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Emergency Department Visits Related To Mental Health Disorders

A new report from the National Center for Health Statistics (NCHS) describes emergency department (ED) visits related to mental health disorders among adults and assesses differences in mental health-related ED visit characteristics by race and Hispanic ethnicity. Nationally representative estimates in this report are derived from data collected in the 2018–2020 National Hospital Ambulatory Medical Care Survey (NHAMCS). Rates of mental health-related ED visits by race and Hispanic ethnicity were highest among non-Hispanic Black adults (96.8 visits per 1,000 adults), followed by non-Hispanic White (53.4) and Hispanic (36.0) adults. Rates of ED visits for specific mental health disorders, including substance use disorders, anxiety disorders, and mood disorders, were also highest among non-Hispanic Black adults. A higher percentage of visits by Hispanic (57.7%) and non-Hispanic Black (49.5%) adults had Medicaid as the expected primary source of payment than visits by non-Hispanic White adults (36.1%).  

Skull Fractures In Female Versus Male Geriatric Patients Who Sustain Head Injuries

Head trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. A study described in the March 2023 issue of The American Journal of Emergency Medicine that was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents aimed to evaluate the role of sex in the risk of skull fracture in patients over the age of 65. Among 5,402 patients enrolled, 3,010 (56%) were female and 2,392 (44%) were male. 4,612 (85%) of the head injuries sustained were due to falls, and 4,536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2–2.1, p = 0.002). This trend also was seen across race/ethnicity and mechanism of injury. The outcome was unexpected, since previous literature indicated females being more susceptible to facial fracture.  

HEALTH TECHNOLOGY CORNER 

Inhalable Hydrogel Protects Lungs From SARS-Cov-2

Mutations in SARS-CoV-2, the virus that causes COVID-19, continue to produce new virus variants. Some mutations may confer resistance to the immunity induced by vaccines or prior SARS-CoV-2 infections. Thus, there is a need for strategies that could prevent infection by a range of SARS-CoV-2 variants. Physical barriers, such as the mucus lining of the airways, provide the first line of defense against infections. A research team at North Carolina State University set out to develop a way to reinforce this mucus barrier. They described their method, dubbed spherical hydrogel inhalation for enhanced lung defense, or SHIELD, in the journal Nature Materials on February 9, 2023. SHIELD consists of an inhalable powder of fine particles, less than 5 μm across, made from an absorbent polymer. The team tested whether it could protect against virus infection in mice. It was not toxic to cells in culture, and did not affect normal lung function in mice after two weeks of daily dosing.  

Technological Solutions To Loneliness—Are They Enough?

Loneliness is a major public health concern, particularly during pandemics such as COVID-19. It is extremely common and it poses a major risk to human health, such as higher rates of depression and increased mortality.Technological solutions including social media, robots, and virtual reality have been advocated and implemented to relieve loneliness. A paper in the March 2022 issue of the journal Bioethics explores the use of technological solutions from a normative perspective, asking whether and to what extent such measures should indeed be relied upon. A conclusion is that technological solutions are unquestionably part of the solution to loneliness, but that they cannot and should not constitute the whole solution because they arguably are insufficient to alleviate loneliness wholly and should not be perceived as sufficient. Another conclusion is that the essence of what it means to be human or the essence of human interactions cannot be substituted entirely by technological measures, sophisticated as they may be.

DEVELOPMENTS IN HIGHER EDUCATION

U.S. Senators Bernie Sanders (I-VT), chairperson of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Bill Cassidy (R-LA), ranking member of the Committee, on March 2, 2023 sent a letter to health care providers and other interested parties requesting information on the root causes of the current health care workforce shortage and potential ways to address it. The plan is to use what is derived from this invitational effort to identify bipartisan solutions that can be included in future legislation. Under new leadership in the 1st Session of the 118th Congress, the HELP Committee on February 16, 2023 conducted a hearing entitled, “Examining Health Care Workforce Shortages: Where Do We Go From Here?

Detailed workforce data can be derived for health professions, such as medicine, but that capability does not exist across the health professions. Although it is possible to generate information from professional organizations that collect membership data and political agencies that compile licensing data, uniformity often is lacking, which means that many gaps remain to be filled in constructing a comprehensive profile of health workforce shortages in the U.S.  Written responses to the letter from the two senators should be sent to HealthWorkforceComments@help.senate.gov by March 20, 2023. 

