URBAN-RURAL DISPARITIES IN DEATHS OF DESPAIR

Although improvements in socioeconomic conditions and medical and technologic advancements contribute to reduced mortality rates over the past century, health disparities across various dimensions (e.g., race/ethnicity, gender, geographic location, and age) are becoming larger than ever in the U.S. As discussed in a paper in the February 2023 issue of the American Journal of Preventive Medicine, recent studies indicate increasing geographic inequalities in life expectancy. Regional variation in health outcomes is explained by differences in community-level factors, such as residential location, access to health care, access to healthy food, and proportion of college graduates. Health disparities can arise or be exacerbated when there is unequal access to these opportunities or resources. A dramatic increase in mortality occurs because of drug overdoses, suicide, and alcohol poisoning, referred to as deaths of despair or stress-related conditions (SRCs). A rise in SRC (2000-2015) first was reported among the non-Hispanic (NH) middle-aged White population in rural areas across the U.S.  

Midlife death rates also rose significantly between 1999 and 2016 among people of color that was driven primarily by drug, alcohol, and suicide deaths, but also because of increases in dozens of organ ailments, such as hypertensive heart disease and liver cancer. In general, rural areas are likely to have fewer socioeconomic resources than urban areas because of their physical location and lack of material and human resources. Separation from others who may provide social support also could exacerbate mental health problems and thus increase the risk of drug, alcohol, and suicide mortality. A study described in the aforementioned paper indicates that SRC mortality rates from 2004 to 2016 were not distributed randomly across the contiguous counties in the U.S. Findings suggest that educational attainment, disability status, access to health care, and contextual conditions can serve as measures to develop more effective prevention and intervention programs to target specific localities and tackle the deaths of despair epidemic. 

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Levels & Trends In Child Mortality 

Child survival is a critical marker of a thriving society. In 2021, there were an estimated five million deaths of children under age five. Sadly, this devastating loss of life was mostly preventable with widespread and effective interventions like improved care around the time of birth, vaccination, nutritional supplementation and water and sanitation programs. Without urgent action to reduce under-five mortality, more than 50 countries will not meet the underfive mortality target by 2030 and more than 60 countries will miss the neonatal mortality target. A new report by representatives from UNICEF, the World Health Organization, the World Bank, and the U.N. Department of Economic and Social Affairs indicates countries can take steps to further child mortality further, such as: Increase investment in primary health care; Scale up prevention and treatment of the leading causes of child mortality, such as newborn complications, pneumonia, diarrhea, malaria, and noncommunicable diseases; Provide sufficient food; Ensure water, sanitation, and hygiene in health facilities; and Establish peace and security. The report can be obtained here.

Race, Ethnicity, And The Design Of State Grant Aid Programs 

Most states use grant programs to lower the prices individual college students pay for their education. Unlike overall reductions in tuition prices for public institutions, these grant policies allow some students to pay less than others. The programs’ policy design and eligibility requirements vary by state and even across sectors. Some state grant aid, based on factors other than financial need, is distributed to students based on high school grades or test scores, intended courses of study, parental occupation, or other characteristics. According to a new report from the Urban Institute, this aid usually aims to reward achievement, to induce talented students to stay in state for college, to encourage students to prepare for occupations in high demand, or to acknowledge the challenges students in specific circumstances face. Need-based aid programs direct funds toward students for whom paying for college is difficult because of financial circumstances. These policies are rooted in both equity and efficiency goals. There is broad consensus that it is unfair to deny college access to potential students because of their inability to pay. Providing sufficient financial support to enable all admitted students to enroll in and succeed at an institution increases labor force productivity and reduces the need for publicly funded social supports. The report can be obtained here.

The Demographic Outlook: 2023 To 2053 

The size of the U.S. population, as well as its age and sex composition, affects the economy and the federal budget. For example, the size of the population ages 25 to 54 affects the number of individuals employed. Likewise, the size of the population age 65 or older affects the number of beneficiaries of federal programs, such as Social Security and Medicare. The Congressional Budget Office (CBO) in a new report describes its population projections, which underlie the agency’s baseline budget projections and economic forecast that will be published later this year. According to CBO projections, the Social Security area population, the relevant population for calculating Social Security payroll taxes and benefits and the measure of population used in this report, increases from 336 million individuals in 2023 to 373 million in 2053. As growth of the population age 65 or older outpaces growth of younger age groups, the population is projected to continue to become older and larger (by 0.8% in 2052, the final year of the projections that CBO released last year) and to grow slightly faster, on average, in this year’s projections, for two main reasons. First, net immigration is projected to be higher and second, mortality rates for the group age 65 or older are projected to be lower over the first two decades of the projection period. The decline stems from fewer deaths in 2022 due to COVID-19 infections than CBO previously projected. The report can be obtained here.

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Reasons For Receiving Or Not Receiving Bivalent COVID-19 Booster Vaccinations

Bivalent COVID-19 booster vaccines, developed to protect against both ancestral and Omicron BA.4/BA.5 variants, are recommended to increase protection against SARS-CoV-2 infection and severe disease. Relatively few eligible U.S. adults have received a bivalent booster dose, however, and reasons for low coverage are unclear. As indicated in the January 20, 2023 Morbidity and Mortality Weekly Report, an opt-in Internet survey of 1,200 COVID-19–vaccinated U.S. adults was conducted to assess reasons for receiving or not receiving a bivalent booster dose. The most common reasons cited for not receiving the bivalent booster dose were lack of awareness of eligibility for vaccination (23.2%) or of vaccine availability (19.3%), and perceived immunity against infection (18.9%). Participants who still had not received the booster dose most commonly reported being too busy to be vaccinated (35.6%). To help increase bivalent coverage, officials should use evidence-based strategies to convey information.  

Mortality In The United States, 2021

A new Data Brief (No. 456--December 2022) from the National Center for Health Statistics (NCHS) presents final 2021 U.S. mortality data on deaths and death rates by demographic and medical characteristics. Among the findings are the following: Life expectancy for the U.S. population in 2021 was 76.4 years, a decrease of 0.6 year from 2020. The age-adjusted death rate increased by 5.3% from 835.4 deaths per 100,000 standard population in 2020 to 879.7 in 2021. Age-specific death rates increased from 2020 to 2021 for each age group one year and older. Nine of the 10 leading causes of death in 2021 remained the same as in 2020. Heart disease, cancer, and COVID-19 remained the top three leading causes. The infant mortality rate was 543.6 infant deaths per 100,000 live births in 2021. The change in infant mortality from 2020 was not statistically significant. 

