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For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care. [ABSTRACT FROM AUTHOR]

Diet and physical activity guidelines for cancer survivorship are less likely to be followed by populations of minority cancer survivors, such as Latina/Hispanic women, compared to non-Hispanic White women. It is important to understand psychosocial mechanisms that may increase adherence to healthy lifestyle habits, especially in populations at risk for poorer cancer outcomes. This cross-sectional study examined the relationships between overall social support (SS) and SS from three sources (family, friends, and significant other) with diet (fruit and vegetables, fat, energy density, and diet quality), and moderate-to-vigorous physical activity (MVPA) behaviors in Latina/Hispanic women with a history of breast cancer (n = 85; M age = 55.2; SD = 9.2). Linear regression models and odds ratios were used to examine associations and adjusted for age, income, and acculturation. Family, significant other, and total SS were positively related to total fruit and vegetable intake but SS from friends was not. Higher levels of SS from all sources were each related to a low energy density diet. A higher quality diet was only related to SS from family. SS was not related to fat intake or MVPA. Higher SS from family and a significant other were associated with higher odds of meeting the fruit/vegetable guidelines; (family, OR = 3.72, 95% CI [1.21, 11.39]; significant other, OR = 3.32, 95% CI [1.08, 10.30]). Having more SS from family or a significant other may contribute to Latina/Hispanic women breast cancer survivors meeting national guidelines for a diet high in fruits and vegetables and low in energy density. [ABSTRACT FROM AUTHOR]

Two studies (N = 676) highlight the nuanced relationship between conservatism and adherence to COVID-19 policy and recommendations intended to slow the spread of the pandemic in the United States. Study 1 provided evidence that conservative Americans who felt uncertain about themselves and the future experienced elevated levels of symbolic threat (attacks to sociopolitical identity; e.g., the pandemic threatening American democracy) and realistic threat (concrete attacks to material resources or well-being; e.g., the pandemic threatening physical health) in comparison to their more certain counterparts. In Study 2, the association between this form of uncertainty and frequency of risky social behaviors (behaviors that increase the risk of virus transmission) was partially mediated by threat perception for Americans both low and high in conservatism. We discuss findings as an integration of the motivated social cognition framework and uncertainty-identity theory. While self-uncertainty was more associated with greater overall COVID-19 threat perception for Americans high (vs. low) in conservatism, threat perception and frequency of risky social behaviors were associated with self-uncertainty in a manner that is consistent with prevailing liberal and conservative norms. [ABSTRACT FROM AUTHOR]

This article presents a synthesis of previous ideas relating to student evaluation of teaching (SET) results in higher education institutions (HEIs), with particular focus upon possible validity issues and matters that HEI decision-makers should consider prior to interpreting survey results and using them summatively. Furthermore, the research explores relevant legal issues (namely, defamation, breach of the duty to take reasonable care for an employee's welfare, breach of the duty of trust and confidence, breach of the right to privacy and, if the lecturer is forced to resign as a consequence of such infringements, constructive dismissal) that decision-makers, in UK HEIs, should appreciate if survey results are widely published or used to inform employment decisions. The resulting recommendations should enable HEIs to avoid litigation and/or a deterioration of the employer-employee relationship of trust whilst still allowing SETs to be used for quality enhancement purposes. The research is timely as most studies to date have been completed in the context of the US or Australian education systems. Additionally, current major changes in the UK higher education sector, such as the increase in the use of the student as customer metaphor and potential job losses, mean that decision-makers need to be cautious if utilising SET results summatively.

PURPOSE Complementary and alternative medicine (CAM) use during cancer treatment is controversial. We aim to evaluate contemporary CAM use, patient perceptions and attitudes, and trust in various sources of information regarding CAM. METHODS A multi-institutional questionnaire was distributed to patients receiving cancer treatment. Collected information included respondents' clinical and demographic characteristics, rates of CAM exposure/use, information sources regarding CAM, and trust in each information source. Comparisons between CAM users and nonusers were performed with chi-squared tests and one-way analysis of variance. Multivariable logistic regression models for trust in physician and nonphysician sources of information regarding CAM were evaluated. RESULTS Among 749 respondents, the most common goals of CAM use were management of symptoms (42.2%) and treatment of cancer (30.4%). Most CAM users learned of CAM from nonphysician sources. Of CAM users, 27% reported not discussing CAM with their treating oncologists. Overall trust in physicians was high in both CAM users and nonusers. The only predictor of trust in physician sources of information was income >$100,000 in US dollars per year. Likelihood of trust in nonphysician sources of information was higher in females and lower in those with graduate degrees. CONCLUSION A large proportion of patients with cancer are using CAM, some with the goal of treating their cancer. Although patients are primarily exposed to CAM through nonphysician sources of information, trust in physicians remains high. More research is needed to improve patient-clinician communication regarding CAM use. [ABSTRACT FROM AUTHOR]

