Psychosocial Correlates of Insomnia Among College Students.

INTRODUCTION: Among college students, insomnia remains a topic of research focus, especially as it pertains to its correlates and the extent of its association with mental conditions. This study aimed to shed light on the chief predictors of insomnia among college students. METHODS: A cross-sectional survey on a convenience sample of college students (aged ≥18 years) at 2 large midwestern universities was conducted from March 18 through August 23, 2019. All participants were administered validated screening instruments used to screen for insomnia, depression, and attention deficit hyperactivity disorder (ADHD). Insomnia correlates were identified by using multivariate logistic regression. RESULTS: Overall, 26.4% of students experienced insomnia; 41.2% and 15.8% had depression and had ADHD symptoms, respectively. Students with depression (adjusted odds ratio, 9.54; 95% CI, 4.50-20.26) and students with ADHD (adjusted odds ratio, 3.48; 95% CI, 1.48-8.19) had significantly higher odds of insomnia. The odds of insomnia were also significantly higher among employed students (odds ratio, 2.10; 95% CI, 1.05-4.18). CONCLUSION: This study showed an association between insomnia and mental health conditions among college students. Policy efforts should be directed toward primary and secondary prevention programs that enforce sleep education interventions, particularly among employed college students and those with mental illnesses.

Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States.

The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.

Variations in VA and Medicare Use Among Veterans With Diabetes: Impacts on Ambulatory Care Sensitive Conditions Hospitalizations for 2008, 2009, and 2010.

INTRODUCTION: VA and Medicare use among older Veterans has been considered fragmented care, however, it may represent access to needed care. METHODS: The population studied were Veterans with diabetes, age 66 years and older, dually enrolled in VA and Medicare. DATA SOURCE/STUDY SETTING: We conducted a dynamic retrospective cohort study with 2008, 2009, and 2010 as the outcome years (Ambulatory Care Sensitive Conditions Hospitalization (ACSC-H) or not). We analyzed administrative data to identify comorbidities; ambulatory care utilization to identify variations in use before hospitalization. We linked 2007 primary care (PC) survey data to assess if organizational factors were associated with ACSC-H. MEASURES AND ANALYSIS: We identified ACSC-Hs using a validated definition. We categorized VA/Medicare use as: single system; dual system: supplemental specialty care use; or primary care use. Using hierarchical logistic regression models, we tested for associations between VA/Medicare use, organizational characteristics, and ACSC-H controlling for patient-level, organizational-level, and area-level characteristics. RESULTS: Our analytic population was comprised of 210,726 Medicare-eligible Veterans; more than one quarter had an ACSC-H. We found that single system users had higher odds of ACSC-H compared with dual system specialty supplemental care use (odds ratio, 1.14; 95% confidence interval, 1.09-1.20), and no significant difference between dual-system users. Veterans obtaining care at sites where PC leaders reported greater autonomy (eg, authority over personnel issues) had lower odds of ACSC-H (odds ratio, 0.74; 95% confidence interval, 0.59-0.92). DISCUSSION: Our findings suggest that earlier assumptions about VA/Medicare use should be weighed against the possibility that neither VA nor Medicare may address complex Veterans' health needs. Greater PC leader autonomy may allow for tailoring of care to match local clinical contexts.

Impact of Incident Cancer on Short-Term Coronary Artery Disease-Related Healthcare Expenditures Among Medicare Beneficiaries.

Background: Healthcare spending for coronary artery disease (CAD)-related services is higher than for other chronic conditions. Diagnosis of incident cancer may impede management of CAD, thereby increasing the risk of CAD-related complications and associated healthcare expenditures. This study examined the relationship between incident cancer and CAD-related expenditures among elderly Medicare beneficiaries. Patients and Methods: A retrospective longitudinal study was conducted using the SEER-Medicare linked registries and a 5% noncancer random sample of Medicare beneficiaries. Elderly fee-for-service Medicare beneficiaries with preexisting CAD and with incident breast, colorectal, or prostate cancer (N=12,095) or no cancer (N=34,237) were included. CAD-related healthcare expenditures comprised Medicare payments for inpatient, home healthcare, and outpatient services. Expenditures were measured every 120 days during the 1-year preindex and 1-year postindex periods. Adjusted relationship between incident cancer and expenditures was analyzed using the generalized linear mixed models. Results: Overall, CAD-related mean healthcare expenditures in the preindex period accounted for approximately 32.6% to 39.5% of total expenditures among women and 41.5% to 46.8% among men. All incident cancer groups had significantly higher CAD-related expenditures compared with noncancer groups (P<.0001). Men and women with colorectal cancer (CRC) had 166% and 153% higher expenditures, respectively, compared with their noncancer counterparts. Furthermore, men and women with CRC had 57% and 55% higher expenditures compared with those with prostate or breast cancer, respectively. Conclusions: CAD-related expenditures were higher for elderly Medicare beneficiaries with incident cancer, specifically for those with CRC. This warrants the need for effective programs and policies to reduce CAD-related expenditures. Close monitoring of patients with a cancer diagnosis and preexisting CAD may prevent CAD-related events and expenditures.