American College President Study

The American Council on Education’s (ACE’s) American College President Study (ACPS) has long served the higher education community as the most comprehensive, in-depth, and frequently cited source of information about the college presidency and pathways to higher education leadership. The last ACPS report was released in 2017. The recent survey of more than 1,000 presidents captures demographics; search and selection processes; career trajectories; and duties and responsibilities—with profiles of women presidents and presidents of color. New data this year will be revealed on the average age of aspiration, application, and appointment for college presidents by race, ethnicity, and gender, among other data points. Programming at the ACE annual meeting will include the unveiling of the report at a session called, “The American College President in 2023 and Beyond.”  

The Supreme Court And The Administration’s Student Debt Relief Plan

The fate of President Biden’s proposed student debt relief program is under review by the U.S. Supreme Court. An amicus brief signed by 128 House Republicans requests the Court to invalidate the program. Their argument is based on opposing an assertion of power to forgive every federal student loan in the country, potentially even a decade after the COVID-19 pandemic ends, which raises significant separation of powers concerns. House members contend that the power of the purse is one of Congress’s most potent checks against the executive branch, yet Petitioners’ overly broad reading of the HEROES Act risks encroaching on that power, as well as on Congress’s Article I legislative authority, by arrogating to the Secretary of Education the authority to forgive a trillion dollars in federal debt that otherwise would be owed to the Treasury. The brief states that the Court should require clear statutory authority before adopting an interpretation that risks significant conflict between the legislative and executive branches.  

Resources On Equal Athletic Opportunities Under Title IX

The Department of Education’s Office for Civil Rights on February 17, 2023 released three new resources to support equal opportunity in athletic programs consistent with Title IX of the Education Amendments of 1972. The documents are designed to help students, parents, coaches, athletic directors, and school officials evaluate whether a school is meeting its legal duty to provide equal athletic opportunity regardless of sex. The overview resource provides examples of the kinds of situations that could, depending upon facts and circumstances, raise Title IX concerns at any education level. The two specialized resources – one for K-12 schools and one for colleges and universities – offer information specific to these school communities. The resource for colleges and universities can be obtained here.

HEALTH REFORM DEVELOPMENTS

Since its enactment in 2010, the Affordable Care Act has undergone various refinements. A recent example stems from the passage of the Inflation Reduction Act (P.L. 117-169) that President Biden signed into law on August 16, 2022. One of its features is that Medicare will be able to negotiate drug prices starting in 2026. Nearly 20 years after the creation of the Medicare Part D program, the Centers for Medicare & Medicaid Services (CMS) will be able to negotiate drug prices directly with manufacturers. Thus far, the Congressional Budget Office (CBO) has estimated the total savings achieved each year for negotiation, but has not publicly identified the drugs anticipated to be negotiated. The March 2023 issue of the Journal of Managed Care+Specialty Pharmacy (JMCP) contains an article regarding drugs that are likely subject to Medicare negotiation.  

Medicare will be able to negotiate drug prices starting in 2026. By 2028, prices for 38 drugs dispensed in pharmacies and two drugs provided in physician offices will be negotiated. Medicare drug price negotiation will benefit patients with common diseases, such as diabetes, cancer, respiratory conditions, or cardiovascular disease. Combined, the 40 products eligible for negotiation in 2026-2028 accounted for $67.4 billion in gross Medicare spending in 2020. Part D drugs eligible for negotiation in 2026-2028 include seven inhalers, eight antidiabetics, five kinase inhibitors, and three oral anticoagulants. In all but five cases, high-spend drugs ineligible for negotiation were disqualified because of generic or biosimilar competition. By generating the list of drugs likely subject to Medicare negotiation in the initial years, the Journal article authors hope to provide researchers, policymakers, prescribers, and patient advocates with expectations on which drugs are expected to see reductions in beneficiary cost sharing. 

