Kristen Truong

October 21, 2020

Trends Archives

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

October 21, 2020

Trends Archives

U.S. Women Living In Areas Devoid Of Proper Maternity Care

Maternity care deserts are characterized as being areas without hospitals that offer obstetric care, birth centers, or a specialized provider. According to a new report from the March of Dimes, these areas continue to be a problem in the U.S. as women die of pregnancy complications at rates higher than women in other high-income nations. More than 2.2 million women of childbearing age live in such deserts and an additional 4.8 million live in areas with limited access to maternity care. Women in the rural U.S. are especially at risk of giving birth without proper access to care. Also, there are more than four times as many rural counties that are maternity care deserts than urban counties, and only 8% of obstetrics providers report working in rural areas. At the same time, 1 in 3 women of childbearing age in a maternity care desert lives in an urban setting. The report can be obtained here.

Mental Health Of U.S. Adults

Three new data briefs from the CDC outline the state of mental health among U.S. adults in 2019. More than 1 in 7 of these individuals experienced some level of anxiety during 2019, before the pandemic, while nearly 1 in 5 reported depression. Additional information is as follows:

Anxiety: When asked about their anxiety symptoms in the two weeks prior to being surveyed, nearly 10% of adults reported mild anxiety, while around 3% reported severe forms of anxiety. Women and those aged 18-29 were most likely to report being anxious. The data brief can be obtained here.

Depression: Nearly 12% of respondents reported mild depression symptoms in the two weeks prior to being surveyed, while nearly 3% reported severe depression. White and Black adults were most likely to report depression than other racial groups. The data brief can be obtained here.

Treatment: Around 1 in 5 U.S. adults reported having any mental health treatment last year. Around 16% said they had taken some medication, while around 10% reported obtaining counseling. The data brief can be obtained here.

Integrating Systems And Sectors Toward Obesity Solutions

The Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine held a virtual public workshop, Integrating Systems and Sectors Toward Obesity Solutions, on April 6, 2020 (Part I), and June 30, 2020 (Part II). The event explored complex systems and contributing factors that can influence obesity, and shared real-life examples of applying systems thinking and systems science approaches to addressing obesity and population health and well-being. In Part I, speakers provided an overview of systems science theories and approaches and their application. In Part II, speakers discussed complex systems in society that have the potential to shape the public’s health and considered opportunities for systems change with regard to obesity solutions. Specifically, the workshop explored how factors such as power dynamics, structural racism, relationships, resources, place-based issues, policy, and political will affect systems that can influence obesity, as well as how these factors can have an impact on communications and cross-sector collaboration to address obesity. The Proceedings of the Workshop can obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

October 21, 2020

Trends Archives

American Adolescents And Mental Illness Treatment Variation

A new national investigation finds that many youth do not receive appropriate follow-up care soon after an initial insurance claim for a mental health condition. The study included data from more than two million children covered by Blue Cross Blue Shield. Of the more than 200,000 children in the study with at least one mental health claim, nearly 30% did not obtain any follow-up treatment in the three months after an initial claim. Published on September 29, 2020 in Proceedings of the National Academy of Sciences of the USA, the study examined insurance claims from children between the ages of 10 and 17 covered by Blue Cross Blue Shield. Of the more than two million children included in the study, nearly one in 10 had a claim related to mental illness between 2012 and 2018. Of those who were prescribed medication, 45% were given drugs that could be addictive or that were not FDA-approved for use in children. Having more psychiatrists in each child’s zip code increased the likelihood of medication treatment, while more therapists in the area increased the chances of therapy alone.

Alcohol-Induced Deaths Among Adults Aged 25 And Over: United States, 2000–2018

As reported in an October 2020 Data Brief from the National Center for Health Statistics, excessive alcohol consumption is a well-known risk factor for mortality and has been causally linked to many diseases, conditions, and injuries, including alcohol-attributable cancer, liver cirrhosis, and alcohol poisonings. Age-adjusted rates of alcohol-induced deaths among adults aged 25 and over were stable from 2000 to 2006, then increased 43% from 10.7 per 100,000 in 2006 to 15.3 in 2018. For both males and females, alcohol-induced death rates increased at a greater rate between 2000 and 2018 in rural compared with urban areas. Among males, the rate of alcohol-induced deaths was highest in large central metro areas in 2000 (21.3); by 2018, rates in medium (25.1) and small metro (25.9), micropolitan (26.7), and noncore (25.3) areas were highest. Among females, the rate of alcohol-induced deaths in noncore areas (4.4) was among the lowest in 2000; by 2018, rates in noncore areas had more than doubled (9.9).

HEALTH TECHNOLOGY CORNER

Use Of Holographic Imaging To Detect Viruses And Antibodies

A team of New York University scientists has developed a method using holographic imaging to detect both viruses and antibodies. This approach has the potential to aid in medical diagnoses and, specifically, those related to the COVID-19 pandemic. Holographic immunassays can be targeted for specific diseases by replacing protein A as a surface binding group with appropriate specific antigens, including peptides, proteins, or other biomolecules. Holographic analysis yields results faster and at lower cost by eliminating reagents, processing steps, and expertise needed to apply fluorescent labels while yielding quantitative results for antibody concentration without requiring extensive calibration. According to an article published on October 8, 2020 in the journal Soft Matter, if fully realized, this proposed test could be done in under 30 minutes, is highly accurate, and can be performed by minimally trained personnel. Moreover, the method can test for either the virus (current infection) or antibodies (immunity).

Cell Revival Following A Heart Attack

Extracellular vesicles (EVs), small membrane-bound particles released from cells, have been shown to have cardioprotective effects and are promising tools for the next generation of therapies for everything from autoimmune and neurodegenerative diseases to cancer and tissue injury. EVs derived from stem cells help heart cells recover after a heart attack. Exactly how they help and whether the beneficial effect is specific to EVs derived from stem cells has remained a mystery. Now, according to a study reported in the October 14, 2020 issue of the journal Science Translational Medicine, investigators from Harvard University have unraveled potential mechanisms behind the healing power of EVs and demonstrated their capacity not only to revive cells after a heart attack, but keep them functioning while deprived of oxygen during a heart attack. This functionality in human tissue was demonstrated using a heart-on-a-chip with embedded sensors that continuously tracked tissue contractions.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

October 21, 2020

Trends Archives

The beginning of the fall semester each year is highlighted by the return of college football. Due to COVID-19, many teams have decided to play fewer games this season compared to previous years. Some major conferences originally decided to postpone competition until 2021, but subsequently agreed to play a limited number of games later this year. Depending on the team, some players, coaches, and other personnel have tested positive for the virus, which led to decisions to postpone some contests to later dates. A common feature has been either to have no fans present in stadiums or to reduce the usual attendance drastically. Meanwhile, the non-football side of academic institution life also displays a considerable amount of variation regarding the volume of disease testing that occurs and whether to send students home who test positive or just quarantine them for different periods of time. Schools also vary on the proportion of students who decided to enroll for the fall semester. Each college and university is affected differently by reductions in revenue derived from tuition, housing, meals provision, and activity fees.

