of objectives with complementary aims, using HEIAs to promote equitable outcomes from diverse stakeholders, the representative governance structure beyond individuals with disabilities and caregivers, and the use of experiences and stories to inform development. Next steps: This examination of specific strategies related to co-design focused on partnership engagement and informed targets for enhancement of the PPPlus initiative. These include being more intentional in developing a more rigorous process for evaluation that includes an assessment of strategies and their impact--especially as related to partner engagement. In addition, ongoing and enhanced efforts will focus on developing knowledge products that bring to life the most salient experience-based user stories emerging from the environmental scan with these being used to drive distinct co-creation events as well as serve other knowledge mobilization purposes (i.e., supporting policy change). [ABSTRACT FROM AUTHOR]

Goal: The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery. Methods: Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders. Principal Findings: The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions. Practical Applications: Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation. [ABSTRACT FROM AUTHOR]

Design. Retrospective review. Objective. Characterize negative reviews of spine surgeons in the United States. Summary. Physician rating websites significantly influence the selection of doctors by other patients. Negative experiences are impacted by various factors, both clinical and nonclinical, geography, and practice structure. The purpose of this study was to evaluate and categorize negative reviews of spine surgeons in the United States, with a focus on surgical versus nonsurgical reviewers. Methods. Spine surgeons were selected from available online professional society membership directories. A search for reviews was performed on Healthgrades.com, Vitals.com, and RateMDs. com for the past 10 years. Free response reviews were coded by complaint, and qualitative analysis was performed. χ2 and Fisher exact tests were used to compare categorical variables, and multiple comparisons were adjusted with Benjamini-Hochberg correction. A binary logistic regression model was performed for the top three most mentioned nonclinical and clinical complaint labels. A P-value <0.05 was considered statistically significant. Results. A total of 16,695 online reviews were evaluated, including 1690 one-star reviews (10.1%). Among one-star reviews, 64.7% were written by nonsurgical patients and 35.3% by surgical patients. Nonclinical and clinical comments constituted 54.9% and 45.1% of reviews, respectively. Surgeons in the South had more "bedside manner" comments (43.3%, P <0.0001), while Northeast surgeons had more "poor surgical outcome" remarks compared with all other geographic regions (14.4%, P< 0.001). Practicing in the South and Northeast were independent predictors of having complaints about "bedside manner" and "poor surgical outcome," respectively. Conclusion. Most one-star reviews of spine surgeons were attributed to nonsurgical patients, who tended to be unsatisfied with nonclinical factors, especially "bedside manner." However, there was substantial geographic variation. These results suggest that spine surgeons could benefit from focusing on nonclinical factors (bedside manner), especially among nonoperative patients, and that regional nuances should be considered in delivering spine care. [ABSTRACT FROM AUTHOR]

Agriculture is the mainstay of Kenya's economy and contributes significantly to the gross domestic product. A great majority of this contribution comes from smallholder farmers who paradoxically face numerous obstacles ranging from a lack of support structures to poor policies and inadequate resources. A major challenge is assisting these farmers with making improvements in their production ventures, with the recently devolved form of government in Kenya enabling any assistance to be concentrated at a much lower and specific level within established counties. The United States International University (USIU) has been involved in the development of training materials for farmers and farmer organizations, specifically a course module based on several interdisciplinary field case studies. This farmers' agribusiness training course was developed on an open educational resource (OER) platform to help both farmers, who had limited training in commercialization of agriculture, and farmer organizations. The intention of the course was to provide access to additional skills and knowledge, allowing farmers to move from a farm to a "firm." Five farmers were identified from various parts of the country and participated in partnership with USIU faculty to develop the modules for the course over a one-year period. In order to complete these modules with the farmers, project staff frequently followed up with the farmers via field trips. The farmers provided positive feedback on the OER materials despite some challenges, such as the need for participants to be computer literate in order to utilize the materials directly. However, mobile learning presents an opportunity to address this shortcoming. Kenya has witnessed tremendous growth in the use of mobile phones in the rural population whose main occupation is agriculture. Although a few farmers were found to already be using a mobile SMS service to seek recommendations from the Ministry of Agriculture on the best agriculture practices and produce marketing, there is a need to establish whether mobile technologies can enhance farmers' training and support in the rural communities.

Purpose Pharmacist-driven transitions of care interventions have been shown to improve patient clinical outcomes. However, the evidence in the literature on the impact of pharmacy transitions of care services on hospitalization and emergency department visit rates is inconclusive. The purpose of this study is to determine the impact of a pharmacist-driven transitions of care program on hospitalization and emergency department visit rates at an academic medical center. Methods This retrospective observational cohort study was conducted via pre- and postintervention analyses. The data collection period included 30 days before the date of pharmacist intervention and 30 days after the date of intervention. The study evaluated patients who were enrolled in the Transitional Inpatient Rounding Experience (TIRE) program at Wake Forest Baptist Health between August 2017 and September 2020. Patients excluded were less than 18 years old, in hospice care, discharged to long-term care, or did not have a hospitalization within 90 days of intervention. The Wilcoxon signed rank test was utilized to analyze continuous data. Standard descriptive statistics were used for categorical data. Results One hundred patients met the inclusion criteria for this study. For the primary outcome, the TIRE intervention resulted in a reduction of 31 hospitalizations, or 50% (62 prior hospitalizations in the 30 days before the intervention vs 31 admissions in the 30 days after the intervention; P < 0.001). There were significant reductions in the secondary outcomes of 90-day hospitalizations (24% fewer with intervention; P = 0.028) and 30-day emergency department visits (65% fewer with intervention; P =0.006). For the outcome of 90-day emergency department visits, there was a 36% reduction (P = 0.240). Conclusion The results of the study demonstrate that a pharmacy transitions of care program may lead to a reduction in hospitalization and emergency department visit rates. The study also found potential cost savings associated with a pharmacy transitions of care program. [ABSTRACT FROM AUTHOR]

