March 22, 2021

EMERGING CLINICAL ROLE OF WEARABLES

March 22, 2021

Wearable technology, also known as “wearable devices” or simply “wearables,” generally refers to any miniaturized electronic device that easily can be donned on and off the body, or incorporated into clothing or other body-worn accessories. While wearables have established utility in the fitness, gaming, and entertainment industries, their role in the healthcare environment remains less clear. According to a manuscript published on March 10, 2021 online in the journal npj Digital Medicine, to date most commercially available wearables are limited in scope, tracking one or two health-related variables, and have yet to produce accurate measurement of many markers of health status that they attempt to assess such as heart rate variability, nutrition, and mood. To the extent that wearables overcome these limitations, they hold much promise towards expanding the clinical repertoire of patient-specific measures. They are considered an important tool for the future of precision health. For example, physical activity is a well-established marker of current health status and future health risks, it is a useful estimate of real-life functional performance, and it has been tracked in health research using body-worn sensors for many decades. Given the ubiquity of physical activity monitors, it is surprising their effective incorporation into clinical care remains a challenge, especially in face of the multiple known health benefits of physical activity and the many healthcare scenarios where physical activity information has a clinical use.

Two of the NIH’s Big Data to Knowledge Centers of Excellence organized a workshop on potential clinical applications of wearables to address various challenges. A workgroup from diverse backgrounds (hospital administration, clinical medicine, academia, insurance, and the commercial device industry) discussed two successful digital health interventions that involve wearables to identify common features responsible for their success. Seven features were identified including: a clearly defined problem, integration into a system of healthcare delivery, technology support, personalized experience, focus on end-user experience, alignment with reimbursement models, and inclusion of clinician champions. For each feature, problems are outlined within the patient domain that are addressed per feature and specific representative examples of solutions are provided for these problems by the two sample digital health programs. Health providers and systems eager to establish new models of care inclusive of wearables may consider these features during program design. A better understanding of these features is necessary to guide future clinical applications of wearable technology.

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OBTAINABLE RESOURCES

Kristen Truong

March 22, 2021

Academic Incentives And Research Impact

The road to tenure can be viewed as paved with measures of peer-reviewed publications, first authorships, citations, journal impact, grant funding, and national or international reputation. According to the author of a paper that was prepared for the organization AcademyHealth, a proposition is offered that for the most part, measures of research impact on societal problems are missing in action from performance evaluation criteria within academic disciplines. So, the paper aims to encourage creative thinking around academic incentives and research impact by challenging existing orthodoxies, generating new insights, and stimulating a productive debate within the discipline. As a means of accomplishing these objectives, cases are presented to explore efforts challenging the status quo of academic research incentives and realigning them to focus more on societal impact. The cases are organized around a system-, institutional-, and individual-level framework. Examples are furnished that highlight the range of efforts explored more fully in the paper to align academic incentives with societal impact. The paper can be obtained here.

Student Debt And Its Impact On Black Americans

As more students take out more loans at higher amounts, the issue of student debt and proposals to mitigate it has taken greater prominence in national policy debates. According to a report from the Brookings Institution, the problem especially is pertinent for Black households, for whom a lack of generational wealth risks making student debt a long-term financial burden. After graduation, loans quickly balloon, delaying or even preventing Black Americans from building wealth. Based on the 2018 Survey of Income and Program Participation (SIPP), the authors indicate that because student debt disproportionately harms the wealth-poor, and the Black wealth-poor in particular, student debt cancellation could be a powerful tool in dismantling institutional discrimination and shrinking racial wealth disparities if implemented correctly. They center the Black experience in their consideration of student loan debt and draw from their own analysis to argue for debt cancellation that is not means-tested (predicated upon household income) as an important mechanism for closing the racial wealth gap. They compare the effects of cancelling debt against the status quo, and at three different levels of intervention: 1) $10,000 cancelled for all (as President Joe Biden has proposed); 2) up to $50,000 cancelled based on means-testing for households earning under $100,000 and a sliding scale cancellation for households earning up to $250,000 (as Senator Elizabeth Warren [D-MA] has proposed); and 3) total debt cancellation (as Senator Bernie Sanders [I-Vt.] has proposed). They find that the more student debt that is cancelled, the greater the effect increasing Black wealth, particularly for households below the wealth median. The report can be obtained here.

Adult Family Care As An Alternative To Nursing Homes

A report from AARP that was written for consumers, advocates, and state policy staff, summarizes some key features of Adult Family Care (AFC), along with ideas for expanding its availability. Individuals who need long-term services and supports want alternatives to nursing homes as living options. AFC, which is not as well known among consumers as home care and assisted living, gives older adults and persons with disabilities a viable alternative. In AFC, sometimes called adult foster care or adult family homes, residents live full-time in a house or other small residential setting where they receive assistance with activities of daily living, personal care, and help with medications and other health care tasks, in collaboration with health care professionals. More than 40 years ago, Oregon and Washington were the first states to establish AFCs as an option for both private pay residents and those receiving public funds. Many jurisdictions have had difficulty recruiting providers and consumers since then. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

March 22, 2021

U.S. State Life Tables, 2018

A new report from the National Center for Health Statistics presents the first set of annual complete period life tables for each of the 50 states and the District of Columbia (D.C.) for the year 2018. The period life table does not represent the mortality experience of an actual birth cohort. Rather, it presents what would happen to a hypothetical cohort if it experienced throughout its entire life the mortality conditions of a particular period in time. Life tables were produced for the total, male, and female populations of each state and D.C. based on age-specific death rates for that year. Among the 50 states and the District of Columbia, Hawaii had the highest life expectancy at birth, 81.0 years in 2018, and West Virginia had the lowest, 74.4 years. Life expectancy at age 65 ranged from 17.5 years in Kentucky to 21.1 years in Hawaii. Life expectancy at birth was higher for females in all states and D.C. The difference in life expectancy between females and males ranged from 3.8 years in Utah to 6.2 years in New Mexico.