Fostering Research Integrity And The Responsible Conduct Of Research

As posted on October 19, 2020 in the Federal Register on pages 66341-66342, the Department of Health and Human Services (HHS), Office of Research Integrity (ORI) seeks information and comments from entities and individuals regarding activities that foster research integrity and promote the responsible conduct of research. In particular, ORI is interested in learning about best practices, challenges, and needs related to teaching the responsible conduct of research, promoting research integrity, and preventing research misconduct. ORI will use this information to support the goal of conducting outreach and developing educational resources that best support the Public Health Service (PHS) funded research community. Responses to the RFI must be received electronically no later than 5:00 p.m. ET on the 60th day following the date of publication of this announcement in the Federal Register.

The following three categories are of interest:

Using Training and Education To Foster Research Integrity (ORI seeks to understand key challenges to using training and educational efforts to foster a climate that encourages research integrity and the responsible conduct of research.)

Research Integrity/Responsible Conduct of Research Program Administration and Facilitation of Training (ORI requests answers to 10 questions.)

Research Integrity/Responsible Conduct of Research Training Sessions (ORI seeks information on institutional experiences, practices, and needs.)

U.S. Department Of Education Launches 2021-2022 FAFSA Cycle

The U.S. Department of Education on October 1, 2020 released the 2021–2022 Free Application for Federal Student Aid (FAFSA) form as a means of providing information, tools, and resources to help students make informed decisions about their education options. This year, enhanced help topics provide even more guidance through the form. As a result of user feedback, many financial help topics on fafsa.gov feature images of the forms with relevant line numbers visually highlighted to help applicants navigate the FAFSA form. Additionally, skip-logic functionality means applicants see only the questions that pertain to them. The Department also furnishes other tools and resources designed to help students complete and submit the FAFSA form and make informed choices.

The Annual Student Loan Acknowledgment provides links to College Scoreboard where students can estimate their post-completion starting salary based on the school they plan to attend and the program in which they will enroll. For borrowers with existing loans, the Annual Student Loan Acknowledgment outlines how much they owe and how much more they can borrow, and grant recipients can see how much they have received and their remaining eligibility. Starting with the 2021–2022 award year, the Annual Student Loan Acknowledgment will be required before borrowers can receive a financial aid disbursement.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

October 21, 2020

Trends Archives

A decade has passed since the Patient Protection and Affordable Care Act (ACA) became law. This legislation continues to be controversial, however, as evidenced by a series of exchanges between members of the U.S. Senate Judiciary Committee and Judge Amy Coney Barrett, a nominee to the Supreme Court to fill a vacancy resulting from the death of Judge Ruth Bader Ginsburg. Democrats on the committee pressed her on her views regarding how she might vote on the case California v. Texas, which is scheduled for oral argument at the Supreme Court on November 10. These individuals are expected to vote against her confirmation because of a fear that she will be instrumental in overturning the ACA.

Apart from several attempts by Congressional Republicans over the past 10 years to repeal the ACA, this latest manifestation of opposition stems from a case, NFIB v. Sebelius, in which the deciding vote cast by Chief Justice John Roberts found that the individual mandate could not be justified under the constitution’s Commerce or Necessary and Proper clauses, but it could be upheld as an exercise of Congress’ taxing power. Since then, the 2017 Tax Cuts and Jobs Act set the mandate penalty at zero beginning in 2019. Subsequently, Attorneys General in 17 states argued in court that since the mandate no longer produces revenue and is not a tax, not only the mandate, but the entire law is unconstitutional. A district court agreed, indicating that the mandate was an essential part of the law, was not severable, thereby rendering the entire law as being unconstitutional. Next, the Fifth U.S. Circuit Court of Appeals allowed the Democrat-controlled House of Representatives to intervene to defend the ACA on appeal. That step led to a decision by the Supreme Court to accept a petition to conduct an immediate review.

Policies To Achieve Near-Universal Health Insurance Coverage

A report from the Congressional Budget Office (CBO) in October 2020 examines policy approaches to achieve near-universal health insurance coverage using some form of automatic coverage through a default plan. As defined by CBO, a proposal would achieve near-universal coverage if close to 99% of citizens and noncitizens who are lawfully present in this country were insured either by enrolling in a comprehensive major medical plan or government program or by receiving automatic coverage through a default plan. Proposals to achieve near-universal coverage would have two primary features. At a minimum, if they required premiums, those premiums would be subsidized for low- and moderate-income individuals, and would include a mandatory component that would not allow them to forgo coverage or that would provide such coverage automatically.

CBO organized existing proposals into four general approaches, ranging from one that would retain existing sources of coverage to one that would almost entirely replace the current system with a government-run program. All four approaches would provide automatic coverage to individuals who did not enroll in a plan on their own. Two approaches would fully subsidize coverage for lower-income people and partially subsidize coverage for middle-income and some higher-income people while retaining employment-based coverage. Another two approaches would fully subsidize coverage for individuals at all income levels.

Nationwide Evaluation Of Health Care Prices Paid By Private Health Plans

A new analysis from the RAND Corporation indicates that private health plans in the U.S. pay hospitals an average of 247% percent of what Medicare would pay for the same services at the same facilities. Wide variation exists in pricing among states (e.g., Michigan under 200% and Florida more than 325%). Addressing prices paid by employer-sponsored and other private insurance plans represents a tangible way to reduce health care spending. Where quality and convenience are comparable, employers can use network and benefit design approaches to move patient volume away from higher-priced, lower-value hospitals and hospital systems and toward lower-priced, higher-value providers. Employers also can use this information to reformulate how contracts are negotiated on their behalf. Various changes are not possible without price transparency information. Price transparency by itself will not be sufficient, however, if employers do not act on price information. In some cases, employers may need state or federal policy interventions to rebalance negotiating leverage between hospitals and their health plans.

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DUELING COVID-19 AID PACKAGES

Kristen Truong

October 21, 2020

Trends Archives

Prior to reaching agreement on the size of another package of financial aid in response to COVID-19, a more immediate test for Congress was to agree on legislation to provide funding to prevent a federal government shutdown at the start of a new fiscal year on October 1, 2020. Legislators were able to pass that test by producing a $1.4 trillion stopgap spending measure to fund the federal government at current levels through December 11 of this year. Still pending is the necessity of completing work on the 12 annual appropriations bills for fiscal year 2021 during the lame duck session of Congress that will follow the elections on November 3.

An effort to agree on the size of an aid package to address a wide range of problems stemming from the coronavirus has proved, however, to be much more challenging and nettlesome. Last May, the House of Representatives passed a $3.4 trillion stimulus bill (H.R.6800, the Health and Economic Recovery Omnibus Emergency Solutions Act or the HEROES Act) that included aid for state and local governments; rent and mortgage relief; expanded unemployment benefits and food assistance; another round of direct cash payments of up to $1,200 to individuals; and a two-year federal backstop of subsidies to support health plans and coverage of job-based insurance premiums between March and next January for workers who have been laid off or furloughed. Senate Republicans responded by indicating that among many other objections, they would not approve an extension and were in no hurry to pass more relief. Instead, they were in favor of gauging the impact of previously passed stimulus packages before considering additional legislation.

