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The purpose of this study was to examine the lived experiences of Latinx cancer survivors and their family caregivers during survivorship. Eighteen semi-structured interviews were conducted with a variety of stakeholders including Latinx cancer survivors (n = 8), their family caregivers (n = 5), and cancer care providers (n = 5). Data were analyzed thematically to describe occupational participation. Latinx families lived in political, economic, language, and social contexts that facilitated and hindered their well-being. Survivors simultaneously experienced occupational deprivation and posttraumatic growth. To promote occupational justice, occupational therapy practitioners and researchers are called to partner with Latinx survivors and their families to facilitate skills needed for everyday participation. [ABSTRACT FROM AUTHOR]

To investigate differential item functioning (DIF) of PROMIS Depression items between US and German samples we compared data from the US PROMIS calibration sample ( n = 780), a German general population survey ( n = 2,500) and a German clinical sample ( n = 621). DIF was assessed in an ordinal logistic regression framework, with 0.02 as criterion for R2-change and 0.096 for Raju's non-compensatory DIF. Item parameters were initially fixed to the PROMIS Depression metric; we used plausible values to account for uncertainty in depression estimates. Only four items showed DIF. Accounting for DIF led to negligible effects for the full item bank as well as a post hoc simulated computer-adaptive test (< 0.1 point on the PROMIS metric [mean = 50, standard deviation =10]), while the effect on the short forms was small (< 1 point). The mean depression severity (43.6) in the German general population sample was considerably lower compared to the US reference value of 50. Overall, we found little evidence for language DIF between US and German samples, which could be addressed by either replacing the DIF items by items not showing DIF or by scoring the short form in German samples with the corrected item parameters reported. [ABSTRACT FROM AUTHOR]

