Social Norms for Cannabis Use After Nonmedical Legalization in Canada.

INTRODUCTION: Social norms play an important role in cannabis use; however, there is little evidence on how social norms change in jurisdictions that legalize cannabis. This study examined trends in social norms before and after legalization of nonmedical cannabis in Canada in 2018. METHODS: Data are from the International Cannabis Policy Study, a series of cross-sectional surveys conducted annually with Canadian respondents aged 16-65 years. Analyses were conducted in 2023 and included data from 58,045 respondents across 4 waves: the year immediately before legalization (2018) and 3 post-legalization waves (2019-2021). Regression models examined trends in injunctive norms (perceived approval of cannabis) and comfort in using cannabis in six different social contexts, adjusting for cannabis use frequency, medical authorization, and sociodemographic covariates. RESULTS: Perceived social approval of cannabis use and comfort using cannabis in different social contexts was highest among males, frequent cannabis consumers, and those who reported medical authorization (p<0.05 in all cases). No changes in perceived approval were observed across years, except a temporary decrease in 2020 versus 2018 (OR=0.87, 95% CI=0.80, 0.95). Modest increases in comfort of using cannabis in 6 different social contexts were observed in 2019 (ß=0.10, p=0.001), 2020 (ß=0.10, p=0.001), and 2021 (ß=0.12, p<0.001) versus in 2018. CONCLUSIONS: Social norms have remained relatively stable after nonmedical legalization in Canada, with only modest increases in comfort of using cannabis in different social settings. The findings may reflect widespread cannabis use in Canada prior to nonmedical legalization in 2018 as well as comprehensive restrictions on promotion and advertising.

Health-related quality of life in people with different diabetes-related foot ulcer health states: A cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states.

AIMS: Diabetes-related foot ulcers (DFU) are a leading cause of infection, hospitalisation and amputation. However, to our knowledge no studies have compared the health-related quality of life (HRQoL) of people with DFU that were infected, hospitalised or amputated. This study aimed to investigate and compare the HRQoL of different groups of people with healed, non-infected, infected, hospitalised, or amputated DFU. METHODS: This was a multi-centre cross-sectional study measuring the HRQoL of patients, attending one of 18 Diabetic Foot Services across Queensland, Australia, with one of five DFU health states: healed, non-infected, infected, hospitalised, amputated. HRQoL was measured using the EQ-5D-5L to estimate age-sex adjusted utility values. RESULTS: Of 376 included patients (mean age 63 (12) years, 75% male), age-sex adjusted HRQoL utility estimates (95% CIs) were: healed DFU 0.57 (0.51-0.64), non-infected DFU 0.55 (0.49-0.62), infected DFU 0.45 (0.36-0.55), hospitalised DFU 0.53 (0.42-0.64), and amputated DFU 0.55 (0.46-0.63). CONCLUSION: People in any DFU health state have considerably reduced HRQoL, with greatest reductions in those with infected DFU. These findings provide valuable HRQoL estimates and comparisons for several different important DFU health states, adding to our understanding of the impact of DFU on HRQoL and facilitating future economic evaluations.

Surveillance of Naegleria fowleri in Louisiana's public water systems.

The free-living amoeba Naegleria fowleri (Nf) inhabits soil and natural waters worldwide: it is thermophilic and thrives at temperatures up to 45 °C and in a multitude of environments. Three deaths in Louisiana were attributed to primary amoebic meningoencephalitis (PAM) caused by Nf infection in 2011 and 2013. Following these incidents, public water systems are now monitored for the presence of Nf in Louisiana. From 2014 to 2018, 29% (27/93) of samples collected showed positive for Nf and 68% (63/93) showed all thermophilic amoeba culture. Ten raw water sources and 17 distribution water systems tested positive. The year 2017 showed the highest number of samples with Nf (n = 10) followed by nine samples in 2015. As climate change increases surface water temperatures, continued testing for Nf prevalence will be an important facet of water monitoring and will need to extend into locations farther north than the current most common range.

Model-Assisted Interpretation of 4,4'-Methylene Dianiline Adsorption on Soils at Micromolar Concentrations.

