Risks of opioid abuse among uninsured primary care patients utilizing a free clinic.

The annual number of opioid prescriptions for pain relief has been increasing in the United States. This increase has raised concerns about prescription opioid abuse and overdose. The purpose of this study was to examine opioid risks (risk factors that increase the chance of opioid abuse) among uninsured primary care patients utilizing a free clinic. Data were collected using a self-administered paper survey in the waiting room of the free clinic from May to July 2017 (N = 506). Higher levels of somatic symptoms were associated with higher levels of opioid risks. U.S.-born English speakers had higher levels of opioid risk than non-U.S.-born English speakers and Spanish speakers. Being employed was associated with higher levels of opioid risk while attending college or being postcollegiate was related to lower levels of opioid risk. Research surrounding best practices, prescription trends, and population risk is vital in driving health and social policy. Further research would benefit from examining where people are obtaining opioids. In addition, further research on opioid abuse among Hispanic populations would be beneficial. Finally, future studies should examine how prescribing practices are different among free clinic health professionals in comparison to health care professionals working in-patient or at for-profit clinics.

"Find that Balance:" The Impact of Cultural Consonance and Dissonance on Mental Health among Utah and Mormon Women.

Cultural consonance and religious participation are both associated with salutogenic mental health outcomes. Yet studies of religious and other cultural models must take into account multiple and conflicting cultural norms. In this article, we explore the consequences of trying to adhere to the oppositional cultural models of religious (Latter-day Saint or Mormon) and secular American gender roles as perceived by college-aged women at a Utah university. Using cultural consensus and cultural consonance analysis, we demonstrate that while conforming with one model may provide social and mental health benefits, striving for consonance with both results in increased perceived stress levels for Latter-day Saints and nonmembers alike. Such cultural dissonance may be a contributing factor to the current mental health crisis among Utah youth. This work expands the theory of cultural consonance by examining it in the context of two incongruent lifestyles.

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation.

BACKGROUND: Native American communities experience greater burden of diabetes than the general population, including high rates of Type 2 diabetes among women of childbearing age. Diabetes in pregnancy is associated with risks to both the mother and offspring, and glycemic control surrounding the pregnancy period is of vital importance. METHODS: A retrospective chart review was conducted at a major Navajo Area Indian Health Service (IHS) hospital, tracking women with pre-existing diabetes who became pregnant between 2010 and 2012. Logistic regression was performed to find patient-level predictors of our desired primary outcome-having hemoglobin A1c (HbA1c) consistently < 8% within 2 years after pregnancy. Descriptive statistics were generated for other outcomes, including glycemic control and seeking timely IHS care. RESULTS: One hundred twenty-two pregnancies and 114 individuals were identified in the dataset. Baseline HbA1c was the only covariate which predicted our primary outcome (OR = 1.821, 95% CI = 1.184-2.801). Examining glycemic control among pregnancies with complete HbA1c data (n = 59), 59% were controlled before, 85% during, and 34% after pregnancy. While nearly all women received care in the immediate postpartum period, only 49% of women visited a primary care provider and 71% had HbA1c testing in the 2 years after pregnancy. CONCLUSIONS: This is the first analysis of outcomes among women with diabetes in pregnancy in Navajo Nation, the largest reservation and tribal health system in the United States. Our findings demonstrate the positive impact of specialized prenatal care in achieving glycemic control during pregnancy, while highlighting the challenges in maintaining glycemic control and continuity of healthcare after pregnancy.

Modeling SNP array ascertainment with Approximate Bayesian Computation for demographic inference.

Single nucleotide polymorphisms (SNPs) in commercial arrays have often been discovered in a small number of samples from selected populations. This ascertainment skews patterns of nucleotide diversity and affects population genetic inferences. We propose a demographic inference pipeline that explicitly models the SNP discovery protocol in an Approximate Bayesian Computation (ABC) framework. We simulated genomic regions according to a demographic model incorporating parameters for the divergence of three well-characterized HapMap populations and recreated the SNP distribution of a commercial array by varying the number of haploid samples and the allele frequency cut-off in the given regions. We then calculated summary statistics obtained from both the ascertained and genomic data and inferred ascertainment and demographic parameters. We implemented our pipeline to study the admixture process that gave rise to the present-day Mexican population. Our estimate of the time of admixture is closer to the historical dates than those in previous works which did not consider ascertainment bias. Although the use of whole genome sequences for demographic inference is becoming the norm, there are still underrepresented areas of the world from where only SNP array data are available. Our inference framework is applicable to those cases and will help with the demographic inference.

Is God just a big person? Children's conceptions of God across cultures and religious traditions.