By early July, Republicans expressed interest in having coronavirus legislation that would prioritize COVID-19 testing and vaccine research, and address expanded unemployment benefits that were scheduled to expire at the end of July. By the middle of that month, White House officials and Senate Republicans agreed that relief legislation should cost $1 trillion or less. By the end of July, GOP members favored having another round of loans for the Paycheck Protection Program (PPP), stimulus checks for individual Americans, and provisions to protect seniors from a potential increase in their health insurance premiums. White House officials were less enthusiastic about including stimulus check eligibility and a possible payroll tax cut. By early August, congressional Republicans favored a $1.1 trillion stimulus package. Unable to overcome an impasse on Capitol Hill, as reported in the July/August 2020 issue of this newsletter, President Trump released a series of executive orders in August to address several current needs.

By the start of October, House Democrats were willing to trim their aid package to $2.2 trillion, but Senate Republicans showed little interest in providing funds at that level. House Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steven Mnuchin met to negotiate on several occasions, but could not finalize an agreement. Next, Republicans agreed to increase their proposal to $1.6 trillion, but Democrats insisted a larger amount is needed. By October 9, President Trump was willing to go as high as $1.88 trillion, but as of the time this issue of the newsletter is being distributed, final results still are pending.

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IN SEARCH OF CONNECTIONS

Kristen Truong

October 21, 2020

Trends Archives

Epidemiologists serve as detectives in rooting out the causes of disease. Not only are they often successful in identifying the multifactorial origins of specific causes of morbidity and mortality, they also can show how all aspects of a given condition are connected. A death certificate may contain the singular label cardiovascular disease, but a more accurate descriptor involves connections among several factors in the form of social determinants, such as inadequate nutrition, residence in unsafe neighborhoods, unemployment/underemployment, and exposure to pollution.

A vivid illustration from the public health realm of the importance of establishing connections is an epidemiological study of a deadly cholera outbreak in London in 1854. John Snow was convinced that the disease was caused by a contagious agent. He conducted interviews with residents of the area about their water sources, while meticulously recording the time, person, and place of disease events. He integrated the interview data with disease-event information and concluded that cholera was occurring mostly in victims who were drawing their water from the Broad Street water pump. He convinced skeptical authorities to remove the pump handle and the outbreak was brought to a halt.

As described in a paper appearing in the October 5, 2020 issue of the journal Current Biology, it wasn’t until 30 years later when the renowned microbe hunter, Robert Koch, independently discovered V. cholerae that its responsibility for cholera became common knowledge. Koch and his contemporaries were part of the golden age of microbe hunting during which microscopes were trained onto many disease states and linked with their causative pathogens, leading to the widespread acceptance of the germ theory of disease underpinned by his famous four postulates. Snow’s pioneering epidemiological methods for tracing disease now could be coupled with microbiological methods that identify causative pathogens. Connecting disease and infection proved to be pivotal for the management of infectious agents.

Rolling ahead to the current pandemic, weekly reports from the CDC indicate that for only 6% of deaths, COVID-19 is the only cause mentioned. Other underlying conditions or comorbidities, such as influenza/pneumonia, respiratory failure, hypertension, diabetes, and cardiac arrest account for the remaining 94% of mortality. Another important connection pertains to perceived collateral damage from social lockdown policies that are associated with lower childhood vaccination rates, fewer cancer screenings, and deteriorating mental health that can lead to greater excess mortality.

Moreover, a steady growth in the size of the human population has led to increased encroachment on forests that previously were inhabited only by animals. Greater exposure to zoonotic diseases that jump from other species (e.g., bats) to humans can result in more infectious disease epidemics and pandemics. Successful virus mutations in humans then can be transmitted from human to human. Hence, it is likely our species is in it for the long haul regarding infectious disease outbreaks.

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THE NEUROBIOLOGY OF SOCIAL DISTANCE

Kristen Truong

September 22, 2020

Social isolation on a massive scale is a product of responding to COVID-19 while recognizing that the social environment has a dramatic impact on a sense of life satisfaction and well-being. When under duress, human resilience depends on the richness and strength of social connections, along with active engagement in groups and communities. Evidence that has emerged in recent years makes it abundantly clear that perceived social isolation (i.e., loneliness) may be the most potent threat to survival and longevity. The World Health Organization in 2019 declared that loneliness is a major health concern worldwide and the United Kingdom recently appointed its first Minister of Loneliness. A manuscript published in the September 2020 issue of the journal Trends in Cognitive Sciences highlights the benefits of social bonds; the choreographies of bond creation and maintenance; and the neurocognitive basis of social isolation and its deep consequences for mental and physical health. Accumulating evidence indicates that friendships are a conditio sine qua non for health quality. The tighter someone is embedded in a network of friends, the less likely it is that an individual will become ill. The higher the level of social capital, the faster the recovery time will be after becoming ill, the quicker to recover from surgery, and the longer the length of life.

Researchers in the journal study explored the neurobiology of social isolation and the consequences it has for health and psychological well-being. They outline the evidence for the many benefits of social interaction and consider why an individual cannot have an unlimited number of friends, even though they are highly beneficial. These investigators also briefly survey the behavioral patterns that play a central role in creating and maintaining strong social bonds. Finally, an examination is performed of key neurobiological mechanisms underlying social interplay and the impact that social deprivation has on them.

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COMPOSITION AND CAPACITY OF THE GENETICS WORKFORCE

Kristen Truong

September 22, 2020

As genetics increasingly becomes integrated into all areas of health care and the use of complex genetic tests continues to grow, the clinical genetics workforce likely will face greatly increased demand for its services. Genetic testing in clinical settings has increased significantly over the past 10 years. The trend has been driven in part by the rapid decline in the cost of sequencing and been accompanied by the advent of clinical genome-wide sequencing (GWS). Consequently, demand for counseling and consultations with clinical genetics professionals has grown rapidly, resulting in concerns about potential workforce shortages and insufficient health system capacity to meet this growing demand. As a means of informing strategic planning by health-care systems to prepare to meet this future demand, the results of a scoping review of the genetics workforce in high-income countries, summarizing all available evidence on its composition and capacity published between 2010 and 2019, are reported in the September 2020 issue of the journal Genetics in Medicine.

