Search

Conflicting findings have emerged from research on the relationship between thinking styles and supernatural beliefs. In two studies, we examined this relationship through meta‐cognitive trust and developed a new: (1) experimental manipulation, a short scientific article describing the benefits of thinking styles: (2) trust in thinking styles measure, the Ambiguous Decisions task; and (3) supernatural belief measure, the Belief in Psychic Ability scale. In Study 1 (N = 415) we found differences in metacognitive trust in thinking styles between the analytical and intuitive condition, and overall greater trust in analytical thinking. We also found stronger correlations between thinking style measures (in particular intuitive thinking) and psychic ability and paranormal beliefs than with religious beliefs, but a mixed‐effect linear regression showed little to no variation in how measures of thinking style related to types of supernatural beliefs. In Study 2, we replicated Study 1 with participants from the United States, Canada, and Brazil (N = 802), and found similar results, with the Brazilian participants showing a reduced emphasis on analytical thinking. We conclude that our new design, task, and scale may be particularly useful for dual‐processing research on supernatural belief. [ABSTRACT FROM AUTHOR]

Mycobacteria cause tuberculosis and other serious diseases. Understanding their mechanisms of resistance to our immune system and exploring novel drugs are critical strategies to combat infections. A bibliometric analysis was performed to identify publication trends and critical research areas in the field of the antimicrobial activity of desferrioxamine. A total of twenty-four publications on the topic, from 2012 to 2023, were retrieved from databases including Web of Science, Scopus, PubMed, and Embase, using specific keywords. The quality of the publications was assessed using impact and productivity metrics, with an average annual publication rate of 2.1 articles. The United States emerged as the most productive country, with medicine (23.4%, 11 publications) and biochemistry, genetics, and molecular biology (21.3%, 10 publications) as the top research fields. The five most cited publications accounted for 672 citations, with a relatively low h-index (11:11). In conclusion, there has been a lack of publications on this topic in the last decade. The United States dominates production and publication in this area, and there appears to be limited exchange of knowledge, ideas, and technology within the field. Therefore, fostering international cooperation through funding is essential to facilitate further research and development of desferrioxamine-related studies. [ABSTRACT FROM AUTHOR]

There is a dearth of research on cognitive aging and dementia in Asian Americans, particularly Vietnamese Americans, who are the fourth largest Asian subgroup in the United States. The National Institutes of Health is mandated to make certain that racially and ethnically diverse populations are included in clinical research. Despite the widespread recognition to ensure that research findings can be generalizable to all groups, there are no estimates of the prevalence or incidence of mild cognitive impairment and Alzheimer's disease and related dementias (ADRD) in Vietnamese Americans, nor do we understand ADRD risk and protective factors in this group. In this article, we posit that studying Vietnamese Americans contributes to a better understanding of ADRD in general and offers unique opportunities for elucidating life course and sociocultural factors that contribute to cognitive aging disparities. That is, the unique context of Vietnamese Americans may provide understanding in terms of within‐group heterogeneity and key factors in ADRD and cognitive aging. Here, we provide a brief history of Vietnamese American immigration and describe the large but often ignored heterogeneity of Asian Americans in the United States, elucidate how early life adversity and stress might influence late‐life cognitive aging, and provide a basis for the role of sociocultural and health factors in the study of Vietnamese cognitive aging disparities. Research with older Vietnamese Americans provides a unique and timely opportunity to more fully delineate the factors that contribute to ADRD disparities for all populations. [ABSTRACT FROM AUTHOR]

The Ogallala Aquifer, located in the Central Plains of the United States, is essential for agricultural irrigation and public water supply. Indiscriminate pumping from the aquifer has caused several negative impacts, such as deterioration of water quality and depletion of groundwater levels, which urgently demand better management. This paper applies hierarchical cluster analysis (HCA) and artificial neural networks (ANNs) for predicting annual groundwater levels in 403 wells of the Ogallala Aquifer. First, the methodology employed HCA to cluster homogeneous wells based on the time series of groundwater levels. Then, the study calibrated an ANN model for each cluster (composed of one or more wells) using previous annual values of groundwater levels as input. The HCA results showed a particular pattern in the spatial distribution of the 30 found clusters, revealing that the Ogallala Aquifer holds higher groundwater levels in the western part, which gradually decrease, advancing to the east. The ANN models provided proper predictions even for wells outside of the calibration data set. This investigation concludes that the integration of HCA and ANN enabled single models to accurately forecast annual groundwater levels for sets of wells in the Ogallala Aquifer. [ABSTRACT FROM AUTHOR]

Background Little is known about the ability of the recently released Brazilian gestational weight gain (GWG) charts to predict the occurrence of adverse birth outcomes. Objectives We compared the new Brazilian weight gain charts with 3 international charts and determined their ability to predict the occurrence of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births in Brazilian women. Methods A subsample of 6888 adult women (43,931 weight measurements) with singleton pregnancies from a nationwide, hospital-based cohort study conducted in 2011–2012 was analyzed. Selected percentiles from Brazilian GWG charts were compared with those from American, International Fetal and Newborn Growth Consortium for the 21st Century study, and Lifecycle consortium charts. Sensitivity, specificity, and AUROC values for SGA and LGA births were estimated with 95% CIs using the classification of GWG below or above selected percentiles of each chart. Results The weight gain corresponding to a given percentile varied among the charts, especially for women with pre-pregnancy overweight and obesity. The proportions of women with GWG classified below or above selected percentiles were closest to the expected values for all pre-pregnancy BMI categories in the Brazilian and Lifecycle charts. At the 10th percentile, the highest sensitivity for SGA births was observed for the American charts at midpregnancy (36.8%) and the highest specificity was observed using the Brazilian charts in the first trimester (93.4%). At the 90th percentile, the highest sensitivity for LGA births occurred in midpregnancy for the Lifecycle charts (26.8%) and the highest specificity occurred in the American charts using total GWG (97.1%). All the AUROCs were under 0.5 for SGA births and ranged from 0.55 (first trimester) to 0.62 (total GWG) for LGA births. Conclusions The charts differ in GWG trajectories, especially for women with overweight and obesity. The 4 charts had low predictive ability of SGA and LGA births and should not be considered as isolated screening tools for those outcomes. [ABSTRACT FROM AUTHOR]