Adsorption kinetics and isotherms were determined for 4,4'-methylene dianiline (MDA) on five diverse soils at nominal concentrations of 0.01-1.0 mg L-1 (nominal soil loading 0.1-40 µg gs -1 ). The data were used to model the adsorption process based on the two-step mechanism that is characteristic of the adsorption of aromatic amines, consisting of a physical equilibrium between the aqueous phase and the soil organic matter and a chemical reaction between the adsorbed MDA and reactive sites in the soil organic matter. Generic parameters were determined that enabled application of the model to other soils, which was checked against previously published data for MDA adsorption. At the low concentrations evaluated, the adsorption process took place almost exclusively in the organic matter without the need to account for a separate ion exchange process with the soil mineral fraction. Physical adsorption was found to be mainly dependent on the protonation state of MDA and increased with decreasing pH of the soils. Because of the chemical reaction taking place, adsorption equilibrium constants (organic-carbon partition coefficient [KOC ]) normalized to the organic carbon content in the soil gradually increased with time; and it was demonstrated that, at steady-state conditions, values of log KOC > 3.5 can be expected for most any soil at conservatively estimated potential environmental MDA concentrations. Environ Toxicol Chem 2023;42:2580-2588. © 2023 SETAC.

HABs Karenia brevis and Pseudo-nitzschia pre- and post-Hurricane Michael.

Increased occurrences of harmful algal blooms (HAB) in the Gulf of Mexico, and even worldwide, yield concern for increases in brevetoxin exposure leading to respiratory illness or even death, highlighting the need for extensive scientific research and human health monitoring. It is known that major events such as tropical storms and hurricanes are followed by periods of increased red tides caused by HABs; however, the nature by which phytoplankton blooms proliferate following major events remains a topic of great interest and research. The impact of Hurricane Michael on October 10, 2018 on HABs in the Florida panhandle was examined by analyzing data from the Florida Fish and Wildlife Conservation Commission in coordination with Normalized Fluorescence Line Height (nFLH) data from the University of South Florida College of Marine Science. Results presented here demonstrate four phases of HABs during storm events: 1. Pre-storm concentrations, 2. Decreased concentration during the storm, 3. Elevated concentrations following the storm and 4. Recovery period. This time frame can serve to be important in understanding the health dynamics of coastal systems following major storm events.

1-Propyl-4(5)-Methylimidazole Isomers for Temperature Swing Solvent Extraction.

Temperature swing solvent extraction (TSSE) utilizes an amine solvent with temperature-dependent water solubility to dissolve water at a lower temperature to concentrate or crystallize the brine and the phases are separated. Then, the water in solvent mixture is heated to reduce water solubility and cause phase separation between the solvent and water. The solvent and de-salted water phases are separated, and the regenerated solvent can be recycled. Issues with current TSSE solvents include the high solvent in water solubility and the high solvent volatility. This project used the highly tunable platform molecule imidazole to create two 1-butylimidazole isomers, specifically 1-propyl-4(5)-methylimidazole, to test their effectiveness for TSSE. The imidazoles take in more water than their current state-of-the-art counterparts, but do not desalinate the product water and dissolve in water at higher concentrations. Thus, while imidazoles make intriguing candidates for TSSE, further work is needed to understand how to design imidazoles that will be useful for TSSE applications.

Genomic erosion in a demographically recovered bird species during conservation rescue.

The pink pigeon (Nesoenas mayeri) is an endemic species of Mauritius that has made a remarkable recovery after a severe population bottleneck in the 1970s to early 1990s. Prior to this bottleneck, an ex situ population was established from which captive-bred individuals were released into free-living subpopulations to increase population size and genetic variation. This conservation rescue led to rapid population recovery to 400-480 individuals, and the species was twice downlisted on the International Union for the Conservation of Nature (IUCN) Red List. We analyzed the impacts of the bottleneck and genetic rescue on neutral genetic variation during and after population recovery (1993-2008) with restriction site-associated sequencing, microsatellite analyses, and quantitative genetic analysis of studbook data of 1112 birds from zoos in Europe and the United States. We used computer simulations to study the predicted changes in genetic variation and population viability from the past into the future. Genetic variation declined rapidly, despite the population rebound, and the effective population size was approximately an order of magnitude smaller than census size. The species carried a high genetic load of circa 15 lethal equivalents for longevity. Our computer simulations predicted continued inbreeding will likely result in increased expression of deleterious mutations (i.e., a high realized load) and severe inbreeding depression. Without continued conservation actions, it is likely that the pink pigeon will go extinct in the wild within 100 years. Conservation rescue of the pink pigeon has been instrumental in the recovery of the free-living population. However, further genetic rescue with captive-bred birds from zoos is required to recover lost variation, reduce expression of harmful deleterious variation, and prevent extinction. The use of genomics and modeling data can inform IUCN assessments of the viability and extinction risk of species, and it helps in assessments of the conservation dependency of populations.