Prescription Drugs For Older Adults And The Risk Of Falling

Published on February 3, 2021 in Pharmacoepidemiology and Drug Safety, a study reported from the University at Buffalo examined data on deaths due to falls and prescription fills among patients 65 and older from the National Vital Statistics System and the Medical Expenditure Panel Survey. Age-adjusted mortality due to falls increased from 29.40 per 100,000 in 1999 to 63.27 per 100,000 in 2017. The percent of individuals who received at least one prescription for a fall risk increasing drug, including antidepressants, anticonvulsants, antipsychotics, antihypertensives (for high blood pressure), opioids, sedative hypnotics, and benzodiazepines (tranquilizers such as Valium and Xanax) increased from 57% in 1999 to 94% in 2017. Fall risk increasing drugs may partially explain the increase in mortality due to falls, but cannot be firmly concluded from the current study. Future research involving nationally representative person‐level data are needed.

HEALTH TECHNOLOGY CORNER

Sex Differences In Neurodegenerative Diseases

Many neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, and motor neuron disease, demonstrate clear sexual dimorphisms. While sex as a biological variable must now be included in animal studies, sex rarely is included in in vitro models of human neurodegenerative disease. A review published on March 16, 2021 online in APL Bioengineering describes these sex-related differences in neurodegenerative diseases and the blood–brain barrier (BBB), whose dysfunction is linked to neurodegenerative disease development and progression. The authors from the University of Maryland highlight a growing body of research suggesting sex differences play roles in how patients respond to these ailments. The authors note that some research suggests the barrier can be stronger in women than men, and the barriers in men and women are built and behave differently. They hope their article will serve as a reminder across the sciences, that accounting for sex differences leads to better results.

Female College Athletes And Traumatic Brain Injury

Female athletes are under-studied in the field of concussion research, despite evidence of higher injury prevalence and longer recovery time. Hormonal fluctuations caused by the natural menstrual cycle (MC) or hormonal contraceptive (HC) use have an impact on both post-injury symptoms and neuroimaging findings, but the relationships among hormone, symptoms, and brain-based measures have not been jointly considered in concussion studies. A preliminary investigation from the Northwestern University Feinberg School of Medicine published on February 24, 2021 in the Journal of Neurotrauma compared cerebral blood flow (CBF) measured with arterial spin labeling between concussed female club athletes 3–10 days after mild traumatic brain injury (mTBI) and demographic, HC/MC matched controls (CON). Researchers tested whether CBF statistically mediates the relationship between progesterone serum levels and post-injury symptoms, which may support a hypothesis for that hormone's role in neuroprotection. The findings support a hypothesis for its having a neuroprotective role after concussion and highlight the importance of controlling for the effects of sex hormones in future concussion studies.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

March 22, 2021

Another section of this newsletter indicates that the $1.9 trillion COVID-19 relief legislation called the American Rescue Plan Act (P.L. 117-2) was signed into law by President Joe Biden on March 11, 2021. One of its provisions is Section 2003, Higher Education Emergency Relief Fund. The amount of $39,584,570,000 will be made available through September 30, 2023, for making allocations for colleges and college students. Institutions receiving aid must dedicate at least half of the funding for emergency financial aid grants to prevent hunger, homelessness, and other hardships that students are facing because of the pandemic. Funds also can be used for general expenditures for institutions of higher education to cover those expenses associated with a disruption in services or operations related to coronavirus, including defraying expenses caused by lost revenue and reimbursing expenses already incurred.

The public health workforce consists of a great many different kinds of health professionals. Section 2501, Funding For Public Health Workforce will furnish $7,660,000,000, to remain available until expended, to carry out activities related to establishing, expanding, and sustaining a public health workforce, including by making awards to State, local, and territorial public health departments. The money shall be used for costs, including wages and benefits, related to the recruiting, hiring, and training of individuals to serve as case investigators, contact tracers, social support specialists, community health workers, public health nurses, disease intervention specialists, epidemiologists, program managers, laboratory personnel, informaticians, communication and policy experts, and any other positions as may be required to prevent, prepare for, and respond to COVID–19. This financial support is aimed at personnel who are employed by governmental public health departments and nonprofit private or public organizations with demonstrated expertise in implementing public health programs, particularly in medically underserved areas.

Counting U.S. Postsecondary And Secondary Credentials

The organization Credential Engine since 2017 has been engaged in laying bare an increasingly complex and confusing landscape of U.S. credentials, and to create the building blocks to make reliable and useful credential information more accessible for students, workers, and the employers who hire them. Part of the effort has consisted in creating a common taxonomy, or schema, through the Credential Transparency Description Language (CTDL) that allows individuals to make “apples-to-apples” comparisons between and among credentials, making it possible to map connecting points between credentials, competencies, jobs, education, and training opportunities. The driving force has been a lack of clarity about what exactly is available in education and training, the value of credentials in the labor market, and what enables certain individuals to benefit from those opportunities more than others. The CTDL is regarded as the standard language through which these million unique credentials and their competencies can be connected, compared, and contrasted, from evaluating whether a credential leads to a specific career and higher wages or if it leads to a higher-level credential, enhancing economic momentum and mobility.