This study used a novel survey instrument to evaluate the hypothesis that U.S. agricultural producers have significantly different stress and recovery experiences following acute-onset natural disaster compared to their non-agricultural counterparts. Participants were recruited through local organizations and targeted email and social media in communities in Arkansas and Nebraska that had experienced violent tornadoes in 2014 and/or severe flooding in 2019. The survey instrument incorporated the Brief Resilience Scale, the Revised Impact of Event Scale referencing two time points, the Posttraumatic Growth Inventory-Short Form, and original questions. Demographic, exposure, stress, and recovery measures were analyzed in SAS with Chi-square tests, t-tests, Wilcoxon tests, and multiple linear regression modeling to test for differences between agricultural and non-agricultural groups in resilience, event exposure, stress symptoms in the week after the event, stress symptoms in the month before the survey, a calculated recovery ratio, and posttraumatic growth. Analysis sample (N = 159) contained 20.8% agricultural occupation, 71.1% female, and 49.1% over age 55. No significant differences were found between agricultural and non-agricultural participants when comparing resilience, stress, or recovery ratio measures. Unadjusted posttraumatic growth score was significantly lower in the agriculture group (P =.02), and an occupation group by sex interaction was significantly associated with posttraumatic growth score (P =.02) when controlled for number of initial posttraumatic stress symptoms in the adjusted model, with agricultural women showing lower growth. Overall, there was no evidence of significant difference in disaster stress and recovery between agricultural and rural, non-agricultural groups in this study. There was some evidence that women in agriculture may have lower levels of recovery. Data indicated that rural residents continue to experience posttraumatic-type symptoms up to 8 years beyond the acute-onset natural disaster events. Communities should include strategies to support mental and emotional health in their preparedness, response, and recovery plans with intentional inclusion of agricultural populations. [ABSTRACT FROM AUTHOR]

Increased water scarcity and drought frequency are creating water management challenges for many communities in the western U.S. In response, the Western Association of Agricultural Experiment Station Directors sponsored a virtual summit in August 2020 to develop a framework for identifying and addressing the most pressing water issues in the western United States (the West). Summit attendees were research scientists, university extension specialists and professionals, and federal/state agency representatives with knowledge and expertise of water management in the West. The summit elicited opinions from 54 experts on pressing water issues and possible methods for addressing them. A follow‐on survey of 49 individuals increased the depth and breadth of perspectives collected. Summit and survey results show that water scarcity is a growing concern among water scientists and other experts. Increased water scarcity is leading to overallocated river basins, depleted aquifers, and elevated tensions between water use sectors. Summit and survey participants emphasized the need for increased integration—across research, extension, and education efforts; across the social and physical sciences; across uses (including ecological); and across surface and groundwater systems. These results serve as a sensing of what many of our colleagues believe to be the major western water issues over the next 30 years and, in some cases, possible solutions for addressing them. The expert opinions elicited through the summit and survey informed the creation of the Western Water Network, whose mission is to advance collaborative, proactive, science‐based water decision‐making that supports dynamic human and natural systems in the West. [ABSTRACT FROM AUTHOR]

Policy PointsOver the past century, the tax‐financed share of health care spending has risen from 9% in 1923 to 69% in 2020; a large part of this tax financing is now the subsidization of private health insurance.For‐profit ownership of health care facilities has also increased in recent decades and now predominates for many health subsectors. A rising share of physicians are now employees.US health care is, increasingly, publicly financed yet investor owned, a trend that has been accompanied by rising medical costs and, in recent years, stagnating or even worsening population health. A reconsideration of US health care financing and ownership appears warranted. Context: Who pays for health care—and who owns it—determine what care is delivered, who receives it, and who profits from it. We examined trends in health care ownership and financing over a century. Methods: We used multiple historical and current data sources (including data from the American Medical Association, the American Hospital Association, government publications and surveys, and analyses of Medicare Provider of Services files) to classify health care provider ownership as: public, private (for‐profit), and private (not‐for‐profit). We used US Census data to classify physicians' employers as public, not‐for‐profit, or for‐profit entities or "self‐employed." We combined estimates from the official National Health Expenditures Accounts with other data sources to determine the public vs. private share of health care spending since 1923; we calculated a "comprehensive" public share metric that accounted for public subsidization of private health expenditures, mostly via the tax exemption for employer‐sponsored insurance plans or government purchase of such plans for public employees. Findings: For‐profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not‐for‐profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer‐financed share of health care spending has increased dramatically from 9% in 1923 to 69% in 2020, with taxpayer‐financed subsidies to private expenditures accounting for much of the recent growth. Conclusions: American health care is increasingly publicly financed yet investor owned, a trend accompanied by rising costs and, recently, worsening population health. A reassessment of the US mode of health care financing and ownership appears warranted. [ABSTRACT FROM AUTHOR]

Objectives. To assess the risk of COVID-19 by occupation and industry in the United States. Methods. Using the 2020–2021 National Health Interview Survey, we estimated the risk of having had a diagnosis of COVID-19 by workers' industry and occupation, with and without adjustment for confounders. We also examined COVID-19 period prevalence by the number of workers in a household. Results. Relative to workers in other industries and occupations, those in the industry "health care and social assistance" (adjusted prevalence ratio = 1.23; 95% confidence interval = 1.11, 1.37), or in the occupations "health practitioners and technical," "health care support," or "protective services" had elevated risks of COVID-19. However, compared with nonworkers, workers in 12 of 21 industries and 11 of 23 occupations (e.g., manufacturing, food preparation, and sales) were at elevated risk. COVID-19 prevalence rose with each additional worker in a household. Conclusions. Workers in several industries and occupations with public-facing roles and adults in households with multiple workers had elevated risk of COVID-19. Public Health Implications. Stronger workplace protections, paid sick leave, and better health care access might mitigate working families' risks from this and future pandemics. (Am J Public Health. 2023;113(6):647–656. https://doi.org/10.2105/AJPH.2023.307249) [ABSTRACT FROM AUTHOR]