In natural ecosystems, arthropod predation on herbivore prey is higher at lower latitudes, mirroring the latitudinal diversity gradient observed across many taxa. This pattern has not been systematically examined in human‐dominated ecosystems, where frequent disturbances can shift the identity and abundance of local predators, altering predation rates from those observed in natural ecosystems. We investigated how latitude, biogeographical, and local ecological factors influenced arthropod predation in Brassica oleracea‐dominated agroecosystems in 55 plots spread among 5 sites in the United States and 4 sites in Brazil, spanning at least 15° latitude in each country. In both the United States and Brazil, arthropod predator attacks on sentinel model caterpillar prey were highest at the highest latitude studied and declined at lower latitudes. The rate of increased arthropod attacks per degree latitude was higher in the United States and the overall gradient was shifted poleward as compared to Brazil. PiecewiseSEM analysis revealed that aridity mediates the effect of latitude on arthropod predation and largely explains the differences in the intensity of the latitudinal gradient between study countries. Neither predator richness, predator density, nor predator resource availability predicted variation in predator attack rates. Only greater non‐crop plant density drove greater predation rates, though this effect was weaker than the effect of aridity. We conclude that climatic factors rather than ecological community structure shape latitudinal arthropod predation patterns and that high levels of aridity in agroecosystems may dampen the ability of arthropod predators to provide herbivore control services as compared to natural ecosystems. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of pediatric intensive care neurologists and their practice in the United States and Canada. Methods: We performed a survey-based study of child neurologists who self-identify as 'intensive care neurologists'. The survey included questions about demographics, training, pediatric neurocritical care service and job structure, teaching, academics, challenges, and views on the future of pediatric neurocritical care. Results: We analyzed 55 surveys. Most respondents were 31-50 years of age with ≤10 years of practice experience. Fifty-four percent identified as female. Most completed subspecialty training after child neurology residency. The majority practice at highly resourced centers with >45 intensive care unit beds. Respondents cover a variety of inpatient (critical and noncritical care) services, at times simultaneously, for a median of 19.5 weeks/y and work >70 hours/wk when on service for pediatric neurocritical care. The top 3 challenges reported were competing demands for time, excess volume, and communication with critical care medicine. Top priorities for the "ideal pediatric neurocritical care service" were attendings with training in pediatric neurocritical care or a related field and joint rounding with critical care medicine. Conclusion: We report a survey-based analysis of the demographics and scope of practice of pediatric critical care neurologists. We highlight challenges faced and provide a framework for the further development of this rapidly growing field. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is characterized by painful lesions that are amenable to palliative radiotherapy (PRT) but racial disparities may exist. In the current study, the National Cancer Database was queried for patients diagnosed with MM from 2004 to 2016 who received PRT. The percentages of patients receiving PRT within 12 months of diagnosis by race/ethnicity were: 15.5% non-Hispanic white (NHW), 14.3% African American (AA), 15.8% Hispanic, and 14.4% other. On multivariable logistic regression, the odds of receiving RT were 13% less for AAs compared to NHWs (OR = 0.87, 95% CI = 0.83–0.90, p <.0001) and the odds of dying within 30 days of PRT were 18% less for AAs compared to NHWs (OR = 0.82, 95% CI = 0.67–1.00, p =.046). This study highlights a health disparity affecting AA patients who despite having a higher incidence and mortality from MM are also less likely to receive PRT within 1 year of diagnosis and near the end of life. [ABSTRACT FROM AUTHOR]

This article discusses how the race issue was approached in American Modern Spiritualism. Its starting point is Allan Kardec's hypothesis, published in the Revue Spirite, that American spiritualists rejected belief in reincarnation due to the strong race prejudice that existed in the United States. The analysis takes place on two levels: first, we examine the current status of the subject in the recent historiography of Spiritualism; then, we describe the way Kardec dealt with this doctrinal divergence between spiritists and spiritualists, taking as a case study the French-speaking spiritualists of New Orleans. [ABSTRACT FROM AUTHOR]

Summary: Childhood obesity is a major problem in Latin America and among US Latinos. Effective public health policies require contextually relevant evidence to guide them, which demands sustained research capacity. The objectives of this study are to determine research productivity in Latin America and in the United States focused on Latino populations and examine domains of research capacity (research infrastructure, training programs, mentoring, funding, and networks). We conducted a scoping review of indexed childhood obesity‐related articles published June 2015–December 2019. We collected data on perceptions of capacity for childhood obesity research among Latin American investigators through an online survey. We identified 612 childhood obesity‐related articles (505 from Latin America, 124 from the United States, and 17 US–Latin America collaborations). Brazil, Mexico, Chile, Colombia, and the United States are the top publishing countries. There are similar numbers of obesity, nutrition, and physical activity articles, but physical activity research capacity lagged in other domains (research training, funding, and networking opportunities). Complementary research areas, including sedentary behavior, systems science, and policy studies, are uncommon in Latin America but more prevalent in the United States, whereas sleep research is nascent across settings. Realizing the promise of an effective cross‐border collaborative childhood obesity prevention agenda will require committed investment in all domains of research capacity and across all relevant topics. [ABSTRACT FROM AUTHOR]

Summary: To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA‐promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA‐promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA‐promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context‐specific priorities and exchanging lessons learned. [ABSTRACT FROM AUTHOR]

