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The objective was to evaluate the association between serum carotenoid levels and respiratory morbidity and mortality in a nationally representative sample of US adults. We assessed the association of serum carotenoid levels with respiratory morbidity and mortality using logistic regression and proportional hazards regression models. Meanwhile, a series of confounders were controlled in regression models and restricted cubic spline, which included age, sex, race, marriage, education, income, drinking, smoking, regular exercise, BMI, daily energy intake, vitamin E, vitamin C, fruit intake, vegetable intake, diabetes, hypertension, asthma, emphysema and chronic bronchitis. Compared with participants in the lowest tertiles, participants in the highest tertiles of serum total carotenoids, β -cryptoxanthin and lutein/zeaxanthin levels had a significantly lower prevalence of emphysema (ORtotal carotenoids = 0·61, 95% CI: 0·41–0·89, OR β -cryptoxanthin = 0·67, 95% CI: 0·49–0·92), chronic bronchitis (OR β -cryptoxanthin = 0·66, 95% CI: 0·50–0·87) and asthma (Q2: ORlutein/zeaxanthin = 0·78, 95% CI: 0·62–0·97); participants in the highest tertiles of total carotenoids, α -carotene, lutein/zeaxanthin and lycopene had a lower risk of respiratory mortality (hazard ratio (HR)total carotenoids = 0·62, 95% CI: 0·42–0·90, HR α -carotene = 0·54, 95% CI: 0·36–0·82, HRlutein/zeaxanthin = 0·48, 95% CI: 0·33–0·71, HRlycopene = 0·66, 95% CI: 0·45–0·96) than those in the lowest tertiles. Higher serum total carotenoids and β -cryptoxanthin levels is associated with decreased prevalence of emphysema and chronic bronchitis, and higher serum total carotenoids, α -carotene, lutein/zeaxanthin and lycopene levels had a lower mortality of respiratory disease. [ABSTRACT FROM AUTHOR]

Collective action researchers have recently started investigating solidarity‐based collective action by advantaged groups. This literature, however, has overlooked intergroup meta‐beliefs (MBs, i.e., beliefs about the outgroup's beliefs), which we argue are crucial, since solidarity inherently involves protesting for the outgroup. In the context of racial inequality in the U.S., we focused on three MBs White Americans could hold: responsibility, inactivity, and allyship. In two studies (Ntotal = 648), we found that inactive and responsible MBs predicted higher collective action tendencies among low White identifiers via guilt and obligation to act. Conversely, we found that both predicted lower collective action tendencies among high White identifiers, via perceived unfairness. Finally, we found that ally MB was positively associated with collective action tendencies, regardless of identification. We highlight the importance of the meta‐perspective in understanding solidarity‐based collective action, and discuss conceptual and practical implications of these findings. [ABSTRACT FROM AUTHOR]

This study estimates the association between temperature and self-reported mental health. We match individual-level mental health data for over three million Americans between 1993 and 2010 to historical daily weather information. We exploit the random fluctuations in temperature over time within counties to identify its effect on a 30-day measure of self-reported mental health. Compared to the temperature range of 60–70°F, cooler days in the past month reduce the probability of reporting days of bad mental health while hotter days increase this probability. We also find a salience effect: cooler days have an immediate effect, whereas hotter days tend to matter most after about 10 days. Using our estimates, we calculate the willingness to pay to avoid an additional hot day in terms of its impact on self-reported mental health. [ABSTRACT FROM AUTHOR]