The evidence presented includes the composition and size of the workforce; the scope of practice for genetics and non-genetics specialists; the time required to perform genetics-related tasks; caseloads of genetics providers; and opportunities to increase efficiency and capacity. Allied health care providers, along with nurses and pharmacists are considered to be among non-genetics specialists. Presently, there is a shortage of genetics providers and a lack of consensus about the appropriate boundaries between the scopes of practice for genetics and non-genetics personnel. A concern is that continued growth in the clinical implementation of GWS is likely to add further pressure on this segment of the health workforce because it requires more intensive decisional support for both patients and health-care practitioners than for less comprehensive genetic tests. Reasons why include the possibility of secondary findings, privacy concerns, difficulty in interpreting test results, and the need to support patients faced with the complex and often unanticipated psychological and informational impacts of genomic testing.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

September 22, 2020

Scorecard On State Health System Performance

Well before the appearance of COVID-19 in the U.S., there were worrying signs on the horizon for health care in this nation. The Commonwealth Fund’s latest Scorecard on State Health System Performance identifies a range of problems that likely were made worse by the pandemic. In assessing health care in every state and the District of Columbia on 49 measures, this new report finds that:

Americans are living shorter lives than they did in 2014, and Black Americans are nearly twice as likely as whites to die from treatable conditions.
Health coverage gains have stalled, while affordability of insurance and out-of-pocket costs have worsened.
Public health dollars are being stretched thin at a time when states face unprecedented challenges from COVID-19.

The scorecard has information about these trends, enabling readers to make comparisons among states, and it can be obtained here.

Racial Disparities In Cancer

The American Association for Cancer Research has released its first report on racial disparities in cancer. Even though the disparity in cancer deaths between Black and white individuals has been reduced from 33% in 1990 to 14% in 2016, the report states that Black Americans have had the highest death toll from cancer among all racial groups in the U.S. for the past 40 years. At the same time, individuals from non-white backgrounds have at least twice the rate of death from stomach cancer than white patients with the disease. The inequities exist beyond racial lines. Other marginalized groups, including bisexual women and those with low incomes, tend to have higher cancer rates. The report also outlines how disparities in underlying risk factors, such as HIV and hepatitis infections, contribute to inequities in cancer rates, as do lower rates of cancer screening and insurance in vulnerable portions of the population. The report can be obtained here.

The State of Obesity 2020: Better Policies For A Healthier America

According to a report from Trust for America's Health (TFAH), the U.S. adult obesity rate stands at 42.4%, the first time the national rate has passed the 40% mark, and further evidence of the country’s obesity crisis. The national adult obesity rate has increased by 26% since 2008. Based in part on newly released 2019 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System (BFRSS) and analysis by TFAH, this report provides an annual snapshot of rates of overweight and obesity nationwide including by age, gender, race and state of residence. Obesity rates vary considerably between states and regions of the country. Mississippi has the highest adult obesity rate in the country at 40.8% and Colorado has the lowest at 23.8%. Twelve states having adult rates above 35% percent are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia. As recently as 2012, no state had an adult obesity rate above 35%; in 2000 no state had an adult obesity rate above 25%. Rates of childhood obesity are also increasing with the latest data showing that 19.3% of U.S. youth ages 2 to 19 have obesity. In the mid-1970s, 5.5% of youth had obesity. Being overweight or having obesity at a young age places these individuals at higher risk for having obesity and its related health risks as an adult. Furthermore, children are exhibiting earlier onset of what used to be considered adult conditions, including hypertension and high cholesterol. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

September 22, 2020

Delaying Or Avoiding Health Care During The Pandemic Because Of Concerns About COVID-19

According to the September 11, 2020 issue of Morbidity And Mortality Weekly Report, as of June 30, 2020, an estimated 41% of U.S. adults reported having delayed or avoided medical care during the pandemic because of concerns about COVID-19, including 12% who reported having avoided urgent or emergency care. These findings align with recent reports that hospital admissions, overall emergency department (ED) visits, and the number of ED visits for heart attack, stroke, and hyperglycemic crisis have declined since the start of the pandemic, and that excess deaths directly or indirectly related to COVID-19 have increased in 2020 versus prior years. Delayed or avoided medical care might increase morbidity and mortality associated with both chronic and acute health conditions. Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, individuals with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities.

Trends And Patterns In Menarche In The United States: 1995 Through 2013–2017

A report on September 10, 2020 from the National Center for Health Statistics (NCHS) presents national estimates of age at first menstrual period for women aged 15–44 in the United States in 2013–2017 based on data from the National Survey of Family Growth (NSFG). The median age at menarche decreased from 1995 (12.1) to 2013–2017 (11.9). The cumulative probability of menarche at young ages was higher in 2013 –2017 compared with 1995. Differences in age at menarche exist by Hispanic origin and race, mother’s education, and living arrangement at age 14. A decreasing linear trend in the probability of age at first sexual intercourse by age at menarche was seen. Earlier age at menarche has been associated with greater risk of health problems including breast cancer, obesity, diabetes, liver disease, depression, eating disorders, and substance abuse during adolescence.

HEALTH TECHNOLOGY CORNER

Machine Learning Maps Research Needs In COVID-19 Literature

Since the start of the COVID-19 pandemic, scientific and medical journals have published more than 100,000 studies on SARS-CoV-2. According to data scientists who created a machine-learning tool to analyze the deluge of publications, however, basic lab-based studies on the microbiology of the virus, including research on its pathogenesis and mechanisms of viral transmission, are lacking. Their analysis was published on September 16, 2020 in the journal Patterns. Topic modeling indicates that COVID-19 publications have focused on public health, outbreak reporting, clinical care, and testing for 30 coronaviruses, as opposed to the more limited number focused on basic microbiology, including pathogenesis and transmission. A fast, scalable, and reusable framework to parse novel disease literature, machine learning approaches rapidly can survey the actual text of publication abstracts to identify research overlap between COVID-19 and other coronaviruses, research hotspots, and areas warranting exploration.

Rapid Blood Test Could Detect Brain Injury In Minutes

A blood protein test could detect the severity of head trauma in under 15 minutes, according to research published on September 14, 2020 in the Journal of Neurotrauma. By showing that glial fibrillary acidic protein (GFAP) can determine the severity of a brain injury through a blood test accurately, a research team at the University of Pittsburgh advanced the development of a point-of-care testing device designed to help clinicians assess traumatic brain injury (TBI) in minutes. For the rapid test, the vision included using a hand-held device with a cartridge that would measure GFAP in a patient’s blood. Researchers at Abbott Laboratories, a global health care company, will need to finalize the test for the i-STAT device, which already is used by the military and health care providers around the world to perform several common blood tests within minutes. The blood test would reveal a patient’s GFAP level. An advantage is that guesswork will be eliminated in diagnosing TBIs and learning whether a patient requires further treatment.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

September 22, 2020

Several issue of this newsletter over the months and years have provided information about an important piece of federal legislation known as reauthorization of the Higher Education Act (HEA). Typically, each new session of Congress begins with a pronouncement that the long-awaited reauthorization will occur in coming months. Senator Lamar Alexander (R-TN), chairman of the Health, Education, Labor and Pensions Committee, on several occasions has established reauthorization as a top personal priority that he wanted to see achieved before retiring from Congress this year. Hearings are conducted annually and in October 2019, the House Education and Labor Committee was successful in producing a huge overhaul of higher education programs in the bill H.R. 4674, but it has not been enacted into law.