Background: Ovarian cancer is the fifth most common female cancer in the United States. There have been very few studies investigating mental health diagnoses among ovarian cancer survivors with long‐term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors. Patients and methods: Cohorts of 1689 ovarian cancer patients diagnosed between 1996 and 2012 and 7038 women without cancer matched by age and birth state from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Results: Ovarian cancer survivors experienced increased risks of mental illnesses within the first 2 years after cancer diagnosis (HR = 3.55, 95% CI = 3.04–4.14). The risks of depression among ovarian cancer survivors were nearly 3‐fold within the first 2 years of cancer diagnosis (HR = 2.59, 95% CI = 1.94–3.47), and 1.69‐fold at 2–5 years after cancer diagnosis (HR = 1.69, 95% CI = 1.18–2.42). Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR = 1.80, 95% CI = 1.48–2.18) and a 94% increased risk of death with a depression diagnosis (HR = 1.94, 95% CI = 1.56–2.40). Conclusions: Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow‐up periods of 0–2 years and 2–5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors. [ABSTRACT FROM AUTHOR]

On May 12, 2022, Senator Bernie Sanders held a hearing in the U.S. Senate Budget Committee on Medicare for All legislation. These were the first such hearings in the U.S. Senate. In testimony presented to the Budget Committee, I argued that the achievement of Medicare for All was a medical and moral imperative. I explored the problem of uninsurance, noting that 30 million Americans remain uninsured at a cost of more than 30,000 deaths annually. I contended that improving the quality of coverage was equally crucial, describing how some 41 million Americans remain underinsured at a grave cost to their health and financial wellbeing. Finally, I examined the economics of Medicare for All reform, and showed how the reduction of the enormous administrative waste in American healthcare could save hundreds of billions of dollars a year. Medicare for All, I concluded, is the one health reform that could expand and improve coverage for all while simultaneously controlling costs. [ABSTRACT FROM AUTHOR]

1. Participants will be able to summarize the key components of the four-week curriculum offer to 4th year medical students. 2. Participants will be able to evaluate the efficacy of the curriculum based on the learner-reported feedback about the educational curriculum. This presentation summarizes the evaluations of 81 medical students who participated in an immersive palliative care elective during the past six years. Our findings show increases in learner self-perception of preparedness to lead serious illness conversations and care for symptomatic patients at end-of-life. Student feedback highlights repeated calls for increased exposure to palliative care in the medical school curriculum. There is an urgent need to equip all medical providers with primary palliative care skills to meet the needs of patients with serious illness, particularly given the aging population of the United States. One way to address this need is to offer more palliative care training to medical students. We designed and evaluated an immersive, four-week elective for fourth year medical students as a potential model for enhancing primary palliative care skills. This elective was offered to two fourth-year medical students per month. Students spend two weeks on the adult palliative care consult service, one week at our inpatient hospice unit, and one week with either pediatric palliative care, radiation oncology, anesthesia pain, or additional time on the adult palliative care consult service. During the elective, students spend time with each member of the interdisciplinary team. Each student also leads an end-of-rotation presentation on a topic of their choosing and completes a reflection that allows them to process their experiences. To evaluate the curriculum, each student completes a pre-survey and post-survey. From 2017-2023, 81 students participated in the elective. All students completed the pre-survey and 85% completed the post-survey. Self-reported preparedness for serious illness communication increased from 38% to 100%. Comfort in leading code status discussions increased from 58% up to 100%. Learners unanimously reported that they felt better prepared to handle end-of-life issues and manage symptoms in seriously ill patients. In the qualitative analysis, students confirmed that their goals for the elective were met. Student feedback was critical of the lack of palliative care education throughout the standard medical school curriculum and called for earlier exposure. The feedback about this elective was overwhelmingly positive with students reporting significant improvement in self-perceived palliative care skills. Many called for more palliative care education earlier in medical school. Workforce / Career Development [ABSTRACT FROM AUTHOR]

Recent reports have highlighted a lower-than-expected prevalence of neoplasia in elephants and suggested mechanisms for cancer resistance. But despite infrequent reports in the literature, uterine neoplasia is common in managed Asian elephants (Elephas maximus). This study is an archival review of reproductive tract neoplasia in 80 adult female Asian elephant mortalities in managed care facilities in the United States from 1988 to 2019. Neoplasms occurred in 64/80 (80%) of cases. Most were in the uterus (63/64; 98%) with only a single case of ovarian neoplasia. Myometrial leiomyomas were present in 57/63 (90%) cases with uterine neoplasia. Uterine adenocarcinoma was present in 8/63 (13%) cases. Remaining cases included endometrial adenoma (2), focal carcinoma in situ in endometrial polyps (1), anaplastic carcinoma (1), endometrial hemangioma (1), primitive neuroectodermal tumor (PNET; 1), and angiosarcoma (1). One case with uterine adenocarcinoma had a separate pelvic mass histologically characterized as an anaplastic sarcoma. Distant metastases were documented in 5/8 (63%) cases of uterine adenocarcinoma, and in the uterine anaplastic carcinoma, PNET, and angiosarcoma. Four uterine adenocarcinomas and one carcinoma in situ were examined immunohistochemically for pan-cytokeratin, vimentin, and estrogen receptor. In all, neoplastic cells were pan-cytokeratin positive and vimentin negative, and in 2 cases were immunoreactive for estrogen receptor. Results show that female reproductive tract neoplasia, particularly of the uterus, is common in Asian elephants and is not limited to leiomyomas. Importantly, uterine neoplasms have the potential to impact fecundity and may represent obstacles to conservation in managed care. [ABSTRACT FROM AUTHOR]