The landscape of oncology drug development has witnessed remarkable advancements over the last few decades, significantly improving clinical outcomes and quality of life for patients with cancer. Project Optimus, introduced by the U.S. Food and Drug Administration, stands as a groundbreaking endeavor to reform dose selection of oncology drugs, presenting both opportunities and challenges for the field. To address complex dose optimization challenges, an Oncology Dose Optimization IQ Working Group was created to characterize current practices, provide recommendations for improvement, develop a clinical toolkit, and engage Health Authorities. Historically, dose selection for cytotoxic chemotherapeutics has focused on the maximum tolerated dose, a paradigm that is less relevant for targeted therapies and new treatment modalities. A survey conducted by this group gathered insights from member companies regarding industry practices in oncology dose optimization. Given oncology drug development is a complex effort with multidimensional optimization and high failure rates due to lack of clinically relevant efficacy, this Working Group advocates for a case-by-case approach to inform the timing, specific quantitative targets, and strategies for dose optimization, depending on factors such as disease characteristics, patient population, mechanism of action, including associated resistance mechanisms, and therapeutic index. This white paper highlights the evolving nature of oncology dose optimization, the impact of Project Optimus, and the need for a tailored and evidence-based approach to optimize oncology drug dosing regimens effectively., (© 2024 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Importance: Direct costs of substance use disorders (SUDs) in the United States are incurred primarily among the working-age population. Quantifying the medical cost of SUDs in the employer-sponsored insurance (ESI) population can improve understanding of how SUDs are affecting workplaces and inform decision-making on the value of prevention strategies., Objective: To estimate the annual attributable medical cost of SUDs in the ESI population from the health care payer perspective., Design, Setting, and Participants: In this economic evaluation, Merative MarketScan 2018 databases were weighted to represent the non-Medicare eligible ESI population. Regression and mathematical modeling of medical expenditures controlled for insurance enrollee demographic, clinical, and insurance factors to compare enrollees with and without an SUD diagnosis to identify the annual attributable medical cost of SUDs. Data analysis was conducted from January to March 2022., Exposures: International Statistical Classification of Diseases, Tenth Revision, Clinical Modification SUD diagnoses on inpatient or outpatient medical records according to Clinical Classifications Software categories (alcohol-, cannabis-, hallucinogen-, inhalant-, opioid-, sedative-, stimulant-, and other substance-related disorders)., Main Outcomes and Measures: Annual SUD medical cost in the ESI population overall and by substance type (eg, alcohol). Number of enrollees with an SUD diagnosis and the annual mean cost per affected enrollee of SUD diagnosis (any and by substance type) are also reported., Results: Among 162 million ESI enrollees, 2.3 million (1.4%) had an SUD diagnosis in 2018. The regression analysis sample included 210 225 individuals with an SUD diagnosis (121 357 [57.7%] male individuals; 68 325 [32.5%] aged 25-44 years) and 1 049 539 individuals with no SUD diagnosis. The mean annual medical cost attributable to SUD diagnosis per affected enrollee was $15 640 (95% CI, $15 340-$15 940), and the total annual medical cost in the ESI population was $35.3 billion (2018 USD). Alcohol use disorder ($10.2 billion) and opioid use disorder ($7.3 billion) were the most costly., Conclusions and Relevance: In this economic evaluation of medical expenditures in the ESI population, the per-person and total medical costs of SUDs were substantial. Strategies to support employees and their health insurance dependents to prevent and treat SUDs can be considered in terms of potentially offsetting the existing high medical cost of SUDs. Medical expenditures for SUDs represent the minimum direct cost that employers and health insurers face because not all people with SUDs have a diagnosis, and costs related to absenteeism, presenteeism, job retention, and mortality are not addressed.

Objective: This study aimed to investigate the status quo and the influencing factors of fatigue and professional identity among the Centers for Disease Control and Prevention (CDC) workers in China during the pandemic., Design: A cross-sectional design., Setting: CDC workers employed by the Liaoning CDC system were enrolled (administrative staffs were excluded)., Participants: 1020 CDC workers., Primary Outcome Measures: Fatigue scores and professional identity scores., Secondary Outcome Measures: Postcompetency scores, respect scores, occupational stress scores, resilience scores and self-efficacy scores., Results: The average scores of fatigue and professional identity were 8.23, 38.88, respectively. Factors including perceived public respect ( β =-0.129, p<0.01), resilience ( β =-0.104, p<0.05) and self-efficacy ( β =-0.22, p<0.01) were negatively associated with fatigue. Educational background (bachelor vs junior college or below) ( β =0.105, p<0.01), (master or above vs junior college or below) ( β =0.092, p<0.05), workplace (county vs district) ( β =0.067, p<0.05), (city vs district) ( β =0.085, p<0.05), fighting the COVID-19 on the front line ( β =0.059, p<0.05) and occupational stress ( β =0.166, p<0.01) were positively correlated with fatigue. Educational background (bachelor vs junior college or below) ( β =-0.097, p<0.01), (master or above vs junior college or below) ( β =-0.114, p<0.01), workplace (city vs district) ( β =-0.114, p<0.01), fighting the COVID-19 on the front line ( β =-0.047, p<0.05) and occupational stress ( β =-0.105, p<0.01) were negatively associated with professional identity. Factors including postcompetency ( β =0.362, p<0.01), perceived public respect (general vs low) ( β =0.219, p<0.01), (high vs low) ( β =0.288, p<0.01), resilience ( β =0.097, p<0.05) and self-efficacy ( β =0.113, p<0.01) were positively connected with professional identity., Conclusion: The fatigue among the CDC workers was at a higher level. The level of professional identity was high, and administrators should take measures to alleviate fatigue and maintain professional identity. In addition, methods aiming to attenuate occupational stress, and improve resilience and self-efficacy should be immediately put into action., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