Veterinary personnel are an essential yet often underappreciated workforce, critical for zoonotic disease prevention and response efforts that impact human health. During the early COVID-19 pandemic, the veterinary workforce supported emergency responses by promoting zoonotic disease risk communication, sharing animal health expertise, and boosting laboratory surge capacity against SARS-CoV-2 in animals and people. However, small animal veterinary workers (SAVWs), similar to healthcare workers, faced organizational challenges in providing clinical care to family pets, including those susceptible to SARS-CoV-2. We analyzed a cross-sectional survey of 1,204 SAVWs in the United States to assess veterinary clinic adaptations and their associations with SAVWs' self-perceived readiness, willingness, and ability to respond to the COVID-19 pandemic as a workforce. SAVWs who worked fewer hours than before the pandemic (ready, OR 0.59; willing, OR 0.66; able, OR 0.52) or used personal protective equipment less frequently for protection in the clinic (ready, OR 0.69; willing, OR 0.69; able, OR 0.64) felt less ready, willing, and able to respond to COVID-19. SAVWs working remotely felt less ready (OR 0.46) but not less willing or able to respond to COVID-19. Lastly, SAVWs with dependents felt less ready (OR 0.67) and able (OR 0.49) to respond to COVID-19 than SAVWs without dependents. Our findings highlight the importance of proactively managing work schedules, having access to personal protective equipment, and addressing caregiving concerns to enhance SAVW preparedness and response outcomes. SAVWs are knowledgeable, motivated personnel who should be integrated into local public health emergency preparedness and response plans, supporting a One Health framework that unites multidisciplinary teams to respond to future zoonotic disease threats. [ABSTRACT FROM AUTHOR]

In 2019, the National Health Interview survey found that nearly 59% of adults reported pain some, most, or every day in the past 3 months, with 39% reporting back pain, making back pain the most prevalent source of pain, and a significant issue among adults. Often, identifying a direct, treatable cause for back pain is challenging, especially as it is often attributed to complex, multifaceted issues involving biological, psychological, and social components. Due to the difficulty in treating the true cause of chronic low back pain (cLBP), an over-reliance on opioid pain medications among cLBP patients has developed, which is associated with increased prevalence of opioid use disorder and increased risk of death. To combat the rise of opioid-related deaths, the National Institutes of Health (NIH) initiated the Helping to End Addiction Long-TermSM (HEAL) initiative, whose goal is to address the causes and treatment of opioid use disorder while also seeking to better understand, diagnose, and treat chronic pain. The NIH Back Pain Consortium (BACPAC) Research Program, a network of 14 funded entities, was launched as a part of the HEAL initiative to help address limitations surrounding the diagnosis and treatment of cLBP. This paper provides an overview of the BACPAC research program's goals and overall structure, and describes the harmonization efforts across the consortium, define its research agenda, and develop a collaborative project which utilizes the strengths of the network. The purpose of this paper is to serve as a blueprint for other consortia tasked with the advancement of pain related science. [ABSTRACT FROM AUTHOR]

Background Following historically low influenza activity during the 2020–2021 season, the United States saw an increase in influenza circulating during the 2021–2022 season. Most viruses belonged to the influenza A(H3N2) 3C.2a1b 2a.2 subclade. Methods We conducted a test-negative case-control analysis among adults ≥18 years of age at 3 sites within the VISION Network. Encounters included emergency department/urgent care (ED/UC) visits or hospitalizations with ≥1 acute respiratory illness (ARI) discharge diagnosis codes and molecular testing for influenza. Vaccine effectiveness (VE) was calculated by comparing the odds of influenza vaccination ≥14 days before the encounter date between influenza-positive cases (type A) and influenza-negative and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–negative controls, applying inverse probability-to-be-vaccinated weights, and adjusting for confounders. Results In total, 86 732 ED/UC ARI-associated encounters (7696 [9%] cases) and 16 805 hospitalized ARI-associated encounters (649 [4%] cases) were included. VE against influenza-associated ED/UC encounters was 25% (95% confidence interval (CI), 20%–29%) and 25% (95% CI, 11%–37%) against influenza-associated hospitalizations. VE against ED/UC encounters was lower in adults ≥65 years of age (7%; 95% CI, −5% to 17%) or with immunocompromising conditions (4%; 95% CI, −45% to 36%). Conclusions During an influenza A(H3N2)-predominant influenza season, modest VE was observed. These findings highlight the need for improved vaccines, particularly for A(H3N2) viruses that are historically associated with lower VE. [ABSTRACT FROM AUTHOR]

This article examines how international differences in age-grade distributions and grade effects contribute to science scores among 27 Organization for Economic Cooperation and Development countries. As shown in the 2006 Program for International Student Assessment, countries vary substantially in the grade distribution of 15-year-olds. The costs of being in a grade lower than one's 15-year-old peers are higher in some countries (e.g., Greece and Spain); conversely, the benefits of being in a higher grade are greater in others (e.g., Australia and Luxembourg). Although the United States has relatively greater percentages of 15-year-olds in higher grades, US 15-year-olds receive relatively fewer benefits from higher-grade membership. (Contains 3 figures, 4 tables, and 17 footnotes.)

This article is based on a study of hundreds of children's bible storybooks available in the United States from 1850 to the present and focuses on the way the biblical stories of Noah and Jonah have been retold for children. These children's bible storybooks lend insight into the American church's changing assumptions about the purpose of the religious education of children and the nature of the Bible and its role in religious instruction. The author suggests that these retellings often change Hebrew Bible stories in ways that rob them of the very features that make them helpful resources for religious education. The author also offers suggestions for future authors, illustrators, and consumers of children's bible storybooks.