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Passive Monitoring By Smart Toilets For Precision Health 

Precision health is an approach to prevent, diagnose, and monitor disease using data gleaned from an individual’s biological information. Passive monitoring in a smart home setting, where appliances and devices are connected and controlled automatically, may provide such information. As described in the February 1, 2023 issue of Science Translational Medicine, of the possible locations in a smart home, the bathroom, and more specifically the toilet, is particularly well suited for such passive sensors. A “smart toilet” not only can monitor standard health characteristics, including temperature, heart rate, and oxygenation through sensors in the toilet seat, but also can collect biological samples (i.e., urine and stool) that contain useful health information. Yet, a reluctance to discuss excreta openly hampers the development and acceptance of smart toilets, which hold the potential to integrate urine and stool analyses seamlessly as part of routine toileting events and to serve as a gateway to the “digitalization” of health care in the home. 

Use Of Peptide 3D-Printing Inks To Advance Regenerative Medicine

Is it possible to build complex structures for housing cells using a material as soft as Jello? Scientists at Rice University believe that 3D printing represents a primary fabrication strategy used in biomedical research as recent efforts have focused on the 3D printing of hydrogels to create structures that better replicate the mechanical properties of biological tissues. As described in a study published on January 4, 2023 in the journal Advance Materials, these investigators envision that eventually the goal is to print structures with cells and grow mature tissue in a petri dish. These tissues then can be transplanted to treat injuries, or used to learn about how an illness works and to test drug candidates. There have been other attempts to 3D-print using other self-assembling peptides, but this effort is the first time that any self-assembling peptide system has been used to 3D-print such complex structures successfully. The structures were printed with either positively charged or negatively charged multidomain peptides.  

CONGRESSIONAL LEGISLATIVE OUTLOOK

Using multiple poll results, an article published in the February 2, 2023 issue of the New England Journal of Medicine seeks to explain how the outcome of the 2022 mid-term election is likely to affect health policy issues. Data are derived from three types of polls: (1) a 2022 national exit poll, comprising the responses of voters as they exited voting places and those from telephone and online interviews with those who had voted before election day; (2) a national poll of voters conducted by Harvard T.H. Chan School of Public Health at the time of the election, including responses from telephone and online interviews with those who had already voted and likely voters during the week leading to election day; and (3) nine other polls conducted by telephone, online, or both with samples of U.S. adults between September 2020 and October 2022, with one exception.  

A general conclusion is that after the 2022 election, critical health policy issues will face a sharply divided Congress, which is likely to hinder their resolution. Reflecting attitudes of their own parties’ voters, Republican and Democratic members in Congress will differ not only in their support for specific policies, but also in underlying values, e.g., in a December 2020 poll of the general public, 87% of Democrats said it is the responsibility of the federal government to make sure all Americans have health care coverage, as compared with only 22% of Republicans. It can be expected that Republicans are likely to oppose any major expansion in domestic spending, including for health-related issues. A majority of Republicans believe the major domestic spending bills proposed by the Biden administration have been inflationary, while a majority of Democrats do not. In a March 2022 poll of the public, 87% of Democrats had a favorable view of the Affordable Care Act (ACA) as compared with 21% of Republicans. Thus, enacting any extensive ACA enlargement is unlikely. Reducing health care costs and drug prices are a top issue, but whether any agreements can be reached is unclear.  

Periodically, some high drama unfolds when there is a necessity to raise the national debt ceiling. For example, when President Barack Obama was in office in 2011, an impasse was not resolved until a couple of days before the ceiling was about to be reached. Whenever that situation occurs, financial markets can become quite agitated as the nation appears unable to continue meeting its financial obligations. Yet, the ceiling was raised with less effort three times when Donald Trump was president, a period in which Republicans were willing to cooperate even though the amount of debt increased by eight trillion dollars.  

Currently, however, members of that party are much less inclined to support an increase unless it is accompanied by concrete steps to reduce federal spending. Whether popular entitlement programs, such as Medicare and Social Security might be targets is worrisome. Steady growth in the portion of the population age 65 and older, combined with the fact that many of these individuals have two or more chronic health problems, essentially means that such expenditures will continue to increase.

ACHIEVING MAJOR HEALTH POLICY GOALS

Health policy in the United States centers on providing access to all of the nation’s inhabitants in need of health care, controlling costs, and assuring the provision of high quality services. Related to the notion of quality is the necessity of having suitable quantitative measures to evaluate the health of the population. As indicated in an article published in January 2023 in the Journal of Health Economics, mortality indicators (such as life expectancy) typically were used first. Although still of great importance, a growing consensus exists to combine them with morbidity indicators. Presently, it is widely accepted that the benefit a patient derives from a particular health care intervention can be defined according to two natural dimensions: quality of life and quantity of life.  

Quality-adjusted life years (QALYs) were developed to combine the two natural dimensions. Arguably it is the most widely accepted methodology in the economic evaluation of health care, serving as a reference standard in cost-effectiveness analysis. Alternative health outcome measures also became popular, such as Disability-adjusted life years (DALYs). Primarily a measure of disease burden, it arose in the early 1990s as a result of an effort to quantify the global burden of premature death, disease, and injury and to make recommendations that would improve health, particularly in developing nations.  

An illustration of how various measures are employed operationally is provided by the Inflation Reduction Act (P.L. 117-169) enacted in August 2022. This new law empowers the Centers for Medicare and Medicaid Services (CMS) to negotiate directly with pharmaceutical companies to set prices for a limited set of high-cost drugs covered by Medicare. The law does not, however, detail a process for determining fair prices, other than a consideration for how long drugs are on the market. A report published on October 27, 2022 by The Commonwealth Fund discusses how historically, prices for drugs in the U.S. have been disconnected from the clinical benefit they provide. Without this information, health insurers and pharmacy benefit managers have no way of knowing which investments are the most beneficial. Several approaches are described to assess a drug’s value, each with its advantages and drawbacks. Along with QALYs and DALYs, they include: Life year (LY), Equal value life years (evLY), Health years in total (HYT), Value of a statistical life (VSL), Added benefit, Clinical effectiveness rating, Multicriteria decision analysis (MCDA), and Social return on investment (SROI). 

Some controversy exists in this aspect of health policy as shown by the introduction on January 24, 2023 of the Protecting Health Care for All Patients Act (H.R. 485) in Congress. The bill would prohibit the use of QALYs in all federal programs, an expansion from the current prohibition that only applies in a limited fashion to the Medicare program. A rationale is that this discriminatory metric intentionally devalues treatments for disabled individuals and patients with chronic illnesses for purposes of determining whether the treatment is cost-effective enough to be paid for by the federal government.