Background: Racial and ethnic as well as economic disparities in access to care among persons with asthma and COPD have been described, but long-term access trends are unclear.Research Question: Have health coverage and access to care and medications among adults with airways disease improved, and have disparities narrowed?Study Design and Methods: Using the 1997 through 2018 National Health Interview Survey, we examined time trends in health coverage and the affordability of medical care and prescription drugs for adults with asthma and COPD, overall and by income and by race and ethnicity. We performed multivariate linear probability regressions comparing coverage and access in 2018 with that in 1997.Results: Our sample included 76,843 adults with asthma and 30,548 adults with COPD. Among adults with asthma, lack of insurance rose in the first decade of the twenty-first century, peaking with the Great Recession, but fell after implementation of the Affordable Care Act (ACA). From 1997 through 2018, the uninsured rate among adults with asthma decreased from 19.4% to 9.6% (adjusted 9.27 percentage points; 95% CI, 7.1%-11.5%). However, the proportions delaying or foregoing medical care because of cost or going without medications did not improve. Racial and ethnic as well as economic disparities present in 1997 persisted over the study period. Trends and disparities among those with COPD were similar, although the proportion going without needed medications worsened, rising by an adjusted 7.8 percentage points.Interpretation: Coverage losses among persons with airways disease in the first decade of the twenty-first century were reversed by the ACA, but neither care affordability nor disparities improved. Further reform is needed to close these gaps. [ABSTRACT FROM AUTHOR]

Understanding local adaptation to climate is critical for managing ecosystems in the face of climate change. While there have been many provenance studies in trees, less is known about local adaptation in herbaceous species, including the perennial grasses that dominate arid and semiarid rangeland ecosystems. We used a common garden study to quantify variation in growth and drought resistance traits in 99 populations of Elymus elymoides from a broad geographic and climatic range in the western United States. Ecotypes from drier sites produced less biomass and smaller seeds, and had traits associated with greater drought resistance: small leaves with low osmotic potential and high integrated water use efficiency (δ13C). Seasonality also influenced plant traits. Plants from regions with relatively warm, wet summers had large seeds, large leaves, and low δ13C. Irrespective of climate, we also observed trade‐offs between biomass production and drought resistance traits. Together, these results suggest that much of the phenotypic variation among E. elymoides ecotypes represents local adaptation to differences in the amount and timing of water availability. In addition, ecotypes that grow rapidly may be less able to persist under dry conditions. Land managers may be able to use this variation to improve restoration success by seeding ecotypes with multiple drought resistance traits in areas with lower precipitation. The future success of this common rangeland species will likely depend on the use of tools such as seed transfer zones to match local variation in growth and drought resistance to predicted climatic conditions. [ABSTRACT FROM AUTHOR]

The return of a Democratic administration to the White House, coupled with coronavirus disease 2019 (COVID-19) pandemic-induced contractions of job-based insurance, may reignite debate over public coverage expansion and its costs. Decades of research demonstrate that uninsured people and people with copays and deductibles use less care than people with first-dollar coverage. Hence, most economic analyses of Medicare for All proposals and other coverage expansions project increased utilization and associated costs. We review the utilization surges that such analyses have predicted and contrast them with the more modest utilization increments observed after past coverage expansions in the US and other affluent nations. The discrepancy between predicted and observed utilization changes suggests that analysts underestimate the role of supply-side constraints--for example, the finite number of physicians and hospital beds. Our review of the utilization effects of past coverage expansions suggests that a first-dollar universal coverage expansion would increase ambulatory visits by 7-10 percent and hospital use by 0-3 percent. Modest administrative savings could offset the costs of such increases. [ABSTRACT FROM AUTHOR]

While the COVID-19 pandemic presents every nation with challenges, the United States' underfunded public health infrastructure, fragmented medical care system, and inadequate social protections impose particular impediments to mitigating and managing the outbreak. Years of inadequate funding of the nation's federal, state, and local public health agencies, together with mismanagement by the Trump administration, hampered the early response to the epidemic. Meanwhile, barriers to care faced by uninsured and underinsured individuals in the United States could deter COVID-19 care and hamper containment efforts, and lead to adverse medical and financial outcomes for infected individuals and their families, particularly those from disadvantaged groups. While the United States has a relatively generous supply of Intensive Care Unit beds and most other health care infrastructure, such medical resources are often unevenly distributed or deployed, leaving some areas ill-prepared for a severe respiratory epidemic. These deficiencies and shortfalls have stimulated a debate about policy solutions. Recent legislation, for instance, expanded coverage for testing for COVID-19 for the uninsured and underinsured, and additional reforms have been proposed. However comprehensive health care reform – for example, via national health insurance – is needed to provide full protection to American families during the COVID-19 outbreak and in its aftermath. [ABSTRACT FROM AUTHOR]

This study proposes a method for calculating the annual incidence rate of sibling bereavement among US youth using national epidemiological data. The proposed model combines data on family household size with national death statistics to calculate the number of siblings affected by the death of a child annually. From 2012 to 2015, an average of 61,389 children per year experienced the death of a sibling, resulting in an estimate of 0.0832% of children bereaved by the death of a sibling annually. Data indicate a need for greater awareness and dialog concerning the frequency with which children experience the death of a sibling. [ABSTRACT FROM AUTHOR]

Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2001 to 2015 and recorded 30-day infection rates and emergency department, hospital and, intensive care unit (ICU) admissions. We performed adjusted analyses to analyze the effect of age, demographic data, surgeon volume, rectal swab use, and biopsy year on infections.Results: We found that the overall rate of postbiopsy infections increased from 2001 (5.9%) to 2007 (7.2%) but remained stable through 2015. Despite this, postbiopsy emergency room visits rose from 0.2% to 0.5% (95% confidence interval [CI] 0.2%-0.4%, P < .01), hospitalizations rose from 0.5% to 1.3% (95% CI 0.5%-1.0%, P < .01), and ICU admissions increased from 0.1% to 0.3% (95% CI 0.1%-0.3%, P < .01). Patients of surgeons who performed 25 biopsies per year had lower odds of postbiopsy infection (odds ratio 0.65; 95% CI 0.61-0.69) and a lower risk of hospitalization (odds ratio 0.50; 95% CI 0.43-0.59) as compared to patients of surgeons who performed one biopsy per year. Rectal swab use increased over the study period but remained low (1.8% in 2015).Conclusion: While the overall rate of postbiopsy infections has stabilized since 2007, admissions to the emergency room, hospital, and ICU continue to rise. Increased surgeon volume was associated with a decreased risk of infection. [ABSTRACT FROM AUTHOR]

Background: The United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS).Methods and Findings: Data were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation.Conclusions: In this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the effects of the 2 major coverage expansions in US history—Medicare/Medicaid in 1966 and the Affordable Care Act (ACA) in 2014—on the utilization of physician care. Methods. Using the National Health Interview Survey (1963–1969; 2011–2016), we analyzed trends in utilization of physician services society-wide and by targeted subgroups. Results. Following Medicare/Medicaid's implementation, society-wide utilization remained unchanged. While visits by low-income persons increased 6.2% (P <.01) and surgical procedures among the elderly increased 14.7% (P <.01), decreases among nontargeted groups offset these increases. After the ACA, society-wide utilization again remained unchanged. Increased utilization among targeted low-income groups (e.g., a 3.5-percentage-point increase in the proportion of persons earning less than or equal to 138% of the federal poverty level with at least 1 office visit [ P <.001]) was offset by small, nonsignificant reductions among the nontargeted population. Conclusions. Past coverage expansions in the United States have redistributed physician care, but have not increased society-wide utilization in the short term, possibly because of the limited supply of physicians. Public Health Implications. These findings suggest that future expansions may not cause unaffordable surges in utilization. [ABSTRACT FROM AUTHOR]

Background: Persons with comprehensive health insurance use more hospital care than those who are uninsured or have high-deductible plans. Consequently, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. However, a limited supply of beds might constrain this growth.Objective: To determine how the implementations of Medicare and Medicaid (1966) and the Patient Protection and Affordable Care Act (ACA) (2014) affected hospital use.Design: Repeated cross-sectional study.Setting: Nationally representative surveys.Participants: Respondents to the National Health Interview Survey (1962 to 1970) and Medical Expenditure Panel Survey (2008 to 2015).Measurements: Mean hospital discharges and days were measured, both society-wide and among subgroups defined by income, age, and health status. Changes between preexpansion and postexpansion periods were analyzed using multivariable negative binomial regression.Results: Overall hospital discharges averaged 12.8 per 100 persons in the 3 years before implementation of Medicare and Medicaid and 12.7 per 100 persons in the 4 years after (adjusted difference, 0.2 discharges [95% CI, -0.1 to 0.4 discharges] per 100 persons; P = 0.26). Hospital days did not change in the first 2 years after implementation but increased later. Effects differed by subpopulation: Adjusted discharges increased by 2.4 (CI, 1.7 to 3.1) per 100 persons among elderly compared with nonelderly persons (P < 0.001) and also increased among those with low incomes compared with high-income populations. For younger and higher-income persons, use decreased. Similarly, after the ACA's implementation, overall hospital use did not change: Society-wide rates of discharge were 9.4 per 100 persons before the ACA and 9.0 per 100 persons after the ACA (adjusted difference, -0.6 discharges [CI, -1.3 to 0.2 discharges] per 100 persons; P = 0.133), and hospital days were also stable. Trends differed for some subgroups, and rates decreased significantly in unadjusted (but not adjusted) analyses among persons reporting good or better health status and increased nonsignificantly among those in worse health.Limitation: Data sources relied on participant recall, surveys excluded institutionalized persons, and follow-up after the ACA was limited.Conclusion: Past coverage expansions were associated with little or no change in society-wide hospital use; increases in groups who gained coverage were offset by reductions among others, suggesting that bed supply limited increases in use. Reducing coverage may merely shift care toward wealthier and healthier persons. Conversely, universal coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained.Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Background: As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication.Objective: To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood."Design: Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013).Participants: Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba).Main Measures: DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization.Key Results: The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba.Conclusions: In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute. [ABSTRACT FROM AUTHOR]

The article provides information on air pollution in the U.S. Air pollution is a serious problem contributed by the pressure of excessive consumption of air mass and difficult to trace its source and destination. It is facilitated by dispersing the population in a wider area and reducing the given volume of pollutants with more air. Overuse of air damages anyone surrounded by air envelop as well as the human wellness and enjoyment. Air conservation policy, an economic routine that anticipates public participation, is the only way to control and prevent air pollution.

The article examines how the Covid-19 pandemic laid bare the need for cooperation in health services; and proper health planning in the U.S. It mentions about the wasteful bidding wars for testing supplies and personal protective equipment (PPE) among hospitals and state and local governments; and the Medicare for All bills in Congress, if enacted, would do much to advance planning. It mentions that adequate investment in stockpiles of PPE and other equipment and the capacity to rapidly distribute it could also be undertaken by such a system.