Political misinformation poses a major threat to democracies worldwide, often inciting intense disputes between opposing political groups. Despite its central role for informed electorates and political decision making, little is known about how aware people are of whether they are right or wrong when distinguishing accurate political information from falsehood. Here, we investigate people's metacognitive insight into their own ability to detect political misinformation. We use data from a unique longitudinal study spanning 12 waves over 6 months that surveyed a representative U.S. sample (N = 1,191) on the most widely circulating political (mis)information online. Harnessing signal detection theory methods to model metacognition, we found that people from both the political left and the political right were aware of how well they distinguished accurate political information from falsehood across all news. However, this metacognitive insight was considerably lower for Republicans and conservatives-than for Democrats and liberals-when the information in question challenged their ideological commitments. That is, given their level of knowledge, Republicans' and conservatives' confidence was less likely to reflect the correctness of their truth judgments for true and false political statements that were at odds with their political views. These results reveal the intricate and systematic ways in which political preferences are linked to the accuracy with which people assess their own truth discernment. More broadly, by identifying a specific political asymmetry-for discordant relative to concordant news-our findings highlight the role of metacognition in perpetuating and exacerbating ideological divides. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Tuberculosis (TB) is a public health threat, with >80% of active TB in the United States occurring due to reactivation of latent TB infection (LTBI). We may be underscreening those with high risk for LTBI and overtesting those at lower risk. A better understanding of gaps in current LTBI testing practices in relation to LTBI test positivity is needed., Methods: This study, conducted between 1 January 2008 and 31 December 2019 at Kaiser Permanente Southern California, included individuals aged ≥18 years without a history of active TB. We examined factors associated with LTBI testing and LTBI positivity., Results: Among 3 816 884 adults (52% female, 37% White, 37% Hispanic, mean age 43.5 years [standard deviation, 16.1]), 706 367 (19%) were tested for LTBI, among whom 60 393 (9%) had ≥1 positive result. Among 1 211 971 individuals who met ≥1 screening criteria for LTBI, 210 025 (17%) were tested for LTBI. Factors associated with higher adjusted odds of testing positive included male sex (1.32; 95% confidence interval, 1.30-1.35), Asian/Pacific Islander (2.78, 2.68-2.88), current smoking (1.24, 1.20-1.28), diabetes (1.13, 1.09-1.16), hepatitis B (1.45, 1.34-1.57), hepatitis C (1.54, 1.44-1.66), and birth in a country with an elevated TB rate (3.40, 3.31-3.49). Despite being risk factors for testing positive for LTBI, none of these factors were associated with higher odds of LTBI testing., Conclusions: Current LTBI testing practices may be missing individuals at high risk of LTBI. Additional work is needed to refine and implement screening guidelines that appropriately target testing for those at highest risk for LTBI., Competing Interests: Potential conflicts of interest. K. A. B. reports research funding from Dynavax, GSK, Moderna, and Pfizer. H. K. reports research funding from GSK and Moderna. L. X. Q. reports research funding from Moderna, GSK, and Dynavax. J. S. reports funding from NIH (R01) and has a research contract with the CDC. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Comparative evidence is needed when deciding which bariatric operation to undergo for long-term cardiovascular risk reduction., Objectives: The Effectiveness of Gastric Bypass vs. Gastric Sleeve for Cardiovascular Disease (ENGAGE CVD) study compared the effectiveness of vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) operations for reduction of the American College of Cardiology and the American Heart Association-predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk 5 years after surgery., Setting: Data for this study came from a large integrated healthcare system in the Southern California region of the United States. This is one of the most ethnically diverse (64% non-White) bariatric populations in the literature., Methods: The ENGAGE CVD cohort consisted of 22,095 patients who underwent VSG or RYGB from 2009-2016. The VSG and RYGB were compared using a local instrumental variable approach to address observed and unobserved confounding, as well as to conduct heterogeneity of treatment effects for patients of different age groups, baseline-predicted 10-year CVD risk using the ASCVD risk score, and those who had type 2 diabetes (T2D) at the time of surgery., Results: Patients (2771 RYGB and 6256 VVSG) were primarily women (80.6%), Hispanic or non-Hispanic Black (63.7%), and 46 ± 10 years of age, with a body mass index of 43.40 ± 6.5 kg/m 2 . The predicted 10-year ASCVD risk at surgery was 4.1% for VSG and 5.1% for RYGB, decreasing to 2.6% for VSG and 2.8% for RYGB 1 year postoperatively. By 5 years after surgery, patients remained with relatively low risk levels (3.0% for VSG and 3.3% for RYGB) and there were no significant differences in predicted 10-year ASCVD risk between VSG and RYGB at any time., Conclusion: Predicted 10-year ASCVD risk was low in this population and remained low up to 5 years for those with diabetes, Black and Hispanic patients, and older adults. Literature reporting significant differences between VSG and RYGB in 10-year ASCVD risk may be a result of residual confounding., (Copyright © 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Vaccine effectiveness studies have not differentiated the effect of the delta (B.1.617.2) variant and potential waning immunity in observed reductions in effectiveness against SARS-CoV-2 infections. We aimed to evaluate overall and variant-specific effectiveness of BNT162b2 (tozinameran, Pfizer-BioNTech) against SARS-CoV-2 infections and COVID-19-related hospital admissions by time since vaccination among members of a large US health-care system., Methods: In this retrospective cohort study, we analysed electronic health records of individuals (≥12 years) who were members of the health-care organisation Kaiser Permanente Southern California (CA, USA), to assess BNT162b2 vaccine effectiveness against SARS-CoV-2 infections and COVID-19-related hospital admissions for up to 6 months. Participants were required to have 1 year or more previous membership of the organisation. Outcomes comprised SARS-CoV-2 PCR-positive tests and COVID-19-related hospital admissions. Effectiveness calculations were based on hazard ratios from adjusted Cox models. This study was registered with ClinicalTrials.gov, NCT04848584., Findings: Between Dec 14, 2020, and Aug 8, 2021, of 4 920 549 individuals assessed for eligibility, we included 3 436 957 (median age 45 years [IQR 29-61]; 1 799 395 [52·4%] female and 1 637 394 [47·6%] male). For fully vaccinated individuals, effectiveness against SARS-CoV-2 infections was 73% (95% CI 72-74) and against COVID-19-related hospital admissions was 90% (89-92). Effectiveness against infections declined from 88% (95% CI 86-89) during the first month after full vaccination to 47% (43-51) after 5 months. Among sequenced infections, vaccine effectiveness against infections of the delta variant was high during the first month after full vaccination (93% [95% CI 85-97]) but declined to 53% [39-65] after 4 months. Effectiveness against other (non-delta) variants the first month after full vaccination was also high at 97% (95% CI 95-99), but waned to 67% (45-80) at 4-5 months. Vaccine effectiveness against hospital admissions for infections with the delta variant for all ages was high overall (93% [95% CI 84-96]) up to 6 months., Interpretation: Our results provide support for high effectiveness of BNT162b2 against hospital admissions up until around 6 months after being fully vaccinated, even in the face of widespread dissemination of the delta variant. Reduction in vaccine effectiveness against SARS-CoV-2 infections over time is probably primarily due to waning immunity with time rather than the delta variant escaping vaccine protection., Funding: Pfizer., Competing Interests: Declaration of interests JMZ, SG, KP, FJA, LJ, SRV, and JMM are employees of and hold stock and stock options in Pfizer. TBF holds shares of Pfizer stock. SYT, JMS, HF, VH, BKA, ONR, TBF, and OAO received research support from Pfizer during the conduct of this study that was paid directly to KPSC. For work unrelated to this project, SYT received research funding from Gilead, GlaxoSmithKline, and Genentech; BKA received research funding from GlaxoSmithKline, Novavax, Dynavax, Genentech, Novartis, Seqirus, and Moderna; JMS received research funding from Novavax, Dynavax, and ALK; and HF received research funding from Genentech. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The aim of this work was to study weight loss and risk of cardiovascular disease (CVD) or death associated with longer-term phentermine use., Methods: Using electronic health record data, 13,972 adults were identified with a first phentermine fill in 2010 to 2015, creating exposure categories according to a patient's duration of use (referent: ≤ 3 months). Multivariable linear models were used to compare percent weight loss across categories at 6, 12, and 24 months, and Cox proportional hazards models were used to compare risk of composite CVD or death, up to 3 years after starting phentermine., Results: The cohort was 84% female and 45% white, with a mean (SD) baseline age 43.5 (10.7) years and BMI of 37.8 (7.2) kg/m 2 . In multivariable models, longer-term users of phentermine experienced more weight loss; patients using continuously for > 12 months lost 7.4% more than the referent group at 24 months (P < 0.001). The composite CVD or death outcome was rare (0.3%, 41 events), with no significant difference in hazard ratios between groups., Conclusions: Greater weight loss without increased risk of incident CVD or death was observed in patients using phentermine monotherapy for longer than 3 months. Despite the limitations of the observational design, this study supports the effectiveness and safety of longer-term phentermine use for low-risk individuals., (© 2019 The Obesity Society.)