Consumer Adoption Of Digital Health

Based on a new survey released by Rock Health, a non-profit venture fund, and Stanford University’s Center for Digital Health, most U.S. adults prefer obtaining prescription refills and care for minor illnesses via telemedicine rather than in-person care. Since 2015, Rock Health annually has surveyed a U.S. Census-matched sample of adults to check the pulse on consumers’ attitudes toward and behaviors surrounding digital health. Respondents used their personal desktop, laptop, smartphone, or tablet to complete the survey in English. The 2022 study of more than 8,000 adults found that approximately two-thirds of Americans prefer in-person care for visits related to chronic conditions and mental health, while three-quarters of adults prefer in-person visits for annual wellness checks, emergency care, and physical therapy. 

In the 2022 Survey, 80% of all respondents reported having accessed care via telemedicine at some point in their lives, an increase of eight percentage points from 2021. While telemedicine use continues to vary across demographic segments, 2022 saw notable adoption increases among groups that have long been underserved in health care. The greatest year-over-year increases were observed among respondents aged 55+ (76%, up from 64%), respondents living in rural areas (73%, up from 60%), and respondents without health insurance at the time of the survey (50%, up from 37%). Telemedicine use also increased among women, with 82% of respondents reporting having used telemedicine (a 9% increase from 2021). Eighty-two percent of Hispanic respondents reported telemedicine use, reflecting a 9% increase since 2021, the greatest percentage point increase among all racial and ethnic groups captured by the Survey.

Protecting Beneficiaries From “Junk” Health Plan Coverage

A group of Senate Democrats sent a letter to Department of Health and Human Services Secretary  Xavier Becerra on February 22, 2022 urging the administration to take immediate action to address the availability of short-term, limited duration health insurance plans that violate the Affordable Care Act. The letter expresses concerns about individuals who will lose Medicaid coverage gained during the COVID-19 pandemic as state programs begin their redetermination processes. Beginning in April 2023, millions of Americans are at risk of losing Medicaid coverage that they have relied upon during the COVID-19 pandemic. Without additional protections they could find themselves enrolled in “junk” plans that do not provide comprehensive coverage or protection for individuals with pre-existing conditions. Steps also must be taken to ensure that these plans are not allowed to proliferate further.

AVOIDING THE THIRD RAIL

An old adage in the nation’s capital that many legislators have abided by is to avoid issues that are considered to be as perilous as being exposed to a subway third rail. The basic idea is that if you touch it, you will perish. Two prominent third rail items are the Social Security and Medicare programs. A vivid illustration occurred on Capitol Hill on February 7, 2023 during President Biden’s state of the union address when he suggested that Republicans may be inclined to damage those two programs, such as by reducing benefits or raising taxes.  

As stated at the opening of the Olympics every two and four years, “Let the games begin.” Democrats initiated their concerns by pointing to a proposal by Senator Rick Scott (R-FL) to sunset all federal programs every five years. If not renewed by fresh legislation then, they would be allowed to expire. Subsequently, he revised his plan by indicating that Social Security, Medicare, national security, veterans benefits, and other essential services would be specific exceptions.  

Whenever Democrats and Republicans are under assault, they have a gift for rapidly turning matters around so that any former accuser now becomes the accused. After vigorously denying that they would ever adopt behavior causing distress among Social Security and Medicare beneficiaries, Republicans retaliated by pointing to new rules from the Centers for Medicare and Medicaid Services (CMS) in the Biden administration aimed at reducing overpayments to Medicare Advantage plans. Approximately 40% of all beneficiaries are enrolled in Advantage plans that serve as an alternative to traditional Medicare by being administered by private health insurers. These plans now must pay back the government for overpayments as shown by a recently finalized rule that would over 10 years recoup more than $4 billion in overpayments to plans. Also, by offering to increase CMS support of Medicare Advantage by only 1% next year, the figure is looked upon as a benefit cut because it fails to keep pace with inflation.   

A steady growth in the number and proportion of individuals in the U.S. reaching age 65 every year guarantees that Congress must continue to devote attention to preserving the solvency of both the Social Security and Medicare programs. A related issue is the Medicaid program, which is funded by federal and state governments. It faces many of the same problems as Medicare, such as a growing number of older beneficiaries, many of whom must deal with multiple crippling health and health-related social problems involving long-term care. The COVID-19 public health emergency, which has been in effect since January 2020, is scheduled to end on May 11 of this year. A result is that states have had to begin a process of reassessing eligibility for their Medicaid-covered residents. Under the Families First Coronavirus Relief Act (FFCRA), states received enhanced federal funding in exchange for covering all enrolled Medicaid beneficiaries continuously. This requirement ends on April 1, after which states can begin disenrolling individuals who are determined to be eligible for Medicaid no longer.

