Representative US Research Articles

Tesla under International Capital Flow: An Empirical Research Based on Time-series Model

The announcement that the Federal Reserve may announce its eighth interest rate hike in almost a year on 23 March 2023. The trend of international capital flows to the U.S. has become more pronounced. However, this is a double-edged sword for U.S. multinationals. The entry of international capital into the U.S. may contribute to a more prosperous U.S. financial market. However, at the same time, a higher dollar exchange rate means that multinationals' revenues may fall. This paper, therefore, chooses to analyse Tesla, one of the most representative US multinationals. A VAR and an ARMA-GARCH model are used to analyse Tesla's share price movement and the U.S. dollar index futures price movement. This paper finds a correlation between the U.S. dollar index futures price and Tesla's share price. Based on the results of this paper, investors can adjust their investment decisions in Tesla stock based on the following Federal Reserve policy.

Value Investing for Technology Companies

Electronic products are constantly flooding our lives. More and more technology companies invest more capital to research electronic products. This paper analyses the data for five representative US technology companies from year 2015 to 2021, from a value investing perspective. Specifically, this paper looks at factors like profitability, valuation, growth, pay out and returns. By analysing those factors with historical data, this paper looks at the value changes and explain the possible reason behind. This paper further compares each of those factors across the five companies and it is concluded that Apple Inc ranks the first and worth to invest in our five-company portfolio. Dell, being the second the best choice, rank ahead of other three companies by a large margin. This paper suggest that one can have APPL and Dell in the portfolio but not to invest the other three companies.

Disparities in the use of colorectal cancer screening in a universally insured population during the COVID-19 pandemic.

Despite the known efficacy of colorectal cancer (CRC) screening, the rates of individuals undergoing such testing have remained lower than target thresholds, even prior to the healthcare disruptions associated with the COVID-19 pandemic. We evaluated the impact of the COVID-19 pandemic on CRC screening within a nationally representative US population and assessed disparities in screening across racial/ethnic groups and socioeconomic (SES) strata. We performed a retrospective cross-sectional study using all eligible TRICARE beneficiaries aged 45-64 years between FY 2018 and 2021. High-risk individuals, those with a previous or current CRC diagnosis, and/or a personal/family history of colonic polyps, were excluded. The pre-COVID-19 period (September 1, 2018-March 31, 2020) was compared to the COVID-19 period (April 1, 2020-September 30, 2021). Secondary analyses were performed, evaluating the interaction between the COVID-19 time period, race, and our proxy for socioeconomic status. During the study period, we identified 1,749,688 eligible individuals. Following the onset of the COVID-19 pandemic, CRC screening overall decreased from 34% in the pre-pandemic period to 30% following the onset of the pandemic (p < 0.001). This finding persisted even after adjusting for confounders in multivariable analysis (odds ratio [OR] for the pandemic timeframe: 0.79; 95% CI: 0.27, 0.31; p < 0.001). In the setting of SES, in the pandemic period, the odds of individuals from both Senior Enlisted (OR: 0.55; 95% CI: 0.54, 0.56) and Junior Enlisted sponsor ranks (OR: 0.27; 95% CI: 0.25, 0.30) were diminished as compared to Senior Officers. We found a 21% reduction in the odds of CRC screening in the context of the COVID-19 pandemic. Reductions in colonoscopies and other types of screening tests were not offset by changes in the use of at-home tests such as Cologuard.

Examining the Association Between Adverse Childhood Experiences and Lifetime History of Head or Neck Injury and Concussion in Children From the United States.

Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort. This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health. There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children. The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form. The sample ( N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion. ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.

Joint effect of whole blood metals exposure with dyslipidemia in representative US adults in NHANES 2011-2020.