Some Impacts Of COVID-19 On Higher Education

New international student enrollment in the United States and online outside the United States decreased by 43% in Fall 2020. Many international students studying at U.S. institutions took advantage of opportunities to begin their studies remotely. Ninety percent of institutions reported international student deferrals in Fall 2020. Respondents indicated that nearly 40,000 students had deferred enrollment to a future term. (Source: Institute of International Education)
The drop in the number of undergraduates enrolled in the fall of 2020 was 3.6% or a decrease of 360,000 students from a year earlier. (Source: National Student Clearinghouse Research Center)
Colleges and universities closed out 2020 with continued job losses, resulting in a 13% drop of 650,000 workers since February of that year. (Source: Bureau of Labor Statistics)

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

March 22, 2021

Congress represents a fascinating portion of American life. Elected officials in both chambers find themselves on every major issue needing to decide whether their vote will advance the interests of their supporters in congressional districts and states back home, who made it possible for them to be elected, or have it enhance the welfare of the nation as a whole. Conflicts of this nature arise all the time. For example, improving the environment would seem to be a goal with widespread appeal, but if it means seriously damaging the fossil fuel industry in a state that is heavily dependent on jobs and revenues from oil, coal, and gas economic activities, it becomes less easy for officials from there to cast votes that favor the nation over the locale. Doing so usually will result in a rapid, undesired exit from political office following the next election.

Despite several decades of efforts on Capitol Hill to ensure that all inhabitants of the U.S. have adequate health insurance coverage, many individuals continue to lack that form of protection. Congress is balanced evenly in the number of Democrats and Republicans in the Senate while the House tilts slightly in favor of the Democrats numerically. As reported on March 5, 2021 in the New England Journal of Medicine, on the issue of universal health insurance coverage, the two parties’ constituents appear to be sharply divided. Nearly nine in 10 Democrats (87%) reported that they believe it is the responsibility of the government to ensure all individuals in the U.S. have health insurance coverage, a view shared by fewer than one in four Republicans (23%). Among Democrats, 75% reported that they prefer a health insurance system mostly run by the government, whereas 79% of Republicans reported that they prefer a system based mostly on private health insurance.

Regarding specific coverage proposals, Democrats expressed support for the following: building on the Affordable Care Act (ACA) [93%], Medicare-for-All (85%), and a Medicare buy-in to the ACA referred to as “the public option” (82%). In contrast, only 30% of Republicans expressed support for building on the ACA and 28% supported Medicare-for-All. While 62% of Republicans reported that they support a Medicare buy-in to the ACA, that support does not represent an endorsement of the notion that government should ensure universal coverage. Also, 64% of Republicans reported that they support replacing the ACA with a state-based private health insurance alternative compared with 36% of Democrats. These substantial differences do not bode well for implementing major changes any time soon in how health insurance is provided in this nation.

Medicare Payment Advisory Commission (MedPAC)

Apart from highly trained staff members in Congress, elected officials often profit from advice provided by other sources, one of which is MedPAC. The Commission is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105–33) to advise the Congress on issues affecting the Medicare program. Besides advising that body on payments to health plans participating in the Medicare Advantage program and providers in Medicare’s traditional fee-for-service program, MedPAC has additional responsibilities that involve analyzing access to care, quality of care, and other issues affecting the Medicare program. Its 17 members can seek to influence the work of Congress in several ways, one of which is the issuance of reports in March and June each year that contain various Commission recommendations.

The report sent on March 15, 2021 consists of 14 chapters that deal with such matters as: the near-term consequences of the coronavirus pandemic and the longer-term effects of Medicare spending on the federal budget and the program’s financial sustainability, and an option for Medicare’s coverage of telehealth services after the coronavirus public health emergency. Both the short- and long-term contexts for the Medicare program are sobering. Because of the pandemic, in the short term, beneficiaries are at particular risk. Patients over 65 are more likely to suffer severe COVID-19 cases and complications and die than those who are younger and have fewer comorbidities. Long-term, the financial future of the Medicare program was already problematic, but as a result of job losses, in 2020 the Congressional Budget Office projected that Medicare’s Hospital Insurance Trust Fund will become insolvent by 2024, two years earlier than previously expected.

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AMERICAN RESCUE PLAN BECOMES LAW

Kristen Truong

March 22, 2021

The American Rescue Plan Act (P.L. 117-2) was signed into law by President Joe Biden on March 11, 2021. A $1.9 trillion COVID-19 relief package, a final version of this legislation (H.R. 1319) was passed by the House of Representatives on a 220-211 vote on March 10 after the Senate voted 50-49 to amend the House’s initial version on March 6. No Republicans supported the legislation. Representative Jared Golden (D-ME) was the only Democrat to oppose it. A 1,149-page House Report of the Committee on the Budget, together with Minority Views, accompanied H.R. 1319. Among the key provisions of this law are the following in rounded numbers:

$48 billion for COVID-19 testing and tracing
$7.5 billion for the Centers for Disease Control and Prevention’s (CDC) vaccine distribution effort
$1.75 billion for the CDC to increase genome sequencing of SARS-CoV-2 for variant surveillance
$7.7 billion in awards under the Department of Health and Human Services to state, local, and territorial health departments to establish, expand, and sustain the public health workforce
$140 million in a one-time supplemental appropriation for HRSA training programs to address and prevent suicide, burnout, mental health conditions, and substance use disorders affecting the health workforce
$40 billion for the Higher Education Emergency Relief Fund

The bill also expands access to health care by providing tax subsidies to a wider range of individuals and families who purchase health insurance on the markets established under the Affordable Care Act (ACA). Additionally, P.L. 117-2 temporarily covers the entire cost of COBRA premiums for individuals who lose their jobs and incentivizes additional states to expand Medicaid as allowed under the ACA.

According to a report issued by the Congressional Budget Office (CBO) in March 2021, by the end of fiscal year 2021 on September 30, federal debt held by the public is projected to equal 102% of gross domestic product (GDP). If current laws governing taxes and spending generally remain unchanged, debt would equal 107% of GDP in 2031, its highest level in the nation’s history. Growth in outlays would outpace growth in revenues in subsequent decades, leading to growing budget deficits over the long term. As a result, federal debt would continue to increase, exceeding 200% of GDP by 2051.

Eventually, the federal government will have to create a means of paying for benefits flowing from the American Rescue Plan Act, along with pandemic-related expenditures from legislation enacted in 2020. Three ways of doing so are to: increase borrowing, raise taxes, and reduce other kinds of federal spending. Both near and distant future actions by Congress will determine what steps will be taken.