Had Congress been successful this year, the HEA would have been reauthorized for the first time since 2008. That previous reauthorization expired in 2013. Similar to pubic health pieces of legislation, such as health professions education, existing programs continue to be funded. Technically, they should expire if left unauthorized, but that step would be too disastrous to take. Even though the HEA as a whole was left unaddressed this year, last December 19th some constructive action did occur. P.L. 116-91, ‘‘Fostering Undergraduate Talent by Unlocking Resources for Education Act’’ or the ‘‘FUTURE Act,’’ provides $225 million in annual funding to historically Black colleges and universities and minority-serving institutions; the Free Application for Federal Student Aid process was simplified; and repayment for certain student loan borrowers was streamlined. Meanwhile, the COVID-19 pandemic helped play a decisive role in obstructing any progress in reauthorizing the HEA in 2020. Instead, whatever appropriations legislation or continuing resolutions are produced for FY 2021, which begins on October 1 of this year, it is expected that higher education programs will continue to be funded at existing levels,

Final Distance Education And Innovation Regulations

The U.S. Department of Education (USDE) on September 2, 2020 published in the Federal Register its final Distance Education and Innovation regulations. These measures will become effective on July 1, 2021. The regulations were developed as a result of a 2019 USDE negotiated rulemaking in which the committee reached consensus on the proposed regulations after seeking comments on what was being proposed prior to issuing final regulations. On the topic of distance learning, it was noted that during the COVID–19 pandemic, some accrediting agencies and State licensing boards are beginning to recognize opportunities presented by distance learning and are permitting certain portions of programs to be provided through distance modalities. The Department will continue to rely on accrediting agencies and State licensing boards to determine if and when distance learning opportunities meet the education and training needs of students in particular fields. Other provisions that pertain to accreditation include:

Providing flexibility for distance education and competency-based education, relying on a demonstration of learning rather than “seat time.”
More clearly defining the requirements for “regular and substantive interaction” in distance education and the permissibility of engaging instructional teams in its delivery.
Providing flexibility to institutions to modify their curricula at the recommendations of industry advisory boards without relying on a traditional faculty-led decision-making process.
Clarifying that an institution may demonstrate a reasonable relationship between the length of a program and the entry-level requirements of the occupation for which that program prepares students.

Rescinding USDE Guidance Documents

The Department announced on August 31, 2020 that it is rescinding several guidance documents because they are outdated and superseded either by subsequent amendments or enactments. Examples are: Institutional Accreditation for Distance Learning Programs (issued September 28, 2006), State authorization under the Program Integrity Regulations (issued April 21, 2011), Implementing Program Integrity Regulations (issued July 20, 2011), and Clarifying flexibility for accrediting agencies (issued November 5, 2015).

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

September 22, 2020

Although the availability and accessibility of high quality health care services play an obvious and indispensable role in enhancing individual and community health status, health care by itself is not sufficient to produce desirable outcomes. Family history helps to determine the degree to which an individual may be at a higher risk for acquiring various ailments, such as cancer and cardiovascular disease. Poverty can affect the ability to obtain an education, live in a safe neighborhood in housing that is not substandard, afford a nutritious diet, have access to suitable transportation, and be able to meet any out-of-pocket health care expenses. Lifestyle factors from the standpoint of avoiding substance abuse and engaging in risky behavior that increases the risk of accidents also will be determinants of health status.

Poverty Rates For Blacks And Hispanics Reach Historic Lows

The state of the U.S. economy influences the kinds and availability of employment opportunities open to individuals seeking jobs. Positions that pay a satisfactory wage and include health insurance coverage contribute to improved health. In 2019, the poverty rate in this nation was 10.5%, the lowest since estimates were first released for 1959. Poverty rates declined between 2018 and 2019 for all major race and Hispanic origin groups. Blacks and Hispanics, reached historic lows in their poverty rates in 2019. The rate for Blacks was 18.8% and for Hispanics, it was 15.7%. These estimates were released on September 16, 2020 by the U.S. Census Bureau. They are from the Current Population Survey Annual Social and Economic Supplement. Nonetheless, it remains significant that inequalities persist. Even with these gains, Blacks and Hispanics continue to be over-represented in the population in poverty relative to their representation in the overall population.

In 2019, the share of Blacks in poverty was 1.8 times greater than their share among the general population. Blacks represented 13.2% of the total population in the United States, but 23.8% of the poverty population. The share of Hispanics in poverty was 1.5 times more than their share in the general population. Hispanics comprised 18.7% of the total population, but 28.1% of the population in poverty. In contrast, non-Hispanic Whites and Asians were under-represented in the poverty population. Non-Hispanic Whites made up 59.9% of the total population but only 41.6% of the population in poverty. Asians represented 6.1% of the population and 4.3% of the population in poverty. These disparities are especially pronounced among children and individuals ages 65 and older.

Necessity Of Having An Adequate Supply Of Competently-Prepared Health Personnel

Much emphasis is placed on health policy development regarding the provision of health insurance coverage and beneficiary ability to obtain care. An aspect that deserves considerably more attention is the health workforce. An implicit assumption seems to be that everything will fall into place nicely once the insurance coverage and access to health care parts of the puzzle are resolved. A different kind of problem that needs to be addressed is whether there is a proper mix of health professionals and the extent to which they are distributed evenly in all regions of the U.S. where their services are required. For example, rural areas tend to experience severe shortages of all kinds of health personnel. A key ingredient in the ability to produce an adequate supply of competently-prepared health professionals is scope of practice legislation where the major focus is at the state rather than the federal level.

States across the nation represent battlegrounds where different professional groups (e.g. psychiatrists vs, psychologists, dentists vs. dental therapists, anesthesiologists vs. nurse anesthetists) vie with one another to determine which practitioners should be given sole authority to treat patients. Claims for exclusivity tend to be based on protecting the safety of patients. California in September 2020 is the scene of a dispute between physicians and nurse practitioners. AB 890 is a hotly contested bill that would grant full practice authority to nurse practitioners by allowing them to practice without physician supervision. The Golden State is behind most other states in empowering nurse practitioners. Currently, nearly 40 other states grant some level of independence to the nursing group and 22 states grant full independence. Nurse practitioners argue that the measure would ease primary care shortages, especially in rural areas, a problem exacerbated by the COVID-19 pandemic. Physicians counter with a view that eliminating oversight by them would lead to a lower standard of care, while also expressing doubt that nurse practitioners would go to rural areas once unencumbered by medical supervision.

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WHISTLING THE COLLEGE HORNPIPE

Kristen Truong

September 22, 2020

In the novel David Copperfield by Charles Dickens, Mister Micawber gave young Copperfield a piece of advice that may exceed in prescience the cumulative wisdom of all treatises ever written on the subject of home economics.

“Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness.
Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

The blossom is blighted, the leaf is withered, the God of day goes down upon the dreary scene, and-and in short you are for ever floored. As I am.”

In order to underscore the grave and serious nature of his contention, Mr. Micawber then drank a glass of punch with an air of great enjoyment and satisfaction, and whistled the college hornpipe.