The present research examines the influence of intuitive cognitive domain and religion on the God concepts of children growing up in religious traditions that present God in ways varying from abstract to concrete. In Study 1, we compared children from a Latter-Day Saints (LDS) background with those from mainstream Christian (MC) backgrounds in the United States. In contrast to MC theology that holds that God is all-knowing, all-powerful, and disembodied, LDS theology depicts God as embodied. In Study 1, 3- to 7-year-olds from LDS and MC backgrounds were asked about supernatural mental and immaterial attributes of God, a ghost, a dad, and a bug. In Study 2, children ages 3-7 from Muslim and Catholic backgrounds in Indonesia were presented with a variant of Study 1. Taken together, the two studies examine the God concepts of children raised in three different religious traditions with God concepts that range from highly abstract to concrete. Overall, we find that the youngest children, regardless of religion, distinguish God from humans and hold similar ideas of God, attributing more supernatural psychological than physical properties. Older children's conceptions of God are more in line with the theological notions of their traditions. The results suggest that children are not simply anthropomorphic in their God concepts, but early on understand supernatural agents as having special mental properties and they continue to learn about differences between agents, influenced by their religious traditions. Statement of contribution What is already known on this subject Research on children's God concepts has established that children begin to distinguish the mind of God from that of humans by around age 4-5. The main debate in the field is whether children start out thinking about God in anthropomorphic terms or whether they start out with an undifferentiated idea of agents' minds as all having access to knowledge. Research on children's understanding of immortality has demonstrated that around the same age that children begin differentiating God's mind from human minds, they also differentiate between the two in terms of life-cycle attributes, attributing immortality to God, but not to humans. What does this study add? The present research contributes to the field by examining the God concepts of children from different religious backgrounds. These religious backgrounds have theologies with God concepts that range from physically concrete (Latter-Day Saints or Mormonism) to highly abstract (Islam). We also include Christian samples for comparison. The present research examines children's attributions to different supernatural agents including God, but also a ghost and an angel. The present studies look at children's attribution of not only supernatural mental attributions, but also the supernatural physical attributions of immateriality and omnipresence that have been understudied.

ReCAP: Gaps in Insurance Coverage for Pediatric Patients With Acute Lymphoblastic Leukemia.

PURPOSE: Continuous insurance coverage is an important component of effective health care. Evaluation of insurance gaps in pediatric cancer care is an understudied area. METHODS: We conducted a retrospective analysis of payer data from outpatient oncology encounters at Primary Children's Hospital (Salt Lake City, UT) over the first 2 years of therapy for pediatric patients with acute lymphoblastic leukemia diagnosed from 1998 to 2010 (N = 380). Using logistic regression, we evaluated demographic and clinical predictors (age at diagnosis, sex, ethnicity, high/standard acute lymphoblastic leukemia risk, and rural/urban county of residence at diagnosis) of a gap in health insurance. RESULTS: The median age at diagnosis was 4 years (interquartile range, 3 to 8 years), and 172 patients (45%) were girls. In the first 2 years of treatment, 45 patients (12%) experienced a gap in health insurance. The odds of having a gap in insurance coverage decreased by 16% each year from 1998 to 2010 (odds ratio, 0.84; 95% CI, 0.76 to 0.93; test for trend, P = .001). Public insurance at diagnosis was associated with a four-fold increased likelihood of experiencing an insurance gap (odds ratio, 4.09; 95% CI, 1.98 to 8.44; P < .001) compared with patients with private insurance at diagnosis. CONCLUSION: Gaps in insurance coverage during pediatric cancer treatment are not uncommon, which highlights the importance of discussing insurance status at diagnosis and throughout a patient's treatment course to help patients and their families prepare for any changes and avoid unnecessary financial burden. Future research should focus on examining the effect of insurance gaps on patient outcomes and evaluating likelihood of gaps in insurance after health care reform.

Designating longevity hotspots: cautions concerning the instability of per capita centenarian estimates.

Estimates of per capita centenarians in a Utah population varied between one per 12,864 and one per 4,675, depending on the data that were used, the population assumptions that were made, and the boundary limits that were employed. In general, caution is warranted in claims about the existence of longevity hotspots.

Offspring sex preference in frontier America.

Analysis of the fertility histories of women born between 1850 and 1900, as given in the Utah Population Database (UPDB), reveals the effect of the number, as well as the sex composition, of previous children on birth-stopping and birth-spacing decisions. Specifically, agricultural and Church of Jesus Christ of Latter-day Saints (LDS) households­two sub-populations that might have placed different values on male and female children for economic, social, and/or cultural reasons­showed a distinct preference for male children, as expressed by birth stopping after the birth of a male child and shorter birth intervals in higher-parity births when most previous children were female. Remarkably, women in both the early "natural fertility" and the later contraceptive eras used spacing behavior to achieve a desired sex mix. Although the LDS population had relatively high fertility rates, it had the same preferences for male children as the non-LDS population did. Farmers, who presumably had a need for family labor, were more interested in the quantity than in the sex mix of their children.

Intergenerational transmission of reproductive behavior during the demographic transition.

New evidence from the Utah Population Database (UPDP) reveals that at the onset of the fertility transition, reproductive behavior was transmitted across generations - between women and their mothers, as well as between women and their husbands' family of origin. Age at marriage, age at last birth, and the number of children ever born are positively correlated in the data, most strongly among first-born daughters and among cohorts born later in the fertility transition. Intergenerational ties, including the presence of mothers and mothers-in-law, influenced the hazard of progressing to a next birth. The findings suggest that the practice of parity-dependent marital fertility control and inter-birth spacing behavior derived, in part, from the previous generation and that the potential for mothers and mothers-in-law to help in the rearing of children encouraged higher marital fertility.

A good social work: women's clubs, libraries, and the construction of a secular society in Utah, 1890-1920.

After the renunciation of polygamy, Mormon women formed secular women's clubs as a means of collaborating with non-Mormon women in the construction of a shared secular society. Their common goal was the establishment and maintenance of the mainstream American social order. Activity in these clubs extended women's sphere into the public realm through socially acceptable public activities such as the temperance cause, civic improvements, political reform movements, and child welfare. The women campaigned for public support of libraries as institutions that would construct, preserve, and transmit American culture, educate the young, strengthen the home and family, and reform society.