Racial/ethnic disparities in the prevalence of diagnosed hypertension are persistent but may be partially explained by racial/ethnic differences in weight category and neighborhood socioeconomic status. The authors compared hypertension prevalence rates among 4 060 585 adults with overweight or obesity across 10 healthcare systems by weight category and neighborhood education level in geographically and racially diverse individuals. Data were obtained from electronic health records. Hypertension was defined as at least two outpatient visits or one inpatient hospitalization with a coded diagnosis. Logistic regression, adjusted for age, sex, and site, with two-way interactions between race/ethnicity and weight category or neighborhood education, was used to examine the association between hypertension and race/ethnicity, with whites as the reference. Results documented that odds ratios for hypertension prevalence were greater for blacks, American Indians/Alaskan Natives, Asians, and Native Hawaiians/other Pacific Islanders compared with whites and lower for Hispanics in similar weight categories and neighborhood education levels. Although two-way interactions were statistically significant, the magnitude of the odds of hypertension compared with whites did not substantially vary across weight or neighborhood education. Hypertension odds were almost double relative to whites for blacks and Native Hawaiians/other Pacific Islanders across most weight categories and all neighborhood education levels. Odds of hypertension were about 50% greater for Asians relative to whites across weight categories. Results suggest that other factors might be associated with racial/ethnic disparities in hypertension. More research is needed to understand the many factors that may contribute to variation in diagnosed hypertension across racial/ethnic groups with overweight or obesity., (©2018 Wiley Periodicals, Inc.)