Introduction. Intensive care has played a pivotal role during the COVID-19 pandemic as many patients developed severe pulmonary complications. The availability of information in pediatric intensive care units (PICUs) remains limited. The purpose of this study is to characterize COVID-19 positive admissions (CPAs) in the United States and to determine factors that may impact those admissions. Materials and Methods. This is a retrospective cohort study using data from the COVID-19 Virtual Pediatric System (VPS) dashboard containing information regarding respiratory support and comorbidities for all CPAs between March and April 2020. The state-level data contained 13 different factors from population density, comorbid conditions, and social distancing score. The absolute CPA count was converted to frequency using the state's population. Univariate and multivariate regression analyses were performed to assess the association between CPA frequency and admission endpoints. Results. A total of 205 CPAs were reported by 167 PICUs across 48 states. The estimated CPA frequency was 2.8 per million children in a one-month period. A total of 3,235 tests were conducted of which 6.3% were positive. Children above 11 years of age comprised 69.7% of the total cohort and 35.1% had moderated or severe comorbidities. The median duration of a CPA was 4.9 days (1.25–12.00 days). Out of the 1,132 total CPA days, 592 (52.2%) involved mechanical ventilation. The inpatient mortalities were 3 (1.4%). Multivariate analyses demonstrated an association between CPAs with greater population density (beta coefficient 0.01, p < 0.01). Multivariate analyses also demonstrated an association between pediatric type 1 diabetes mellitus with increased CPA duration requiring advanced respiratory support (beta coefficient 5.1, p < 0.01) and intubation (beta coefficient 4.6, p < 0.01). Conclusions. Inpatient mortality during PICU CPAs is relatively low at 1.4%. CPA frequency seems to be impacted by population density. Type 1 DM appears to be associated with increased duration of HFNC and intubation. These factors should be included in future studies using patient-level data. [ABSTRACT FROM AUTHOR]

Headlines abound with news of migrant family separation at the United States- Mexico border. Many of those articles attribute the practice of family separation to recent policy shifts under the current administration. Though this administration's policies are especially cruel and punitive, they are not novel. The separation of Black families, noncitizens at the time, was a practice endemic to U.S. slavery. The historic practice of statesponsored family separation persists today--at least in part--via criminal and immigration incarceration. Family separation disproportionately impacts families of color. When confronted with family unity cases, United States courts have patched together a constitutional right to family unity. However, over time, courts have denied and/or eroded due process protections that should accompany the right. By removing due process protections, courts have removed the force of the right to family unity. And, courts have done so in a way that implicates Equal Protection violations as low-income families and families of color are disproportionately kept from enjoying a right to family unity. Guaranteeing adequate and equal due process in all parental termination proceedings is central to realizing an equitable right to family unity. This Article utilizes a reproductive justice frame to investigate the ways in which the family separation we are seeing today is rooted in slavery and exacerbated in carceral settings. In response, this Article calls for federal protection. First, the Article revisits the infamous Dred Scott case from a family reunification perspective and highlights how the Court's holding serves a reproductive injustice. Next, the Article evaluates the case of Abby Lassiter, in which the Supreme Court denied a right to counsel in parental termination proceedings. Together, Dred Scott and Lassiter highlight the ways in which white supremacy and the erosion of due process combine to create a legal system ripe for the immigration abuses we are currently witnessing. This Article goes on to examine some of those immigration abuses with an emphasis on family separation at the point of birth while incarcerated. In light of the heritage of family separation in the United States and the Supreme Court's failure to protect a right to family unity for families of color, this Article concludes by calling for a de jure constitutionalized right to family unity for all people subject to United States jurisdiction. [ABSTRACT FROM AUTHOR]

Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient–physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies. [ABSTRACT FROM AUTHOR]

We estimate the labor force participation and the full‐time and part‐time work decisions of female registered nurses (RNs) and find higher wages are not a significant factor to (a) increase the likelihood of working nor (b) to encourage full‐time work. Another key factor is age which, given the aging of the RN population, foreshadows dwindling labor supply. This, while demand for RNs is predicted to continue to rise, will exacerbate labor shortages in the market for RNs. The results also offer insight to explain the reduction in labor supply wage elasticities for female workers in general in the United States. [ABSTRACT FROM AUTHOR]

Background: Black women are more likely to be diagnosed with later stage breast cancer compared to white women due to biological or access to care factors. Therefore, our objective was to identify whether racial/ethnic differences in patient experiences with healthcare are associated with stage at diagnosis.Methods: We used the SEER registry data linked with patient surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) completed prior to the diagnosis date. We examined responses about various aspects of their care such as the ability to get needed care, and to get care quickly. We used multivariable linear regression to examine racial/ethnic differences in patient experiences, and a multivariable ordinal logistic regression to determine the association between patient experiences and earlier stage at diagnosis.Results: Of the 10,144 patients, 80.7% were non-Hispanic white, 7.6% black, 7.1% Hispanic, and 4.6% Asian. After controlling for potential confounders, black patients had significantly lower mean scores for getting care quickly (β =  - 2.78), getting needed care (β =  - 2.26), getting needed prescription drugs (β =  - 3.83), and lower ratings of their health care (β =  - 2.33) compared to white patients. More importantly, we found that black patients who reported a 1-unit increase in rating of their experiences with customer service (OR 1.04, 95% CI 1.01-1.06) and the ability to get care quickly (OR 1.03, 1.01-1.05) had higher odds of earlier stage breast cancer.Conclusion: Racial/ethnic minorities reported poorer patient experiences with care preceding a diagnosis of breast cancer. Better ratings among black patients were associated with earlier stage at diagnosis. [ABSTRACT FROM AUTHOR]

This study evaluated the rose bengal‐ and erythrosine‐mediated photoinactivation against Salmonella Typhimurium and Staphylococcus aureus planktonic and sessile cells using green LED as a light source. The free‐living or 2‐day‐old biofilm cells were treated with different concentrations of the photosensitizing agents and subjected to irradiation. Only 5 min photosensitization with rose bengal at 25 nmol L−1 and 75 μmol L−1 completely eliminated S. aureus and S. Typhimurium planktonic cells, respectively. Erythrosine at 500 nmol L−1 and 5 min of light exposure also reduced S. aureus planktonic cells to undetectable levels. Eradication of S. aureus biofilms was achieved when 500 μmol L−1 of erythrosine or 250 μmol L−1 of rose bengal was combined with 30 min of irradiation. Scanning electron microscopy allowed the observation of morphological changes in planktonic cells and disruption of the biofilm architecture after photodynamic treatment. The overall data demonstrate that rose bengal and erythrosine activated by green LED may be a targeted strategy for controlling foodborne pathogens in both planktonic and sessile states. [ABSTRACT FROM AUTHOR]