Health reform under the patient protection and Affordable Care Act: characteristics of exchange-based health insurance enrollees.

The Affordable Care Act (ACA) reformed and expanded healthcare coverage with an exchange-based health insurance program. While millions of Americans have benefited from enrollment in ACA marketplace insurance plans, many individuals are likely to be affected by potential future policy changes. Since few studies on the features of marketplace enrollees exist, we adopted a retrospective, cross-sectional study design using 2016 National Health Interview data to identify sociodemographic and health characteristics of enrollees, comparing them to those without insurance. Chi-square tests and logistic regression examined factors associated with enrollees. Adults with multiple chronic diseases (AOR = 1.90, 95% CI = 1.44, 2.50), a history of smoking (AOR = 2.44, 95% CI = 1.82, 3.26), females, married, age 50-64 years, higher educational attainment, and retirees (AOR = 1.86, 95% CI = 1.06, 3.27) were more likely to be enrollees. Since enrollees are largely higher risk individuals with greater healthcare needs, policies that modify the ACA should take these factors into account to reduce potential adverse impacts on enrollees.

Opioid Overdose Knowledge among College Students in a High Overdose Death State.

PURPOSE: The goal of this study was to investigate university students' knowledge about identification of opioid overdose and actions to take in an overdose emergency. METHODS: A cross-sectional, anonymous, 36-item survey was developed and administered to West Virginia University (WVU) students. Overdose knowledge was assessed using the Opioid Overdose Knowledge Scale (OOKS). Demographic information, health insurance coverage status, previously receiving an opioid prescription, and knowledge about West Virginia Good Samaritan laws were also collected. Online survey responses were collected via REDCap. RESULTS: The study sample (n=214) was 90% white, 72.5% female, had a mean age of 24.8 years, and over half previously received a prescription opioid (51.9%). Additionally, 6.5% reported witnessing an overdose in the past year, and 15.9% previously received naloxone training. Overall, our participants had an average score of 30.9 out of 45 on the OOKS. Participants who previously received naloxone training scored higher overall on the OOKS than participants who did not (p<0.001). Similarly, participants who previously received a prescription for an opioid also scored higher than participants who had never had a previous prescription for an opioid (p<0.001). CONCLUSIONS: University students' knowledge suggests that previous exposure to opioid prescriptions and naloxone training increase a student's knowledge about opioid overdose. This information is not surprising; however, this does make the case that students may benefit from brief overdose education programs that could be implemented across university health education curricula. However, a larger effort may need to be implemented to encourage students to participate in such programs.

Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden Among Elderly Medicare Beneficiaries.

OBJECTIVE: To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). METHODS: We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. RESULTS: The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95% confidence interval, 1.13-1.97) compared with those without ADRD. CONCLUSION: ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

The dynamic relationships between economic status and health measures among working-age adults in the United States.

We examine the dynamic relationships between economic status and health measures using data from 8 waves of the Panel Study of Income Dynamics from 1999 to 2013. Health measures are self-rated health (SRH) and functional limitations; economic status measures are labor income (earnings), family income, and net wealth. We use 3 different types of models: (a) ordinary least squares regression, (b) first-difference, and (c) system-generalized method of moment (GMM). Using ordinary least squares regression and first difference models, we find that higher levels of economic status are associated with better SRH and functional status among both men and women, although declines in income and wealth are associated with a decline in health for men only. Using system-GMM estimators, we find evidence of a causal link from labor income to SRH and functional status for both genders. Among men only, system-GMM results indicate that there is a causal link from net wealth to SRH and functional status. Results overall highlight the need for integrated economic and health policies, and for policies that mitigate the potential adverse health effects of short-term changes in economic status.