Recent research has brought attention to the hardship faced by children of immigrants in the United States, particularly in the Mexican-origin population. In this study, the authors are concerned with the extent to which U.S.-born children of Mexican immigrants who live in unmarried families may face exceptional risks. Using data from the Fragile Families and Child Wellbeing Study, the authors find that young children of Mexican immigrants in unmarried families face significant disadvantages on a variety of levels compared with children of U.S.-born mothers. Mexican immigrant mothers have significantly lower levels of education and employment and much higher rates of poverty, as well as less access to social services. Although characterized by low rates of low birth weight and more positive maternal health behaviors, their poor socioeconomic and social service profile suggests that even when healthy at the starting gate, they may potentially face poor outcomes during childhood and beyond. (Contains 5 tables.)

In this consensus report by a diverse group of academics who conduct and/or are concerned about social and behavioral genomics (SBG) research, the authors recount the often‐ugly history of scientific attempts to understand the genetic contributions to human behaviors and social outcomes. They then describe what the current science—including genomewide association studies and polygenic indexes—can and cannot tell us, as well as its risks and potential benefits. They conclude with a discussion of responsible behavior in the context of SBG research. SBG research that compares individuals within a group according to a "sensitive" phenotype requires extra attention to responsible conduct and to responsible communication about the research and its findings. SBG research (1) on sensitive phenotypes that (2) compares two or more groups defined by (a) race, (b) ethnicity, or (c) genetic ancestry (where genetic ancestry could easily be misunderstood as race or ethnicity) requires a compelling justification to be conducted, funded, or published. All authors agree that this justification at least requires a convincing argument that a study's design could yield scientifically valid results; some authors would additionally require the study to have a socially favorable risk‐benefit profile. [ABSTRACT FROM AUTHOR]

Examines the effects of peer and parent attitudes regarding academic performance on students' educational aspirations in 12 countries. Indicates that peers and parents influence educational goals in countries with relatively undifferentiated secondary schooling, while the influence of significant others is negligible in societies with more differentiated secondary education. (CAJ)

The article discuses the need to shift from pursuing complete denuclearisation of North Korea to a policy of deterrence and arms control. It argues that the U.S. and its East Asian allies need to accept the fact that North Korea possesses nuclear weapons and adjust their policies accordingly. It also highlights the importance of arms control measures to mitigate arms racing and reduce the potential risks and consequences of deterrence failure.

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Importance: Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance. Objective: To (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. Evidence Review: Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare & Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area. Findings: A total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with >100 beds), as were system physician practices (74% vs 12% with >100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large. Conclusions and Relevance: In 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost. This Special Communication examines health systems in the United States, assesses differences between physicians and hospitals in and outside of health systems, and compares quality and cost of care delivered by physicians and hospitals in and outside of health systems. [ABSTRACT FROM AUTHOR]

Introduction: Antenatal depression and suicidal ideation represent serious pregnancy-related complications, yet comprehensive estimates of the prevalence and predictors of these diagnoses among birthing people remain unclear.Objective: This study aimed to characterize trends in the prevalence of depression and suicidal ideation diagnoses identified among pregnant individuals prior to giving birth.Methods: This study included 536,647 individuals aged 15-44 years continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. The primary outcomes included depression or suicidal ideation based on identification of the relevant ICD-9 and ICD-10 diagnosis codes during pregnancy.Results: Rates (95 % CIs) of depression increased by 39 % from 540 (520-560) per 10,000 individuals in 2008 to 750 (730-770) per 10,000 individuals in 2018. Suicidal ideation increased by 100 % from 15 (12-18) per 10,000 individuals in 2008 to 44 (39-50) per 10,000 individuals in 2018. Black birthing people experiencing the sharpest proportional increases.Conclusions: The prevalence of depression and suicidal ideation occurring during pregnancy substantially increased over a ten-year period. Further, suicidal ideation diagnosis increased the most for among Black birthing people compared to all groups, resulting in a need for future studies in this area to determine the reasons for an increase in diagnosis and any change in resulting treatment of follow up. [ABSTRACT FROM AUTHOR]

Introduction: Cannabis use in the United States is increasingly accepted and legal. Rise in use among childbearing aged adults is potentially concerning, as the impacts of parental cannabis use on children are largely unknown, especially for young children. This study examined whether cannabis use is associated with increased risk for negative parenting and child emotional and behavioral problems among the parents of young children. Methods: We conducted a cross-sectional survey of parents and child behavior, recruited through five primary care practices in three states. Parents of children aged 1.5–5 years reported on family demographics, last 6-months cannabis use, negative parenting, parent mental health, parents' adverse childhood experiences (ACEs), and child emotional/behavioral problems. We conducted hierarchical regressions to determine if parental cannabis use predicts negative parenting and/or child emotional/behavioral problems when controlling for other risk factors. Results: Of 266 responding parents, 34 (13%) reported cannabis use in the last 6 months. Parents who endorsed cannabis use reported significantly more negative parenting, ACEs, anxiety, depression, and child emotional/behavioral problems. Adjusting for the effects of other risk factors, cannabis use significantly predicted more negative parenting, but was not uniquely and significantly associated with child emotional/behavioral problems. Conclusion: Parental cannabis predicted negative parenting, which in turn predicted early childhood emotional/behavioral problems; however, parental cannabis use did not predict child emotional/behavioral problems when other risk factors were considered. Further research is needed to elucidate the nature and direction of relationships between parent cannabis use, negative parenting, child psychological outcomes, and other risk factors. [ABSTRACT FROM AUTHOR]