UNSETTLED SCIENCE AND TERMINOLOGY INEXACTITUDES

The perspective that a body of knowledge is settled or broadly considered to be proven, is not exclusive to a particular science, but occurs widely. As described in the January 2023 issue of the journal Medical Care, health services research is not immune to this phenomenon. Thomas Kuhn warned in The Structure of Scientific Revolution, that in what he referred to as normal science, it is the current paradigms that hold substantial sway over scientific disciplines. These paradigms provide the structure by which scientists go about finding out new knowledge to fill in the accepted framework of understanding. Evidence consistent with the paradigm is accepted as verification that the theory or paradigm is correct while anything contrary is questioned as to its authenticity. Thus, current paradigms of normal science may persist in the face of accumulating anomalies until it is not possible to dismiss or otherwise explain them away.  

A paper in the December 2022 issue of the journal Neurology indicates that disease terminology should convey an accurate and understandable picture, ideally with corresponding prognostic, therapeutic, and pathophysiologic utility. Optic neuritis refers to an inflammatory optic nerve process related to multiple sclerosis or other identifiable autoimmune diseases of the CNS. Recently, salient clinical features distinguishing optic neuritis have been identified, highlighting the need for diagnostic precision superseding crude binary classifications of "typical" vs "atypical" optic neuritis. The authors propose elimination of the term "atypical optic neuritis" since the "itis" modifier is often erroneous and the term may instill a false sense of diagnostic security in the clinician, implying a more definitive diagnosis and resulting in therapeutic delays or administration of therapies with deleterious effects. Considered more broadly, current inconsistencies in terminology act as barriers to research and development of the good practices required for effective provision of rehabilitation and assistive technology (AT). According to Issue 8 in 2022 of the journal Disability and Rehabilitation: Assistive Technology, information exchange among all participants in the AT value chain can only become interoperable when terminology standards for concepts, terms, and definitions are established and used. The development of more precise terminology in health care should be instrumental in producing more settled rather less settled science.

DEBATE OVER ADOPTION OF PERMANENT STANDARD TIME IN THE U.S.

A national debate in the United States over Daylight saving time (DST) is a timely issue. In March 2022, the U.S. Senate passed the Sunshine Protection Act to make DST permanent in states that previously have chosen to make that change. The U.S. House has not passed this legislation. Daylight saving time (DST) refers to the practice of advancing clock time by one hour each spring, with a return (setting back) to standard time (ST) each fall. Numerous sleep and circadian societies have published statements in support of permanent ST, which also has received support from multiple medical societies and organizations. Recently, the Sleep Research Society (SRS) in the December 2022 issue of its journal Sleep advocates the adoption of permanent ST. In contrast, on the opposing side of the debate is that the business community, including the National Association of Convenience Stores and the Sporting Goods Manufacturing Association support permanent DST. One of the most prominent arguments in the debate over adopting permanent ST (rather than permanent DST) is how health, sleep, and circadian biology are affected.  

DST shifts daylight into the early evening in exchange for less daylight in the early morning when more individuals are presumed to be asleep. This light exchange has both social and economic benefits, with more natural light for evening activities and less need for artificial light in the evening. Nonetheless, there are health consequences to DST for those whose school or jobs require them to awaken early. Evening light extended too close to bedtime also can disrupt sleep patterns. Compared to individuals living on the eastern edge of a time zone, residents living on the western edge of a time zone, who obtain light later in the morning, and later in the evening, self-report having less sleep based on time-use data. Sleep loss in adults has been associated with weight gain and obesity; diabetes; hypertension; heart disease; and stroke, depression, and increased risk of death, along with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents. Sleep loss in children has been associated with attention, behavior, and learning problems; along with increased risk of accidents, injuries, hypertension, obesity, diabetes, depression, self-harm, suicidal thoughts, and suicide attempts.

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Observing Race And Ethnicity Through A New Lens 

Survey questions about race and ethnicity can shed light on how experiences differ across groups and ultimately help policymakers and other interested parties address inequities in health and other outcomes. Yet, such questions often focus only on self-identified race and ethnicity and lump together diverse populations, masking substantial differences within groups and yielding results with insufficient nuance to understand and address inequities appropriately. A brief from the Urban Institute explores what can be learned by measuring race and ethnicity in alternative ways on surveys and what is missed by focusing only on one set of measures of these two factors. The assessment involves nonelderly adults’ perceptions of how others see their race based on their physical appearance (henceforth “street race”) and how responses to questions about street race vary depending on the response options given. The investigation proceeded by analyzing data from the December 2021 round of the Urban Institute’s Well-Being and Basic Needs Survey (WBNS), a nationally representative, internet-based study of adults ages 18 to 64. The brief can be obtained here.

What A Decline In Fertility Means For State Budgets 

Fertility continues to follow a downward trajectory across the U.S., falling to a record low in 2020. State budgets have started to feel the effects of this long-term decline and this historic drop will affect nearly every area of state budgets in the coming years. A brief from The Pew Charitable Trusts indicates that fewer births could yield cost savings. Many school districts are experiencing drops in enrollment and a sharp reduction in teenage pregnancies has helped limit growth in health expenditures. In the coming decades, however, governments may face resource challenges, with a smaller pool of workers likely suppressing income, sales, and other tax revenue sources. The historic decline in fertility will touch nearly every area of state budgets in the coming years. Some fiscal effects have already emerged, while others will be relatively minor or won’t be felt for decades. The implications for individual states vary. Those with shrinking workforces that rely more than other states on taxes sensitive to population declines—such as income and sales taxes—are especially vulnerable to budget pressures. Other demographic shifts, such as migration also will affect many sources of revenue and spending. Today, most states find themselves in a relatively healthy fiscal position, with many enjoying robust budget surpluses. Fewer births in recent years have contributed appreciable cost savings. If low fertility persists, however, states will need to look more for other ways to grow their tax bases or they could face challenges over the long term. The brief can be obtained here.

Families Caring For An Aging America

Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America is a new publication from the National Academies of Sciences, Engineering, and Medicine. The document examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults. The report can be obtained here.

DEVELOPMENTS IN HIGHER EDUCATION

The U.S. Department of Education plans to hold a series of negotiated rule-making sessions in Spring 2023 to propose new rules. Topical areas include amending regulations on accreditation under the Higher Education Act of 1965, as amended (HEA), including rules associated with the standards relating to the Secretary’s recognition of accrediting agencies and accreditation procedures as a component of institutional eligibility for participation in Federal student financial aid. Secretary Miguel Cardona plans to amend regulations on state authorization as a component of institutional eligibility and also plans to propose to amend regulations that determine whether postsecondary educational programs prepare students for gainful employment in recognized occupations, and the conditions under which institutions and programs remain eligible for student financial assistance programs under Title IV of the Higher Education Act (HEA). Another proposal of interest is to amend the definition of distance education. A final set of regulations overhauling Title IX of the Education Amendments of 1972 is expected to occur in May.