Objectives: We assessed the odds of having a family dinner by parental gender, family structure and parental employment., Methods: This study used data from the American Time Use Survey (ATUS) (2006-2008). Multivariate analyses assessed the odds of two outcomes among parents: 1) eating at all with children and 2) having a family dinner., Results: Single men had lower odds of eating at all with children and eating a family dinner in comparison to partnered/married males. Partnered/married women had increased odds of eating at all with children and eating a family dinner compared to their partnered/married male counterparts. While single women had increased odds of eating at all with children compared to partnered/married males, no difference was detected in the odds of having a family dinner. Among dual-headed households, women had lower odds of eating a family dinner when both parents were employed compared a dual-headed household with employed male/non-employed female. There were no differences among men regardless of their employment status or that of their partner/spouse., Conclusions: Family structure, parental gender and employment status all influence the odds of having a family dinner. Future research on family meals should consider all of these factors to better understand trends and disparities across household compositions., (Copyright © 2017. Published by Elsevier Ltd.)

Background: Effective healthcare for people with multiple chronic conditions (MCC) is a US priority, but the inherent complexity makes both research and delivery of care particularly challenging. As part of AHRQ Multiple Chronic Conditions Research Network (MCCRN) efforts, the Network developed a conceptual model to guide research in this area., Objective: To synthesize methodological and topical issues relevant to MCC patient care into a framework that can improve the delivery of care and advance future research about caring for patients with MCC., Methods: The Network synthesized essential constructs for MCC research identified from roundtable discussion, input from expert advisors, and previously published models., Results: The AHRQ MCCRN conceptual model defines complexity as the gap between patient needs and healthcare services, taking into account both the multiple considerations that affect the needs of MCC patients, as well as the contextual factors that influence service delivery. The model reframes processes and outcomes to include not only clinical care quality and experience, but also patient health, well being, and quality of life. The single-condition paradigm for treating needs one-by-one falls apart and highlights the need for care systems to address dynamic patient needs., Conclusions: Defining complexity in terms of the misalignment between patient needs and services offers new insights in how to research and develop solutions to patient care needs.

Background: Latino preschool children in the United States are at high risk for obesity. The objective of this study was to measure over a one-year period whether a parent training based on social learning theory combined with evidence-based interventions to promote optimal nutrition and physical activity will reduce the upward trend of BMI z-scores in groups of 2–4 year old Latino children living in low-income households., Methods: Seven weekly classes with 2 booster classes were delivered to low-income Latino parents with 2–4 year old children. A randomized controlled pilot study evaluated the effectiveness of the intervention that contrasts 61 children whose parents were randomized to receive Parent Training (PT) with 60 Wait-list (WL) subjects. Forty subjects did not attend the one-year follow up assessment, resulting in 81 subjects who have measurements for both baseline and one-year follow up assessments. To adjust for differential dropout rates and missing observations, imputation of missing data was done using a carefully constructed model that included relevant independent variables., Results: There were no significant subject differences between groups at baseline for family characteristics and BMI categories for child and parent. Children in the intervention group decreased their BMI z-scores significantly on average by .20 (SE= .08) compared to children in the control group who increased z scores on average by .04 (SE=.09) at one year (P<.05)., Conclusions: Parent training is effective to reduce the risk of overweight in preschool Latino children living in low-income households. The findings need to be examined in a larger sample of children.

Purpose: This pilot study evaluated potential relationships between dental status and various sociodemographic variables in the age group segment of the United States population at greatest risk for the disruption of dental function due to treatment of an oral cavity cancer., Methods: The Dental Health Supplement of the 1989 National Health Interview Survey was used to evaluate the self-reported status of natural dentition and prior dental rehabilitation among the population of persons 45 years or older., Results: Sociodemographic variables, which showed a significant association with status of natural dentition, were level of income and occupation at lower income levels (p < 0.05). Increased levels of prior dental rehabilitation were significantly associated with lower age, female gender, increased level of income, and occupation (p < 0.05). Occupations that required social interaction had the highest levels of both status of natural dentition and prior dental rehabilitation (p < 0.05)., Conclusions: Overall dental status after treatment of oral cancer may be related to the occupational status of many persons. Sociodemographic factors that influence the dental rehabilitation needs of individual patients after treatment of an oral cancer should be considered in policy decisions affecting accessibility of dental rehabilitative care. A follow-up, survey study that would further define the identified relationships between a person's demographic status and dental rehabilitation needs is recommended.

In deciding to use a new intravascular contrast medium, the considerations should be patient safety, Imaging efficacy, and cost. Balancing these factors, use can be estimated. With the new low-osmolality contrast media, particularly the nonionic media, the expected increased patient safety must be balanced against the much higher cost.