Peruvian veterinarians and animal care workers (VACW) are primary responders in the event of disasters or emergencies, yet they face unique concerns that could impede or block their essential functions in public health preparedness in comparison with VACWs in other countries. In this study, we used the Ready, Willing, and Able model via electronic survey to evaluate the perception of risks and barriers that Peruvian VACWs faced when deciding whether to continue working during the COVID-19 pandemic between July and December 2020. We used logistic regression models to evaluate associations between demographic characteristics, perceived role, and contact scores with 8 outcomes: knowledge of COVID-19; confidence in safety protocols; perceived threat; perceived job efficacy; perceived barriers; and readiness, willingness, and ability to respond to the COVID-19 pandemic. Less than 50% of respondents reported barriers to report to work during the pandemic. Respondents who reported higher contact with coworkers had an increased confidence in safety protocols (OR 5.16; 95% CI, 1.36 to 19.61) and willingness (OR 3.76; 95% CI, 1.14 to 12.47) to respond to the pandemic. Close contacts with essential workers and higher economic income were associated with higher reported knowledge of COVID-19. Respondents with higher perceived job efficacy had higher odds of reporting being ready, willing, and able to respond to COVID-19, while those who identified more barriers to report to work had lower odds of being ready, willing, and able to respond. The findings from this study, which showed differences from VACWs in the United States, can be used by individuals designing programs to improve pandemic and disaster preparedness in this essential, yet understudied and vulnerable, workforce. [ABSTRACT FROM AUTHOR]

Reducing substance use and negative mental health outcomes of interpersonal victimization among sexual and gender minority youth (SGMY) represents a critical public health priority. Victimized individuals often develop cognitive schemas, or organized knowledge structures consisting of traits, values, and memories about the self, such as self-concept factors, in response to interpersonal victimization. Prior studies demonstrate the role of self-concept factors (e.g., mastery, control, and self-esteem) in explaining the relationship between victimization and substance use and mental health. However, mastery, control, and self-esteem have not been explored as mediators of interpersonal victimization and health among SGMY. This study is among the first to apply cognitive schema models of trauma-related health symptoms using a large sample of SGMY to examine (a) whether interpersonal victimization is associated with substance use (i.e., alcohol use, cannabis use, and cigarette use) and mental health problems (i.e., depressive symptoms, self-perceived stress, self-rated health issues) and (b) whether diminished sense of mastery and control and lower self-esteem can partially explain elevated rates of substance use and mental health problems in this population. We used the U.S.-based 2017 LGBTQ National Teen Survey (n = 17,112; M age = 15.57, SD = 1.27); 6,401 (37.4%) identified as gay or lesbian, 7,396 (43.2%) as cisgender women, and 10,245 (59.9%) as White. Substance use and mental health variables were positively associated with interpersonal victimization variables and negatively associated with self-concept factors. Self-concept factors partially mediated the relationship between interpersonal victimization and mental health. This model explained 74.2% of the variance in mental health and 28.4% of the variance in substance use. Cognitive coping may represent an important modifiable factor that can be targeted by trauma-focused interventions in efforts to improve victimized SGMY's mental health. Findings call for the development of identity-affirmative, evidence-based, and trauma-focused interventions for SGMY to improve this populations' overall health. [ABSTRACT FROM AUTHOR]

Objective: To describe postpartum depression and associated risk factors among postpartum patients in the United States (US) between February and July 2020. This study used a cross-sectional descriptive design to collect survey data from a convenience sample of postpartum patients who lived in the US and delivered a live infant after the US declared COVID-19 a public health emergency. Results: Our sample included 670 postpartum patients who completed an online survey inclusive of the Edinburgh Postnatal Depression Scale (EPDS) and selected demographic items (e.g. NICU admission status, infant gestational age, infant feeding method). In our sample, 1 in 3 participants screened positive for postpartum depression and 1 in 5 had major depressive symptoms. Participants who fed their infants formula had 92% greater odds of screening positive for postpartum depression and were 73% more likely to screen positive for major depressive symptoms compared to those who breastfed or bottle-fed with their own human milk. Participants with infants admitted to a NICU had 74% greater odds of screening positive. Each 1 week increase in weeks postpartum increased the odds of screening positive by 4%. Participants who worried about themselves and their infants contracting COVID-19 had 71% greater odds of screening positive. [ABSTRACT FROM AUTHOR]

Disparities in outcomes exist in outcomes of coronavirus disease‐19 (COVID‐19). Little is known about other ethnic minorities in United States. We included all COVID‐19 positive adult patients (≥18 years) hospitalized between March 1, 2020 and February 5th 2021. We compared in hospital mortality, use of intensive care unit services and inflammatory markers between non‐Hispanic whites with non‐White/Black Hispanic. Multivariable Cox proportional Hazard models were used to adjust for differences between the two groups. There were 4059 hospital admissions with COVID‐19 in the study period. Of the 3288 White, 789 (24%) required intensive care unit (ICU) admission in comparison to 187 (24.3%) of the 770 Hispanics. Unadjusted mortality was higher in Whites than Hispanics (17.1% vs. 10.7%; p < 0.001). After adjusting for confounding variables, in‐hospital mortality was not statistically different for Whites in comparison to Hispanics (hazard ratio [HR]: 0.96, 95% confidence interval [CI]: 0.76–1.21, p = 0.73). The adjusted rates of ICU transfers were significantly higher in Hispanics (HR: 1.34, 95% CI: 1.11–1.61, p = 0.002). Hispanics had significantly higher C‐reactive protein, lactate dehydrogenase, and fibrinogen when compared to Whites. Hispanics as compared to Whites with COVID‐19 require higher rates of ICU admission but have a similar mortality. Hispanics as compared to Whites with COVID‐19 require higher rates of ICU admission but have a similar mortality. [ABSTRACT FROM AUTHOR]