As shown in 2020 because of COVID-19, excessive debt can be ruinous, destroying households and business enterprises alike. Government in the U.S. at state and local levels also has been devastated by debt. Meanwhile, along lines of whistling the college hornpipe the federal government continues to thrive despite adding trillions of dollars to an ever growing mountain of debt that already exceeded 20 trillion dollars at the beginning of this year. The difference is that Congress can appropriate funding for emergency purposes while the Federal Reserve can purchase debt instruments, lower interest rates, and print money.

Even when Congress is unable to reach agreement on additional sources of pandemic-related funding, as mentioned in the previous issue of this newsletter, the nation’s president can sign executive orders that influence the flow of money and other policies. During the month of August 2020, President Donald Trump released a series of orders that include: a payroll tax deferral for workers, provision of weekly federal jobless benefits, expansion of a congressionally-approved eviction moratorium that expired in July 2020, relief for student borrowers, increased access to telehealth, support for rural hospitals, and the production of more drugs made in America while loosening federal drug-safety and environmental regulations that are perceived as placing domestic producers at a disadvantage.

Similar to previous years when Congress is unable to complete work on 13 separate appropriation bills by the start of a new fiscal year each October 1, to avoid an impending shutdown one or more short-term continuing resolutions (CRs) are implemented. Currently envisioned is a stopgap spending measure that would be effective until December 11. Despite it being an election year that will reduce the amount of time available to pass other bills while House and Senate members are on the campaign trail, the House Energy and Commerce Committee was able to consider 26 health bills during a September 9 markup that involved expanding access to mental health services, combating the opioid epidemic, and reauthorizing key public health programs. The vast majority of more than 8,349 House bills (1,037 for health) and 4,656 Senate bills (585 for health) introduced in the 116th Congress as of September 22, 2020 will not be passed and enacted, but could be reintroduced beginning next year.

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A QUASI-CATEGORICAL DEMURRAL

Kristen Truong

September 22, 2020

Harvard University Professor Arthur Scheslinger, Jr. served as a special assistant and “court historian” to President John Kennedy until the latter’s death in November 1963. Two years later, his book “A Thousand Days: John F. Kennedy in the White House” was published. Around that same time, when interviewed he was asked to assess the impact of the Kennedy presidency. He easily could have stated that it still is too soon to offer a complete assessment, but instead he indicated that it was best to characterize the situation as a quasi-categorical demurral.

While recognizing it may be highly unlikely that many individuals would express their views in this kind of parlance, for the sake of argument let’s assume for the purpose of the following brief disquisition that the professor’s use of this terminology can be applied constructively to COVID-19 and its imagined aftermath. As indicated by an article on page five of this issue of TRENDS, more than 100,000 scientific publications already have been published about the coronavirus, but until it runs its final course, presumably any satisfying definitive analysis will have to remain a work in progress for the nonce.

The purported necessity of closing down a major portion of the U.S. economy, the largest in the world, is a topic that undoubtedly will attract considerable attention. One aspect certainly will include whether deleterious health impacts, such as increases in child/intimate partner abuse, alcohol/drug substance use/abuse, suicidal ideation, homelessness, and lost educational opportunities for students ultimately proved to be more devastating than COVID-19 itself.

Closer to home regarding the academic community, some insights are provided by an editorial published in the August 29, 2020 issue of the British medical journal The Lancet. For example, the pandemic is undermining the ability of researchers to do their jobs and of universities to provide a high-quality and safe educational experience for students. Moreover, the pandemic will have complex, unexpected, and long-term implications for research that must be anticipated now. Essential pillars are under threat, such as a workforce with the skills, training, experience, relationships, and networks needed for research excellence; necessary resources, including funding; and multidisciplinary perspectives supported by science. Spending on education and research is threatened by economic downturns with academic budgets squeezed by COVID-19, jeopardizing jobs and research funding.

An effective vaccine soon may become available. According to information appearing in the August 29-September 4, 2020 issue of The Economist, the pollster YouGov reveals that only 37% of Republicans and 61% of Democrats say they would be vaccinated for COVID-19. The figure is barely 30% for middle-aged and less-educated individuals on the right end of the political spectrum. Not only in the U.S., but among other nations “anti-vaxx” sentiments have many followers who are even more distrustful about vaccine safety and effectiveness than U.S. residents. Hence, while there is value in looking ahead to a time when this coronavirus disappears, it essentially remains much too soon to understand its full impact.

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PRESIDENT’S CORNER

Kristen Truong

August 27, 2020

Some Reflections On The Health Workforce In A Time Of Pandemic

Surges of COVID-19 patients have influenced state officials across the nation to take numerous steps to remove health workforce barriers. An example is a significant expansion of scopes of practice for various clinicians who were and are being educated today in institutions belonging to ASAHP, e.g., physical therapists, occupational therapists, respiratory therapists, and speech‐language pathologists. Other key changes have included:

Allowing some students in professions, such as medicine and nursing, to perform services they are competent to provide by lessening restrictions involving education requirements.
Granting temporary licenses or allowing certain kinds of students to provide services without a license.
Suspending prohibitions that prevent clinicians from other states from providing care via telemedicine.

Advances in technology will influence how health care services are delivered. For example, articles in issues of the journal Science Robotics in July 2020 and in the July/August 2020 issue of MIT’s Technology Review discuss the enhanced potential for the use of assistive robots during infectious disease outbreaks. Hospitals in Texas are using them to help nurses with tasks involving disinfection, patient intake, and delivery of supplies, such as laboratory samples, intravenous pumps, medications, and protective gear during the current pandemic. As technological developments progress, it becomes increasingly likely that robots not only will assist, but might even replace health workers in the performance of other routine tasks.

As described in an a manuscript in the November 2020 issue of the journal Addictive Behaviors, the COVID-19 pandemic has resulted in unprecedented stress on health care systems throughout the world. Health care workers are bearing the burden of caring for those afflicted with COVID-19, a consequence of which is direct and sustained infection risk. As essential workers are compelled to confront these increased infection risks, they also are faced with a risk of experiencing higher rates of stress from the pandemic.

A tool recently developed that is called COVID Stress Scales categorizes stressors from the pandemic into five categories: danger and contamination fear, social and economic stress, traumatic stress symptoms, checking and reassurance seeking behavior, and xenophobia. In the general population, each factor can contribute to increased substance use and abuse risk. Also of significance is that these factors can be compounded in essential workers, placing this group at particularly high risk for these problems.

This constellation of stressors is viewed as warranting unique programs of intervention to manage drug use and abuse. Research to develop such programs is needed, particularly in consideration of the broad impact of COVID-19. Researchers are encouraged to tackle these important issues systematically in preparation for challenges that individuals may face with substance use and abuse in the face of current pandemic-related circumstances, post-COVID-19, and for future pandemics. It also would seem prudent for faculty members who provide instruction for and clinical supervision of health professions students to consider ways in which education programs can assist these individuals in being better prepared to meet the challenges of working in highly stressful circumstances when they enter the workplace.

TV and the Internet have provided vivid examples of many different kinds of allied health professionals leaving the safety of their homes to commute via public transportation to furnish care for patients in hospitals who are being treated for COVID-19 infection. They place their own lives at risk in order to save the lives of individuals stricken with this disease. Today’s children are witnesses to the efforts being made by these first responders to help others who are less fortunate. It is worth pondering the extent to which these images will inspire the youth of today to desire to become part of the future health workforce.