Treatment for Depression and Health-Related Quality of Life among Adults with Arthritis.

Depression treatment has been proven to relieve depressive symptoms and pain and may therefore improve the health-related quality of life (HRQoL) among adults with arthritis. The objective of the current study was to examine the HRQoL associated with depression treatment among adults with arthritis and depression. A retrospective longitudinal cohort study design using data from the Medical Expenditure Panel Survey (2009-2012) was adopted. The study sample consisted of adults (≥ 21 years) with co-existing arthritis and depression (N = 1692). Depression treatment was categorized into: antidepressants only, psychotherapy with or without antidepressants, and neither antidepressants nor psychotherapy. Multivariable Ordinary Least Square (OLS) regressions, which controlled for observed selection bias with inverse probability treatment weights (IPTW) were built to examine the association between depression treatment categories and the HRQoL scores. The OLS regression controlled for factors in the biological, psychological and social domains that may affect HRQoL. A majority of individuals reported taking antidepressants only (52%), 24.4% reported receiving psychotherapy with or without antidepressants and 23% did not receive either antidepressants or psychotherapy. In multivariable OLS regression with IPTWs, adults using only antidepressants had marginally higher physical component summary scores (beta = 0.96, p value = 0.096) compared to no depression treatment. There were no significant associations between depression categories and mental component summary scores. HRQoL was not affected by depression treatment in adults with coexisting arthritis and depression. Improvement in HRQoL may require a collaborative care approach and such intense care may not be replicated in real-world practice settings.

Nonadherence to Statins and Antihypertensives and Hospitalizations Among Elderly Medicare Beneficiaries With Incident Cancer.

Background: Incident cancer diagnosis may increase the risk of coronary artery disease (CAD)-related hospitalizations, especially in older individuals. Adherence to statins and/or angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs)/ß-blockers reduces CAD-related hospitalizations. This study examined the relationship between medication adherence and CAD-related hospitalizations immediately following cancer diagnosis. Patients and Methods: A retrospective observational longitudinal study was conducted using SEER-Medicare data. Elderly Medicare fee-for-service beneficiaries with preexisting CAD and incident breast, colorectal, or prostate cancer (N=12,096) were observed for 12 months before and after cancer diagnosis. Hospitalizations measured every 120 days were categorized into CAD-related hospitalization, other hospitalization, and no hospitalization. Medication adherence was categorized into 5 mutually exclusive groups: adherent to both statins and ACEIs/ARBs/ß-blockers (reference group), not adherent to both statins and ACEIs/ARBs/ß-blockers, adherent to either statins or ACEIs/ARBs/ß-blockers, use of one medication class and adherent to that class, and use of one medication class and not adherent to that class. The relationship between medication adherence and hospitalization was analyzed using repeated measures multinomial logistic regressions. Inverse probability treatment weights were used to control for observed group differences among medication adherence categories. Results: Adherence to both statins and ACEIs/ARBs/ß-blockers was estimated at 31.2% during the 120-day period immediately following cancer diagnosis; 13.7% were not adherent to both medication classes during the same period, and 27.4% had CAD-related hospitalizations immediately after cancer diagnosis, which declined to 10.6% during the last 4 months of the postdiagnosis period. In the adjusted analyses, those not adherent to both statins and ACEIs/ARBs/ß-blockers were more likely to have CAD-related hospitalization compared with those adherent to both medication classes (adjusted odds ratio, 1.82; 95% CI, 1.72-1.92; P<.0001). Conclusions: Given the complexity of interaction between CAD and cancer, it is important to routinely monitor medication adherence in general clinical practice and to provide linkages to support services that can increase medication adherence.

Health-related quality of life in patients receiving long-term opioid therapy: a systematic review with meta-analysis.