The article focuses on assessing the prevalence of Long COVID among adults in the U.S. in 2022. It examines the range of health problems that persist after acute COVID-19 illness and explores how these conditions impact individuals' health and well-being. It utilizes data from the Behavioral Risk Factor Surveillance System (BRFSS) to analyze self-reported information from noninstitutionalized adults aged 18 years and older.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. High-risk type HPV infections can cause many types of cancers, including oropharyngeal cancer. The HPV vaccine is the most effective method for the prevention of HPV-related cancers. However, HPV vaccination rates remain low in the United States. Dental professionals are well positioned to be at the forefront of educating patients about HPV, discussing the HPV vaccine and promoting vaccination with their patients. [ABSTRACT FROM AUTHOR]

This study examined whether adding Dichrostachys glomerata (DG; 300 mg/d) to thermogenic supplements with (DG + C) and without (DG) caffeine and other nutrients affects weight loss, changes in body composition, and/or markers of health. Sixty-eight participants (female, 54%) were grouped in a double-blind, parallel, stratified random, placebo-controlled manner to supplement their diet with a placebo, DG, or DG + C for 12 weeks while maintaining their normal diet and physical activity. Diet, physical activity, body weight, body composition, anthropometric measures, resting energy expenditure, fasting blood samples, and questionnaires were obtained at 0, 4, 8, and 12 weeks and analyzed using general linear models with repeated measures. Data are reported as mean (±SD) and change from baseline (mean, 95% confidence interval) for weeks 4, 8, and 12, respectively, with p values showing changes from baseline. DG treatment promoted significant but minor reductions in fat mass (−0.56 [−1.02, −0.14], p = 0.01; −0.63 [−1.23, −0.02], p = 0.04; −0.71 [−1.47, 0.09] kg, p = 0.08) and percent body fat (−0.46 [−0.96, −0.04], p = 0.07; −0.63 [−1.16, −0.10], p = 0.02; −0.78 [−1.45, 0.07] %, p = 0.03). There was some evidence that DG + C increased resting energy expenditure, decreased hunger, increased satiety, and improved sleep quality (diminished in DG + C). No other significant effects were observed. Ingestion of thermogenic supplements containing DG (300 mg/d) with and without caffeine and other nutrients in overweight but otherwise healthy participants who did not alter diet or physical activity promoted clinically insignificant changes in body weight and composition. [ABSTRACT FROM AUTHOR]

Introduction: Super-utilizers (patients with 4 or more emergency department [ED] visits a year) account for 10% to 26% of all ED visits and are responsible for a growing proportion of healthcare expenditures. Patients recognize the ED as a reliable provider of acute care, as well as a timely resource for diagnosis and treatment. The value of ED care is indisputable in critical and emergent conditions, but in the case of non-urgent conditions, ED utilization may represent an inefficiency in the healthcare system. We sought to identify patient and clinical characteristics associated with ED super-utilization in a universally insured population.Material and Methods: We performed a retrospective cohort study using TRICARE claims data from the Military Health System Data Repository (2011-2015). We reviewed the claims data of all adult patients (aged 18-64 years) who had at least one encounter at the ED for any cause. Multivariable logistic regression was used to determine independent factors associated with ED super-utilization.Results: Factors associated with increased odds of ED super-utilization included Charlson Score ≥2 (adjusted odds ratio [aOR] 1.98, 95% confidence interval [CI]: 1.90-2.06), being eligible for Medicare (aOR 1.95, 95% CI: 1.90-2.01), and female sex (aOR 1.35, 95% CI: 1.33-1.37). Active duty service members (aOR 0.69, 95% CI 0.68-0.72) and beneficiaries with higher sponsor-rank (Officers: aOR 0.50, 95% CI: 0.55-0.57; Senior enlisted: aOR 0.82, 95% CI: 0.81-0.83) had lower odds of ED super-utilization. The most common primary diagnoses for ED visits among super-utilizers were abdominal pain, headache and migraine, chest pain, urinary tract infection, nausea and vomiting, and low back pain.Conclusions: Risk of ED super-utilization appears to increase with age and diminished health status. Patient demographic and clinical characteristics of ED super-utilization identified in this study can be used to formulate healthcare policies addressing gaps in primary care in diagnoses associated with ED super-utilization and develop interventions to address modifiable risk factors of ED utilization. [ABSTRACT FROM AUTHOR]

Halyomorpha halys (Stål) is an invasive pest in the United States and other countries. In its native range, H. halys eggs are parasitized by a co-evolved parasitoid, Trissolcus japonicus (Ashmead). In the United States, T. japonicus, a classical biological control candidate, is being redistributed in many states where adventive populations exist. To establish if H. halys egg holding conditions affect T. japonicus foraging behavior or successful parasitism, naïve, female parasitoids from an adventive population were allowed to forage in laboratory bioassay arenas with either fresh or frozen (−20 or −80°C) egg masses, the latter held for five durations ranging from 1 h to 112 d. Parasitoid movements were recorded for 1 h. Thereafter, parasitoids were transferred with the same egg mass for 23 h. Additionally, female parasitoids from a quarantine colony were exposed to: 1) pairs of fresh egg masses and egg masses frozen at −40°C (>24 h) or 2) a single fresh egg mass or egg mass frozen at −40°C (<1 h). All exposed egg masses were held to assess progeny emergence. In the foraging bioassay, holding temperature and storage duration appeared to influence host-finding and host quality. Egg masses held at −80°C and fresh egg masses resulted in significantly greater levels of parasitism and progeny emergence compared with eggs held at −20°C. No differences were recorded between egg masses held at −40°C for ≤1 h and fresh egg masses. These results will help refine methods for preparation of egg masses for sentinel monitoring and parasitoid mass rearing protocols. [ABSTRACT FROM AUTHOR]