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AUTOPSIES, HEALTH DISPARITIES, AND INFORMED CONSENT

Kristen Truong

August 25, 2020

A popular ingredient in stories of crime in movies and television programs is the defining moment when a detective and the pathologist are able to solve a puzzling death based on autopsy findings. In contrast to forensic autopsies mandated by law, clinical autopsies are performed to clarify diagnoses. Rates of the latter procedure have declined from a high of 19% (1950s-1970s) to 8% (2007). This decrease is related to financial, legal, and administrative disincentives, along with perceptions that diagnostic improvements render autopsies obsolete. Patient and caregiver factors also may be related to declining rates. Across all conditions, black individuals had a significantly higher rate of autopsies compared with white individuals (difference between races: 0.9% in cancer and 5.6% in cardiovascular disease). According to an item published on June 29, 2020 in the journal JAMA Internal Medicine, it is hypothesized that the higher rate of autopsies in black decedents may reflect health disparities. Less-aggressive diagnostic workups in black patients may translate into less-established diagnoses before death, possibly associated with the rates of autopsies. The higher rate also could reflect altruism, obtaining autopsies for the promotion of science, and perhaps even may represent caregivers wanting to know the “real cause of death,” suggesting mistrust of the health care system.

Another element that may be of some interest is that pathologists likely will incorporate genetic testing into routine autopsies. An article published in the June 2020 issue of the Archives of Pathology & Laboratory Medicine poses the question, should specific consent for genetic autopsy testing be required? An individual consenting to an autopsy should know that genetic testing will be performed and may lead to information that directly will have an impact on the decedent’s family, e.g., an increased risk of untreatable neurodegenerative disease. The author indicates that the person giving informed consent for the autopsy needs to know, understand the benefits, limitations, and alternatives of genetic testing and be able to refuse genetic testing in a private autopsy. Clearly, details of how best to obtain consent for genetic testing in autopsies is a needed area for future discussion and clarification.

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RACIAL DISPARITIES AND NOMENCLATURE IN NEUROSCIENCE

Kristen Truong

August 25, 2020

Minority racial groups are exposed differentially to environmental risk factors (e.g., early life adversity) that are known to play a role in a variety of psychiatric disorders. According to a paper in the July 2020 issue of the journal Neuropsychopharmacology, a significant potential for racial disparities in environmental risk factors to moderate the relationship between neurobiology and psychiatric disorder development currently is unexplored. Early life events, such as childhood trauma, maternal stress, immune system activation, and other risk factors show clear effects on the neural substrates of emotion and stress regulation. Minority racial groups also have lower family income and wealth, and often live in areas with greater disadvantage compared with non-minority racial groups. Recent research further suggests minority racial groups have increased exposure to toxins throughout life which can have potentially deleterious effects on physical and mental health. Racial discrimination also can be damaging psychologically and further alter the neurobiology of psychiatric disorders.

Viewed from a different perspective, neuropsychiatric symptoms are a core feature of Alzheimer’s disease and related dementias. Successful information exchange between clinicians and family caregivers is critical for facilitating effective management of these symptoms. This communication often is challenging, however, due to inconsistent terminology and classification of symptoms, and limited understanding of how family caregivers recognize and describe symptoms. A study reported in the August 2020 issue of the journal The Gerontologist examined the language family caregivers’ use to describe and contextualize neuropsychiatric symptoms. Family caregivers of patients with dementia use a wide range of terminology in their descriptions. Their nomenclature and sense-making appear to contrast with clinical and research classification of neuropsychiatric symptoms that is predominantly deficit-oriented. Thus, reliance on effective communication between caregivers and their clinical teams for effective symptom management may require adopting caregivers’ language or explicit development of shared nomenclature.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

August 25, 2020

Sharing Clinical Trial Data: Challenges And A Way Forward

Responsible sharing of clinical trial data is widely recognized as serving the public interest. Data sharing helps maximize the contributions to scientific knowledge made by clinical trial participants, benefiting patients today and in the future. Clinical trial data sharing can enable reproducibility of research findings, analyses for other areas of study, and exploratory work to generate new research hypotheses. While progress has been made in the endeavor of improving clinical trial data sharing, challenges still remain. On November 18 and 19, 2019, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop, in Washington, DC, titled “Sharing Clinical Trial Data: Challenges and a Way Forward.” The workshop followed the release of the 2015 Institute of Medicine (IOM) consensus study, Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risks, and was designed to examine the current state of clinical trial data sharing and reuse since the report release. The workshop considered ways in which policy, technology, incentives, and governance could be leveraged to overcome remaining barriers and further facilitate data sharing. These proceedings summarize presentations and points made at the workshop in 2019 and can be obtained here.

The 2015 consensus study can be obtained here.

National Inpatient Hospital Costs: The Most Expensive Conditions By Payer, 2017

A Statistical Brief from the Agency for Healthcare Research and Quality (AHRQ) presents data from the Healthcare Cost and Utilization Project (HCUP) on costs of hospital inpatient stays in the United States using the 2017 National Inpatient Sample (NIS). It describes the distribution of costs by primary expected payer and illustrates the conditions accounting for the largest percentage of each payer's hospital costs. Hospital charges were converted to costs using HCUP Cost-to-Charge Ratios. The expected payers examined are Medicare, Medicaid, private insurance, and self-pay/no charge. Because of the large sample size of the NIS data, small differences can be statistically significant. Thus, only differences greater than or equal to 10% are noted in the text. Hospital costs in this Statistical Brief represent the hospital's costs to produce the services, not the amount paid for services by payers, and they do not include separately billed physician fees associated with the hospitalization. Healthcare spending in the United States increased 4.2% between 2016 and 2017 to $3.5 trillion, or $10,739 per person, and accounted for 17.9% of the Gross Domestic Product. Constituting nearly one-third of all healthcare expenditures, hospital spending rose 4.7% to $1.1 trillion during the same time period. Although this growth represented deceleration compared with the 5.8% increase between 2014 and 2015, the consistent year-to-year rise in hospital-related expenses remains a central concern among policymakers. In 2016, there were over 35 million hospital stays, equating to 104.2 stays per 100,000 population. The average cost per hospital stay was $11,700, making hospitalization one of the most expensive types of healthcare utilization. Higher costs are documented for stays among patients with an expected payer of Medicare compared with stays with other expected payers ($13,600 for Medicare vs. $9,300-$12,600 for other payers). The Brief can be obtained here.

Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks

Data from the Morbidity and Mortality Weekly Report of August 21, 2020 show that during March 6–June 5, 2020, workplace outbreaks occurred in 15 Utah industry sectors; 58% of workplace outbreak-associated COVID-19 cases were in three sectors: Manufacturing, Wholesale Trade, and Construction. Despite representing 24% of Utah workers in all affected sectors, Hispanic and nonwhite workers accounted for 73% of workplace outbreak-associated COVID-19 cases. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

August 25, 2020

The COVID-19 Pandemic And Exacerbation Of Physical Intimate Partner Violence

During the COVID-19 pandemic, social distancing and stay-at-home orders have been enacted throughout the world to stop disease transmission and keep individuals safe, but for victims of intimate partner violence (IPV), being quarantined with an abuser means that home may be the most dangerous place to be. In a study published on August 13, 2020 in the journal Radiology, a team led by investigators at Brigham and Women's Hospital in Boston assessed the incidence, pattern, and severity of injuries related to IPV in patients at the facility during the spring of 2020. The researchers found that the incidence of physical abuse IPV and severity of injuries was greater during the pandemic. They also observed a higher incidence of victims of high-risk abuse, including strangulation, use of weapons, stab, and burns. A conclusion reached is that radiologists and other health care providers should proactively participate in identifying IPV victims and reach out to vulnerable communities as an essential service during the pandemic and other crises.

Mental Health, Substance Use, And Suicidal Ideation During The Coronavirus Pandemic

As indicated on August 14, 2020 in the Morbidity and Mortality Weekly Report, during June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. These conditions are affecting specific populations disproportionately, especially young adults, Hispanic persons, black persons, essential workers, unpaid caregivers for adults, and those receiving treatment for preexisting psychiatric conditions. These individuals are experiencing disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation. Unpaid caregivers for adults, many of whom are currently providing critical aid to persons at increased risk for severe illness from COVID-19, had a higher incidence of adverse mental and behavioral health conditions compared with others. Although unpaid caregivers of children were not evaluated in this study, approximately 39% of unpaid caregivers for adults shared a household with children (compared with 27% of other respondents).

HEALTH TECHNOLOGY CORNER

Digital Biomarker Of Diabetes From Smartphone-Based Vascular Signals

Smartphone-based photoplethysmography (PPG) provides a readily attainable, non-invasive digital biomarker of prevalent diabetes. According to an article published on August 17, 2020 in the journal Nature Medicine, PPG is a non-invasive optical technique that detects blood flow changes through a vascular bed. It involves shining light into tissue, such as the fingertip or wrist, and quantifying the backscattered light that corresponds with changes in blood volume. Until recently, PPG recording required specialized equipment, however, technological developments have enabled PPG measurement from sensors on smart devices, such as smartphones. Researchers at the University of California San Francisco developed this biomarker to detect Type 2 diabetes, one of the world's top causes of disease and death, potentially providing a low-cost, in-home alternative to blood draws and clinic-based screening tools. Type 2 diabetes can raise the risk of diseases affecting nearly every organ system, including coronary heart disease.

Using Smartphone Accelerometers To Sense Gait Impairments Due To Alcohol Intoxication

Sensing alcohol intoxication in real time could offer opportunities for triggering just-in-time interventions aimed at improving prevention and treatment of alcohol use disorders. In a laboratory study described on August 18, 2020 in the Journal of Studies on Alcohol and Drugs, researchers found that smartphones can capture unique gait features that are sensitive to alcohol intoxication, classifying it within individuals with an accuracy of around 90%. The findings extend prior published research examining the use of phone sensors to detect gait changes related to alcohol. Despite acknowledged limitations, this proof-of-concept study provides a foundation for future research on using smartphones to detect alcohol-related impairments remotely. Current tools to measure alcohol consumption and/or impairment remotely either require the purchase of additional hardware or the burden of manual recording of consumption. A mobile application could be built to sense periods of walking, measure accelerometer signals, and when sway patterns are recognized, trigger either just-in-time support or use further techniques to improve classification further.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

August 25, 2020

Education administrators at levels ranging from pre-K to colleges and universities, along with public health officials throughout the U.S., continue to observe their best laid plans being stymied by a virus known as COVID-19 that refuses to conform to expectations. Some higher education officials decided that if instruction were to be provided during the fall semester, it would be offered electronically instead of in classrooms. Other administrators were willing to admit students, but had a backup plan ready that would enable a rapid conversion to online education either for a certain number of weeks or for the entire semester in the event a spike in infections occurred. Installing hygienic measures on school grounds and promoting social distancing policies were viewed as measures that would allow students to return safely. Unfortunately, for some college students the urge to socialize and attend large parties both on- and off-campus has contributed to a rise in the number of individuals becoming infected with the coronavirus. Even if extraordinary efforts have been made for a campus to be a safe environment, off-campus gatherings and the arrival of students each day who do not reside on school property are examples of the major challenges involved in efforts to achieve and maintain high standards of hygiene.

Financial Aspects Of An Inability To Be On Campus And Attend Classes

A major item in the budgets of a great many families with college-age offspring is the costs of higher education. Factors such as tuition, room and board, and activity fees often are beyond reach from the standpoint of being able to finance them out-of-pocket. Assistance in the form of loans has become a necessity. Whether students ever graduate within six years, and many of them never do, with and without degrees they are saddled with substantial loans that will take many years of payments before their debt is settled. Accordingly, many families currently are unwilling to pay on-campus rates, particularly when education has shifted to online instruction because of the pandemic. Some institutions have responded by reducing tuition rates for courses offered online or by offering to defer payment until the fall semester in 2021. Meanwhile, litigation moves forward throughout the U.S. by students and families seeking to obtain refunds for unoccupied dormitories and unused food serve halls that were closed in the spring semester when students were compelled to leave campus after the coronavirus emerged as a serious threat.

Addressing The Need And The Demand For Mental Health Services For Students

Even before the appearance of COVID-19 earlier this year, many campus mental health centers were unable to provide assistance to the large number of students who sought help for conditions, such as depression and high anxiety. Currently, most of these same individuals are at home and they are joined by other students who find it difficult to cope with the strains imposed by social lockdowns and worries about what the future may have in store for them. As this infectious disease subsides and the economy achieves a fuller recovery, millions of unemployed workers will be eager to return to whatever old jobs still exist or seek new opportunities. Recent graduates and the class of 2021 may find it difficult to compete with that group of recently displaced individuals. As depicted on page six of the July-August 2020 issue of this newsletter, the Morbidity and Mortality Weekly Report for August 14 of this year indicates that younger adults in the 18-24 age group are among the groups reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation. College-age students that are part of this cohort may benefit through telehealth interventions emanating from campus, but the quality of assistance could vary from what occurs in face-to-face encounters in a clinical setting.

Expansion Of Educational Opportunities For Students

An announcement from the U.S. Department of Education on August 19, 2020 describes a new grant program designed to help institutions of higher education emerge from the coronavirus pandemic more resilient and better able to expand educational opportunities for students. The grants can be used in a variety of ways that include resuming operations, supporting students, reducing disease transmission, and developing more agile instructional delivery models for students who cannot or choose not to attend classes in person. This program also recognizes the benefits to high school students of starting their college career early, while still in high school, and gives priority to applicants who plan to expand those opportunities to students who live or attend high school in an Opportunity Zone or rural community. More information can be obtained here.

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More October 2020 TRENDS Articles

IN SEARCH OF CONNECTIONS

DUELING COVID-19 AID PACKAGES

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)