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HEALTH CARE COMPLEXITY AND UNCERTAINTY

Kristen Truong

March 22, 2021

Two distinguishing characteristics of the health care sphere are complexity and uncertainty. Last month’s issue of this newsletter contained a discussion of a term known as the prodrome, a period in biomedical research wherein an individual experiences some symptoms of an illness before meeting formal diagnostic criteria. It ends once a patient meets such criteria and is diagnosed with a disorder. Diagnostic standards are consequential. Not only can they label and stigmatize, they have the power to confer or deny access to social resources. Related features include fluidity and malleability, with the boundaries between health and illness subject to redefinition and reorganization.

Neuroscientific research suggests the presence of prodromal phases for a growing list of conditions, including schizophrenia and autism. Another example of possible complexity and uncertainty is schizoaffective disorder (SAD), a controversial diagnosis. Debate continues over its conceptualization, with some experts viewing SAD as an independent disorder, while others see it as either a form of schizophrenia or a mood disorder. If the focus is on an episode (DSM-IV, Diagnostic and Statistical Manual of Mental Disorders) rather than on the longitudinal course of the illness (DSM-V), this difference likely could lead to changed rates of diagnosis of SAD, but controversy remains over classification.

A paper appearing on February 16 of this year in the journal Theoretical Medicine and Bioethics indicates that which concept of disease is assumed has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease (disease judgements) and who may be accorded the social privileges and personal responsibilities associated with being sick (sickness judgements). The authors consider an ideal diagnostic test for coronavirus disease (COVID-19) infection regarding four groups of individuals: (1) positive and asymptomatic, (2) positive and symptomatic, (3) negative, and (4) untested, showing how different concepts of disease have an impact on the disease and sickness judgements for these groups.

The third edition of the DSM in 1981 contained a definition of mental disorder that included a harm requirement (necessitating distress or disability to the individual) so that homosexuality could be coherently eliminated from the catalogue of diseases. This move changed the applicability of what is called disease judgement. Given that homosexuality does not cause harm and is therefore not a disease, according to the current definition of mental disorder, individuals who are homosexual cannot be regarded as having a disease. Concepts of disease also have implications for what are called sickness judgements about how the rights and restrictions associated with forms of sickness are attributed to individuals by virtue of their condition (e.g., entitlement to treatment and reimbursements, or the obligation to surrender one’s driving license). Sickness is the social aspect of disease. While disease and sickness judgements do not always correspond, the concept of disease places constraints on what counts as sickness. Thus, attainment of greater clarity among these concepts has the potential to improve clinical care.

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IMPLICATIONS OF GENETIC TESTING FOR SUICIDE RISK

Kristen Truong

February 22, 2021

The article on page one of this issue of TRENDS has a reference to how research soon may allow calculation of polygenic risk scores (PRS) for suicide death. Data reported in a study in the February 2021 issue of the journal Nature Genetic Medicine indicate that suicide claims the lives of over 47,000 individuals annually in the U.S. and the national rate has increased by 33% between 1999 and 2017. Genetic factors are viewed as playing a major role in suicide risk, with an estimated heritability of close to 50% for suicide death and as much as 30% for suicide attempt. Research during the past decade has begun to characterize genetic variation associated with suicide and suicide attempts. Notably, this genetic risk seems independent of variants associated with developing depression or other mental illnesses. Similar to other psychiatric genetic research, suicide research has not yet identified well-replicated genes and gene pathways leading to functional mechanisms, but increasing momentum and support for large-scale research suggests that investigators rapidly are approaching this goal.

Even before specific risk genes and pathways are discovered, studies of suicide risk may allow the calculation of polygenic risk scores for suicidality. Once these data are available, they may rapidly be commercialized and marketed to the public as direct-to-consumer testing that currently is not subject to extensive regulation. Given these rapid developments, there is an urgency to understanding how individuals may interpret and act on this information. The aforementioned journal article reports the results of initial focus group research related to knowledge about and perceived acceptability of genetic testing for suicide risk among suicide attempt survivors and family members of individuals who died of suicide. The findings from the study highlight the importance of extensive engagement with potential stakeholders before such genetic technologies are made available for clinical or public use.

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THE PRODOME: DIAGNOSIS, DISADVANTAGE, AND BIOMEDICAL AMBIGUITY

Kristen Truong

February 22, 2021

According to an article published in the March 2021 issue of the journal Society and Mental Health, diagnostic standards are consequential, as diagnoses can label and stigmatize, while conferring or denying access to social resources. Diagnostic criteria also are fluid and malleable, with the boundaries between health and illness subject to redefinition and reorganization. Technology may be an engine driving such redefinition of diagnoses. Viewed from that perspective, science and technology can create, reveal, or redefine disorders, making some diagnoses possible while hindering others. In this article, the author engages with the intersection of science and diagnosis by demonstrating how the prodrome, an emerging phase of illness characterized by neuroscientific research, creates problems for patients, their families, and health care institutions. In biomedical research, the prodrome is a period wherein someone experiences some symptoms of an illness before meeting formal diagnostic criteria. The prodrome ends once a patient meets formal criteria and is diagnosed with a disorder. It is of biomedical interest because these symptoms might provide advanced notice of impending illness.

The focus of this particular article is on Huntington Disease (HD), while acknowledging that neuroscientific research suggests the presence of prodromal phases for a growing list of conditions, including schizophrenia and autism. In this instance, the prodrome is examined from the standpoint of its social, experiential, and institutional consequences. Based on interviews with individuals and their informal caregivers, an explanation is provided regarding how the prodrome is a site of healthcare disadvantage. Although participants suffer from psychiatric and cognitive prodromal symptoms (e.g., hallucinations, mood changes) and associated challenges (e.g., job loss), they do not receive necessary support because they do not meet formal diagnostic criteria. The prodrome is viewed as being connected to: (1) the inability to access health care, (2) the inability to access health resources, (3) the depletion of personal resources, and (4) extensive caregiver burden and burnout. The HD prodrome also provides a contrast to research on the negative repercussions of diagnostic expansion, as prodromal individuals report struggling with symptoms that are well-characterized in neuroscientific research, but remain unacknowledged and under supported by health care institutions. An argument is advanced that prodromal individuals are shut out of health services as a result of such institutional ambiguities.