La paloma rosada (Nesoenas mayeri) es una especie endémica de Mauricio que se ha recuperado impresionantemente después de un grave cuello de botella poblacional a principios de la década de 1970 que duró hasta inicios de la década de 1990. Antes de este cuello de botella se había establecido una población ex situ de la cual se liberaban individuos reproducidos en cautiverio a las subpoblaciones en libertad para incrementar la variación genética y el tamaño poblacional. Este rescate de conservación derivó en una recuperación rápida de la población (400-480 individuos) y la especie cambió positivamente de categoría dos veces en la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza (UICN). Analizamos los impactos del cuello de botella y el rescate genético sobre la variación genética neutral durante y después de la recuperación poblacional (de 1993 a 2008) mediante secuenciación RAD, análisis de microsatélites y análisis genéticos cuantitativos de los datos del libro genealógico de 1112 aves ubicadas en zoológicos de Europa y los Estados Unidos. Usamos simulaciones por computadora para estudiar los cambios pronosticados en la variación genética y en la viabilidad poblacional del pasado hacia el futuro. La variación genética declinó rápidamente, a pesar de la recuperación poblacional, y el tamaño efectivo de la población fue aproximadamente un orden de magnitud más pequeño que el tamaño del censo. La especie contó con una carga genética elevada de casi 15 equivalentes letales para la longevidad. Nuestras simulaciones pronostican que la endogamia continua probablemente resultará en un incremento en la expresión de mutaciones deletéreas (es decir, una carga realizada elevada) y en una depresión endogámica severa. Sin acciones continuas para la conservación, es probable que la paloma rosada esté extinta en vida libre dentro de cien años. El rescate de conservación de la paloma rosada ha sido fundamental en la recuperación de la población silvestre; sin embargo, se requiere de un rescate genético adicional con las aves de reproducción en cautiverio de los zoológicos para recuperar la variación perdida, reducir la expresión de la variación deletérea dañina y prevenir la extinción. El uso de la genómica y los datos modelados puede orientar las valoraciones de la UICN sobre la viabilidad y el riesgo de extinción de las especies, además de que ayuda en la evaluación de la dependencia que tienen las poblaciones de la conservación.

Characteristics Associated With Consistent Handwashing and Satisfaction in the Workplace: A Pilot Survey of U.S. Workers.

BACKGROUND: This study seeks to determine what handwashing facilities are available to workers, predominantly in the manufacturing and service industries, to find out if their workplace has the appropriate resources to conduct proper handwashing and how that affects handwashing satisfaction. METHODS: This cross-sectional study surveyed U.S. adult workers (N = 241) on their workplace handwashing equipment and facilities. The associations between demographic characteristics, consistent handwashing, and handwashing satisfaction were evaluated using Fisher's exact test. FINDINGS: Eighty-eight percent of respondents reported consistent handwashing. Pulling a handle to exit the restroom was negatively associated with handwashing satisfaction (p = .004) and having difficulty with an automatic faucet or dispenser was negatively marginally significant in its association with handwashing consistency (p = .10). CONCLUSION/APPLICATIONS TO PRACTICE: Greater understanding of the available equipment in workplace restroom facilities and how to improve selection and use of that equipment may improve workers' handwashing experiences.

Interventions Targeting Health and Wellbeing among Nail Salon Workers: A Scoping Review.

OBJECTIVES: To identify existing interventions targeting the health and wellbeing of nail salon workers. METHODS: Arksey and O'Malley's framework on reviews guided this project. The databases MEDLINE, EMBASE, Scopus, CINAHL, and Web of Science were searched. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart was used to capture the inclusion protocol. RESULTS: Four interventions were identified, of which one was a randomized controlled trial. Across the four interventions, there were about 424 participants that were recruited through cosmetology schools and 34 from nail salons. Interventions varied from pamphlet distribution and inspections to full-day training sessions. Intervention effectiveness was determined via pre- and post-tests and infractions frequency. Maximum follow-up time was 8 months. Outcomes included increased knowledge on exposures, fewer infractions, increased adherence to infection control practices and use of personal protective equipment, and behavior and attitude changes. CONCLUSIONS: There is a need for further research on interventions targeting vulnerable workers in nail salons who face numerous hazards on the job. Two of the four interventions targeted nail technician trainees and their instructors, indicating the potential of early interventions before the workers officially enter the workforce.

Effect of Nanopatterning on Concentration Polarization during Nanofiltration.