ChatGPT AND A LITTLE TINK

Albert Einstein achieved fame for his development of theories of special and general relativity. He wrestled over the decades, however, with the task of producing a unified field theory that linked electricity, magnetism, gravity, and quantum mechanics. Whenever feeling stumped by obstacles in successfully completing that pursuit, he would state “I will a little tink.” English was not his native language.  

November 2022 marked the release of a new open source, natural language processing tool by OpenAI called ChatGPT. This new chatbot is designed to simulate human conversation in response to prompts or questions (GPT stands for “generative pretrained transformer”). In January 2023, Nature reported on two preprints and a pair of articles published in the science and health fields that included ChatGPT as a bylined author. These articles and their nonhuman “authors” already have been indexed in PubMed and Google Scholar.  

Two articles published in the March 2023 issue of the journal Lancet Digital Health discuss both the substantial ethical implications of this latest technology innovation as well as how it has potential to improve health care delivery. The publishing industry, for example, is at risk of undesirable consequences because when presented with a query, ChatGPT automatically will generate a response based on thousands of internet sources that may not involve any further interventions by the user. Scholarly manuscripts can be generated that also are accompanied by appropriate references. Ethical considerations abound concerning copyright, attribution, plagiarism, and authorship when AI produces academic text. These concerns especially are pertinent because when copy is AI generated, it currently is imperceptible to human readers and anti-plagiarism software. A significant concern is that the functionality of ChatGPT also has the capacity to cause harm by producing misleading or inaccurate content. 

Presently, ChatGPT is available to use without cost, but OpenAI's leadership has affirmed that free use is temporary and the product eventually will be monetized.  One commercial option for the platform could involve a form of paywall, which might entrench existing international inequalities in scholarly publishing. Although institutions in socioeconomically advantaged areas could probably afford access, those in low- and middle-income countries might not be able to do so, thereby widening existing disparities in knowledge dissemination and scholarly publishing.  

Apart from worrisome aspects of this new innovation, the delivery of health care services may benefit from expanded capabilities associated with further development of ChatGPT. One potential application could be to generate discharge summaries, which may be left under-prioritized that result in delays in patients’ discharges from clinical facilities or insufficient discharge summaries. All things considered, from a much wider perspective it would be advantageous to devote a little more “tink” to contemplating how to optimize the potential contributions this exciting technology has to offer its users.

CLIMATE CHANGE, INSECTS, AND HUMAN HEALTH

The science of astronomy for many centuries was influenced by a Ptolemaic formulation that placed the earth at the center of the universe, with other celestial bodies revolving around that planet. This conception subsequently was replaced by a Copernican model that viewed the sun as being at the center of the universe, with other bodies such as the earth revolving around it. In a parallel sense, it is possible to entertain a view that considers humans as being at the vital center of the animal kingdom, with all other creatures playing a more secondary role. The term anthropogenic has been coined to indicate the dominance of our species. The Oxford English Dictionary (OED) defines it as of or relating to (the study of) human origins or human development (in various contexts). It can be used as an adjective as shown by the expression “anthropogenic climate change.” As discussed in the February 2023 issue of the journal Ecological Monographs, climate warming is considered to be among the most serious of anthropogenic stresses to the environment, because it not only has direct effects on biodiversity, but it also exacerbates the harmful effects of other human-mediated threats.  

Among the most affected groups of animals are insects, central components of many ecosystems, for which climate change has pervasive effects from individuals to communities. The authors issue a warning that if no action is taken to better understand and reduce the action of climate change on insects, an ability to build a sustainable future based on healthy, functional ecosystems will be reduced drastically. A growing body of empirical literature shows that many populations of insects are declining rapidly across many parts of the biosphere. Observed trends in the demographics of many taxa, including important functional groups like pollinators, nutrient cyclers, and natural enemies, as well as in the abundance of crop, forest, and urban pests, currently is considered serious enough to merit profound concern. Important ecosystem services provided by insects are pollination, pest control, and nutrient recycling. Insects and their products also provide resources for higher trophic level organisms, including humans. In natural (unmanaged) ecosystems, abundances of pathogen and vector species are controlled through various food web interactions and habitat conditions, whereas anthropogenic land use changes, such as deforestation, habitat fragmentation, and agricultural development can modify these interactions with consequences for disease transmission affecting humans. The paper summarizes means of safeguarding insect populations for posterity and urges that initiatives be taken to implement them.