Background: There are racial/ethnic disparities in breast cancer mortality may be attributed to differences in receipt of adjuvant cancer treatment. Our purpose was to determine whether the mortality disparities could be explained by racial/ethnic differences in long-term adherence to adjuvant endocrine therapy (AET).Methods: We conducted a retrospective cohort study with the Texas Cancer Registry and Medicaid claims-linked dataset of women (20-64 years) diagnosed with local and regional breast cancer who filled a prescription for AET from 2000-2008. Adherence to AET was measured at three time points (1-, 3-, and 5-year adherence) using a value for the percentage of medication filled for each period divided by the total number of possible prescriptions prescribed (Medication Possession Ratio, MPR). We created a binary variable of adherence (MPR≥80%). We performed multivariable logistic regressions to assess racial differences for the odds of AET adherence and Cox proportional hazard models to determine the risk of mortality adjusting for potential confounding variables of SES, comorbidities, tumor prognostic factors, and other cancer treatment.Results: Of the 1,497 women with breast cancer who initiated AET, 56.9%, 42.3%, and 33.3% were adherent for 1, 3, and 5-years, respectively. Hispanics compared to non-Hispanic whites did differ in the proportion that were adherent to 5-years of AET. In the adjusted analysis for long-term adherence to AET, Hispanics did not have a significantly increased risk of death compared to non-Hispanic white patients (HR: 1.13, 95% CI: 0.58-2.21). However, black compared to non-Hispanic white patients had significantly lower odds of three-year adherence (OR: 0.45, 95% CI: 0.28-0.73). After controlling for 5-year adherence to AET, the risk of death for black compared to non-Hispanic white patients was 12% lower (HR: 1.90; 95% CI: 1.03-3.51) and in the fully adjusted model, the disparity was reduced and no longer significant (OR: 1.86, 95% CI: 0.94-3.66).Conclusions: Long-term adherence in the Medicaid population is suboptimal and racial/ethnic differences in AET adherence may partially explain disparities in mortality. This study underscores the critical need to ensure long-term adherence to AET for all racial/ethnic groups to decrease disparities in mortality. [ABSTRACT FROM AUTHOR]

Copyright of Voluntas: International Journal of Voluntary & Nonprofit Organizations is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Municipal and state governments are surging ahead in obesity prevention, providing a testing ground for innovative policies and shifting social norms in the process. Though high-profile measures such as New York City’s soda portion rule attract significant media attention, we catalog the broader array of initiatives in less-known localities. Local innovation advances prevention policy, but faces legal and political constraints--constitutional challenges, preemption, charges of paternalism, lack of evidence, and widening health inequalities. These arguments can be met with astute framing, empirical evidence, and policy design, enabling local governments to remain at the forefront in transforming obesogenic environments. [ABSTRACT FROM AUTHOR]

We propose a scalable, data-driven method for designing national policies for the allocation of deceased donor kidneys to patients on a waiting list in a fair and efficient way. We focus on policies that have the same form as the one currently used in the United States. In particular, we consider policies that are based on a point system that ranks patients according to some priority criteria, e.g., waiting time, medical urgency, etc., or a combination thereof. Rather than making specific assumptions about fairness principles or priority criteria, our method offers the designer the flexibility to select his desired criteria and fairness constraints from a broad class of allowable constraints. The method then designs a point system that is based on the selected priority criteria and approximately maximizes medical efficiency--i.e., life-year gains from transplant--while simultaneously enforcing selected fairness constraints. Among the several case studies we present employing our method, one case study designs a point system that has the same form, uses the same criteria, and satisfies the same fairness constraints as the point system that was recently proposed by U.S. policy makers. In addition, the point system we design delivers an 8% increase in extra life-year gains. We evaluate the performance of all policies under consideration using the same statistical and simulation tools and data as the U.S. policy makers use. Other case studies perform a sensitivity analysis (for instance, demonstrating that the increase in extra life-year gains by relaxing certain fairness constraints can be as high as 30%) and also pursue the design of policies targeted specifically at remedying criticisms leveled at the recent point system proposed by U.S. policy makers. [ABSTRACT FROM AUTHOR]

The zidovudine (AZT) has been extensively used in the treatment of HIV patients due to its antiretroviral activity. The quality control of this substance in drugs is of outstanding importance to public health because of its undesirable effects and short therapeutic interval. For the determination of AZT in pharmaceuticals, an alternative analytical methodology using voltammetry was developed. The reduction of AZT at a hanging mercury drop electrode (HMDE) is at -0.96 V at pH 8.0. The influence of electroanalytical parameters, such as scan rate (20 mV/s), amplitude (50 mV), nature of the support electrolyte (phosphate buffer), and pH (8.0) on the voltammetric signal, was optimized. Under these optimized conditions, the AZT peak current varied linearly with its concentration from 0.25 to 1.25 mg/L (1 to 5 μM). Detection and determination limits of 0.0025 and 0.025 mg/L, respectively, and recovery of 99.88% with a relative standard deviation of 0.95% were obtained. The results obtained using this methodology in analyzing drugs containing AZT were compared favorably with those obtained by technique liquid chromatography as recommended by The United States Pharmacopoeia. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ovarian cancer is the leading cause of death from gynecologic malignancy in the United States. More than 80% of patients present with advanced disease, with 5 year survival rates between 15% and 45%. In contrast, the survival rate for stage I disease, with malignancy confined to the ovary, is approximately 95%. Given the discrepancy in survival outcomes between early- and late-stage disease, strategies that would allow for the detection of ovarian cancer in its early stages would hold promise to significantly improve the mortality rate from ovarian cancer. Unfortunately, current screening methods for the detection of early stage ovarian cancer are inadequate. However, several recent proteomics-based biomarker discovery projects show promise for the development of highly sensitive and specific markers for gynecological malignancies, including ovarian cancer. In this review, we hope to provide an overview of the early detection ovarian cancer from traditional methods to recent promises in the proteomics pipeline. [Copyright &y& Elsevier]