Membranes used for desalination still face challenges during operation. One of these challenges is the buildup of salt ions at the membrane surface. This is known as concentration polarization, and it has a negative effect on membrane water permeance and salt rejection. In an attempt to decrease concentration polarization, a line-and-groove nanopattern was applied to a nanofiltration (NF) membrane. Aqueous sodium sulfate (Na2SO4) solutions were used to test the rejection and permeance of both pristine and patterned membranes. It was found that the nanopatterns did not reduce but increased the concentration polarization at the membrane surface. Based on these studies, different pattern shapes and sizes should be investigated to gain a fundamental understanding of the influence of pattern size and shape on concentration polarization.

Scaling photosynthetic function and CO2 dynamics from leaf to canopy level for maize - dataset combining diurnal and seasonal measurements of vegetation fluorescence, reflectance and vegetation indices with canopy gross ecosystem productivity.

Recent advances in leaf fluorescence measurements and canopy proximal remote sensing currently enable the non-destructive collection of rich diurnal and seasonal time series, which are required for monitoring vegetation function at the temporal and spatial scales relevant to the natural dynamics of photosynthesis. Remote sensing assessments of vegetation function have traditionally used actively excited foliar chlorophyll fluorescence measurements, canopy optical reflectance data and vegetation indices (VIs), and only recently passive solar induced chlorophyll fluorescence (SIF) measurements. In general, reflectance data are more sensitive to the seasonal variations in canopy chlorophyll content and foliar biomass, while fluorescence observations more closely relate to the dynamic changes in plant photosynthetic function. With this dataset we link leaf level actively excited chlorophyll fluorescence, canopy proximal reflectance and SIF, with eddy covariance measurements of gross ecosystem productivity (GEP). The dataset was collected during the 2017 growing season on maize, using three automated systems (i.e., Monitoring Pulse-Amplitude-Modulation fluorimeter, Moni-PAM; Fluorescence Box, FloX; and from eddy covariance tower). The data were quality checked, filtered and collated to a common 30 minutes timestep. We derived vegetation indices related to canopy functioning (e.g., Photochemical Reflectance Index, PRI; Normalized Difference Vegetation Index, NDVI; Chlorophyll Red-edge, Clre) to investigate how SIF and VIs can be coupled for monitoring vegetation photosynthesis. The raw datasets and the filtered and collated data are provided to enable new processing and analyses.

The Cost Consequences of the Gold Coast Integrated Care Programme.

INTRODUCTION: The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system. This paper reports the economic findings of the trial. METHODS: A pragmatic non-randomised controlled study assessed differences between patients enrolled in the programme (intervention group) and patients who received usual care (control group), in health service utilisation, including Medicare Benefits Schedule and Pharmaceutical Benefits Scheme claims, patient-reported outcome measures, including health-related quality of life, mortality risk, and cost. RESULTS: A total of 1,549 intervention participants were enrolled and matched on the basis of patient level data to 3,042 controls. We found no difference in quality of life between groups, but a greater decrease in capability, social support and satisfaction with care scores and higher hospital service use for the intervention group, leading to a greater cost to the healthcare system of AUD$6,400 per person per year. In addition, the per person per year cost of being in the GCIC programme was AUD$8,700 equating to total healthcare expenditures of AUD$15,100 more for the intervention group than the control group. CONCLUSION: The GCIC programme did not show value for money, incurring additional costs to the health system and demonstrating no significant improvements in health-related quality of life. Because patient recruitment was gradual throughout the trial, we had only one year of complete data for analysis which may be too short a period to determine the true cost-consequences of the program.

Occurrence of SARS-CoV-2 RNA in Six Municipal Wastewater Treatment Plants at the Early Stage of COVID-19 Pandemic in The United States.

In this study, we investigated the occurrence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) RNA in primary influent (n = 42), secondary effluent (n = 24) and tertiary treated effluent (n = 34) collected from six wastewater treatment plants (WWTPs A-F) in Virginia (WWTP A), Florida (WWTPs B, C, and D), and Georgia (WWTPs E and F) in the United States during April-July 2020. Of the 100 wastewater samples analyzed, eight (19%) untreated wastewater samples collected from the primary influents contained SARS-CoV-2 RNA as measured by reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) assays. SARS-CoV-2 RNA were detected in influent wastewater samples collected from WWTP A (Virginia), WWTPs E and F (Georgia) and WWTP D (Florida). Secondary and tertiary effluent samples were not positive for SARS-CoV-2 RNA indicating the treatment processes in these WWTPs potentially removed SARS-CoV-2 RNA during the secondary and tertiary treatment processes. However, further studies are needed to understand the log removal values (LRVs) and transmission risks of SARS-CoV-2 RNA through analyzing wastewater samples from a wider range of WWTPs.