The Biden administration has expressed strong interest in cancelling a portion of student debt. The     proposal would cancel as much as $10,000 in federal student debt for borrowers making under $125,000 a year, or $250,000 for a married couple. Recipients of Pell Grants would be entitled to an extra $10,000 of debt cancellation. Private loans, which make up less than 10% of all outstanding student debt, will not qualify unless they already had been consolidated into a federal loan. An obstacle to implementation occurred on November 14, 2022 when a three-judge panel of the Eighth U.S. Circuit Court of Appeals   issued a preliminary injunction to block the plan. The U.S. Supreme Court has entered the controversy by agreeing to decide whether student-loan debt relief for millions of Americans can go into effect. The Court became involved after Republican officials in six states claimed that the debt relief proposal was an unlawful exercise of presidential authority, which would affect state revenues and tax receipts. The matter is being decided by the justices on a fast-track timeline that may lead to a final ruling by the end of June 2023.

 Departments Of Education And Justice Filed A Legal Brief With The Supreme Court

The Biden administration remains committed to striving to deliver essential student debt relief to tens of millions of Americans. As part of this pledge, the Departments of Education and Justice filed a legal brief with the Supreme Court explaining the legal authority under the Higher Education Relief  Opportunities for Students Act to carry out a program of one-time, targeted debt relief. Department of Education Secretary Cardona stated that the purpose is to helping borrowers recover from the COVID-19 pandemic and providing working families with the breathing room they need to prepare for student loan payments to resume. As previously intended, student loan payments and interests will remain paused until the Supreme Court resolves the case because it is considered deeply unfair to ask borrowers to pay debt they wouldn’t have to pay, were it not for lawsuits viewed by the Administration as meritless.

 Rising Health Fees For College Students

Apropos of the topic of student educational debt, many families find it quite challenging to be able to    finance costs involving tuition, campus housing, meals, and activity fees. Another expense that can add to their anguish is rising health fees. Kaiser Health News discussed this issue in a report on December 19, 2022. Newly enrolled freshmen are discovering that it also is necessary to purchase both a student health insurance premium and a fee that allows them to access on-campus clinics and other services. The costs vary by school, but often can amount to several thousand dollars a year. The average for public colleges is $2,712 and $3,540 for private universities, according to a 2002 survey, but charges can be as high as $4,500 to more than $6,500, depending on the institution. Students can seek a waiver to university health insurance by showing they have their own coverage or are covered by a policy of their parents that meets specific university criteria. Some institutions, however, typically want to know that a student’s own insurance covers local doctors and hospitals for little out-of-pocket cost. 

117th CONGRESS DRAWS TO A CLOSE

Capitol Hill went into a lame duck session after the mid-term election in November 2022 in order to complete some important unfinished business of the 117th Congress. A significant achievement was to send an omnibus spending bill to President Joseph Biden that he signed into law (P.L.117-328) on December 29. The package will fund the federal government through September 2023. It  passed the Senate on a 68-29 vote and the House of Representatives by a vote of 225-201-1. Amounting to $1.7 trillion, it will provide funding for the rest of Fiscal Year 2023, which ends on September 30 of this year. The accomplishment compares well with events that unfolded  during the previous year. A spending agreement could not be reached until March 2022 for Fiscal Year 2022 that ended last September 30.

Weighing in at 4,155 pages, major features of P.L. 117-328 include a total of $209.9 billion (a $14.8 billion increase) for the Labor-HHS-Education account. Within that amount, the National Institutes of Health will receive a total of $47.5 billion and the Centers for Disease Control and Prevention will have $9.2 billion. The bill also contains $15.3 billion in bipartisan earmarks that will provide funding for some 7,000 congressionally-directed spending projects. Many of these endeavors will benefit higher education institutions.

Looking in the legislative rearview mirror, the 117th Congress drew to a close in December 2022. During its two calendar year lifespan, 24,784 measures were introduced that included bills, amendments, resolutions, joint resolutions, and concurrent resolutions. Of these total amounts, the House featured the introduction of 9,704 bills and the Senate 5,357 bills. Topically, in the House 1,292 bills pertained to health and 433 to education while in the Senate, 714 were in health and 220 in education.

Looking forward, the 118th Congress came into existence in January 2023. It differs from its predecessor in two fundamental ways. First, Democrats no longer will hold the majority in both chambers. Republicans now have a slight numerical edge in the House of Representatives. That party is headed by Kevin McCarthy, who succeeds Nancy Pelosi as House Speaker. Both individuals are part of the delegation from California. Another difference worth noting is that in the 118th Congress, women will make up more than a quarter (28%) of all members, the highest percentage in U.S. history and a considerable increase from where matters stood only a decade ago. Counting both the House and the Senate, women made up 153 of 540 voting and nonvoting members of Congress, representing a 59% increase from the 96 women who were serving in the 112th Congress a decade ago. A record 128 women are serving in the newly elected House, accounting for 29% of the chamber’s total. Of the 22 freshman representatives who are women, 15 are Democrats and seven are Republicans. In the Senate, women hold 25 of 100 seats, tying the record number they held in the 116th Congress.

REORIENTING U.S. HEALTH CARE

When considering health care both presently and in the future, two related facts are quite prominent. First, not only is the U.S. population steadily growing in size numerically, but the cohort of individuals ages 65 and older also is doing so at a faster rate proportionately. Accompanying that demographic transition is the fact that huge numbers of individuals who are part of this age group are characterized by having two or more chronic health problems that fuel a demand for health care and health-related social services.

Simultaneously, over the past several decades, health care increasingly has been conceptualized as a series of independent encounters (i.e., transactions) that can be distributed nearly randomly among health care personnel in the clinical setting, e.g., a physician can be on the other side of a telemedicine screen. According to an article in the December 2022 issue of the journal Mayo Clinic Proceedings, a transactional mindset exists that treats clinicians as interchangeable parts, which especially is problematic in specialties where continuity and longitudinal care play a critical role. Consequently, this industrial-based conceptualization has been harmful to health care and has impeded progress toward quadruple-aim outcomes: enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers.

Yet, such fragmentation of care is viewed as being ubiquitous. An example of structural pressures that deprioritize relationships is the adoption of models where care is provided separately by inpatient and outpatient personnel without creating time or incentives for them to coordinate with each other. If it is believed that intentionally reshaping operations, culture, technology, and financial incentives to prioritize relationships will benefit patients, clinicians, and payers who share in the costs of patient care, how can system transformation centered on relationships be accomplished?

The authors present three foundational actions that must be advanced to reorient the care delivery system: structurally prioritize continuity of relationships, make room for relationships by removing sludge from the system, and realign reimbursement and incentives at the delivery-system level. Examples of implementation strategies and tactics in each of these three domains are provided by the authors to guide organizational leaders, policy makers, technology vendors, and other interested parties.