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OBTAINABLE RESOURCES

Kristen Truong

February 22, 2021

Voluntary Support Of Education

Since 1957, the Voluntary Support of Education (VSE) annual survey from the Council for Advancement and Support of Education (CASE) has collected data on fundraising outcomes in higher education institutions in the United States. It is regarded as the definitive source of information on philanthropic support of those institutions. Data from the survey are used to estimate total charitable support of all institutions of higher education in the nation, including nonrespondents. Survey respondents must adhere to the Reporting Standards and Management Guidelines, first published jointly with the National Association of College and University Business Officers (NACUBO) in 1982. CASE updated the standards in 1996, 2004, and 2009. According to the VSE survey, voluntary support of higher education institutions in the United States essentially was flat in the fiscal year that, for most institutions, ended June 30, 2020. While support edged down two-tenths of a percent, at $49.50 billion, nearly half, 48.6%, of responding institutions reported that giving rose in 2020. A CASE analysis of institutions that responded for the past four reporting cycles reveals that varying frequencies of rising and falling gift receipts are the norm. Indeed, even an institution that posts lower levels of giving in a particular year may have had a good year. Sometimes a very large gift the previous year results in a percentage decline that is not really a negative event. The report can be obtained here.

National Healthcare Quality And Disparities Report

The National Healthcare Quality And Disparities Report Chartbook On Patient Safety is the product of collaboration among agencies across the U.S. Department of Health and Human Services (HHS). It is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (NHQDR). The NHQDR is an annual document to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). The NHQDR provides a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups. The purpose of the reports is to assess the performance of the U.S. health care system and to identify areas of strengths and weaknesses along three main axes: access to health care, quality of health care, and NHQDR priorities. The reports are based on more than 250 measures of quality and disparities covering a broad array of health care services and settings. Data generally cover 2000 through 2018. The reports are produced with the help of a Federal Interagency Work Group led by the Agency for Healthcare Research and Quality (AHRQ) and submitted on behalf of the Secretary of the U.S. Department of Health and Human Services (HHS). Chartbooks are organized around six Priority Areas. Patient Safety is one of them. They are interrelated and work to support all priority areas and can support necessary and critical improvements in making care safer. The Chartbook can be obtained here.

50-State Survey Of Telehealth Commercial Insurance Laws

States are stepping up requirements that insurers pay for telehealth at the same rate as in-person services, according to a new report from Foley and Lardner. Four more states required payment parity amid the pandemic last year, bringing the total to 14 states. The law firm argues that without such laws, insurers might set reimbursement rates so low that health providers feel no incentive to adopt telehealth. State-mandated coverage of text messages, images, and other “asynchronous health care” also has grown, with 27 now requiring reimbursement. Telehealth has skyrocketed, driven by patient concerns about contracting the virus during in-person visits to clinics or doctors’ offices. What remains unknown is whether Congress and the Biden Administration will make permanent some of the temporary federal payment policies set for the pandemic once it subsides. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

February 22, 2021

Sexual Orientation Disparities In Risk Factors For Adverse COVID-19–Related Outcomes

Sexual minority individuals experience health disparities associated with sexual stigma and discrimination. Lesbian, gay, and bisexual persons in the U.S. have higher self-reported prevalence of several underlying health conditions associated with severe COVID-19 outcomes, compared to heterosexual persons, according to the February 5, 2021 issue of Morbidity and Mortality Weekly Reports. Between 2017 and 2019, sexual minorities, whether part of the overall population or among racial and ethnic minority groups, reported higher rates of asthma, chronic obstructive pulmonary disease, stroke, kidney disease, cancer and heart disease. Based on these findings, CDC indicated that including information on sexual orientation and gender identity, along with race and ethnicity, in COVID-19 data collections could improve knowledge about disparities in these communities. Current surveillance systems lack information on sexual orientation, hampering examination of COVID-19–associated disparities among sexual minority adults.

Instant Death More Common In Absence Of Physical Exercise

Heart disease is the leading cause of death globally and prevention is a major public health priority. Until recently, an aspect involving little information has been the effect of an active versus sedentary lifestyle on the immediate course of a heart attack. Now, there is evidence that an active lifestyle is linked with a lower chance of dying immediately from a heart attack based on a study published on February 12, 2021 in the European Journal of Preventive Cardiology. Researchers used data from 10 European observational cohorts including healthy participants with a baseline assessment of physical activity who had a heart attack during follow-up, a total of 28,140 individuals. While 17.7% died within 28 days of their heart attack, 62.3% of them died instantly. Patients who had engaged in moderate and high levels of leisure-time physical activity had a 33% and 45% lower risk of instant death compared to sedentary individuals. These numbers were 36% and 28%, respectively at 28 days.

HEALTH TECHNOLOGY CORNER

Identifying Candidates For Drug Repurposing For SARS-CoV-2

When COVID-19 arrived, researchers began seeking effective treatments, but producing new drugs can be a lengthy process. The only expedient option may be to repurpose existing medications. As reported on February 15, 2021 in the journal Nature Communications, a team from MIT's Department of Electrical Engineering and Computer Science, the Institute for Data, Systems and Society, and the Broad Institute of MIT and Harvard developed a machine learning-based approach to identify drugs already on the market that potentially could be repurposed to fight COVID-19, particularly in the elderly. Given that SARS-CoV-2 pathogenicity is highly age-dependent, it is critical to integrate aging signatures into drug discovery platforms. To identify robust druggable protein targets, researchers propose a principled causal framework that makes use of multiple data modalities. The investigators pinpointed the protein RIPK1 as a promising target for COVID-19 drugs, and they identified three approved drugs that act on the expression of RIPK1.