The decision of the United States government to intervene in Cuba, in April 1961, was the result of a combination of historical and political factors. Among them, the history of US interference in the Caribbean context, both directly (between the beginning of the 20th century up to the first years of the 1930's), and, later on, indirectly; the successful interventions promoted by the CIA in Iran (1953) and Guatemala (1954); as well as the political "need", domestically, of recently elected president Kennedy to demonstrate how committed he was with containing communism. Thus, no single factor can solely explain the decision to go ahead with the plan, which turned out to be a huge political failure for the US government. [ABSTRACT FROM AUTHOR]

Aims. To determine whether tooth size and morphology are affected in HFM.Design. The mesiodistal diameter of each tooth of 40 patients with varying severity of HFM was measured with a vernier gauge calibrated to 0·1 mm. Data obtained from teeth on the affected side were compared with data from corresponding teeth on the contralateral side. Setting. Center for Craniofacial Anomalies, School of Dentistry, University of California, San Francisco, USA. Results. Subjects with HFM have smaller teeth on the affected side than on the contralateral side. The more severely affected subjects have the highest degree of tooth size asymmetry. Tooth morphology is also affected in individuals with HFM. [ABSTRACT FROM AUTHOR]

Purpose: To compare the degree of acceptance of behavior guidance techniques (BGT) in pediatric dentistry between American and Colombian parents. Methods: American parents (n=150) and Colombian parents (n=150) of children between three and 12 years of age undergoing pediatric dental treatment participated in this multicenter cross-sectional study. Parents viewed a video depicting 10 BGTs approved by the American Academy of Pediatric Dentistry and rated their acceptance on a visual analog scale. Differences in the degree of acceptance were analyzed using quantile regression analysis. The level of significance was set at five percent. Results: American parents generally demonstrated higher median acceptance scores across various BGTs compared to Colombian parents (P<0.05). American parents exhibited higher acceptance levels of tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, presence/absence of parents and nitrous oxide, with statistically significant differences noted. American parents also displayed higher acceptance scores for advanced techniques such as protective stabilization, conscious sedation and general anesthesia. Conclusion: American parents consistently exhibited higher acceptance BGTs, suggesting variations in cultural attitudes toward pediatric dental care between the two groups. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Multiple myeloma (MM) is a hematologic malignancy that disproportionately affects African Americans (AA) and has a natural history that is often characterized by painful osseous lesions that are amenable to palliative radiotherapy (RT). There are known racial disparities in the definitive treatment of MM and pain management in general in the AA community compared to other racial groups. We sought to determine if racial disparities also exist in use of palliative RT for MM in the United States.Materials/methods: The National Cancer Database was queried for patients 18 years and older who were diagnosed with MM from 2004-2016 and received radiation. RT dose was limited to between (and including) 4Gy to 30Gy to exclude non-standard doses, incomplete courses, and patients treated for plasmacytoma. The main independent variable under investigation was race/ethnicity, defined as non-Hispanic white (NHW), non-Hispanic black (AA), Hispanic, and other race. Outcomes of interest included receipt of palliative RT within 12 months of MM diagnosis and death within 30 days of initiation of palliative RT. Additional covariates included socioeconomic factors, underlying health, and treatment factors. Multivariable logistic regression analyses were performed to measure the associations of patient race/ethnicity with the odds receiving radiation within 12 months of diagnosis and odds of death within 30 days of receiving the first course of RT.Results: Of 23,728 NCDB multiple myeloma patients receiving palliative RT within 12 months of diagnosis, 15.5% of NHW patients, 14.3% of AA patients, 15.8% of Hispanic patients, and 14.4% of other racial/ethnic group patients received palliative RT. The odds of receiving RT were 13% less for AAs compared to NHWs (OR = 0.87, CI = 0.83-0.90, P < 0.0001). Of those receiving radiation, the odds of dying within 30 days of RT were 18% less for AAs compared to NHWs (OR = 0.82, 95% CI = 0.67-1.00, P = 0.046).Conclusion: This study of the NCDB demonstrates that in addition to previously documented disparities in definitive management of MM, AA patients are also less likely to receive palliative RT within 12 months of diagnosis and at the end of life. [ABSTRACT FROM AUTHOR]

From the earliest days of the COVID-19 pandemic, public health officials and news organizations reported pervasive racial disparities in the infection, morbidity, and mortality of the virus. In both the U.S. and Brazil, Black, Native, and mixed-race individuals were more negatively impacted by COVID-19 than White people. Simultaneously, significant social factions downplayed the threat and insisted on living "normally". We examined how these two factors coexisted. We sought to establish whether Whites' anti-Black attitudes predicted their concern about the pandemic and tendency to behave in ways that exacerbated the pandemic. and Results: In five studies, conducted in two countries (total N = 3425), we found that anti-Black attitudes (above and beyond political orientation, White racial identification, and perceptions of racial disparities) were associated with less concern about COVID-19, lower adoption of health and social distancing behaviors, and greater interest in returning to normalcy. We discuss how efforts to combat anti-Blackness may improve the health of the general population. • We examine COVID-19 attitudes in the U.S. and Brazil. • Anti-Black racism predicted Whites' decreased concern about COVID-19. • Racism predicted Whites' decreased intentions to engage in health behaviors. [ABSTRACT FROM AUTHOR]

Background: Multidomain lifestyle interventions may have the potential to slow biological aging as captured by deficit accumulation frailty indices. We describe the distribution and composition of the 49-component frailty index developed by the U.S. POINTER clinical trial team of investigators and assess its cross-sectional associations with sociodemographic factors and markers chosen to be representative of behaviors targeted by the trial's multidomain interventions., Methods: We draw baseline data from the 2 111 volunteers enrolled in U.S. POINTER who were ages 60-79 years and at increased risk for cognitive decline. Frailty components were grouped into 9 domains. Associations that frailty index scores and their domains had with behavioral markers were described with correlations and canonical correlation., Results: The 25th, 50th, and 75th percentiles of the frailty index score distribution were 0.153, 0.189, and 0.235. Higher frailty scores tended to occur among individuals who were older, male, and living in areas of greater deprivation (all p < .001). They were also associated with poorer self-reported diet, less physical activity, and higher Framingham risk scores (all p < .001). Associations were diffusely distributed among the frailty component domains, indicating that no individual domain was dominating associations., Conclusions: The U.S. POINTER deficit accumulation frailty index had expected relationships with sociodemographic factors and sensitivity to the behaviors targeted by the trial's interventions. Our analysis supports its use as a secondary outcome to assess whether the multidomain interventions differentially impact an established marker of biological aging. ClinicalTrials.gov Identifier: NCT03688126., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America.)