PURPOSE: Over 25 million Americans reported having daily pain and between 5 and 8 million Americans used opioids to treat chronic pain in 2012. This is the first systematic review with meta-analysis to determine the effects of long-term opioid use on the Physical Component Summary (PCS) score and Mental Component Summary (MCS) scores of a Health-Related Quality of Life instrument in adults without opioid use disorder. METHODS: The a priori eligibility criteria for the PubMed (MEDLINE), Scopus, and PsyINFO searches were (1) randomized controlled trial, (2) at least one opioid intervention group, (3) minimum of 4-week duration of opioid use, (4) comparative control group, and (5) adults ≥18 years that do not have dominant disease. The unit of analysis was the standardized mean difference effect size (Hedges's g). All results were pooled using random-effects models. RESULTS: Of the 340 non-duplicate citations screened, 19 articles comprising 26 treatment comparisons and 6168 individuals (treatment n = 3160; comparators n = 3008 with duplicates removed) met the inclusion criteria for the systematic review. Thirteen treatment comparisons were available for the meta-analysis. Across all PCS analyses, small, statistically significant improvements were observed (opioid versus opioid only: g = 0.27, 95% CI 0.05-0.50, opioid versus placebo only: g = 0.18, 95% CI 0.08-0.28, and all studies combined: g = 0.22, 95% CI 0.11-0.32). There were small but not statistically significant changes on the MCS scores. Overall, high heterogeneity was present. CONCLUSIONS: PCS scores improve with no change in MCS scores. However, long-term opioid trials are rare and only two trials included lasted longer than 1 year.

Pharmacists' readiness to provide naloxone in community pharmacies in West Virginia.

OBJECTIVES: The objective of this study is to assess West Virginia pharmacists' stocking and dispensing practices of opioid-related medications and to identify the educational needs relating to providing naloxone in community pharmacies. DESIGN: A cross-sectional, anonymous, 49-item survey was created and validated to assess the educational needs of West Virginia community pharmacists. SETTING: West Virginia. PARTICIPANTS: The data collection instrument was administered to 266 pharmacists currently licensed in West Virginia at 6 continuing pharmacy education events throughout the state from March 1 to June 15, 2016. OUTCOME MEASURES: Pharmacists' educational needs were determined using the Extended Parallel Process Model, which has 4 main constructs: perceived severity, perceived susceptibility, response efficacy, and self-efficacy. Pharmacists' stocking and dispensing of opioids and related medications were also assessed. RESULTS: Pharmacists completed 157 surveys. They were mostly male (56.1%), full-time employees (67.5%), worked mostly in community pharmacies (69.4%), and had a mean age of 50.19 years (SD = 13.62). The newly adapted opioid perceived efficacy and perceived severity of opioid adverse events scales were tested for reliability and validity. Only 20.4% of the community pharmacists surveyed felt comfortable selling naloxone without a prescription. As for the other opioid-related medications, only 53.3% stocked buprenorphine and 74.8% stocked buprenorphine/naloxone. CONCLUSIONS: As the most accessible health care providers, community pharmacists are acutely aware of how the opioid epidemic affects their communities. Some pharmacists in West Virginia are hesitant to stock and dispense opioids and opioid-dependence medications. Although this may decrease the flow of potentially abused drugs into the community, it may also restrict access to necessary therapy for patients with opioid use disorder. Furthermore, pharmacists in West Virginia are not yet comfortable stocking and dispensing naloxone. Tailored educational materials can help in controlling the pharmacists' fear and reinforce the benefits of over-the-counter naloxone use.

Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression.

BACKGROUND: There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. METHODS: We used multi-state Medicaid data (2000-2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. RESULTS: Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. CONCLUSIONS: Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.

Polypharmacy and Health-Related Quality of Life Among US Adults With Arthritis, Medical Expenditure Panel Survey, 2010-2012.

INTRODUCTION: Our objective was to determine the relationship between polypharmacy (treatment with prescription drugs from 6 or more drug classes concurrently) and health-related quality of life (HRQoL) among US adults with arthritis. METHODS: We conducted a retrospective cohort study that used 2-year longitudinal data from the Medical Expenditure Panel Survey to analyze a cohort of 6,132 adults aged over 21 years with arthritis. Measures of HRQoL were the summary scores from the mental component summary (MCS) and physical component summary (PCS) of the 12-item short-form health survey. Unadjusted and adjusted regression models were used to evaluate the association between polypharmacy and HRQoL measures. We used SAS, version 9.4, (SAS Institute Inc) to conduct all analyses. RESULTS: In unadjusted analyses, adults with arthritis taking prescription drugs from 6 or more drug classes concurrently had significantly lower MCS and PCS scores (ß, -3.11, P < .001 and ß, -10.26, P < .001, respectively) than adults taking prescription drugs from fewer than 6. After controlling for the demographic characteristics, number of mental and physical chronic conditions, and baseline MCS and PCS scores, adults taking prescription drugs from 6 or more drug classes concurrently had significantly lower PCS scores (ß, -1.68, P < .001), than those taking prescription drugs from fewer than 6. However, no significant difference in MCS scores was found between adults taking prescription drugs from 6 or more drug classes concurrently and those taking prescription drugs from fewer than 6 (ß, -0.27, P = .46). CONCLUSION: Polypharmacy is significantly associated with lower PCS scores among adults with arthritis. Because polypharmacy can lead to drug-drug and drug-disease interactions, health care providers need to consider the risk and adopt a cautious approach in prescribing multiple drugs to manage chronic conditions and in choosing therapies to improve HRQoL among adults with arthritis.