Affordable CRISPR App Reveals Unintended Mutations At Site Of CRISPR Gene Repair

Scientists have developed an affordable, downloadable app that scans for potential unintended mistakes when CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) is used to repair mutations that cause disease. During CRISPR-directed gene editing, multiple gene repair mechanisms interact to produce a wide and largely unpredictable variety of sequence changes across an edited population of cells. Shortcomings inherent to previously available proposal-based insertion and deletion (indel) analysis software necessitated the development of a more comprehensive tool that could detect a larger range and variety of indels while maintaining the ease of use of tools currently available. As reported on February 10, 2021 in The CRISPR Journal, researchers developed Deconvolution of Complex DNA Repair (DECODR) to determine the identities and positions of inserted and deleted bases in DNA extracts from both clonally expanded and bulk cell populations. The software is accurate in making these determinations.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

February 22, 2021

During the campaign for the presidency in the 2020 election, several Democrat candidates expressed an interest in taking actions that will have a strong impact on higher education, such as making it free for many students at public institutions. According to a study released in January 2021 that was commissioned by the Campaign for Free College, it is estimated that if a plan supported by President Biden ever becomes law, enrollment at four-year private institutions over “several years” would be reduced by 12.3%. During the same period, enrollment at four-year public institutions would increase by 17.7%. Unfortunately, not all institutions in the private sector would be able to withstand a shift of this magnitude and it is anticipated that some of them would be forced to close their doors permanently.

Public institutions also experience some unique problems of their own, such as a steady decline over the period of many years in obtaining financial support from state governments. A related concern is that by increasing enrollment at these schools, it is highly likely that additional resources will be required to accommodate the growth in student numbers. The Biden plan does not take that possibility into account while based on recent history, it seems unlikely that support from state governments will be available to reduce the added cost burden. Related policy developments entail the provision of health insurance coverage for state residents who lack it. Medicaid programs, which are funded jointly by the federal government and the states, already exert a heavy toll on finances in many states. As some jurisdictions around the U.S. struggle in their efforts to cope with ever rising health care expenditures, their ability to support the higher education sphere is lessened concomitantly.

Forgiveness Of Student Debt

A related higher education policy issue is to forgive some portion of student debt incurred by individuals who found it necessary to borrow money to meet costs associated with attending colleges and universities. Similar to supporting free education at public institutions, Democrat candidates during the 2020 campaign for the presidency were in favor of reducing the $1.6 trillion in student debt that currently exists. Most of that amount was made by the Treasury Department and is held by the U.S. government. A portion of the total represents loans that originally were made by private lenders and guaranteed by the federal government. President Biden is in favor of forgiving both kinds of loans and has indicated that he is in favor of doing so in a manner that would be covered by federal taxpayers.

Assuming such a policy is enacted, it is reasonable to ask in the name of equity which groups should be the chosen beneficiaries. One segment consists of post-baccalaureate students who in pursuit of higher degrees awarded by prestigious business schools, law schools, and medical schools assume mountains of educational debt. The other side of the coin is that upon completion of their studies, they tend to be in a favorable position to earn highly satisfactory levels of income during their subsequent professional careers. Should their debt-oriented financial plight be viewed with the same degree of concern as students who are less fortunate? For example, proposed forms of debt absolution, such as writing off as much as $50,000 per student, will not be as beneficial for large numbers of individuals who decided not to attend college or who instead chose to work either before or during their college years to offset educational costs.

Vaccinating College Students

It is not all that uncommon to see photographs of students attending crowded social events while not wearing masks. Not generally perceived as a group that will suffer the worst effects of the coronavirus if they become infected, a bigger concern is the potential they have to be part of the super spreader portion of the community. Now that more colleges and universities have reopened their campuses, institutions such as the University of California, Berkeley; University of Massachusetts at Amherst; and the University of North Carolina at Chapel Hill have found it advisable to impose lockdowns in residence halls and encourage students to avoid travel. A related issue is the possibility of ensuring that students are vaccinated prior to leaving campus at semester’s end to prevent them from spreading the disease to older individuals.

return to February 2021 trends

HEALTH REFORM DEVELOPMENTS

Kristen Truong

February 22, 2021

During the early days of cinematography, it was common for the lights in a movie theater to be turned on as an employee mounted the stage to make the following announcement, “One minute please while we change reels.” Federal health policy in the United States often is implemented in a similar manner. Regardless of the many alterations made during any presidential administration, as soon as a new president arrives on the scene from the opposing political party, several items are at a high risk of being reversed. Some examples of changes that have been made by the Biden Administration are as follows:

The regular Affordable Care Act sign-up period ended on December 15, but President Biden signed an executive order launching a special 90-day enrollment period for ACA coverage, which began on February 15. The Administration seeks to increase public awareness of the extended timeframe through a $50 million marketing campaign.

An executive order directs the U.S. Department of Health and Human Services (HHS) to review the interoperability of public health data systems across the nation. The objective is to improve COVID data sharing throughout the federal government, enhance vaccine distribution, and increase the understanding of the scope of the pandemic in communities throughout the country.

The following rules proposed by the Centers for Medicare and Medicaid Services (CMS) during the Trump administration have been withdrawn: Conditions for Coverage for End-Stage Renal Disease Facilities—Third Party Payments; Strengthening Oversight of Accrediting Organizations (AO) and Preventing AO Conflict of Interest, and Related Provisions; and Revisions to Medicare Part A Enrollments.