With little knowledge on the joint effects of metal exposure on dyslipidemia, we aimed to investigate the relationship between exposure to metal and dyslipidemia among US adults based on the National Health and Nutrition Examination Survey (NHANES). Based on the five NHANES waves (2011-2020), we selected five metals in blood as exposure, namely, cadmium (Cd), lead (Pb), total mercury (Hg), manganese (Mn), and selenium (Se), which were detected by inductively coupled plasma mass spectrometry. Survey-multivariable logistic regression, generalized weighted quantile sum (WQS), and Bayesian kernel machine regression (BKMR) were performed to determine whether dyslipidemia was associated with single metals or mixed metals. Our study included 12,526 participants aged from 20 to 80, representing 577.1 million non-institutionalized US adults. We found a positive association between several metals including Pb [adjusted odds ratio (AOR) = 1.332, 95%CI: 1.165, 1.522], total Hg (AOR = 1.264, 95%CI: 1.120, 1.427), Mn (AOR = 1.181, 95%CI: 1.046, 1.334), and Se (AOR = 1.771, 95%CI: 1.576, 1.992) and dyslipidemia. According to the WQS approach, metal mixtures were positively associated with dyslipidemia (AOR: 1.310, 95%CI: 1.216, 1.411) after a full-model adjustment. As is shown in the BKMR model, mixed metals tended to be positively associated with dyslipidemia ratios in a significant manner. Females, non-Hispanic White populations, people aged over 60, and those who did a little physical activity had a greater risk for dyslipidemia. Our findings suggest metals including Cd, Pb, Hg, Mn, and Se and their combinations may adversely affect dyslipidemia among US adults. Due to the cross-sectional nature of the study, it is possible that reverse causation may exist.

Racial and Ethnic Differences in Openness to Communication From Local Faith-Based Congregations During Public Health Emergencies.

During public health emergencies, people at risk of exposure or illness will likely be presented with extensive information about an unfamiliar topic and be asked to make decisions quickly. In difficult situations, people often turn to trusted leaders, including from their local faith-based congregation (FBC). We examined how people receive, interpret, and respond to health communication information from clergy and lay leaders from their local FBC during public health emergencies. We analyzed responses to 10 questions from a 2021 nationally representative US survey. Porter Novelli designed the survey and administered it to 4510 US adults aged ≥18 years, of whom 3553 people completed the survey. We examined sociodemographic characteristics, trust of health information from clergy and lay leaders, and willingness to engage in health behaviors recommended by their FBC and receive health services through their local FBC. All estimates were weighted. We conducted bivariate analysis with contrast t tests for proportions at α = .05. More than half of adults (55.4%), including 65.8% of non-Hispanic Black and 58.8% of Hispanic or Latino adults, were members of an FBC. Among FBC members, a higher percentage of Hispanic or Latino (29.1%) and non-Hispanic Black (36.3%) adults than non-Hispanic White adults (20.4%) reported trust in their FBC for health information (P < .05). This trust translated into greater intent to engage in health behaviors promoted by the local FBC among non-Hispanic Black respondents (31.4%) compared with non-Hispanic White respondents (22.5%) (P < .05). Public health officials can consider ways to better understand how the cultures and practices of populations being served influence people's health perceptions and behaviors. Collaboration between federal, state, and local public health officials and FBCs can promote health equity during public health emergencies.

Late meal intake is associated with abdominal obesity and metabolic disorders related to metabolic syndrome: A chrononutrition approach using data from NHANES 2015–2018

Chrononutrition is an emerging area that suggests that late eating time is associated with poor nutritional and metabolic outcomes. However, epidemiological studies are scarce on this topic. The aim of this study was to characterize the chrononutrition patterns in a large and representative US population (NHANES 2015-2016 and 2017-2018) of adults and elderly and investigate their association with obesity and metabolic disorders that make up the metabolic syndrome. A total of 7379 adults and elderly individuals were included in the analysis. Meal timing data were collected through two 24-h dietary recalls in both cycles. Poisson regression adjusted for confounders was used to evaluate the association between chrononutrition variables (eating duration and tertiles of first and last meal timing, eating midpoint and eating occasions) and obesity, abdominal obesity and metabolic parameters from metabolic syndrome. Adults with a longer eating duration (>12h) had a higher prevalence of abdominal obesity (IRR, 1.15; 95% CI, 1.03-1.28) when compared with those who ate their meals in a shorter eating duration (≤12h). In addition, adults in the third tertile of the time of the last meal (mean 22:03) had a higher prevalence of abdominal obesity (IRR, 1.12; 95% CI, 1.01-1.25) compared to first tertile. Adults with later eating midpoints (second and third tertile) had a higher prevalence of elevated fasting glucose (IRR, 1.30; 95% CI, 1.07-1.59 and IRR, 1.65; 95% CI, 1.22-2.22, respectively). Among the elderly, participants with a longer eating duration (>12h) had a higher prevalence of elevated triglycerides (IRR, 2.74; 95% CI, 1.25-5.96) when compared with those elderly who ate their meals in a shorter eating duration (≤12h). These findings suggest that a long eating duration and late first and last meal timing are chrononutrition patterns associated with cardiometabolic risks in free-living Americans.