Discrimination has historically contributed to coercive contraceptive in the United States. We investigated associations between perceived discrimination, or the perception of unequal treatment in everyday life, and contraceptive method use among U.S. women. We analyzed population-based data from a 2013 study of U.S. women who were premenopausal, age 18–50, sexually active with a male partner in the last year and were not attempting pregnancy. Perceived discrimination was measured using the Everyday Discrimination Scale. Contraceptive method use was categorized into five method categories: permanent, highly effective reversible, moderately effective, barrier and no method. We analyzed relationships between perceived discrimination and contraceptive method use with several regression models, controlling for covariates. Among 539 women in our analytic sample, those with high perceived discrimination had lower incomes, less educational attainment and were less likely to be insured. Perceived discrimination was associated with a reduced odds of using any contraceptive method (aOR 0.43, CI 0.21–0.87, p <.001). Contraceptive method users with high perceived discrimination had an increased odds of using highly effective reversible methods versus moderately effective methods (aOR 5.28, CI 1.63–17.07 p = <.001). Women who perceived discrimination were at risk for contraceptive nonuse; however, among contraceptive users, perceived discrimination was associated with the use of more effective reversible methods. [ABSTRACT FROM AUTHOR]

Objectives: Agriculture remains one of the most dangerous industries in the United States. Fatal injury reports influence outreach and education training topics and assist in prioritizing research efforts and federal funding priorities. News stories of agricultural fatalities are routinely collected and cataloged by the New York Center for Agricultural Medicine and Health (NYCAMH). Methods: The database was queried for agricultural fatalities in New York State between January 1, 2009 and December 31, 2018. Descriptive statistics were calculated based on a variety of factors including age, gender, geographic location, type of event, and source of injury. The 2017 Census of Agriculture data was used to calculate denominator data for persons at risk. Results: Over the ten-year period from 2009 to 2018, one hundred sixty-nine (169) people were killed in agricultural injury events in New York. The most frequent cause of fatality was tractor related incidents, comprising nearly half of all fatalities (44%). There were 14 deaths of children nine and younger and an additional 11 deaths of adolescents between 10–19 years old. Steuben County had the highest rate of fatal injury at 20.9/100,000 FTE, followed by Jefferson County at 19.4/100,000 FTE. Conclusions: While the rates of workers killed on the job have dramatically dropped in many industries, agricultural fatalities remain stubbornly elevated above the all-worker fatality rate of 3.5/100,000 FTE. These data, along with non-fatal injury data, should be used to guide prevention and intervention activities. Such loss of life should underscore the tremendous stress the agricultural community is under, and serve to funnel resources to strengthen these communities, businesses and workers. [ABSTRACT FROM AUTHOR]

Accurately measuring body weight (BW) is of great importance for cow-calf producers in the United States, which can lead to better marketing and nutrient management decisions. Traditionally, BW has been recorded using a walk-over scale or approximated by visual observation. Recently, technology has come out that allows BW prediction using three-dimensional (3D) images. The objective of this study was to determine the efficacy of 3D imaging technology as a method to predict BW of beef heifers. Dorsal 3D images were collected on 69 Red Angus/Simmental yearling heifers. Heifers were approximately 12 mo of age that ranged from 282.1 to 440.0 kg of BW. For image collection, a depth camera (Kinect Azure, Microsoft) was placed above the animals, approximately 3 to 4 meters above the floor surface within the alley of a working facility. The image collection software was written in Python (version 3.8) programming language. For a high-quality image to be recorded, heifers needed to be handled in small groups and kept separate. Heifers also needed to have all four feet on the ground and no interference from other animals in the image. Corresponding scale-measured BW were also recorded for each animal concurrent with depth images collection. Heifers were limit fed and weighed in the morning before feeding for both scale measured BW and image collection. The depth images were analyzed using a customized program written in MATLAB (R2022a). Heifer dorsal projected volume was estimated by adding height pixel values that formed the heifer's dorsal area, excluding the head region. Body weights were regressed from projected heifer body volumes extracted from the depth images, and then metabolic BW (MBW) was calculated using the 0.75 power adjustment of BW. Performance of the prediction model was analyzed using the coefficient of determination (R2) obtained from the regression of projected volume and actual scale BW and the standard error of the mean (SEM) of the predicted BW. Data were analyzed using the PROC REG and PROC CORR procedures in SAS (v9.4). Prediction of BW using image-extracted dorsal projected volume produced an R 2 = 0.89 and SEM = 3.3 kg. When analyzing the correlation of volume to BW, the Pearson correlation coefficient of r = 0.94 (P < 0.0001) was obtained. Regression of projected volume to MBW produced an R 2 = 0.89 and SEM = 0.57 kg. Results show that this model demonstrates the ability to accurately predict BW using depth images projected dorsal volumes on yearling heifers. These results illustrate that 3D images can be used to accurately measure BW of growing heifers that may enhance the ability of cow-calf producers to pro-actively manage grazing livestock. [ABSTRACT FROM AUTHOR]

Introduction: Bundled payments for spine surgery, which is known for having high overall cost with wide variation, have been previously studied in older adults. However, there has been limited work examining bundled payments in working-age patients. We sought to identify the variation in the cost of spine surgery among working age adults in a large, national insurance claims database.Methods: We queried the TRICARE claims database for all patients, aged 18-64, undergoing cervical and non-cervical spinal fusion surgery between 2012 and 2014. We calculated the case mix adjusted, price standardized payments for all aspects of care during the 60-, 90-, and 180-day periods post operation. Variation was assessed by stratifying Hospital Referral Regions into quintiles.Results: After adjusting for case mix, there was significant variation in the cost of both cervical ($10,538.23, 60% of first quintile) and non-cervical ($20,155.59, 74%). Relative variation in total cost decreased from 60- to 180-days (63 to 55% and 76 to 69%). Index hospitalization was the primary driver of costs and variation for both cervical (1st-to-5th quintile range: $11,033-$19,960) and non-cervical ($18,565-$36,844) followed by readmissions for cervical ($0-$11,521) and non-cervical ($0-$13,932). Even at the highest quintile, post-acute care remained the lowest contribution to overall cost ($2070 & $2984).Conclusions: There is wide variation in the cost of spine surgery across the United States for working age adults, driven largely by index procedure and readmissions costs. Our findings suggest that implementing episodes longer than the current 90-day standard would do little to better control cost variation. [ABSTRACT FROM AUTHOR]