Unwinding Medicaid Work Requirements

The Biden Administration has expressed strong interest in beginning the process of rolling back Medicaid work requirements, an initiative developed when President Trump was in office, which generally mandated that beneficiaries log 20 or more hours on a job, look for work, perform community service, or take educational classes to be eligible for Medicaid benefits. Kentucky, Arkansas, and Nebraska are among 12 states that received federal approval to impose such requirements, although some plans were blocked by the courts. A possibility remains that some states may elect to challenge these roll back efforts.

Concentration Of Health Care Expenditures

A significant portion of health legislation is aimed at controlling health care costs. In the newest Statistical Brief, data from the Agency for Healthcare Research and Quality (AHRQ) Medical Expenditure Panel Survey Household Component (MEPS-HC) describe the overall concentration of health care expenses across the U.S. civilian noninstitutionalized population in 2018. Spending on health care that year accounted for 17.7% of the U.S. gross domestic product, yet the majority of this spending was concentrated in a small percentage of the population. Older individuals disproportionately were represented in the higher healthcare spending tiers. Among the entire U.S. civilian noninstitutionalized population in 2018, 16.8% were 65 and older, while 22.6% were under age 18. Among the top 5% of spenders, however, 39.0% were 65 and older, while only 5.8% were children under age 18. In contrast, among the bottom 50% of spenders, 30.6% were children while only 6.0% were 65 years and older.

Steady growth in the portion of individuals age 65 and older in the population will have an impact on efforts to lower health care spending due to the amount of money that will be spent on addressing their health care needs. The most commonly treated condition among the top 5% percent of spenders in 2018 was hypertension (48.8%), followed by osteoarthritis/other non-traumatic joint disorders (44%), and nervous system disorders (40.0%). While these conditions are the most common among high spenders, they are not necessarily the most expensive ones to treat. Instead, the top spending group is more likely to include patients with multiple chronic conditions or expensive treatments (e.g., surgeries, and hospitalizations) related to these conditions.

return to February 2021 trends

AMERICAN RESCUE PLAN AND COVID-19

Kristen Truong

February 22, 2021

The new Biden Administration arrived in the nation’s capital with ambitious plans to work cooperatively with Congress in dealing with the many problems associated with the coronavirus pandemic. The president’s American Rescue Plan is a centerpiece of that effort. Major committees on Capitol Hill have responded positively and have begun to set in motion legislation to achieve several important objectives aimed at combining individual bills into a $1.9 trillion COVID-19 relief package, which the House Budget Committee “marked up” and passed today, combining the individual Committee proposals into a single reconciliation bill that will be taken up on the House floor at the end of the week, with enactment expected in mid-March.

As described in the previous issue of this newsletter, reconciliation legislation is a fast-track process that can be passed by a simple majority without having to be filibustered in the Senate. Some limitations exist in this approach because budget reconciliation cannot be used for any and all federal legislation. Instead, bills must contain provisions that affect revenue and spending, with no extraneous items allowed, according to a restriction known as the “Byrd Rule.”

The House Education and Labor Committee’s portion of the reconciliation bill provides $170 billion to K-12 and postsecondary education, with $40 billion dedicated to higher education to make necessary COVID related improvements on campus and provide additional student supports. Funding will be provided to institutions via the Higher Education Emergency Relief Fund (HEERF) created in the CARES Act

The House Energy and Commerce Committee bill includes more than $46 billion for COVID-19 national testing efforts and $20 billion to improve vaccine distribution. Additional funds will be used to incentivize states to expand their Medicaid programs, allow new mothers to stay on the program for up to a year, and eliminate a cap on Medicaid drug rebates beginning in 2023.

House Ways and Means Committee legislation has features that include capping the cost of coverage in the individual health insurance market through increasing Affordable Care Act (ACA) tax credits for 2021 and 2022. ACA plans would be available at no cost for individuals making up to 150% of the federal poverty level and also for unemployment insurance beneficiaries. The bill includes additional direct payments of $1,400 to individuals and an extension of temporary federal unemployment benefits.

Proposed legislation by the House Oversight and Reform Committee provides $340 billion to state and local government jurisdictions. Aid would be split with states receiving 60% of funding and localities obtaining the other 40%. This funding can be utilized for a host of different COVID related needs as determined by state and local officials, including further assistance to postsecondary institutions.

The House Small Business Committee would add $7.25 billion for the Paycheck Protection Program (PPP) and also create a new program to support the restaurant industry.

The Senate is expected to take up the House passed bill next week, with the House’s increase of the federal minimum wage to $15 in 2025 the item most at risk of being eliminated. In separate news, the important Senate Committee on Health, Education Labor & Pensions will have Patty Murray (D-WA) serve as chairperson and Richard Burr (R-NC) as ranking member.

return to February 2021 trends

PALIMSEST AS METAPHOR

Kristen Truong

February 22, 2021

The Oxford English Dictionary defines palimpsest in various ways, including (1) a parchment or other writing surface on which the original text has been effaced or partially erased, and then overwritten by another, (2) a manuscript in which later writing has been superimposed on earlier (effaced) writing, (3) having been reused or altered while still retaining traces of its earlier form, (4) as a structure characterized by superimposed features produced at two or more distinct periods in physical geography and geology, and (5) a multilayered record. Based on these definitions, the term may be considered metaphorically in relation to this newsletter, with COVID-19 serving as an apt illustration of a topic that has been discussed on several occasions in these pages over the last several months.

The coronavirus pandemic is the equivalent of a verbal diorama under construction where events continue to unfold. Older controversies remain unresolved while new ones appear at regular intervals. Meanwhile, it essentially seems likely that the final chapter will not be written any time soon. Going back more than one year ago, debates continue about the origin of this disease. Did it arise in China and in Wuhan in particular? Was the source a wet market that sold bats and other animal kinds of foods or did this ailment emerge accidentally from an infectious disease laboratory?