Risk factors for severe COVID-19 among patients with systemic lupus erythematosus: a real-world analysis of a large representative US administrative claims database, 2020–2021

ObjectivesTo identify risk factors for progression to severe COVID-19 and estimate the odds of severe COVID-19 associated with vaccination among patients with systemic lupus erythematosus (SLE).MethodsThis retrospective cohort study identified...

Pain is associated with exclusive use and co-use of tobacco and cannabis: Findings from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study

IntroductionRates of tobacco and cannabis use are disproportionately high among individuals with pain, and evidence suggests that pain may engender greater likelihood of substance co-use, yielding additive risk. This study examined national associations of pain with past-month tobacco use, cannabis use, and co-use of tobacco and cannabis. MethodsData came from a nationally representative US sample of adults in Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health study (N = 32,014). The sample included civilian, non-institutionalized people who use tobacco and people who do not use tobacco. Past-week pain intensity (0–10) was dichotomized (0–4 no/low pain; 5–10 moderate/severe pain). Multinomial models adjusted for demographics examined substance use category membership (no tobacco or cannabis use, exclusive cannabis use, exclusive tobacco use, co-use) as a function of pain status. ResultsModerate/severe pain was associated with increased relative risk of exclusive tobacco use (RRR [CI] 2.26 [2.05, 2.49], p <.001), exclusive cannabis use (1.49 [1.22, 1.82], p <.001), and co-use of tobacco and cannabis (2.79 [2.51, 3.10], p <.001), in comparison to no tobacco or cannabis use. Additionally, moderate/severe pain was associated with increased risk of co-use compared to exclusive tobacco use (1.23 [1.11, 1.37], p <.001) and exclusive cannabis use (1.88 [1.54, 2.29], p <.001). DiscussionFindings suggest that not only is pain independently associated with greater risk of exclusively using tobacco or cannabis, but pain is also associated with heightened risk of co-using both products. Future work should examine the dynamic and potentially bidirectional relationships between pain and use of cannabis and tobacco.

Development of Accurate Long-lead COVID-19 Forecast.

Coronavirus disease 2019 (COVID-19) will likely remain a major public health burden; accurate forecast of COVID-19 epidemic outcomes several months into the future is needed to support more proactive planning. Here, we propose strategies to address three major forecast challenges, i.e., error growth, the emergence of new variants, and infection seasonality. Using these strategies in combination we generate retrospective predictions of COVID-19 cases and deaths 6 months in the future for 10 representative US states. Tallied over >25,000 retrospective predictions through September 2022, the forecast approach using all three strategies consistently outperformed a baseline forecast approach without these strategies across different variant waves and locations, for all forecast targets. Overall, probabilistic forecast accuracy improved by 64% and 38% and point prediction accuracy by 133% and 87% for cases and deaths, respectively. Real-time 6-month lead predictions made in early October 2022 suggested large attack rates in most states but a lower burden of deaths than previous waves during October 2022 -March 2023; these predictions are in general accurate compared to reported data. The superior skill of the forecast methods developed here demonstrate means for generating more accurate long-lead forecast of COVID-19 and possibly other infectious diseases.