Background: Cancer survivors are at increased risk for cardiometabolic comorbidities following cancer treatment, which may be further exacerbated by cannabis and alcohol use. We aimed to examine the direct relationships of cannabis, alcohol, and the co-use of both substances with cardiometabolic risk factors and to explore disparities by race/ethnicity and sex., Methods: Cross-sectional data were extracted from adult cancer survivors in the "All of Us" from 2018 to 2022. Cannabis use was defined as occasional or frequent/regular cannabis use (vs. never) in the past 3 months and hazardous alcohol intake (AUDIT-C >3 for females; AUDIT-C >4 for males) versus nonhazardous in the past year, respectively. Co-use was defined as participants who engaged in regular cannabis and hazardous alcohol intake. We identified binary cardiovascular, immune, and metabolic system biomarkers, with high values defined by clinically established cutoffs or >75th percentile. We used multivariable logistic regression adjusting for sociodemographic and clinical factors., Results: In our sample (N = 7,054), 7.6% were Hispanic, 6.2% were Black, and 86.2% were White cancer survivors. Less than 5% of Hispanic and White survivors reported substance co-use compared with 7% of Black survivors. Compared with never-users, co-users were 1.58 (95% confidence interval, 1.14-2.19) more likely to have high blood pressure. No significant associations were found between co-use and immune biomarkers or sex differences., Conclusions: Co-use of cannabis and hazardous alcohol may worsen high blood pressure in survivors, who are at higher risk for cardiometabolic comorbidities., Impact: The study investigates substance use and cardiometabolic biomarkers, urging much research on their effects on cancer survivors., (©2024 American Association for Cancer Research.)

Purpose: Cancer survivors are considered by public health officials as a high-risk group in the United States for severe complications from COVID-19. We aimed to characterize patterns of early uptake of the COVID-19 vaccine among cancer survivors and to determine modifiable barriers to vaccine completion that can be addressed to ensure future booster adherence., Methods: Cross-sectional data of vaccine uptake by summer 2021 was extracted from adult cancer survivors enrolled in the "All of Us" research program. Vaccine completion was determined based on receiving at least two doses. We assessed sociodemographic factors, socioeconomic barriers (education, income, health insurance status, housing, and employment status), and COVID-19 vaccine uptake by Summer 2021, employing multivariable ordinal logistic regression for those who were unvaccinated, had initiated vaccine uptake, and had completed COVID-19 vaccination., Results: Of the 514 cancer survivors in the sample, 73.7% were fully vaccinated by summer 2021. Those who received no vaccine doses showed higher proportions of SES barriers, medical distrust, and perceived lack of need barriers. Race (non-Hispanic White vs. other) was not statistically significantly associated with vaccine uptake (OR (95% CI) = 0.94 (0.51, 1.70)), while for every additional SES barrier, there was a 40% decrease (OR (95% CI) = 0.60 (0.48, 0.75)) in the odds of receiving more COVID-19 vaccine doses. Higher medical distrust and perceived lack of need were associated with 56% (OR = 0.44, 95% CI: 0.32-0.59) and 39% (OR = 0.61, 95% CI: 0.43-0.87) lower odds, respectively., Conclusion: Racial/ethnic disparities in vaccine uptake may be explained by SES barriers. Addressing SES disparities and fostering medical trust may enhance future COVID-19 vaccination uptake rates for this high-risk group., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Direct-acting antivirals ledipasvir (LDV) and daclatasvir (DCV) are widely used as part of combination therapies to treat Hepatitis C infections. Here we show that these compounds inhibit the proliferation, invasion, and colony formation of triple-negative MDA-MB-231 breast cancer cells, SRC-transduced SW620 colon cancer cells and SRC- transduced NIH3T3 fibroblasts. DCV also inhibits the expression of PDL-1, which is responsible for resistance to immunotherapy in breast cancer cells. The demonstrated low toxicity in many Hepatitis C patients suggests LDV and DCV could be used in combination therapies for cancer patients. At the molecular level, these direct-acting antivirals inhibit the phosphorylation of Akt and the ephrin type A receptor 2 (EPHA2) by destabilizing a Src-EPHA2 complex, although they do not affect the general kinase activity of Src. Thus, LDV and DCV could be effective drugs for Src-associated cancers without the inherent toxicity of classical Src inhibitors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Good fortune can be attributed to many sources, including other people, personal efforts, and various theistic and nontheistic supernatural forces (e.g., God, karma). Four studies (total N = 4,579) of religiously diverse samples from the United States and the United Kingdom investigated the distinct emotional reactions to recalled positive experiences attributed to natural and supernatural benefactors. We found that the hallmarks of interpersonal gratitude (e.g., thankfulness, admiration, indebtedness) were reported when believers attributed their good fortune to a personal, benevolent God. However, a distinct emotional profile arose when participants attributed good fortune to the process of karmic payback, which was associated with relatively less gratitude but with higher scores for feelings of pride and deservingness. These results were partially explained by participants' attributions of positive experiences to an external agent (e.g., God) versus a universal law or internal factors as in the case of karma. We conclude that diverse spiritual beliefs influence causal attributions for good fortune, which, in turn, predict distinct emotional responses. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: The objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality., Methods: We conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute's SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group., Results: Of the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding "getting all needed prescriptions" and the lowest score for "getting care quickly." In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = - 4.34, B = - 4.32, B = - 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = - 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003)., Conclusion: Our research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients' perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes., (© 2023. The Author(s).)