One of the most fragile points of disjuncture within the health care system occurs at hospital discharge. In a system that radically is reoriented around relationships, the patient would not be discharged with the attendant risk of being unable to arrange necessary follow-up appointments or being seen by clinicians who lack information about the recent hospitalization. Instead, the patient would leave the hospital with actual appointments (date, time, and location) for all follow-up required to continue care safely. Systems would be built to communicate with the ambulatory clinic to arrange these appointments.

A REVIEW OF AMISH HEALTH CONDITIONS AND SOCIAL MECHANISMS

Health researchers and service providers increasingly are interested in the Amish, a North American-based population whose rapid growth is occurring almost entirely in rural North America. In these rural locations, they have an outsized impact on local culture and infrastructure, both as they concentrate in existing communities and migrate to new places. Amishness refers to an ethnic group defined by a sense of shared history represented in part by a closed genetic pool of Swiss-German origin, a minority language, and a subjective sense of shared culture transmitted across generations and evident in, for example, ethnic and ancestral literature; ethnic enclaves and landscapes; insider-specific systems of symbols and meaning-making; and particular lifestyle-behavioral patterns. As an ethnic religion, the Amish are of interest to population health researchers due to a distinctive health profile arising from ethnic attributes, including a closed genetic pool and shared culture that shapes lifestyle practices. Amish-focused health research both furthers the knowledge base of health conditions by comparing Amish with non-Amish and assists health practitioners in serving this rapidly growing population.  

Amish health research is in need of review from the perspective of strengthening this knowledge body’s coherence, clarifying research directions, and identifying knowledge gaps, lapses, and stagnations. As described in the November 2022 issue of the journal Ethnicity & Health, researchers synthesize and discuss Amish physical health conditions research, both the population’s distinctive health profile and mechanisms shaping it. Specifically, they summarize research addressing body mass index (BMI), physical activity, and body image; diet and supplements; cancer; cardiovascular conditions; communicable diseases; immunity; sleep; genetic disorders; tobacco and alcohol use; periodontal conditions; traumatic injuries; natural treatments for burns; fertility; and sexually transmitted diseases. Upon reflection, questions are raised about the nature of intervening mechanisms shaping the Amish health profile, the strange omission of several common independent variables commonly used when studying other ethnic groups’ health, several recurring methodological complications, and public health policy considerations. A concluding thought is that because the Amish population is growing, any unresolved Amish-specific public health concerns will only increase. For example, they have a disproportionate share of individuals who reject many or all vaccinations. The possibility for vaccine-specific outbreaks will only grow (e.g., measles).

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Population-Level Trends In Adult Pain Treatments, 2011-2019

As reported in the December 2022 issue of the journal Archives of Physical Medicine and Rehabilitation, a study was conducted that included a comparison of the annual use of nonpharmacologic pain treatments versus prescription opioids among cancer-free adults. Other objectives were to estimate the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; determine whether calendar year was associated with treatment type; and explore whether pain treatments varied by pain severity. The prevalence of nonpharmacologic treatments increased while prescription opioid use declined following policy and practice changes during the past decade. Nonpharmacologic pain treatments may be appropriate for all degrees of pain severity. Chiropractic care and physical therapy were the most common nonpharmacologic treatment providers. Nonpharmacologic treatments did not vary based on pain severity.

Severe Maternal Morbidity and Mortality Risk

Differences in rates of severe maternal morbidity and mortality (SMMM) have been studied among Medicaid-funded compared with privately insured hospital births through specific additive and intersectional risk by rural or urban geography; race and ethnicity; and clinical factors. Maternal discharge records from childbirth hospitalizations in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2007 to 2015 were used. As reported in the November-December 2022 issue of the periodical Women’s Health Issues, the highest rate of SMMM (224.9 per 10,000 births) occurred among rural Indigenous Medicaid-funded births. Those births among Black rural and urban residents, and among Hispanic urban residents, also experienced elevated rates and significant additive interaction. These rates indicate an opportunity for tailored state and federal policy responses to address the particular maternal health challenges faced by Medicaid beneficiaries, including Black, Indigenous, and rural residents.

HEALTH TECHNOLOGY CORNER

Delivery Of Human Organ Transplantation By Drones

Organs are in short supply for patients in need of a life-saving transplant. The moment an organ is removed from the human body, it begins to deteriorate rapidly. Historically, organ transport has relied on standard ground and air transportation. Although these methods are satisfactory, they are risky, inefficient, and expensive. Significant delays persist and are exacerbated by road traffic and transportation availability in metropolitan areas. According to an article published on December 21, 2022 in the journal Science Robotics, researchers validated the process of donor lung transportation via remote piloted aircraft system (RPAS) in controlled airspace over a densely populated urban environment of downtown Toronto, Canada.  With the successful delivery of kidneys and now lungs, the development of a universal transport system for all organs is within reach. Thus, RPAS technology is likely to see early adoption in American Northeast, Southeast, and Ontario, Canada.

Applications Of Speech Analysis In Psychiatry

The need for objective measurement in psychiatry has stimulated interest in alternative indicators of the presence and severity of illness. Speech may offer a source of information that bridges the subjective and objective in the assessment of mental disorders. As reported in the January/February 2023 issue of the Harvard Review of Psychiatry, the utility of speech analysis depends on how accurately speech features represent clinical symptoms within and across disorders. Four domains of the application of speech analysis in the literature are: diagnostic classification, assessment of illness severity, prediction of onset of illness, and prognosis and treatment outcomes. Models that bring together multiple speech features can distinguish speakers with psychiatric disorders from healthy controls with high accuracy. Convergent progress in speech research and computer sciences opens avenues for implementing speech analysis to enhance objectivity of assessment in clinical practice.

OBTAINABLE RESOURCES

Global Roadmap For Healthy Longevity

With unprecedented global aging, societies must undertake all-of-society efforts to maximize the benefits and minimize the burdens of aging populations. The Global Roadmap for Healthy Longevity (Global Roadmap) describes a realistic vision of healthy longevity that could be achieved by 2050. The vision includes full inclusion of individuals of all ages, regardless of health or functional status, in all aspects of society and societies characterized by social cohesion and equity. To achieve the vision, Global Roadmap recommends changes that need to be made to health systems, social infrastructure, physical environments, education, work, and retirement. In some cases, the recommended changes benefit older persons most directly, but when the older portion of the population thrives, members of all ages benefit. If adopted and implemented, the recommendations of this report can support individuals of all ages in all corners of the globe to live long, meaningful, and purpose-driven lives by 2050. The report can be obtained here. 