Importance: Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described.Objective: To characterize trends in suicidality among childbearing individuals.Design, Setting, and Participants: This serial cross-sectional study analyzed data from a medical claims database for a large commercially insured population in the US from January 2006 to December 2017. There were 2714 diagnoses of suicidality 1 year before or after 698 239 deliveries among 595 237 individuals aged 15 to 44 years who were continuously enrolled in a single commercial health insurance plan. Data were analyzed from October 2019 to September 2020.Main Outcomes and Measures: The primary outcome was diagnosis of suicidality in childbearing individuals 1 year before or after birth based on the identification of relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes during at least 1 inpatient or 2 outpatient visits.Results: Of 595 237 included childbearing individuals, the mean (SD) age at delivery was 31.9 (6.4) years. A total of 40 568 individuals (6.8%) were Asian, 52 613 (8.6%) were Black, 73 172 (12.1%) were Hispanic, 369 501 (63.1%) were White, and 59 383 (9.5%) had unknown or missing race/ethnicity data. A total of 2683 individuals were diagnosed with suicidality 1 year before or after giving birth for a total of 2714 diagnoses. The prevalence of suicidal ideation increased from 0.1% per 100 individuals in 2006 to 0.5% per 100 individuals in 2017 (difference, 0.4%; SE, 0.03; P < .001). Intentional self-harm prevalence increased from 0.1% per 100 individuals in 2006 to 0.2% per 100 individuals in 2017 (difference, 0.1%; SE, 0.02; P < .001). Suicidality prevalence increased from 0.2% per 100 individuals in 2006 to 0.6% per 100 individuals in 2017 (difference, 0.4%; SE, 0.04; P < .001). Diagnoses of suicidality with comorbid depression or anxiety increased from 1.2% per 100 individuals in 2006 to 2.6% per 100 individuals in 2017 (difference, 1.4%; SE, 0.2; P < .001). Diagnoses of suicidality with comorbid bipolar or psychotic disorders increased from 6.9% per 100 individuals in 2006 to 16.9% per 100 individuals in 2017 (difference, 10.1%; SE, 0.2; P < .001). Non-Hispanic Black individuals, individuals with lower income, and younger individuals experienced larger increases in suicidality over the study period.Conclusions and Relevance: In this cross-sectional study of US childbearing individuals, the prevalence of suicidal ideation and intentional self-harm occurring in the year preceding or following birth increased substantially over a 12-year period. Policy makers, health plans, and clinicians should ensure access to universal suicidality screening and appropriate treatment for pregnant and postpartum individuals and seek health system and policy avenues to mitigate this growing public health crisis, particularly for high-risk groups. [ABSTRACT FROM AUTHOR]

A just transition to renewable energy requires accounting for the effects of offshore wind projects (OWPs) on the fishing industry. Research on the interaction of OWPs with coastal communities and fisheries in the United Kingdom and the United States offers insights into minimizing conflict and enhancing constructive engagement between fishers and wind energy developers. Recent innovations include earlier and more meaningful inclusion of fisheries representatives in planning and decisionmaking, involving fisheries liaisons in the process, and conducting more cumulative studies and taking collaborative approaches to considering the effects of OWP on fishing. [ABSTRACT FROM AUTHOR]

Graph Number of colposcopy... Graph Median out-of-pocket... Our findings suggest that, among commercially insured women aged 21-65 years, out-of-pocket costs for colposcopy were very common and significant and have increased over time. However, coverage without patient cost sharing is not mandated for colposcopy-an evidence-based, recommended procedure for women with an abnormal initial cervical cancer screening test result.[1] Cost barriers for care required to complete the cervical cancer screening process may lead to delays in or deferrals of clinically indicated care and may create financial hardship for individuals. We included colposcopy episodes associated with excisional procedures that are both diagnostic and therapeutic, because all colposcopies are aimed at cancer prevention and shortening time to diagnosis and treatment of cancer. [Extracted from the article]

Purpose: We undertook a study to assess the associations between barriers to insurance coverage for gender-affirming hormones (either lack of insurance or claim denial) and patterns of hormone use among transgender adults.Methods: We used data from the US Transgender Survey, a large national sample of 27,715 transgender adults, collected from August to September 2015. We calculated weighted proportions and performed multivariate logistic regression analyses.Results: Of 12,037 transgender adults using hormones, 992 (9.17%) were using nonprescription hormones. Among insured respondents, 2,528 (20.81%) reported that their claims were denied. Use of nonprescription hormones was more common among respondents who were uninsured (odds ratio = 2.64; 95% CI, 1.88-3.71; P <.001) or whose claims were denied (odds ratio = 2.53; 95% CI, 1.61-3.97; P <.001). Uninsured respondents were also less likely to be using hormones (odds ratio = 0.37; 95% CI, 0.24-0.56; P <.001).Conclusions: Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies. [ABSTRACT FROM AUTHOR]

