American journal of preventive medicine
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This study investigated whether individual-level social capital modifies the association between adverse childhood experiences and dementia onset. ⋯ Among older adults in Japan, adverse childhood experiences were associated with increased dementia incidence only for those with low social capital.
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This paper describes the sources, magnitude, and correlates of missing data in the Behavioral Risk Factor Surveillance System Sexual Orientation and Gender Identity module. ⋯ Missing the Behavioral Risk Factor Surveillance System Sexual Orientation and Gender Identity data is much more prevalent than item nonresponse alone would suggest. Analytic techniques that consider only item nonresponse, such as complete case analysis, risk producing biased findings. Including the Sexual Orientation and Gender Identity module in the required core demographics section is the only feasible method to reduce the amount and complexity of missing data.
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High-deductible health plans are often touted to motivate patients to become informed healthcare purchasers; however, racial/ethnic minorities report that high deductibles prevent them from seeking the needed care. One proposed way to mitigate the financial burden of high-deductible health plans is the use of health savings plans. This cross-sectional study investigates whether chronically ill Blacks and Hispanics enrolled in high-deductible health plans experience greater access to care difficulties than non-Hispanic Whites and whether racial/ethnic disparities are mitigated by the use of health savings plans. ⋯ Understanding how health savings plans function to improve access to care within racial/ethnic minority groups may help to inform policy approaches related to their use.
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Individuals with noncommunicable diseases account for a disproportionate share of medical expenditures, absenteeism, and presenteeism. Therefore, employers are increasingly looking to worksite wellness programs as a cost-containment strategy. Previous reviews examining whether worksite wellness programs deliver a positive return on investment have shown mixed results, possibly because the more optimistic findings come from studies with poorer methodologic quality. The purpose of this systematic review is to critically revisit and update this literature to explore that hypothesis. ⋯ The highest-quality studies do not support the hypothesis that worksite wellness programs deliver a positive return on investment within the first few years of initiation.
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In the U.S., universal genotyping of culture-confirmed tuberculosis cases facilitates cluster detection. Early recognition of the small clusters more likely to become outbreaks can help prioritize public health resources for immediate interventions. ⋯ Clusters accumulating ≥3 cases within a year should be prioritized for intervention. Effective response strategies should include plans for targeted outreach to U.S.-born individuals, incarcerated people, those experiencing homelessness, people using substances, and individuals self-identifying as being of American Indian or Alaska Native race or of Black race.