The Gold Coast Integrated Care Programme: The Perspectives of Patients, Carers, General Practitioners and Healthcare Staff.

INTRODUCTION: The Australian Gold Coast Integrated Care programme trialled an innovative model of care to proactively manage high risk patients with complex and chronic conditions in collaboration with general practitioners. The objective was to enhance coordination and continuity of care across primary and secondary health services from a single point-of-entry multidisciplinary coordination centre. This case study, embedded in the broader trial, analysed the perceptions of patients, healthcare staff and general practitioners on the adequacy, comprehensiveness, timeliness and acceptability of the new model of care to help inform the decision by the health service whether to adopt it beyond the trial. METHODS: This mixed method embedded, explanatory case study design included surveys of general practice staff and focus groups with patients, carers and coordination centre staff. Qualitative data were thematically analysed and findings merged with survey data in a narrative explanatory case report. DISCUSSION: Staff, patients, general practitioners and practice nurses were generally satisfied with services, coordination of care and information sharing but general practice staff satisfaction ratings declined over time. CONCLUSION: The programme enhanced care and coordination of services and was valued by patients and healthcare providers. Study results provide a rationale for adopting the model for those with chronic and complex conditions.

Description and psychometric properties of a prototype to test tactile acuity in the neck.

BACKGROUND: Clinical tools assessing tactile acuity in people with persistent pain have limitations. Therefore, a novel and semi-automated tool was developed: The Imprint Tactile Acuity Device (iTAD). AIM: To describe the iTAD prototype and present the psychometric properties of its tactile acuity assessments: the localisation test, the orientation test and the overall score (mean of both tests). METHOD: A test-retest design with fifty healthy participants was used to assess intra-rater reliability (ICC(2.1)), internal consistency (ICC(2.4)) and measurement error (SEM) of the three assessments (0-100% accuracy scores each) performed at the neck. Using a known-group comparison design, balanced by age and sex, scores of thirty individuals with persistent neck pain were compared to thirty healthy controls to determine construct validity. RESULTS: The ICC(2,1) and ICC(2,4) were 0.60 and 0.78 for the localisation test, 0.66 and 0.77 for the orientation test, and 0.73 and 0.84 for the overall score. The SEMs were 9.0%, 8.1% and 6.0%, respectively. No fixed or proportional bias, or signs of heteroscedasticity were observed. Overall, no between group differences were observed (p = 0.49). In the male subgroup, however, the overall score was lower for people with neck pain than for healthy participants (mean difference (SE); 7.6% (2.5); p = 0.008). DISCUSSION: The tactile acuity assessments of the iTAD demonstrate moderate reliability and good internal consistency. Measurement errors appear comparable to currently preferred methods. Clear construct validity was not established, but results may be biased by design issues of the prototype. Taken together, the iTAD shows promise but further fine-tuning is needed.

Surface deformation associated with fractures near the 2019 Ridgecrest earthquake sequence.

Contemporary earthquake hazard models hinge on an understanding of how strain is distributed in the crust and the ability to precisely detect millimeter-scale deformation over broad regions of active faulting. Satellite radar observations revealed hundreds of previously unmapped linear strain concentrations (or fractures) surrounding the 2019 Ridgecrest earthquake sequence. We documented and analyzed displacements and widths of 169 of these fractures. Although most fractures are displaced in the direction of the prevailing tectonic stress (prograde), a large number of them are displaced in the opposite (retrograde) direction. We developed a model to explain the existence and behavior of these displacements. A major implication is that much of the prograde tectonic strain is accommodated by frictional slip on many preexisting faults.

First detection of SARS-CoV-2 RNA in wastewater in North America: A study in Louisiana, USA.

We investigated the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater samples in southern Louisiana, USA. Untreated and treated wastewater samples were collected on five occasions over a four-month period from January to April 2020. The wastewater samples were concentrated via ultrafiltration (Method A), and an adsorption-elution method using electronegative membranes (Method B). SARS-CoV-2 RNA was detected in 2 out of 15 wastewater samples using two reverse transcription-quantitative polymerase chain reaction (RT-qPCR) assays (CDC N1 and N2). None of the secondary treated and final effluent samples tested positive for SARS-CoV-2 RNA. To our knowledge, this is the first study reporting the detection of SARS-CoV-2 RNA in wastewater in North America, including the USA. However, concentration methods and RT-qPCR assays need to be refined and validated to increase the sensitivity of SARS-CoV-2 RNA detection in wastewater.