In democratic elections, constituents may view unconventional or non‐prototypical candidates as attempting to reshape their national identity in the wrong direction. When a non‐prototypical candidate actually steps into a leadership role, the group's consensual view of their prototype may shift to position this new leader as prototypical. This process should be bound in member consensus, evidenced by the leader's successful election. The current work examines American Republicans (N = 297) and Democrats (N = 322) before and after the 2016 US election. We focus on Republicans' interpretations of their candidate Donald Trump's prototypicality and ability to bolster or subvert their party identity pre‐election. Post‐election, we examine changes to these processes, related in part to Republicans' homogenized view of Trump's prototypicality. In comparison, we examine these processes in the Democratic Party. Results suggest that whereas Democrats increased in their desire to leave their party, Republicans decreased in their desire to leave their party, an effect that is related to increasing perceptions of Trump's prototypicality and representation of the Republican Party. These findings have important implications for how the contexts of elections rapidly shape party identity through the election of leaders such as Trump. [ABSTRACT FROM AUTHOR]

Social psychological models of group identity and collective action should be particularly adept at providing psychological explanations for growing rates of populism in the Western World. Because populism tends to arise in times of societal shifts that reflect both economic and cultural changes, populist attitudes are likely grounded in perceptions of intergroup relations and collective attitudes. We surveyed 95 demonstrators at the 2016 Republican National Convention and 108 demonstrators at the Democratic National Convention. Results support the idea that relative anger prototypicality, in this case, the extent to which people believe that their own anger toward politicians is representative of most Americans' anger, predicts feelings of group‐based relative deprivation. Importantly, these feelings of deprivation mediate the relationship between prototypical anger and populist attitudes. These findings provide a unique picture of current political engagement, motivated by feelings of shared anger and collective feelings of lacking representation and voice. [ABSTRACT FROM AUTHOR]

Background U.S. Army Basic Combat Training (BCT) is a physically-demanding program at the start of military service. Whereas animal studies have shown that increased mechanical loading rapidly alters bone structure, there is limited evidence of changes in bone density and structure in humans exposed to a brief period of unaccustomed physical activity. Purpose We aimed to characterize changes in tibial bone density and microarchitecture and serum-based biochemical markers of bone metabolism in female recruits as a result of 8 weeks of BCT. Methods We collected high-resolution peripheral quantitative computed tomographic images of the distal tibial metaphysis and diaphysis (4% and 30% of tibia length from the distal growth plate, respectively) and serum markers of bone metabolism before and after BCT. Linear mixed models were used to estimate the mean difference for each outcome from pre- to post-BCT, while controlling for race/ethnicity, age, and body mass index. Results 91 female BCT recruits volunteered and completed this observational study (age = 21.5 ± 3.3 yrs). At the distal tibial metaphysis, cortical thickness, trabecular thickness, trabecular number, bone volume/total volume, and total and trabecular volumetric bone density (vBMD) increased significantly by 1–2% (all p < 0.05) over the BCT period, whereas trabecular separation, cortical tissue mineral density (TMD), and cortical vBMD decreased significantly by 0.3–1.0% (all p < 0.05). At the tibial diaphysis, cortical vBMD and cortical TMD decreased significantly (both −0.7%, p < 0.001). Bone strength, estimated by micro finite element analysis, increased by 2.5% and 0.7% at the distal tibial metaphysis and diaphysis, respectively (both p < 0.05). Among the biochemical markers of bone metabolism, sclerostin decreased (−5.7%), whereas bone alkaline phosphatase, C-telopeptide cross-links of type 1 collagen, tartrate-resistance acid phosphatase, and 25(OH)D increased by 10–28% (all p < 0.05). Conclusion BCT leads to improvements in trabecular bone microarchitecture and increases in serum bone formation markers indicative of new bone formation, as well as increases in serum bone resorption markers and decreases in cortical vBMD consistent with intracortical remodeling. Together, these results demonstrate specific changes in trabecular and cortical bone density and microarchitecture following 8 weeks of unaccustomed physical activity in women. [ABSTRACT FROM AUTHOR]

The article discusses a previous study on ambient asbestos fibers concentrations and long-term trends in pleural mesothelioma incidence between U.S. urban and rural areas between 1973 and 2012, and its findings. A letter in response to the findings had pointed out that asbestos exposures arising from the use of body and baby powders had been not been taken into account, the response to which is lack of any scientific evidence to support the hypotheses of contamination by cosmetic talc products.

The article highlights the contribution of two people in the U.S. health care Thomas Clement Douglas, and Ernest Charles Manning. It mentions that Douglas was a Canadian democratic socialist politician and Baptist minister, who was elected to the Canadian House of Commons in 1935 whose government was the first democratic socialist government in North America, and it introduced the continent's first single-payer, universal health care program, that led to Medicare. It discusses Manning, a Canadian politician, was the eighth premier of Alberta between 1943 and 1968 for the Social Credit Party of Alberta who foresaw practical problems with the Saskatchewan model which provided universal coverage of physicians' services in Canada.