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. 

HEALTH TECHNOLOGY CORNER 

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.

OBTAINABLE RESOURCES

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.

HEALTH REFORM DEVELOPMENTS

Apart from lacking insurance coverage to pay for health care costs, a related concern is that although some patients may be able meet such expenses, they reside in locations marked by serious health personnel shortages. Along with mental health services, dentistry represents that deficiency all too well. An inability to obtain dental care can lead to serious health problems that will result in more expensive interventions at a later time. According to the Health Resources and Services Administration (HRSA), 70 million individuals live in areas with a shortage of dental providers. Access especially is limited for those who receive their dental coverage through Medicaid, because it is estimated by the American Dental Association that approximately only 38% or about 75,000 of the 200,000 licensed dentists in the U.S. accepted that form of insurance. 

A challenge for dentistry is to expand the size of its health care team. A positive development is the inclusion of dental therapists, a group of licensed providers that work under the supervision of dentists to provide routine care involving dental exams and fillings. A problem is that they are authorized to work in only 13 states, but current efforts to expand their numbers in other states will make it possible to treat larger numbers of patients in different settings that include private practices and nursing homes. Higher education institutions have an important role to play in producing greater numbers of these essential practitioners.

National Health Spending

A decline in federal government spending led to more modest growth in health care expenditures in 2021, according to figures released in December 2022 by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). The 2021 National Health Expenditures (NHE) Report found that U.S. health care spending grew 2.7% to reach $4.3 trillion in 2021, slower than the increase of 10.3% in 2020. The slowdown was driven by a 3.5% decline in federal government expenditures for health care that followed strong growth in 2020 due to the COVID-19 pandemic response. This decline more than offset the impact of greater use of health care goods and services and increased insurance coverage in 2021. In 2021, the federal government and households accounted for the largest shares of national health spending (34% and 27%, respectively), followed by private businesses (17%), state and local governments (15%), and other private revenues (7%).

Health spending by major funds sources was as follows: Private Health Insurance (28% share) spending increased by 5.8% in 2021 to $1.2 trillion. Medicare (21% share) spending increased 8.4% to reach $900.8 billion in 2021, Medicaid (17% share) spending increased 9.2% to $734.0 billion in 2021, Out-of-Pocket (10% share) spending increased by 10.4% to $433.2 billion in 2021. Health care spending in 2021 for the largest three services—hospital care, physician and clinical services, and retail prescription drugs—was: Hospital Care (31% share) spending increased 4.4% in 2021 to reach $1.3 trillion, Physician and Clinical Services (20% share) spending increased 5.6% to $864.6 billion,    Retail Prescription Drugs (9% share) spending increased 7.8% to $378.0 billion in 2021, a faster rate than in 2020 when spending increased by 3.7%. The acceleration in growth was due to an increase in the use of prescription drugs in 2021.

New Medicare-Funded Residency Slots For Hospitals In Underserved Communities

The Centers for Medicare & Medicaid Services (CMS) on January 9, 2023 took a critical step to advance health equity and access to care, awarding the first 200 of 1,000 Medicare-funded physician residency slots to enhance the health care workforce and fund additional positions in hospitals serving underserved communities. Approximately three-quarters of the new positions will be for primary care and mental health specialties. The Fiscal Year 2022 Inpatient Prospective Payment System (IPPS) final rule established policies to implement new Medicare-funded physician residency slots to qualifying hospitals authorized by the Consolidated Appropriations Act, 2021, phasing in 200 slots per year over five years. In allocating these new residency slots, CMS prioritized hospitals with training programs in geographic areas demonstrating the greatest need for additional providers, as determined by Health Professional Shortage Areas. The first round of 200 residency positions awarded are for 100 teaching hospitals across 30 states, the District of Columbia, and Puerto Rico. They become effective on July 1 of this year.

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).

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

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.