Treating Older Patients In The Emergency Room 

AARP has teamed up with the Geriatric Emergency Department Collaborative (GEDC) to publish two new videos designed to educate and raise awareness about the serious issues of dementia and delirium in health care settings, particularly emergency rooms. These short educational resources provide action steps for providers, patients, and family caregivers to identify and manage issues related to brain health in the emergency room more effectively. By implementing relatively straightforward and cost-effective measures outlined in the videos, human brain health can be protected and medical outcomes can be improved. The videos are: 

· Dementia in the ED: Providing Better Care for Older ED Patients  

· Delirium in the Emergency Department: Serious, Costly, and Potentially Deadly 

They can be viewed here.  

Annual Report To The Nation On The Status Of Cancer 

Overall cancer death rates continued to decline among men, women, children, and adolescents and young adults in every major racial and ethnic group in the United States from 2015 to 2019, according to the latest Annual Report to the Nation on the Status of Cancer. From 2014 to 2018, overall cancer incidence, or new cases of cancer, remained stable for men and children, but increased for women and adolescents and young adults. This year’s report, published October 27, 2022, in the journal Cancer, also highlights longer-term trends in pancreatic cancer, as well as racial and ethnic disparities in incidence and death rates for many individual cancer sites. The report can be obtained here.  

Improving And Strengthening Employer-Sponsored Health Insurance 

Employer-sponsored insurance (ESI) represents the nation’s largest source of health coverage, but in-depth policy discussion on how to improve the employer system is lacking. With the current policy focus on Medicare, Medicaid, and the individual market, decision-makers are left wanting for ESI-dedicated proposals and analysis. Consequently, both employers and employees need solutions to improve ESI so it can remain in place for the foreseeable future. A new report from the Bipartisan Policy Center discusses this important topic and can be obtained here.

DEVELOPMENTS IN HIGHER EDUCATION

When faced with the daunting task of designing an effective structure for the U.S. government, the founders of this nation envisioned having a legislature to produce laws, a separate executive branch to implement those laws, and an independent judiciary to resolve any differences between them. For the most part, the arrangement functions reasonably well, but not always. An example is when the legislature is unable to reach agreement on a bill that is desired by the chief executive who occupies the White House. Whenever that situation arises, the result can best be described by President Obama who stated, “I've got a pen, and I've got a phone," thereby making it possible to issue executive orders to bypass congressional deadlock.  

It is an effective mechanism, but depending on the nature of that order and how contentious it is, the ruling may not have a long shelf life. For example, once a new president is elected from a different political party, that individual’s first actions might include rescinding a predecessor’s executive orders. A second remedy also is available by having a preliminary injunction granted, which occurred on November 14, 2022 by a three-judge panel of the Eighth U.S. Circuit Court of Appeals. That judicial decision blocks the Biden administration’s plan to cancel some student debt. According to U.S. Secretary of Education Miguel Cardona, as of mid-November 2022, more than 26 million borrowers have provided the information needed to process their applications for relief and 16 million applications have been approved and sent to loan servicers to be discharged when allowed by the courts. 

Time will tell whether students will reap the benefit of efforts to improve their financial situation. Focusing on the possibility that debt relief subsequently will go into effect, the U.S. Department of Education on October 31, 2022 released final regulations that streamline and improve the rules for major targeted debt relief programs. The regulations expand eligibility, remove barriers to relief, and encourage automatic discharges for borrowers who are eligible for loan relief because their school closed; they have a total and permanent disability; or their loan was falsely certified. The rules also establish a fairer process for borrowers to raise a defense to repayment, while preserving borrowers’ day in court by preventing institutions of higher education from forcing students to sign away their legal rights using mandatory     arbitration agreements and class action waivers. Finally, the rules help borrowers avoid spiraling student loan balances by eliminating all instances of interest capitalization not required by statute, which occur when unpaid interest is added to a borrower’s principal balance, increasing the total amount that may have to be paid.     

U.S. Supreme Court And College Admissions

The Supreme Court on August 31, 2022 heard several hours of oral arguments in two cases against Harvard University and the University of North Carolina that were brought by Students for Fair Admissions (SFFA) seeking to overturn four decades of precedent allowing the consideration of race in college admissions. Specifically, this group is petitioning justices to overturn a ruling in the case Grutter v. Bollinger, a decision in 2003 that enabled institutions of higher education to use race as part of a holistic review of admissions applications when narrowly tailored. The Court is expected to announce its decision in 2023, perhaps by early June.

Reauthorization Of The Higher Education Act (HEA)

The Higher Education Act of 1965 (P.L. 89-329, as amended), authorizes a broad array of federal student aid programs that assist students and their families with financing the cost of a postsecondary education, as well as programs that provide federal support to postsecondary institutions of higher education (IHEs). The Department of Education administers the programs authorized by the HEA. The most prominent components are the Title IV programs that provide financial assistance to students and their families. The HEA was first enacted in 1965 and has since been amended and extended numerous times. It has been comprehensively reauthorized eight times. The most recent comprehensive reauthorization occurred in 2008 for a five-year period. Whether it will be reauthorized in 2023 is uncertain. This newsletter will keep readers apprised of any developments that unfold.

HEALTH REFORM DEVELOPMENTS

The availability of high quality health care services is a key factor in producing satisfactory individual and community health status outcomes. A central role in achieving important objectives is played by the health workforce. A problem is that apart from medicine, few professions have data systems that make it possible to enumerate how many students are in the educational pipeline and how many qualified  personnel are in practice, which are determinations required to assess if the workforce matches the health care needs of patients. 

The Bureau of Health Professions (BHPr) in the Health Resources and Services Administration (HRSA) in the U.S. Public Health Service for many years in the 1980s and 1990s made important contributions to efforts aimed at producing an allied health workforce data system. An entity known as the Forum on Allied Health Data (FAHD) made it possible for data experts from several professions to gather annually to improve the collection and distribution of workforce information. The Association of Schools Advancing Health Professions (known as the Association of Schools of Allied Health Professions in the 1990s) hosted FAHD meetings and was awarded two federal contracts by the BHPr in that decade.  

One project was used to identify workforce data sources extant in federal government agencies (e.g., the Veterans Health Administration, Department of Defense, Indian Health Service, Bureau of Labor Statistics); state and city health departments; and professional organizations. A second project was aimed at developing a Minimum Data Set (MDS) that all of these sources could use to produce comparable kinds of information. The idea was to develop a system that reflected common data elements collected at similar periodic intervals. Unfortunately, that result never was achieved. Although the BHPr continues to receive federal appropriations, no funding is intended specifically for allied health workforce data considerations. Apart from a Bureau endeavor that enabled the Institute of Medicine to host an Allied Health Workforce and Services Workshop in 2011, related substantive efforts have lagged. 