Preeclampsia is a multifactorial pathology with negative outcomes in affected patients in both the peripartum and postpartum period. Black patients in the United States, when compared to their White and Hispanic counterparts, have higher rates of preeclampsia. This article aims to review the current literature to investigate how race, social determinants of health, and genetic profiles influence the prevalence and outcomes of patients with preeclampsia. Published studies utilized in this review were identified through PubMed using authors' topic knowledge and a focused search through a Medline search strategy. These articles were thoroughly reviewed to explore the contributing biosocial factors, genes/biomarkers, as well as negative outcomes associated with disparate rates of preeclampsia. Increased rates of contributing comorbidities, including hypertension and obesity, which are largely associated with low access to care in Black patient populations lead to disparate rates of preeclampsia in this population. Limited research shows an association between increased rate of preeclampsia in Black patients and specific APOL1, HLA-G, and PP13 gene polymorphisms as well as factor V Leiden mutations. Further research is required to understand the use of certain biomarkers in predicting preeclampsia within racial populations. Understanding contributing biosocial factors and identifying genes that may predispose high-risk populations may help to address the disparate rates of preeclampsia in Black patients as described in this review. Further research is required to understand if serum, placental, or urine biomarkers may be used to predict individuals at risk of developing preeclampsia in pregnancy. KEY POINTS: · Prevalence of preeclampsia in the U.S. is higher in Black patients compared to other racial groups.. · Patients with preeclampsia are at risk for poorer health outcomes both during and after delivery.. · Limited research suggests specific biomarkers or gene polymorphisms contribute to this difference; however, explanations for this disparity are multifactorial and further investigation is necessary.., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: Patient-reported outcomes are recognized as strong predictors of cancer prognosis. This study examines racial and ethnic differences in self-reported general health status (GHS) and mental health status (MHS) among patients with colorectal cancer (CRC)., Methods: A retrospective analysis of Medicare beneficiaries between 1998 and 2011 with non-distant CRC who underwent curative resection and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey within 6-36 months of CRC diagnosis. Analysis included a stepwise logistic regression to examine the relationship between race and ethnicity and fair or poor health status, and a proportional hazards model to determine the mortality risk associated with fair or poor health status., Results: Of 1867 patients, Non-Hispanic Black (OR 1.56, 95% CI 1.06-2.28) and Hispanic (OR 1.48, 95% CI 1.04-2.11) patients had higher unadjusted odds for fair or poor GHS compared to Non-Hispanic White patients, also Hispanic patients had higher unadjusted odds for fair or poor MHS (OR 1.92, 95% CI 1.23-3.01). These relationships persisted after adjusting for clinical factors but were attenuated after subsequently adjusting for sociodemographic factors. Compared to those reporting good to excellent health status, patients reporting fair or poor GHS or MHS had an increased mortality risk (OR 1.52, 95% CI 1.31-1.76 and OR 1.63, 95% CI 1.34-1.99, respectively)., Conclusion: Racial and ethnic differences in GHS and MHS reported after CRC diagnosis are mainly driven by sociodemographic factors and reflect a higher risk of mortality. Identifying unmet biopsychosocial needs is necessary to promote equitable care., (© 2023. The Author(s).)

Abstract: Language-concordant care improves patient satisfaction. Given the increase in Spanish-speaking persons requiring orthopaedic care in the United States, it is essential to increase the Spanish-speaking workforce in orthopaedic surgery. We have proposed strategies to improve the proportion of Spanish-speaking orthopaedic surgeons in the U.S. through early exposure to orthopaedic surgery, by creating collaborative advancement and mentorship opportunities, by endorsing Spanish-language immersion opportunities, and by increasing workforce diversity awareness. Furthermore, we have suggested a strategy to better equip non-Spanish-speaking orthopaedic surgeons while caring for Spanish-speaking patients. Together, the suggested strategies offer a variety of approaches that can have a direct, tangible impact on optimizing orthopaedic care while enhancing patient-physician communication in the Spanish language., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H685 )., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: We determined whether racial/ethnic differences in patient experiences with care influence timeliness and type of initial surgical breast cancer treatment for a sample of female Medicare cancer patients., Methods: We conducted a retrospective cohort study using the linked Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset. The outcomes were: (1) time-to-initial surgical treatment, and (2) type of treatment [breast conserving surgery (BCS) vs. mastectomy]. The indicators were reports of four types of patient experiences with care including doctor communication, getting care quickly, getting needed care, and getting needed Rx. Interaction terms in each multivariable logistic model examined if the associations varied by race/ethnicity., Results: Of the 2069 patients, 84.6% were White, 7.6% Black and 7.8% Hispanic. After adjusting for potential confounders, non-Hispanic Black patients who provided excellent reports of their ability to get needed prescriptions had lower odds of receiving surgery within 2-months of diagnosis, compared to NH-Whites who provided less than excellent reports (aOR: 0.29, 95% CI 0.09-0.98). There were no differences based on 1-month or 3-month thresholds. We found no other statistically significant effect of race/ethnicity. As to type of surgery, among NH Blacks, excellent reports of getting care quickly were associated with higher odds of receiving BCS versus mastectomy (aOR: 2.82, 95% CI 1.16-6.85) compared to NH Whites with less than excellent reports. We found no other statistically significant differences by race/ethnicity., Conclusion: Experiences with care are measurable and modifiable factors that can be used to assess and improve aspects of patient-centered care. Improvements in patient care experiences of older adults with cancer, particularly among minorities, may help to eliminate racial/ethnic disparities in timeliness and type of surgical treatment., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In the U.S., more than one million older adults with low incomes live in apartment buildings subsidized by the Low-Income Housing Tax Credit. Although this population experiences disproportionate rates of nursing home admission, little is known about residents' perspectives on factors that influence their ability to live independently in these settings. Fifty-eight residents aged 62 and older and eight study partners participated in qualitative interviews about their perspectives on living independently in subsidized housing, including barriers and facilitators. We analyzed transcripts using a hybrid inductive and deductive approach to qualitative thematic analysis. Barriers and facilitators for living independently in subsidized housing related to the influence of the social and physical environment on individuals' experiences of living independently, including factors unique to subsidized housing. Findings suggest how interventions to optimize functional status and promote independence among older adults living in subsidized housing can build on existing strengths of the subsidized housing environment to improve outcomes.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students., (© 2023 American Association for Anatomy.)