U.S.-based research suggests conservatism is linked with less concern about contracting coronavirus and less preventative behaviors to avoid infection. Here, we investigate whether these tendencies are partly attributable to distrust in scientific information, and evaluate whether they generalize outside the U.S., using public data and recruited representative samples across three studies (N total  = 34,710). In Studies 1 and 2, we examine these relationships in the U.S., yielding converging evidence for a sequential indirect effect of conservatism on compliance through scientific (dis)trust and infection concern. In Study 3, we compare these relationships across 19 distinct countries. Although the relationships between trust in scientific information about the coronavirus, concern about coronavirus infection, and compliance are consistent cross-nationally, the relationships between conservatism and trust in scientific information are not. These relationships are strongest in North America. Consequently, the indirect effects observed in Studies 1-2 only replicate in North America (the U.S. and Canada) and in Indonesia. Study 3 also found parallel direct and indirect effects on support for lockdown restrictions. These associations suggest not only that relationships between conservatism and compliance are not universal, but localized to particular countries where conservatism is more strongly related to trust in scientific information about the coronavirus pandemic., (© 2022. The Author(s).)

We remember the past in order not to repeat it, but does remembrance of war in fact shape support for military or diplomatic approaches to international conflict? In seven samples from five countries (collected online, total N = 2,493), we examined support for military and diplomatic approaches to conflict during war commemorations (e.g., Veterans Day). During war commemorations in the United States, support for diplomacy increased, whereas support for military approaches did not change. We found similar results in the United Kingdom and Australia on Remembrance Day, but not in Germany, or France, nor in Australia on Anzac Day. Furthermore, support for diplomacy was predicted by concern about loss of ingroup military lives during war, independently of concern about harm to outgroup civilians. These studies expand our understanding of how collective memories of war may be leveraged to promote diplomatic approaches to contemporary geopolitical conflict.

Approximately 47,000 persons in the United States died from an opioid-involved overdose in 2018 (1), and 2.0 million persons met the diagnostic criteria for an opioid use disorder in 2017 (2). The economic cost of the U.S. opioid epidemic in 2017 was estimated at $1,021 billion, including cost of opioid use disorder estimated at $471 billion and cost of fatal opioid overdose estimated at $550 billion (3). CDC used national-level cost estimates to estimate the state-level economic cost of opioid use disorder and fatal opioid overdose during 2017. Cases and costs of state-level opioid use disorder and fatal opioid overdose and per capita costs were calculated for each of the 38 states and the District of Columbia (DC) that met drug specificity requirements for mortality data (4). Combined costs of opioid use disorder and fatal opioid overdose (combined costs) varied substantially, ranging from $985 million in Wyoming to $72,583 million in Ohio. Per capita combined costs also varied considerably, ranging from $1,204 in Hawaii to $7,247 in West Virginia. States with high per capita combined costs were mainly in two regions: the Ohio Valley and New England. Federal and state public health agencies can use these data to help guide decisions regarding research, prevention and response activities, and resource allocation., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Importance: A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment., Objective: To estimate the annual attributable medical cost of SUD in US hospitals from the health care payer perspective., Design, Setting, and Participants: This economic evaluation of observational data used multivariable regression analysis and mathematical modeling of hospital encounter costs, controlling for patient demographic, clinical, and insurance characteristics, and compared encounters with and without secondary SUD diagnosis to statistically identify the total attributable cost of SUD. Nationally representative hospital emergency department (ED) and inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample were studied. Statistical analysis was performed from March to June 2020., Exposures: International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) principal or secondary SUD diagnosis on the hospital discharge record according to the Clinical Classifications Software categories (disorders related to alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, and other substances)., Main Outcomes and Measures: Annual attributable SUD medical cost in hospitals overall and by substance type (eg, alcohol). The number of encounters (ED and inpatient) with SUD diagnosis (principal or secondary) and the mean cost attributable to SUD per encounter by substance type are also reported., Results: This study examined a total of 124 573 175 hospital ED encounters and 33 648 910 hospital inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample. Total annual estimated attributable SUD medical cost in hospitals was $13.2 billion. By substance type, the cost ranged from $4 million for inhalant-related disorders to $7.6 billion for alcohol-related disorders., Conclusions and Relevance: This study's results suggest that the cost of effective prevention and treatment may be substantially offset by a reduction in the high direct medical cost of SUD hospital care. The findings of this study may inform the treatment of patients with SUD during hospitalization, which presents a critical opportunity to engage patients who are at high risk for overdose. Aligning incentives such that prevention cost savings accrue to payers and practitioners that are otherwise responsible for SUD-related medical costs in hospitals and other health care settings may encourage prevention investment.