Characteristics of patients with pulmonary arterial hypertension from an innovative, comprehensive real‐world patient data repository

AbstractPulmonary arterial hypertension (PAH) is a rare, life‐limiting disease. PAH registries provide real‐world data that complement clinical trial data and inform treatment decisions. The TRIO comprehensive, integrated patient data repository (TRIO CIPDR), is an innovative US repository capturing data on contemporary patients diagnosed with pulmonary hypertension and receiving US Food and Drug Administration‐approved PAH therapies. This repository uniquely combines clinical data from electronic medical records with the ability to track drug‐prescription and drug‐dispensing characteristics, and includes 946 adult patients with PAH (data collected January 2019 to December 2020) enrolled from nine representative US specialist tertiary care centers. Potentially eligible patients were identified based on dispensing data from specialty pharmacies. Hemodynamic and clinical data, as well as dispensing information on prescribed PAH medications, were provided by tertiary centers. At enrollment, 75% of patients were female, 67% were White, median age at PAH diagnosis was 53 years (median time from diagnosis to enrollment was 5 years), and 37% were obese. Comorbidity profiles were as expected for a PAH population, although the proportion with atrial fibrillation (34%) was higher than expected. Overall, 38% of patients had idiopathic PAH and 30% had connective tissue disease‐related PAH. Among 917 patients receiving PAH‐specific therapy, 40% were on monotherapy, 43% on dual therapy, and 17% on triple therapy. Longitudinal data from this repository will allow tracking of the PAH treatment journey in relation to clinical characteristics and outcomes.

Use of Electronic Nicotine Delivery Systems or Cigarette Smoking After US Food and Drug Administration–Prioritized Enforcement Against Fruit-Flavored Cartridges

The Center for Tobacco Products (CTP) of the US Food and Drug Administration prioritized its enforcement efforts against non-tobacco-, non-menthol- (fruit-) flavored cartridge electronic nicotine delivery systems (ENDS) in February 2020. To evaluate adults' use of ENDS and cigarette smoking following the CTP's prioritized enforcement efforts against fruit-flavored cartridge ENDS. In this population-based, nationally representative US cohort study, data were collected from the Population Assessment of Tobacco and Health Study from December 2018 to November 2019 (hereafter referred to as 2019) and/or from September 2020 to December 2020 (Adult Telephone Survey, hereafter referred to as 2020). Adults (aged ≥21 years) who used ENDS in the past 30 days and smoked cigarettes in the past 30 days or quit smoking cigarettes in the past year (n = 3173) were evaluated. Data were analyzed from January 1, 2022, to May 2, 2023. ENDS flavor-device combinations used. Outcome measures were cross-sectional prevalence of ENDS flavor-device combinations used in 2019 (n = 2654) and 2020 (n = 519) and longitudinal transitions in cigarette smoking (cessation [no smoking in the past 30 days in 2020 among those who smoked in 2019; n = 876] and relapse [smoking in the past 30 days in 2020 among those who recently quit in 2019; n = 137]) as a function of ENDS flavor-device combination used in 2019. The sample in 2019 included 2654 individuals (55% male [95% CI, 53%-58%]). Among those who used ENDS and smoked cigarettes, fruit-flavored cartridge ENDS use decreased from 13.9% (95% CI, 12.1%-15.9%) in 2019 to 7.9% (95% CI, 5.1%-12.1%) in 2020 (P = .01), whereas fruit-flavored disposable ENDS use increased from 4.0% (95% CI, 3.1%-5.1%) in 2019 to 14.5% (95% CI, 11.6%-18.0%) in 2020 (P < .001). Patterns were similar among those who recently quit smoking. Neither cigarette cessation nor relapse rates differed between those who used ENDS that were vs were not prioritized for enforcement efforts (cessation: 23.4% [95% CI, 18.1%-29.7%] vs 26.4% [95% CI, 22.4%-30.8%]; adjusted odds ratio, 1.12; 95% CI, 0.57-2.21; relapse: 32.7% [95% CI, 17.1%-53.4%] vs 29.8% [95% CI, 20.3%-41.3%]; adjusted odds ratio, 0.96; 95% CI, 0.24-3.84). In this nationally representative US cohort study of adults who smoked cigarettes and used ENDS, fruit-flavored cartridge ENDS use was nearly halved between 2019 and 2020. Cigarette cessation and relapse rates did not differ between those who used ENDS targeted by CTP and those who used other ENDS.

Real-World Outcomes for Basilar Artery Occlusion Thrombectomy With Mild Deficits: The National Inpatient Sample.