Background & Aims: Liver disease is associated with substantial morbidity and mortality, likely incurring financial distress (i.e. healthcare affordability and accessibility issues), although long-term national-level data are limited., Methods: Using the National Health Interview Survey from 2004 to 2018, we categorised adults based on report of liver disease and other chronic conditions linked to mortality data from the National Death Index. We estimated age-adjusted proportions of adults reporting healthcare affordability and accessibility issues. Multivariable logistic regression and Cox regression were used to assess the association of liver disease with financial distress and financial distress with all-cause mortality, respectively., Results: Among adults with liver disease (n = 19,407) vs. those without liver disease (n = 996,352), those with cancer history (n = 37,225), those with emphysema (n = 7,937), and those with coronary artery disease (n = 21,510), the age-adjusted proportion reporting healthcare affordability issues for medical services was 29.9% (95% CI 29.7-30.1%) vs. 18.1% (95% CI 18.0-18.3%), 26.5% (95% CI 26.3-26.7%), 42.2% (95% CI 42.1-42.4%), and 31.6% (31.5-31.8%), respectively, and for medications: 15.5% (95% CI 15.4-15.6%) vs. 8.2% (95% CI 8.1-8.3%), 14.8% (95% CI 14.7-14.9%), 26.1% (95% CI 26.0-26.2%), and 20.6% (95% CI 20.5-20.7%), respectively. In multivariable analysis, liver disease (vs. without liver disease, vs. cancer history, vs. emphysema, and vs. coronary artery disease) was associated with inability to afford medical services (adjusted odds ratio [aOR] 1.84, 95% CI 1.77-1.92; aOR 1.32, 95% CI 1.25-1.40; aOR 0.91, 95% CI 0.84-0.98; and aOR 1.11, 95% CI 1.04-1.19, respectively) and medications (aOR 1.92, 95% CI 1.82-2.03; aOR 1.24, 95% CI 1.14-1.33; aOR 0.81, 95% CI 0.74-0.90; and aOR 0.94, 95% CI 0.86-1.02, respectively), delays in medical care (aOR 1.77, 95% CI 1.69-1.87; aOR 1.14, 95% CI 1.06-1.22; aOR 0.88, 95% CI 0.79-0.97; and aOR 1.05, 95% CI 0.97-1.14, respectively), and not receiving the needed medical care (aOR 1.86, 95% CI 1.76-1.96; aOR 1.16, 95% CI 1.07-1.26; aOR 0.89, 95% CI 0.80-0.99; aOR 1.06, 95% CI 0.96-1.16, respectively). In multivariable analysis, among adults with liver disease, financial distress (vs. without financial distress) was associated with increased all-cause mortality (aHR 1.24, 95% CI 1.01-1.53)., Conclusions: Adults with liver disease face greater financial distress than adults without liver disease and adults with cancer history. Financial distress is associated with increased risk of all-cause mortality among adults with liver disease. Interventions to improve healthcare affordability should be prioritised in this population., Impact and Implications: Adults with liver disease use many medical services, but long-term national studies regarding the financial repercussions and the effects on mortality for such patients are lacking. This study shows that adults with liver disease are more likely to face issues affording medical services and prescription medication, experience delays in medical care, and needing but not obtaining medical care owing to cost, compared with adults without liver disease, adults with cancer history, are equally likely as adults with coronary artery disease, and less likely than adults with emphysema-patients with liver disease who face these issues are at increased risk of death. This study provides the impetus for medical providers and policymakers to prioritise interventions to improve healthcare affordability for adults with liver disease., (Copyright © 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background and Aims: Days at home (DAH) is a patient-centric metric developed by the Medicare Payment Advisory Commission, capturing annual health care use, including and beyond hospitalizations and mortality. We quantified DAH and assessed factors associated with DAH differences among patients with cirrhosis., Approach and Results: Using a national claims database (Optum) between 2014 and 2018, we calculated DAH (365 minus mortality, inpatient, observation, postacute, and emergency department days). Among 20,776,597 patients, 63,477 had cirrhosis (median age, 66, 52% males, and 63% non-Hispanic White). Age-adjusted mean DAH for cirrhosis was 335.1 days (95% CI: 335.0 to 335.2) vs 360.1 (95% CI: 360.1 to 360.1) without cirrhosis. In mixed-effects linear regression, adjusted for demographic and clinical characteristics, patients with decompensated cirrhosis spent 15.2 days (95% CI: 14.4 to 15.8) in postacute, emergency, and observation settings and 13.8 days (95% CI: 13.5 to 14.0) hospitalized. Hepatic encephalopathy (-29.2 d, 95% CI: -30.4 to -28.0), ascites (-34.6 d, 95% CI: -35.3 to -33.9), and combined ascites and hepatic encephalopathy (-63.8 d, 95% CI: -65.0 to -62.6) were associated with decreased DAH. Variceal bleeding was not associated with a change in DAH (-0.2 d, 95% CI: -1.6 to +1.1). Among hospitalized patients, during the 365 days after index hospitalization, patients with cirrhosis had fewer age-adjusted DAH (272.8 d, 95% CI: 271.5 to 274.1) than congestive heart failure (288.0 d, 95% CI: 287.7 to 288.3) and chronic obstructive pulmonary disease (296.6 d, 95% CI: 296.3 to 297.0)., Conclusions: In this national study, we found that patients with cirrhosis spend as many, if not more, cumulative days receiving postacute, emergency, and observational care, as hospitalized care. Ultimately, up to 2 months of DAH are lost annually with the onset of liver decompensation. DAH may be a useful metric for patients and health systems alike., (Copyright © 2023 American Association for the Study of Liver Diseases.)

Background: To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality., Methods: A retrospective cohort study of lung cancer survivors > 65 years old who completed a CAHPS survey > 6 months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group., Results: Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality., Conclusions: There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups., (© 2022. W. Montague Cobb-NMA Health Institute.)