Objectives: The United States health system is challenged to improve patient and population health, enhance patients' experience of care, and reduce health care costs. Value-based health care (VBHC) models are proposed to address these issues. Medical health systems are making strides toward VBHC, whereas dental care systems lag behind. The aims of this paper are to a) present study findings of an interprofessional practice model integrating oral health and primary care in a dental practice setting, and b) discuss practice and research implications for advancing VBHC approaches in oral health.Methods: A nonexperimental research method was employed to evaluate the Nurse Practitioner-Dentist Model for Primary Care (NPD Model) at the Harvard Dental Center. Pretest/post-test design was used to assess clinical patient outcomes for a convenience cohort of Medicare beneficiaries (n = 31) with a reported diagnosis of hypertension and/or type 2 diabetes. Clinical outcome measures included: blood pressure, weight, body mass index (BMI), and Hemoglobin A1c.Results: Positive and significant improvements in biometrics (blood pressure, body weight, BMI, HbA1c) were found.Conclusions: The NPD Model is an early prototype for interprofessional VBHC in oral health and holds promise for improving patient and population health outcomes. Integration of interprofessional VBHC in oral health is an imperative for achieving the Triple Aim to improve the overall health of our nation. [ABSTRACT FROM AUTHOR]

Background: National estimates of perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) among delivering women over time, as well as associated outcomes and costs, are lacking. The prevalence of perinatal mood and anxiety disorders and serious mental illness from 2006 to 2015 were estimated as well as associated risk of adverse obstetric outcomes, including severe maternal morbidity and mortality (SMMM), and delivery costs.Methods: The study was a serial, cross-sectional analysis of National Inpatient Sample data. The prevalence of PMAD and SMI was estimated among delivering women as well as obstetric outcomes, healthcare utilization, and delivery costs using adjusted weighted logistic with predictive margins and generalized linear regression models, respectively.Results: The study included an estimated 39,025,974 delivery hospitalizations from 2006 to 2015 in the U.S. PMAD increased from 18.4 (95% CI 16.4-20.0) to 40.4 (95% CI 39.3-41.6) per 1000 deliveries. SMI also increased among delivering women over time, from 4.2 (95% CI 3.9-4.6) to 8.1 (95% CI 7.9-8.4) per 1000 deliveries. Medicaid covered 72% (95% CI 71.2-72.9) of deliveries complicated by SMI compared to 44% (95% CI 43.1-45.0) and 43.5% (95% CI 42.5-44.5) among PMAD and all other deliveries, respectively. Women with PMAD and SMI experienced higher incidence of SMMM, and increased hospital transfers, lengths of stay, and delivery-related costs compared to other deliveries (P < .001 for all).Conclusion: Over the past decade, the prevalence of both PMAD and SMI among delivering women increased substantially across the United States, and affected women had more adverse obstetric outcomes and delivery-related costs compared to other deliveries. [ABSTRACT FROM AUTHOR]

Multicultural and social justice teacher education (MSJTE) scholars often have argued the importance of critical reflection in the cultivation of equity and social justice minded educators. In this critical content analysis study, we used existing conceptualizations of critical reflection to analyze reflection assignments from MSJTE courses in education degree and licensing programs in the United States to identify the nature of critical reflection incorporated into them and what distinguished critical reflection opportunities from other reflective assignments. Based on this analysis, we offer the beginnings of a typology of five approaches to reflection in multicultural and social justice education courses: (a) amorphous "cultural" reflection, (b) personal identity reflection, (c) cultural competence reflection, (d) equitable and just school reflection, and (e) social transformation reflection. We describe the characteristics of each and the role they might play in MSJTE contexts. [ABSTRACT FROM AUTHOR]

Obesity and obesity‐related illness are an increasingly prevalent problem globally, especially in Western society. One of the largest contributing factors to the obesity pandemic is the modern food environment and food culture. It is necessary to identify and develop strategies to increase the sensory appeal of healthy food and beverage options in order to provide healthy options to consumers without sacrificing the fundamental sensory enjoyment of eating. Since flavor is the largest driver of food intake and choice, it follows that flavor ought to be part of the solution. This paper reviews the potential of chili pepper or capsaicin (the pungent component of chili pepper) as a healthy eating strategy, by increasing energy expenditure, decreasing intake, decreasing eating rate, and enhancing flavor and satisfaction. Furthermore, we suggest a holistic chemesthetic approach to weight management, by using the sensory impact of trigeminal stimulation (spiciness or heat) in foods, rather than medicinally, in order to cross‐modally enhance tastes and odors, increase perceived complexity and overall flavor, increase sensory satisfaction, and decrease salt and caloric intake. Future research directions are discussed. Practical Application: It is necessary to provide strategies, such as trigeminal stimulation, global culinary practices, and flavor complexity, to consumers to maintain sensory satisfaction derived from healthier foods and beverages. Healthy does not have to equate to flavorless or unappealing, although it is commonly believed that unhealthy = tasty in the United States. Food can be both healthy and flavorful if we harness our collective sensory and culinary knowledge to generate a satisfying sensory experience. Incorporation of trigeminal stimulation, the third dimension of flavor in addition to taste and aroma, such as capsaicin or hot pepper, is an excellent example of drawing from global cuisines, increasing flavor complexity, and increasing overall flavor impression, in order to boost the sensory appeal, nutrition content, and nutrient absorption of healthy foods and to promote healthier eating. [ABSTRACT FROM AUTHOR]

Background: Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. The goal of this study was to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors.Methods: A cohort of ever-smokers aged ≥ 55 years was assembled from 19 years of electronic health record data from our academic community health-care system. Patient demographic characteristics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox proportional hazards model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided.Results: The study included 19,867 male subjects and 21,748 female subjects. Fifty-three percent of the patients were white, 38% were black, and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer compared with those in the least disadvantaged areas (hazard ratio, 1.29; 95% CI 1.07-1.55).Conclusions: Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further research investigating the mechanisms that link neighborhood conditions to lung cancer is warranted. [ABSTRACT FROM AUTHOR]

Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities. [ABSTRACT FROM AUTHOR]