Thrombectomy for basilar artery occlusion (BAO) has proven efficacy in patients with moderate-to-severe deficits, but has unclear benefits for those with mild symptoms. Using an observational cohort design, the US National Inpatient Sample (2018-2020) was queried for adult patients with basilar artery occlusion and National Institutes of Health Stroke Scale (NIHSS) <10 for patients treated with thrombectomy versus medical management. The primary outcome of routine discharge (to home or self-care) was evaluated using multivariable logistic regression and propensity score matching, adjusted for baseline characteristics, stroke severity, and treatment with thrombolysis. Of 17 019 with basilar artery occlusion, 5795 patients met the criteria for inclusion criteria for our study, and 880 (15.4%) were treated with endovascular thrombectomy. In the propensity score-matched cohort, 880 patients were treated with medical management and endovascular thrombectomy, respectively. In multivariable regression, endovascular thrombectomy was associated with both an increased odds of routine discharge (odds ratio, 1.95 [95% CI, 1.31-2.90]; P=0.001) and a decreased length of hospital stay (B, -0.74 [95% CI, -1.36 to -0.11]; P=0.02) compared with medical management. In the propensity score matched cohort, endovascular thrombectomy remained associated with greater odds of routine discharge (2.01 [95% CI, 1.21-3.34]; P=0.007) but no difference in length of hospital stay (B, -0.22 [95% CI, -0.90 to 0.46]; P=0.53). Routine discharge was more common in this representative US cohort of patients with basilar artery occlusion and National Institutes of Health Stroke Scale <10 who underwent thrombectomy compared to conventional medical management. These findings suggest thrombectomy may be associated with better functional outcomes despite lower National Institutes of Health Stroke Scale and should be validated in a clinical trial setting.

Intrathecal Drug Delivery Systems for Cancer Pain Control: Insights on Current Contemporary Practices in the US

ObjectivesAmong patients with cancer with moderate to severe, intractable pain, intrathecal drug delivery using an intrathecal drug delivery system (IDDS) offers effective pain control. In this study, we evaluate the trends of IDDS therapy among patients with cancer, associated comorbidities, complications, and outcomes, using a large representative US administrative inpatient data base. Materials and MethodsThe Nationwide Inpatient Sample (NIS) data base contains data from 48 states and the District of Columbia. The NIS was used to identify patients with cancer who underwent IDDS implantation between 2016 and 2019. Patients with cancer with intrathecal pumps for the treatment of chronic pain were identified using administrative codes. Baseline demographics, hospital characteristics, type of cancer associated with IDDS implantation, palliative care encounters, hospitalization costs, length of stay, and prevalence of bone pain were evaluated in the study. ResultsA total of 22,895 (0.32%) individuals with hospital admission for IDDS surgery were included for analysis among 7.06 million individuals with cancer in the final cohort. The IDDS cohort consisted of patients predominantly in the 65-to-79 years age group (40.49%), female sex (50.42%), and Caucasian ethnicity (75.82%). The top five cancers in patients receiving IDDS were lung (27.15%), colorectal (24.9%), liver (16.44%), bone (8.01%), and liver (7.99%) cancer. In addition, the length of stay was six days (interquartile range [IQR] four–nine days) and the median cost of hospital admission was $29,062 (IQR $19,413–$42,261) in the patients who received an IDDS. These factors were greater than those in patients without IDDS. ConclusionsA very few patients with cancer received IDDS in the US during the study period. Despite recommendations supporting its use, there are significant racial and socioeconomic disparities in IDDS use.

Association of dietary oxidative balance score and sleep duration with the risk of mortality: prospective study in a representative US population.