National Health Care Quality And Disparities Report

On a related note, the Agency for Healthcare Research and Quality (AHRQ) has released its 2022 National Healthcare Quality and Disparities Report (NHQDR). It provides policymakers, health system leaders, and the public with a statistical portrait of how effectively the health care delivery system provides safe, high-quality, and equitable care to all Americans. The report’s “Portrait of American Healthcare” offers numerous important insights, including: life expectancy in the United States falls behind life expectancy in similarly developed countries, and the gap has grown since 1980; a shortage of primary care health professionals compromises access to services in more than 60% of U.S. counties; and social determinants of health may have a stronger influence on health outcomes than clinical services provided by health care delivery systems. 

Medicaid Structured Family Caregiving

The National Academy for State Health Policy (NASHP) has released a report, Medicaid Structured Family Caregiving: Enabling Family Members to Make Caregiving Their Primary Focus. This brief is based on research and interviews with state staff and examines how Georgia, Missouri, and South Dakota are using Medicaid-funded structured family caregiving (SFC) services to help older adults stay in their homes. These services consist of a package that supports a patient’s primary caregiver, including payment, training, coaching, respite care and other ingredients. Meanwhile, the QUICK STAT section of this November 2022 issue of TRENDS also has information about caregiver health status. 

Medicare Payment Advisory Commission (MedPAC)

MedPAC met virtually on November 3-4, 2022 to discuss a variety of policy issues, including aligning fee-for-service (FFS) payment rates across ambulatory settings, Medicare policy options for increasing payment to primary care providers, and differences in quality measure performance across Medicare populations. Commissioners analyzed quality measure results for different Medicare fee-for-service beneficiaries grouped by two social risk factors: race/ethnicity categories and income level. Moving forward, these officials will review and discuss the analyses and findings, and provide direction for   future work.

2022 ELECTION DAY ANTE- AND POSTMORTEM

Pundits were out in full force prior to the mid-term election on November 8, 2022. Emboldened by what some of them believed were preeminent concerns among voters, such as inflation, crime on the streets, and a southern border that is not secure, they enthusiastically predicted a “red wave” that would overwhelm Democrats in both the U.S. House of Representatives and the Senate. Unfortunately, these experts were not even close in their prognostications. Democrats not only survived, but even thrived in many states and congressional districts.

The eminent biologist J.B.S. Haldane suggested that there are four stages of acceptance in the advancement of science: 

· This is worthless nonsense. 

· This is an interesting and perverse point of view. 

· This is true, but quite unimportant. 

· I always said so. 

In the segment of the cognoscente known as political punditry, it did not take long after November 8 for the experts to change course rapidly to arrive at the equivalent of Haldane’s Stage 4. Not too surprisingly, they basically claimed to suspect well beforehand what the eventual outcome of the election would be. More importantly, rather than dwell on rear view mirror images, the main weighty intellectual task lies ahead, i.e., to predict what will happen in the upcoming 2024 presidential election by identifying who is going to run, who can win, and what the price of a pound of bananas will be on election day. 

ASAHP’s Executive Director, John Colbert, offered a detailed, comprehensive explanation on October 20, 2022 during a plenary session presentation at the Association’s Annual Conference regarding what to expect on election day—November 8. Not only did he provide forecasts that actually materialized, he also was able to look ahead at some ramifications of what to expect for the 2024 election. For example, one topic of particular interest to the health professions education community is reauthorization of the Higher Education Act (HEA). It was last reauthorized in 2008 for a five-year period.  

If legislative action is taken on the HEA in the 118th Congress that begins in 2023, it can be anticipated that the House and Senate will produce vastly different proposals, with the new House Republican majority focused on blocking the Administration’s proposal to cancel up to $20,000 in student loan debt for certain borrowers, as well as placing a cap on overall student borrowing, eliminating public service loan forgiveness, and requiring institutions to have “skin in the game,” holding them accountable for successful student outcomes. A narrowly divided Senate will require Democrats and Republicans to produce a bipartisan proposal, which in recent Congresses has proven elusive due to disagreements between the parties over both Title IV student financial aid, as well as Title IX protections.

RESOLVING HEALTH CARE AMBIGUITIES

Previous issues of this newsletter have discussed how an inability to arrive at correct definitions of various health disorders and how to diagnose them accurately will compromise the effectiveness of treatments that are administered. The October 2022 edition indicated that many scholars have noted that the concept of stigma is defined inconsistently throughout the literature, and that it is measured with different instruments. Similarly, the July-August 2022 issue pointed out that effectiveness in academic and clinical communication depends upon agreement on what words and concepts denote and on the consequent ability to argue logically and accurately. In the pain medicine literature, for example, unfortunately there are many examples of imprecision and confusion in this respect, including misnomers and fallacies in reasoning.

It is likely that readers of this newsletter at one time or another have experienced a headache. The entire August 2022 issue of the journal Seminars in Neurology is devoted to a discussion of this disorder. According to that publication, the first coherent headache classification is seen in writings dating back to the 1st century AD. More recently, the first significant modern attempt at classifying headache disorders was done by an ad hoc committee of the NIH in 1962. The system created that year relied on accepted ideas about headache diagnostic classes, including “vascular headaches” and “muscle contraction headaches.” Although there was little evidence for these categories, and the diagnostic definitions were vague, that “ad hoc committee” classification system was used worldwide for many years. Ultimately, its shortcomings were felt to be more of a barrier than an asset in developing a useful tool for both research and clinical needs.

Defining the epidemiology of headache disorders is challenging given the prevalence of stigma and other harmful misconceptions about these diseases. Understanding the widespread impact of such disorders is essential when considering social and policy interventions to mitigate their impact on health status. Tension-type headache still is considered the most common primary headache disorder, but population-based estimates of its prevalence vary widely. Migraine remains the most common headache disorder in patients who receive clinical care. Prevalence estimates have remained fairly stable over the last two decades, with a one-year period prevalence in the U.S. of 18% of women and 6% of men. Studies in the U.S. also show an inverse relationship between income level and migraine incidence and prevalence, particularly for chronic migraine. Factors mediating this relationship are difficult to define.

The burden of migraine is enormous. The Global Burden of Disease study indicates migraine is the number one cause of disability in women younger than 50 years of age and the number two or three cause of disability worldwide. Further study is needed into underdiagnosis, undertreatment, and persistent stigma associated with headache disorders, especially in underserved communities. Headaches constitute just one more health problem where more clarity and less ambiguity are needed.