Abstract: Military defense is generally treated in economics texts as a “public good” because the benefits are presumed to be shared by all citizens. However, defense spending by the United States cannot legitimately be classified as a public good, since the primary purpose of those expenditures has been to project power in support of private business interests. Throughout the course of the 20th century, U.S. military spending has been largely devoted to protecting the overseas assets of multinational corporations that are based in the United States or allied nations. Companies extracting oil, mineral ores, timber, and other raw materials are the primary beneficiaries. The U.S. military provides its services by supporting compliant political leaders in developing countries and by punishing or deposing regimes that threaten the interests of U.S.‐based corporations. The companies involved in this process generally have invested only a small amount of their own capital. Instead, the value of their overseas assets largely derives from the appreciation of oil and other raw materials in situ. Companies bought resource‐rich lands cheaply, as early as the 1930s or 1940s, and then waited for decades to develop them. In order to make a profit on this long‐range strategy, they formed cartels to limit global supply and relied on the U.S. military to help them maintain secure title over a period of decades. Those operations have required suppressing democratic impulses in dozens of nations. The global “sprawl” of extractive companies has been the catalyst of U.S. foreign policy for the past century. The U.S. Department of Defense provides a giant subsidy to companies operating overseas, and the cost is borne by the taxpayers of the United States, not by the corporate beneficiaries. Defining military spending as a “public good” has been a mistake with global ramifications, leading to patriotic support for imperialist behavior. [ABSTRACT FROM AUTHOR]

The article discusses the efforts of Republicans to repeal the Affordable Care Act (ACA) along with health insurance reform with it. Topics discussed include importance of single-payer national health insurance (NHI), universal coverage via NHI enrolment and role of the public and private sectors in health care coverage.

The article presents the author's comment to the proposal by Dana Goldman and Kip Hagopian regarding the need for reforms in health insurance in the U.S. Topics discussed include the number of uninsured persons in the U.S. according to the U.S. Census Bureau, the health care system in the U.S., and the health care spending in the country. Also mentioned is the use of cost sharing to reduce health care spending.

Objective Fetal exposure to maternal anti- SSA/Ro antibodies is necessary but not sufficient for the development of autoimmune congenital heart block ( CHB), suggesting that other factors, such as fetal genetic predisposition, are important. Given the previously described association between major histocompatibility complex alleles and CHB risk, we undertook the present study to test the hypothesis that a variant form of HLA-C Asn80Lys, which binds with high affinity to an inhibitory killer cell immunoglobulin-like receptor ( KIR) and thus renders natural killer ( NK) cells incapable of restricting inflammation, contributes to the development of CHB. Methods Members of 192 pedigrees in the US and Europe (194 cases of CHB, 91 unaffected siblings, 152 fathers, 167 mothers) and 1,073 out-of-study controls were genotyped on the Immunochip single-nucleotide polymorphism microarray. Imputation was used to identify associations at HLA-C Asn80Lys (Asn, C1; Lys, C2) and KIR. Tests for association were performed using logistic regression. McNemar's test and the pedigree disequilibrium test ( PDT) were used for matched analyses between affected and unaffected children. Results Compared with out-of-study controls of the same sex, the C2 allele was less frequent in the mothers (odds ratio [ OR] 0.63, P = 0.0014) and more frequent in the fathers ( OR 1.40, P = 0.0123), yielding a significant sex-by-C2 interaction ( P = 0.0002). The C2 allele was more frequent in affected siblings than in unaffected siblings ( OR 3.67, P = 0.0025), which was consistent with the PDT results ( P = 0.016); these results were observed in both sexes and across the US and European cohorts. There was no difference in the frequency of the inhibitory KIR genotype ( KIR AA) between affected and unaffected children ( P = 0.55). Conclusion These data establish C2 as a novel genetic risk factor associated with CHB. This observation supports a model in which fetuses with C2 ligand expression and maternal anti- SSA/Ro positivity may have impaired NK cell surveillance, resulting in unchecked cardiac inflammation and scarring. [ABSTRACT FROM AUTHOR]

Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access-particularly for poorer Americans, women, and minorities-its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform-especially following the 2016 presidential election-is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity. [ABSTRACT FROM AUTHOR]

Background: The 2010 Healthy Eating Index (HEI-2010), a measure of diet quality, is used to quantify adherence to the Dietary Guidelines for Americans. Better HEI scores have been associated with positive health outcomes; however, the relationship between diet quality and psychological resilience, a mental health attribute for coping with adversity, has not been assessed. Objective: The objective of the present study was to assess the relationship between diet quality and psychological resilience, and the relationship between resilience and demographics, anthropometrics, socioeconomic status, and health behavior. Design: In this cross-sectional study, HEI-2010 scores and resilience were assessed using the Block food frequency questionnaire and the Connor-Davidson Resilience Scale. Other factors that can affect the relationship between HEI-2010 scores and resilience were assessed using surveys, and height and weight were measured to calculate body mass index. Participants/setting: Male and female Army and Air Force recruits (n=834) enrolled in a randomized controlled trial and 656 (mean±standard deviation [SD] age=21±3.3 years) were included in this analysis. Data were collected before the initiation of military training at Fort Sill, OK (2012-2013) and Lackland Air Force Base, TX (2013-2014). Statistical analysis performed: Participants were split into low- and high-resilience groups based on Connor-Davidson Resilience Scale scores. Student's t test and ν2 tests were used to determine differences between groups for continuous and categorical variables, respectively. Logistic regression was utilized to identify predictors of resilience. Results: Better diet quality was associated with resilience; higher HEI predicted an increased likelihood (odds ratio=1.02; 95% CI 1.01 to 1.04) of a participant being in the high-resilience group after including race, ethnicity, education, smoking, age, body mass index, sex, and military branch in the full model. The data indicate that with every 10-point increase in HEI score, there was a 22% increased likelihood of being in the high-resilience group. Conclusions: Registered dietitian nutritionists should continue to encourage attainable changes to improve diet; study data suggest that small improvements in diet quality can be associated with better psychological resilience. [ABSTRACT FROM AUTHOR]

