Faculty Bibliography

BACKGROUND:Marijuana use is increasing among middle-aged and older adults in the US, but little is understood of its pattern of use by this population. METHODS:We performed a cross-sectional analysis of responses from 17,608 adults aged ≥50 years from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. Prevalence of past-year marijuana use was estimated and compared between middle-aged adults (age 50-64) and older adults (≥65). Characteristics of past-year marijuana users including demographics, substance use, chronic disease, and emergency room use, were compared to non-marijuana users and stratified by age group. Marijuana use characteristics were also compared between middle-aged and older adults. We used multivariable logistic regression to determine correlates of past-year marijuana use. RESULTS:Prevalence of past-year marijuana use was 9.0% among adults aged 50-64 and 2.9% among adults aged ≥65. Prevalence of past-year alcohol use disorder (AUD), nicotine dependence, cocaine use, and misuse of prescription medications (i.e., opioids, sedatives, tranquilizers) were higher among marijuana users compared to non-users. In adjusted models, initiation of marijuana use <19 years of age [adjusted odds ratio (AOR) = 13.43, 95% confidence interval (CI) 9.60, 18.78)], AUD (AOR = 2.11, 95% CI 1.51, 2.94), prescription opioid misuse (AOR 2.49, 95% CI 1.61, 3.85), nicotine dependence (AOR = 1.90, 95% CI 1.59, 2.26), and cocaine use (AOR 7.43, 95% CI 4.23, 13.03), were all associated with increased odds of past-year marijuana use. CONCLUSION/CONCLUSIONS:Marijuana use is becoming more prevalent in this population and users are also at high risk for other drug use.

The gap in school readiness skills between children growing up in poverty and other children has become a major policy issue as increasing proportions of families are living in poverty, especially in low-wealth rural communities. The purpose of this paper was to document the degree to which depth, persistence, and timing of poverty was related to the early development of children in a representative sample of 1,292 families in two of the four poor rural regions in the United States, labeled Appalachia and the Black South. Analyses documented the emergence of the poverty gap in the child's first 5 years of life, asking when the gap emerged and whether it continued to grow through the early childhood period. Findings indicated that families who experienced poverty during the child's first 2-years showed substantially lower cognitive, language, executive functioning, and social skills by 2 to 3 years of age (0.5 to 1.0 SD difference) and these gaps appeared to stabilize between 3 and 5 years of age. Transitions into deep poverty during the preschool period (3- to 5-years) were also related to substantially lower scores, and to a lesser extent, transitions out of poverty were related to higher skill levels. Accounting for baseline demographic and maternal characteristics diminished the poverty gap, but did not eliminate it. The poverty gaps at 3-years in language, executive functioning, and social skills accounted for much of the poverty gaps observed at 5-years. Policy implications for early care and education programming are discussed.

AIMS:Clinical heart failure (HF) guidelines recommend monitoring of creatinine and potassium throughout the initial weeks of mineralocorticoid receptor antagonists (MRAs) therapy. We here assessed the extent to which this occurs in our health care. METHODS AND RESULTS:Observational study in 2007-2010 HF patients starting MRA therapy in Stockholm, Sweden. Outcomes included potassium and creatinine laboratory testing before MRA initiation and in the early (Days 1-10) and extended (Days 11-90) post-initiation periods. Exclusion criteria considered death/hospitalization within 90 days, and lack of a second MRA dispense. Of 4036 HF patients starting on MRA, 45% were initiated from a hospital, 24% from a primary care centre, and 30% from other private centres. Overall, 89% underwent pre-initiation testing, being more common among hospital (97%) than for primary care (74%) initiations. Only 24% were adequately monitored in all three recommended intervals, being again more frequent following hospital (33%) than private (21%) or primary care (17%) initiations. In multivariable analyses, adequate monitoring was more likely for hospital [odds ratio (OR) 2.85, 95% confidence interval (95% CI) 2.34-3.56] initiations, and for patients with chronic kidney disease (OR 1.79, 95% CI 1.30-2.43) and concomitant use of angiotensin-converting enzyme (OR 1.27, 95% CI 1.05-1.52), angiotensin receptor blockers (OR 1.19, 95% CI 1.01-1.40) or beta-blockers (OR 1.65, 95% CI 1.22-2.26). Age, sex, and prescribing centre explained a small portion of adequate monitoring (c-statistic 0.63). Addition of comorbidities and medications improved prediction marginally (c-statistic 0.65). CONCLUSION:Although serum potassium and creatinine monitoring before MRA initiation for HF is frequent, rates of post-initiation monitoring remain suboptimal, especially among primary care centres.

Provided methodologic training, more imagers can contribute to the evidence basis on improved health outcomes and value in diagnostic imaging. The Value of Imaging Through Comparative Effectiveness Research Program was developed to provide hands-on, practical training in five core areas for comparative effectiveness and big biomedical data research: decision analysis, cost-effectiveness analysis, evidence synthesis, big data principles, and applications of big data analytics. The program's mixed format consists of web-based modules for asynchronous learning as well as in-person sessions for practical skills and group discussion. Seven diagnostic radiology subspecialties and cardiology are represented in the first group of program participants, showing the collective potential for greater depth of comparative effectiveness research in the imaging community.

This paper draws on ethnographic data collected from two low-income communities in Mumbai India to explore types of risk and intimacy associated with marital practices. A rapidly globalising India offers access to media, social networks and changing gender norms that create opportunities for young women. Concurrently, enduring patriarchal norms impact marriage and the development of intimacy. Young women whose parents decide on early arranged marriages face inequity and difficulties in establishing emotional and physical intimacy with their husbands. Some young women and their families delay an arranged marriage to ensure educational and/or career advancement, seeking a husband and family that will appreciate her independence. Young women in delayed arranged marriages are more prepared for marital relationships but may experience difficulties meeting family and career expectations and establishing intimacy. Young women who develop their own relationships that evolve into 'love' marriages can initially achieve high levels of intimacy, but the strains stemming from the loss of family support can later undermine the spousal relationship. Within and across these different marital types, there is also a great deal of fluidity and variation in young women's experiences as they adapt to globalised and patriarchal norms in urban India.