Prescription Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Incidence of Depression Among Older Cancer Survivors With Osteoarthritis: A Machine Learning Analysis.

ObjectiveS: This study examined prescription NSAIDs as one of the leading predictors of incident depression and assessed the direction of the association among older cancer survivors with osteoarthritis. Methods: This study used a retrospective cohort (N = 14, 992) of older adults with incident cancer (breast, prostate, colorectal cancers, or non-Hodgkin's lymphoma) and osteoarthritis. We used the longitudinal data from the linked Surveillance, Epidemiology, and End Results -Medicare data for the study period from 2006 through 2016, with a 12-month baseline and 12-month follow-up period. Cumulative NSAIDs days was assessed during the baseline period and incident depression was assessed during the follow-up period. An eXtreme Gradient Boosting (XGBoost) model was built with 10-fold repeated stratified cross-validation and hyperparameter tuning using the training dataset. The final model selected from the training data demonstrated high performance (Accuracy: 0.82, Recall: 0.75, Precision: 0.75) when applied to the test data. SHapley Additive exPlanations (SHAP) was used to interpret the output from the XGBoost model. Results: Over 50% of the study cohort had at least one prescption of NSAIDs. Nearly 13% of the cohort were diagnosed with incident depression, with the rates ranging between 7.4% for prostate cancer and 17.0% for colorectal cancer. The highest incident depression rate of 25% was observed at 90 and 120 cumulative NSAIDs days thresholds. Cumulative NSAIDs days was the sixth leading predictor of incident depression among older adults with OA and cancer. Age, education, care fragmentation, polypharmacy, and zip code level poverty were the top 5 predictors of incident depression. Conclusion: Overall, 1 in 8 older adults with cancer and OA were diagnosed with incident depression. Cumulative NSAIDs days was the sixth leading predictor with an overall positive association with incident depression. However, the association was complex and varied by the cumulative NSAIDs days.

Association of multimorbidity with the use of health information technology.

Objective: To examine the association of multimorbidity with health information technology use among adults in the USA. Methods: We used cross-sectional study design and data from the Health Information National Trends Survey 5 Cycle 4. Health information technology use was measured with ten variables comprising access, recent use, and healthcare management. Unadjusted and adjusted logistic and multinomial logistic regressions were used to model the associations of multimorbidity with health information technology use. Results: Among adults with multimorbidity, health information technology use for specific purposes ranged from 37.8% for helping make medical decisions to 51.7% for communicating with healthcare providers. In multivariable regressions, individuals with multimorbidity were more likely to report general use of health information technology (adjusted odds ratios = 1.48, 95% confidence intervals = 1.01-2.15) and more likely to use health information technology to check test results (adjusted odds ratios = 1.85, 95% confidence intervals = 1.33-2.58) compared to adults with only one chronic condition, however, there were no significant differences in other forms of health information technology use. We also observed interactive associations of multimorbidity and age on various components of health information technology use. Compared to younger adults with multimorbidity, older adults (≥ 65 years of age) with multimorbidity were less likely to use almost all aspects of health information technology. Conclusion: Health information technology use disparities by age and multimorbidity were observed. Education and interventions are needed to promote health information technology use among older adults in general and specifically among older adults with multimorbidity.

Factors associated with COVID-19-related mental health among Asian Indians in the United States.