DEVELOPMENTS IN HIGHER EDUCATION

Given the contentious nature of legislation that is enacted into law and also in rules finalized by agencies in the executive branch of the federal government, a plausible subheading for many of these initiatives might be “The Attorneys, Accountants, and Public Relations Organizations Relief Act of (fill in the year).” The government has developed an effective means of guaranteeing life-time job opportunities in the private sector for individuals willing to engage in this form of employment. For example, the deadline for submitting comments on a proposed rule to amend regulations implementing Title IX of the Education Amendments of 1972 closed on September 12, 2022. More than 235,000 were submitted. Just think of how many staff in commercial firms were involved in generating these comments on behalf of special interest group clients. Next, the Department of Education will review this huge volume of correspondence before releasing a final set of regulations. A companion thought worth pondering is how many Department personnel will need to be engaged in what can be expected to be a highly time-consuming operation of reviewing those Title IX comments. Whatever the eventual outcome, it is likely that the courts will be kept busy as opponents seek to have findings overturned.

If matters on the litigation front ever seem to become too quiescent, immediate assistance always is just a short distance away. As an illustration, on August 24, 2022 President Biden announced that he would cancel up to $10,000 in student debt for borrowers making under $125,000 a year, with up to $20,000 in relief for Pell Grant recipients. The U.S. Department of Education on September 29, 2022 released its estimate of the costs of this plan, indicating that it will cost an average of $30 billion a year over the next decade. The Administration points out that debt relief is designed to help borrowers and families most in need as they prepare to resume student loan payments in January 2023, with nearly 90% of relief dollars going to those earning less than $75,000 per year. Not surprisingly, opposition already is underway as lawsuits against the proposal are being filed. Among the concerns are that student debt relief will harm a state’s economy by reducing taxes collected and increasing inflation. On a more personal level, some individuals feel aggrieved because they already have worked diligently to pay off their educational debt and do not qualify for financial assistance while others who originally elected not to go to college view it as a handout at the expense of taxpayers.

 Primary Sources Of Tenure Track Faculty Members

Institutions of higher education in the U.S. hire most of their tenure-track faculty members from the same handful of elite institutions, according to a study published in the journal Nature on July 21, 2022. The finding suggests that prestige is overvalued in hiring decisions and that academic researchers have little opportunity to obtain jobs at institutions considered more elite than the ones at which they were trained. Specifically, the study reveals that just 20% of PhD-granting institutions in the United States supplied 80% of tenure-track faculty members to institutions across the country between 2011 and 2020. No historically Black colleges and universities (HBCUs) or Hispanic-serving institutions (HSIs) were among that 20%. One in eight U.S.-trained tenure-track faculty members obtained their PhDs from just five elite schools: the University of California, Berkeley; Harvard University; the University of Michigan in Ann Arbor; Stanford University; and the University of Wisconsin–Madison.

Exploring The Exodus From Higher Education

Enrollment in education after high school is falling significantly at a time when the economy is demanding more educated workers. It is important to understand why students are not attending or staying in college so that institutional leaders and policymakers can adopt policies and practices that meet more of the situations facing today’s students. HCM Strategists and Edge Research, on behalf of the Bill & Melinda Gates Foundation, were partners in conducting an in-depth analysis of current and former students’ attitudes about pursuing education after high school to understand better what is influencing these           students’ perceptions and plans regarding post-high school education. Among the major findings is that although dollars and debt are significant barriers, multiple factors affect this audience’s ability and interest in obtaining a degree. Individuals express limited life satisfaction, and many note they could not manage the stress/challenges associated with college. Addressing financial burdens alone is not a solution. 

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Numbers And Rates Of Suicide By Month And Demographic Characteristics: U.S., 2021

Suicide is a major contributor to premature death in the United States, especially among individuals aged 10 to 34, for whom it is the second leading cause of death. In this country, suicide increased 35% from 1999 to 2018 before declining by 5% through 2020. Despite the overall recent decline, rates continued to increase among females aged 10–24 and among males aged 10–44 and 75 and over. The increase in the number of suicides was greater for males (4%) than females (2%), with the provisional 2021 number for males (38,025) nearly four times that of females (9,621). According to a National Vital Statistics System Release in September 2022, provisional numbers of suicide by month in 2021 are reported and compared with final 2020 numbers, in total, and are presented by sex and age combined. Reporting of suicides in particular can be delayed because of investigations regarding the cause and circumstances surrounding the death. Rates for females are more likely to be incomplete because their deaths more frequently involve drug poisonings.

Associations Of Air Pollution With Body Size And Composition In Midlife Women

A study was done of longitudinal associations of air pollution exposure, including fine particulate matter, nitrogen dioxide, and ozone with weight, BMI, waist circumference, fat mass, lean mass, and proportion fat mass in midlife women. According to a description of research published on September 9, 2022 in the journal Diabetes Care, analyses provide evidence that exposure to these environmental factors is associated adversely with body composition, including higher fat mass, higher proportional fat mass, and lower lean mass, highlighting their potential contribution to obesity. In this prospective cohort study of 1,654 midlife women representing diverse racial/ethnic groups, exposure to air pollution was associated with adverse changes in body composition measures. In particular, particulate matter and nitrogen dioxide were associated positively with fat mass and proportion fat mass, and inversely associated with lean mass. Ozone was associated positively with proportion fat mass and inversely associated with lean mass.

HEALTH TECHNOLOGY CORNER

 Understanding Canine Diseases To Save Human Lives

Dogs develop diseases similar to those of humans. Their inbred genetics makes them a useful model for disease biology, allowing the development of new therapies for veterinary and human use. Inside the cancer center at the Virginia Tech Carilion Health Sciences and Technology campus, equipment, along with much of the building, is shared between veterinary patients and humans participating in clinical trials where dogs and humans can be treated side by side. According to an article published in the September 2022 issue of the journal Nature Medicine, dogs share the human environment and are prone to experiencing many of the same diseases as humans, which means that studying conditions, such as cancer in dogs can be used to develop new drugs for both species. Beyond tapping into the increasingly lucrative global veterinary medicine market (valued at U.S. $29.4 billion in 2021), researchers hope these efforts can improve the health of both pets and their human companions.

The Effect Of Expressive Writing On Wound Healing

Expressive writing is an intervention whereby individuals typically write for 20 minutes a day for three consecutive days about their deepest thoughts and emotions regarding a previous traumatic event or stressor. This activity has been found to be beneficial not only for self-reported health, psychological well-being, and general functioning, but also for immunological function. As described in a paper in the October 2022 issue of the Journal of Psychosomatic Research, investigators studied whether the content (expressive vs control) and timing (pre- vs post-wounding) of a writing task affect the activation of different cell types in the healing skin. The findings showed main effects of both timing and content, whereby those who wrote on either topic pre-wounding had a higher infiltration of Langerhans cells in the epidermis of the healing skin at day 14 compared to those who wrote post-wounding. These particular cells are critical for wound healing because they facilitate transitions between wound healing stages.