Workplace air samples analyzed for benzene at four US refineries from 1976 to 2007 were pooled into a single dataset to characterize similarities and differences between job titles, tasks and refineries, and to provide a robust dataset for exposure reconstruction. Approximately 12,000 non-task (>180 min) personal samples associated with 50 job titles and 4000 task (<180 min) samples characterizing 24 tasks were evaluated. Personal air sample data from four individual refineries were pooled based on a number of factors including (1) the consistent sampling approach used by refinery industrial hygienists over time, (2) the use of similar exposure controls, (3) the comparability of benzene content of process streams and end products, (4) the ability to assign uniform job titles and task codes across all four refineries, and (5) our analysis of variance (ANOVA) of the distribution of benzene air concentrations for select jobs/tasks across all four refineries. The jobs and tasks most frequently sampled included those with highest potential contact with refinery product streams containing benzene, which reflected the targeted sampling approach utilized by the facility industrial hygienists. Task and non-task data were analyzed to identify and account for significant differences within job-area, taskjob, and task-area categories. This analysis demonstrated that in general, areas with benzene containing process streams were associated with greater benzene air concentrations compared to areas with process streams containing little to no benzene. For several job titles and tasks analyzed, there was a statistically significant decrease in benzene air concentration after 1990. This study provides a job and task-focused analysis of occupational exposure to benzene during refinery operations, and it should be useful for reconstructing refinery workers' exposures to benzene over the past 30 years. [ABSTRACT FROM AUTHOR]

Objectives. Newborn hearing screening programs have been implemented by all 50 states and most U.S. territories to detect hearing loss in infants and prevent delays in speech, language, and social and emotional development. To monitor progress toward national goals, the Centers for Disease Control and Prevention (CDC) collects data from state and territorial programs. This article summarizes findings from the CDC Early Hearing Detection and Intervention (EHDI) Hearing Screening and Follow-up Survey (HSFS) and provides a summary of recent efforts to identify infants with hearing loss in the U.S. Methods. The HSFS was sent to representatives of U.S. EHDI programs to gather aggregate screening, diagnostic, intervention, and demographic data for 2005 and 2006. We analyzed these data to evaluate progress toward national goals. Results. In 2005 and 2006, more than 90% of infants were screened for hearing loss. Of these infants, 2% in both years did not pass their final screening. Out of those not passing the final screening, approximately two-thirds were not documented as having a diagnostic finding. In both years, the reason reported for the majority of infants was loss to follow-up/loss to documentation (LFU/ LTD). Although the majority of infants with permanent hearing loss were receiving intervention, more than 30% were classified as LFU/LTD and could not be documented as receiving intervention services. Conclusions. The HSFS enables the collection of more complete data that highlight the progress in screening infants for hearing loss. However, data indicate improvements are needed to reduce LFU/LTD and meet the national benchmarks. [ABSTRACT FROM AUTHOR]

This article addresses the impact of the Dodd-Frank Act and subsequent rulemaking by the MSRB, including Rule G-42 (Duties of Non-Solicitor Municipal Advisors), on the relationship between issuers and their municipal advisors. It discusses how the access to municipal advice has changed and how new rules and regulations have affected the financing process, solicitation for services, and communication between issuers and their municipal advisors and other professionals. It also considers how issuers can best navigate and manage their municipal advisors and discusses the role and limitations of a municipal advisor in bank loans as one example of where we have yet to see how all of this rulemaking will play out in the diverse municipal marketplace. [ABSTRACT FROM AUTHOR]

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This article provides background, insight and an assessment of the challenges and benefits of using college student interns to monitor public safety cameras. Based on one element of a strong partnership between the Pullman (WA) Police Department and Washington State University, this descriptive study focuses on the formation of a student internship program to monitor public safety cameras in a high-disorder area to enhance crime prevention, police response capacity, and public safety. This effort has been underway for over2 years, and illustrates the positive outcomes for public safety that can result from effective practitioner/academic collaborations. [ABSTRACT FROM AUTHOR]

The article reports the decision of the U.S. Third Circuit court in the case 'In re Forever Green Athletic Fields, Inc.,' in which the court held that an alleged debtor could dismiss an involuntary petition in bankruptcy solely based on the petitioning creditors' bad faith.

The concentrated ownership of farmland has influenced rural life in the state of California for more than a century. Reformers have introduced measures to counteract that concentration, such as acreage limits on farms receiving water from federally funded projects. Large landowners have fought back with policies that have protected their ability to amass and maintain their empires. In the first part of this article, Mason Gaffney presents this historical background in broad outlines. In the second part, Merrill Goodall explains an important policy that preserves the power of entrenched interests: water districts that are governed by a board elected by a voting system that allots one vote to each dollar of land value. In these districts, a tiny handful of landowners is able to control a public agency without opposition and without the need to persuade other voters. [ABSTRACT FROM AUTHOR]

Objective Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage. Methods We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results The IRF5-TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control-adjusted P [ Pgcadj] = 2.61 × 10−29, OR 2.12 [95% CI 1.88-2.39]), followed by HLA class II on the DQA2-DQB1 loci (rs9275572: Pgcadj = 1.11 × 10−16, OR 1.62 [95% CI 1.46-1.80] and rs9271366: Pgcadj = 6.46 × 10−12, OR 2.06 [95% CI 1.71-2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj = 1.39 × 10−8) with an expression quantitative trait locus (eQTL) effect ( Peqtl = 8.0 × 10−37 at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE. Conclusion Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases. [ABSTRACT FROM AUTHOR]