Background: In the United States, the COVID-19 pandemic has caused increased mental health symptoms and mental illness. Specific subgroups such as Asian Indians in the US have also been subject to additional stressors due to unprecedented loss of lives in their home country and increased Asian hate due to the misperception that Asians are to be blamed for the spread of the SARS-CoV-2. Objective: We examined the various factors including discrimination associated with COVID-19-related mental health symptoms among Asian Indians. Methods: We administered an online survey between May 2021 and July 2021 using convenient and snowball sampling methods to recruit Asian Indian adults (age > 18 years, N = 289). The survey included questions on mental health and the experience with unfair treatment in day-to-day life. Descriptive analysis and logistic regressions were performed. Results: Overall, 46.0% reported feeling down, depressed, or lonely and feeling nervous, tense, or worried due to the COVID-19 pandemic; 90.0% had received at least one dose of vaccination and 74.7% reported some form of discrimination. In the fully-adjusted logistic regression, age (AOR = 0.95; 95%CI- 0.92, 0.97;p < 0.01) and general health (AOR=0.84; 95%CI- 0.73, 0.97; p < 0.015) were negatively associated with mental health symptoms. Participants who experienced discrimination were more likely (AOR=1.26; 95%CI- 1.08, 1.46; p < 0.01) to report mental health symptoms. Conclusion: In this highly vaccinated group of Asian Indians discriminatory behaviors were associated with mental health symptoms suggesting the need for novel institutional level policy responses to reduce anti-Asian racism.

Attitudes and Beliefs of College Students towards Pain Management Modalities: Theory of Planned Behavior Approach.

Background: Chronic pain exhibits a burdening onset and duration in young adults. It is critical to understand appropriate pain management decision-making. Objective: To investigate the associations of attitudes and beliefs of college students with their intention and behavior toward pain management modalities using the Theory of Planned Behavior (TPB). Methods: In this cross-sectional online survey study, we recruited college students (age≥18 years) at West Virginia University, Morgantown, West Virginia, United States. We examined four pain management modalities: Over-the-Counter (OTC) pain medications, prescription pain medications (RX), mindfulness therapy, and yoga/exercise. Likert scales were used to assess TPB constructs (attitude, Subjective Norm [SN], Perceived Behavior Control [PBC], intention, and behavior). We analyzed the associations of the TPB constructs with both intention and behavior toward pain management modalities using multiple linear regression. Results: Of the 364 returned surveys, 227 were completed and analyzed. Attitude was found to be significantly associated with the intention to use all pain management modalities, while PBC was significantly associated with the intentions to use RX, mindfulness, and yoga/exercise (RX: ß = 0.38; 95%CI= 0.28, 0.84; p=<0.001, mindfulness: ß=0.27; 95%CI=0.07, 0.76; p=0.019, and Yoga/exercise: ß=0.35; 95%CI=0.25, 0.85; p=<0.001). Furthermore, the intention to use pain management modalities consistently predicted all behaviors (OTC: ß=0.49; 95%CI=0.32, 0.76; p=<0.001, RX: ß=0.47; 95%CI=0.17, 0.58; p=<0.001, Mindfulness: ß=0.62; 95%CI=0.40, 0.72; p=<0.001, Yoga/Exercise: ß=0.59; 95%CI=0.42, 0.84; p=<0.001). Conclusion: College students' attitude and PBC were the top predictors of intention to choose pain management modalities, and intention predicted behavior. Research with robust study design is needed to confirm our study findings.

Acculturation and dental sealant use among US children.

OBJECTIVES: Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit-and-fissure sealant placement, among children in the United States, ages 6-18 years. METHODS: A cross-sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013-2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6-18 years, had been evaluated for pit-and-fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit-and-fissure sealants among groups were determined. RESULTS: There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit-and-fissure sealants. A majority (53.3%) were white and were ages 12-18 years (51.6%). The mean number of dental pit-and-fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit-and-fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit-and-fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58). CONCLUSIONS: In this study, children who had lived in the United States <5 years were less likely to have pit-and-fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States.

Descriptive analysis of workflow variables associated with barcode-based approach to medication administration.

Bedside barcode technology is used during medication administration to ensure patient safety. This study evaluated the workflow variables related to a bedside barcode technology-based medication administration process. A time-and-motion technique was used to assess the observational episodes related to medication administration conducted by registered nurses. In an observational episode, nurses spent adequate time in "documenting medications" and "giving medications." Nurses were primarily engaged in tasks at the patient's bedside.