Attenuation of stress-induced weight loss with a ketogenic diet.

Ketogenic diets (KDs) are high-fat, low-carbohydrate diets that have been used therapeutically for decades, most notably for the treatment of epilepsy and diabetes. Recent data, however, suggest that KD may impart protective effects on mood disorders. The current experiments test the hypothesis that KDs can protect from stress-induced symptoms of mood disorders. To test this, we assessed behavioral and neuroendocrine effects of KD in male and female Long Evans rats. Animals experienced three weeks of chronic mild stress (CMS) while consuming KD or control chow (CH). Body weight and food intake data were recorded daily and behaviors were assayed after three weeks. Plasma beta-hydroxybutyrate (ßHB), corticosterone (CORT) and interleukin-1 beta (IL-1ß) were measured after behavioral testing, along with hypothalamic corticotropin-releasing hormone (CRH) and neuropeptide Y (NPY) mRNA expression. CMS induced weight loss in the CH groups, however the KD-fed rats were resistant to CMS-induced weight loss. Female rats fed KD were protected from CMS-induced reductions in plasma CORT and hypothalamic NPY expression. Collectively, these data suggest protective potential of KDs against chronic stress, particularly in females.

Explaining the Relationship Between Minority Group Status and Health Disparities: A Review of Selected Concepts.

Purpose: There is growing concern that value-based payment for health care may disadvantage health care organizations that serve populations with social risk. In the broader investigation of social risk factors, including income, education, neighborhood deprivation, and other risks, the focus on race and ethnicity as a risk factor for disparities in health and health care has diminished. Understanding the independent contribution of minority group status is critical to this discussion. This narrative review discusses four concepts-minority stress, resilience, epigenetics, and life course-that may help explain the contribution of minority group status and its association with health disparities. Methods: We briefly describe each concept and the supporting evidence. Results: Our results indicate that all four concepts have potential relevance for understanding and addressing health disparities. The life course perspective emphasizes the importance of understanding explanatory mechanisms and factors that contribute to health-including biological, physical, and social factors-over a person's life span. Both minority stress and resilience may influence health in either a negative or positive manner that potentially underlies health changes. Exposure to these factors and others may interact with and modify epigenetic regulation-biological processes that impact how our genes are expressed. This may increase the risk of disease and negative health outcomes, particularly among groups that may be at disproportionate risk because of social circumstances and environmental exposure over the life course. Conclusion: Despite these concepts' relevance, more research is needed to assess how they may explain the relationship between minority status and disparities in health. Such evidence is needed to focus interventions and to inform the design of delivery and payment models that can spur actions to reduce disparities.

Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus.

BACKGROUND: Asthma is a common cause of pediatric hospitalization. Nonadherence to asthma medications is associated with worse outcomes; however, there is a paucity of data regarding posthospitalization prescription filling and hospital reuse. Our objective was to identify patients at risk for hospital reuse after being hospitalized for asthma. METHODS: This is a retrospective study of patients with asthma who were discharged from a children's hospital in which we use Medicaid claims data to evaluate prescription fills within 30 days and 12 months. Chart reviews were used for demographics, chronic asthma severity, admission severity, and hospital reuse. t and χ2 tests were performed for continuous and categorical variables. A generalized linear mixed model was fitted to predict the odds of hospital reuse, which was defined as requiring an emergency department visit or rehospitalization. Survival analysis using log-rank testing was used for modeling the time to hospital reuse. RESULTS: Fifty-four percent of patients discharged with asthma had hospital reuse within 1 year of discharge. There was no association between hospital reuse and prescription filling for systemic steroids (odds ratio [OR] 1.30; confidence interval [CI]: 0.85-2.00; P = .21) or controller medications (OR 1.5; CI: 0.92-2.52; P = .10). There was a higher number of controller and systemic steroid prescription fills over 12 months for patients with hospital reuse. The factors associated with greater odds of hospital reuse were severity of chronic asthma diagnosis (P = .03) as well as African American race (OR 1.92; CI: 1.17-3.13; P = .01). CONCLUSIONS: For Medicaid-insured patients discharged with asthma, worse chronic asthma severity and African American race were associated with greater odds of hospital reuse. Decreased prescription filling was not associated with greater odds of hospital reuse.