We investigated the association between dietary oxidative balance score (DOBS) and mortality and whether this association can be modified by sleep duration. We calculated DOBS to estimate the overall oxidative effects of the diet, with higher DOBS reflecting more antioxidant intake and less pro-oxidant intake. Cox proportional hazards models were employed to examine the associations between DOBS and all-cause, CVD and cancer mortality in the general population and people with different sleep durations. Prospective analysis was conducted using data from the US National Health and Nutrition Examination Survey (NHANES, 2005-2015). A total of 15 991 US adults with complete information on dietary intake, sleep duration and mortality were included. During a median follow-up of 7·4 years, 1675 deaths were observed. Participants in the highest quartile of DOBS were significantly associated with the lower risk of all-cause mortality (hazard ratio (HR) = 0·75; 95 % CI 0·61, 0·93) compared with those in the lowest. Furthermore, we found statistically significant interactions between DOBS and sleep duration on all-cause mortality (P interaction = 0·021). The inverse association between DOBS and all-cause mortality was significant in short sleepers (HR = 0·66, 95 % CI 0·48, 0·92), but not in normal and long sleepers. Our study observed that higher DOBS was associated with lower all-cause mortality, and this association appeared to be stronger among short sleepers. This study provides nutritional guidelines for improving health outcomes in adults, especially for short sleepers.

P12 Unsupervised Clustering and Binary Classification Analysis for Predicting COVID Syndrome (LONG COVID) in US Adults

This study investigated the risk factors of developing COVID Syndrome and identified potential disease profiles that may exist among those who have contracted COVID-19. Data on 13,953 adults who had experienced COVID-19 at any time were analyzed from the 2022 US National Health and Wellness Survey. XGBoost binary classification with 10-fold cross-validation was used to predict long COVID among those who reported experiencing COVID-19 and to extract feature importance. Synthetic minority oversampling technique (SMOTE) was used to address class imbalance in the outcome variable. Variable selection was conducted based on SHAP values. Fifty variables including demographic characteristics, COVID-19 symptoms, comorbidities, and health characteristics were used in the final model. Parameters were tuned using AUC. Among the 2,665 respondents who were diagnosed with long COVID, k-medoids clustering with t-SNE dimensionality reduction was implemented to determine whether distinct symptom profiles exist. Average silhouette score was used to determine the optimal number of clusters. The XGBoost binary classification for predicting long COVID among those with COVID-19 had an AUC of 0.9145, accuracy of 0.9072, sensitivity of 0.9630, specificity of 0.8328, and Brier score of 0.0928. The most important features in predicting long COVID were age, smoking habits, COVID-19 vaccination status, certain COVID-19 symptoms experienced, and certain comorbidities. Among those diagnosed with long COVID, the clustering analysis found nine unique clusters of symptoms. The cluster that experienced the most severe symptoms was older, female, lower income, lower vaccination rate, and had more comorbidities like asthma, chronic bronchitis, and allergies. In a broadly representative US adult population, XGBoost model identified a selection of risk factors for developing long COVID. K-medoids clustering identified clusters of patients that were at risk for developing severe symptoms.

Mental Health and Oral Health in a Nationally Representative Cohort

Evidence connects mental illness to other adverse health conditions, including oral health. However, longitudinal associations between mental and oral health remain understudied. We aimed to examine mental health–oral health associations prospectively in a nationally representative US cohort. Data were from the Population Assessment of Tobacco and Health (PATH) Study. The Global Appraisal of Individual Needs–Short Screener measured 3 types of mental health symptoms: internalizing, externalizing, and substance use problems. Six self-reported oral health conditions related to periodontal disease were evaluated: self-rated oral health, bleeding gums, loose teeth, tooth extraction, gum disease, and bone loss around teeth. Cross-sectional analysis within PATH Study wave 4 (2016 to 2018, n = 30,746) compared the survey-weighted prevalence of the 6 oral health outcomes according to severity of mental health problems. Prospectively, oral health outcomes were assessed 2 y later (wave 5, 2018 to 2019) according to wave 4 (baseline) mental health problems (n = 26,168). Survey-weighted logistic regression models controlled for confounders (age, sex, tobacco use, etc.) with imputation for missing values. All 6 adverse oral health conditions were greater in prevalence among participants with severe internalizing problems. Multiple conditions were also associated with severe externalizing or substance use problems. Longitudinally associations attenuated, but multiple associations of meaningful magnitude persisted, most with internalizing problems. For example, the adjusted odds ratio was 1.27 (95% CI, 1.08 to 1.50) for bleeding gums and 1.37 (95% CI, 1.12 to 1.68) for tooth extraction when we compared severe versus none/low internalizing problems. Providers should expect higher levels of oral disease among patients with adverse mental health symptoms. Independent of externalizing and substance use problems, symptoms of internalizing problems (related to depression and/or anxiety) are plausible risk factors for future oral disease. Better integration and coordination of mental and oral health treatment and prevention are recommended.

The burden of anxiety among a nationally representative US adult population

BackgroundAnxiety disorders are highly prevalent and are associated with a significant humanistic and economic burden. This study evaluates the impact of anxiety symptoms on direct and indirect costs and quality of life in individuals with self-reported and unrecognized anxiety symptoms. MethodsThe 2019 US National Health and Wellness Survey database was analyzed to compare individuals with anxiety symptoms to individuals without symptoms, stratified by responses to a yes/no question about experiencing anxiety symptoms, and further stratified by severity of symptoms based on GAD-7 scores. Individuals who responded ‘yes’ were characterized as having self-reported anxiety symptoms, and those who responded ‘no’ were screened for unrecognized anxiety symptoms. ResultsOverall, 44.0 % of the population experienced anxiety symptoms, of which 32.5 % self-reported experiencing anxiety, while an additional 11.5 % had mild to severe symptoms but did not self-identify as having anxiety. Both groups experienced significantly worse quality of life, and higher direct and indirect costs than a control group who had no anxiety symptoms (GAD-7 ≤ 4). Individuals with more severe anxiety symptoms experienced worse outcomes. LimitationsThe data were cross-sectional, so causality could not be determined. Outcomes were based on self-report, and are therefore subject to reporting and recall bias. Prevalence and severity were assessed using the GAD-7, and not clinically validated. ConclusionA substantial proportion of the population experiences anxiety symptoms without recognizing it. Anxiety symptoms had a significant impact on quality of life, direct costs, and indirect costs, representing a considerable burden that increased with severity of illness.

Searching for Consistency in Attendance Data Recording, Reporting, and Utilization in the USA

According to the United States Department of Education (USDOE), 16% or over eight million kindergarten through twelfth grade students in the US missed 10% or more school days during the 2017−2018 school year. This is approximately 18 of 180 days required. We know this because schools are mandated to report their attendance data to their respective states and to the USDOE. There are concerns around accuracy and consistency because each state is allowed to compile data in their own way and report only select metrics to the USDOE to comply with federal guidelines. The consistency on federal metrics, nonetheless, allows for similar analyses at the federal and state levels and comparisons across states. To best understand what is reported, we report on data compiled by the National Center for Education Statistics (NCES) housed in the Institute of Education Sciences, the science branch of the USDOE, and describe how attendance data are collected, reported, and used at the national level. We share similar findings for two representative US states − Connecticut and Indiana − to highlight similarities and differences between them, and their “best practices.” Key results from these multiple levels of analyses are then discussed, with the goal of informing research, practice, and policy related to school attendance, so that students of all ages and from all backgrounds are provided the opportunity to obtain optimal benefits from schooling throughout their school careers.

Sense of purpose in life and allostatic load in two longitudinal cohorts

ObjectiveSense of purpose in life has been linked with better physical health, longevity, and reduced risk for disability and dementia, but the mechanisms linking sense of purpose with diverse health outcomes are unclear. Sense of purpose may promote better physiological regulation in response to stressors and health challenges, leading to lower allostatic load and disease risk over time. The current study examined the association between sense of purpose in life and allostatic load over time in adults over age 50. MethodsData from the nationally representative US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) were used to examine associations between sense of purpose and allostatic load across 8 and 12 years of follow-up, respectively. Blood-based and anthropometric biomarkers were collected at four-year intervals and used to compute allostatic load scores based on clinical cut-off values representing low, moderate, and high risk. ResultsPopulation-weighted multilevel models revealed that sense of purpose in life was associated with lower overall levels of allostatic load in HRS, but not in ELSA after adjusting for relevant covariates. Sense of purpose in life did not predict rate of change in allostatic load in either sample. ConclusionsThe present investigation supports sense of purpose predicting preserved differentiation of allostatic regulation, with more purposeful individuals demonstrating consistently lower allostatic load over time. Persistent differences in allostatic burden may account for divergent health trajectories between individuals low and high in sense of purpose.