Early guidelines from authoritative organizations, such as the WHO and the CDC indicated that the disease was not transmissible and that wearing masks for protective reasons was unwarranted. Moving ahead to the current month, debates are underway regarding whether one, two, or three masks should be worn. Which medications and related forms of treatment to use in treating infected patients and whether to do so in hospitals or elsewhere represent other areas of disagreement. Somewhat alarmingly, social distancing and lockdown policies are viewed as causing more problems rather than producing constructive solutions for them. While health officials advocate having children return to their classrooms, some teacher unions disagree on the wisdom of doing so. Even though vaccines are available, locales around the U.S. differ on which population subgroups should be given priority to receive them while anti vaxxers resist being immunized at all.

Over the years, this newsletter has contained items about improvements in health care as well as concerns worth addressing. Advances in genomics are associated with new breakthroughs that are destined to arise at regular intervals. Another page of the current issue of this newsletter discusses how research soon may allow calculation of polygenic risk scores (PRS) for suicide death, a top 10 cause of fatality in the U.S. The possibility of this development, which could be marketed directly to consumers, is accompanied by ethical concerns. Anticipated benefits are prevention of suicide and reduced stigma that might be offset by an increase in adverse psychological effects. Innovations in the health realm often are perceived as having significant individual and community-level benefits. Yet, there remains a likelihood of other concerns becoming manifested that relate not only to access to insurance and employment, but also to increased anxiety and depression.

return to February 2021 trends

GENTRIFICATION IMPACTS ON HEALTH

Kristen Truong

January 20, 2021

According to a manuscript published in December 2020 in the Journal of Urban Health, gentrification can be defined as “the process in which neighborhoods with low SES experience increased investment and an influx of new residents of higher SES.” Differing perspectives of policy makers, urban planners, sociologists, environmental scientists, economists, residents, and others have led to debates as to whether gentrification is ultimately of net benefit or harm. Although it is associated with increased proximity to material resources, such as green space, recreational facilities and new businesses, income and education may remain a barrier to accessing these resources. Changes often accompanying gentrification (i.e., limited affordable healthy housing, food insecurity from the need to pay high rent on limited income, increased stress, and changes in social networks) may affect certain residents negatively.

Gentrification can bring about improved neighborhood conditions, reduced rates of crime, and property value increases. It also equally can foster negative conditions associated with poorer health outcomes, such as disrupted social networks from residential displacement and increases in stress. While neighborhood environment consistently is implicated in health outcomes research, the authors indicate that gentrification rarely is conceptualized as a public health issue. They posit that as gentrification occurs across the U.S., it is important to understand how this process has an impact on health. Moreover, while aging cities reinvest in the revitalization of communities, empirical research examining relationships between gentrification and health can help inform policy decisions.

return to December 2020 - January 2021 trends

More December 2020 - January 2021 TRENDS Articles

SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

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looks at some major appropriations that were enacted for fiscal year 2021. Read More

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

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Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

January 20, 2021

PERSONAL RESPONSIBILTY AMID SOCIAL DETERMINANTS

Kristen Truong

January 20, 2021

A debate with a lengthy history involves the degree to which individuals should be held responsible and accountable for misfortunes that occur in their lives versus assigning blame to external forces beyond their personal control. For example, if someone is responsible for personal health, then, all else being equal, that individual should be held accountable for it. Given this line of reasoning, it can be argued that responsibility for health has an important role to play in distributing the benefits and burdens of health care (e.g., charging higher health insurance premiums for those engaged in unhealthy behavior or giving lower priority of care to putatively responsible parties), but some caution is advisable. That health is influenced by social, economic, and environmental factors is a matter of consensus, which leads to a counter argument that in light of social determinants of health, individuals typically are not responsible for their health, rendering inappropriate policies that employ a responsibility-for-health criterion. According to an article published in the January 2021 issue of the journal Bioethics, this debate implicates a number of overlapping concepts and questions that often are difficult to separate. Also, maintaining that social determinants undermine responsibility for health may be latching on to the wrong target.

This perspective holds that social determinants of health are relevant to such policies, but not by globally undermining responsibility. Instead, social determinants are sometimes responsibility-undermining, sometimes responsibility-preserving, and often relevant to whether individuals should be held accountable for their health regardless of their responsibility. A more nuanced appraisal is called for regarding ways in which the social determinants of health are relevant to such policies. After arguing that responsibility is possible amid the social determinants of health, some important ways in which these determinants are directly relevant to individuals’ accountability for their health are surveyed and hurdles are highlighted that any policy holding individuals accountable for their health on the basis of their responsibility must clear. A proposition is advanced that distinguishing responsibility and accountability, and the ways in which social determinants are relevant to each, helps make clear the ways in which the social determinants of health are and are not relevant to policies that employ a responsibility‐for‐health criterion. Thus, it can be maintained that individuals have an obligation to preserve and promote their health, and that they are often responsible for their success or failure to do so, without committing to the thought that they are thereby accountable for their health.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

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looks at some major appropriations that were enacted for fiscal year 2021. Read More

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

DEVELOPMENTS IN HIGHER EDUCATION

lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
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2021 Federal Health Insurance Exchange Weekly Enrollment Read More

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Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

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Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

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January 20, 2021

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

January 20, 2021

When Back To School Meets Stay At Home

Students typically flock to higher education institutions amid a recession, but the COVID-19 pandemic has created a host of new financial and health challenges for those who intended to enroll in a program in the fall. A new analysis, When Back to School Meets Stay at Home, from the Georgetown Center on Education and the Workforce shows that 75% of households in which at least one member intended to take postsecondary classes responded to the pandemic by changing their plans. Some completely canceled them, while others changed the number of classes they took, enrolled in a different program or institution, or took classes in a different format. Taking classes in a different format was the most common change in fall postsecondary plans, experienced by 39% of households with postsecondary plans. More than one-third of households (37%) with such plans, however, reported that a household member had canceled a plan entirely. Postsecondary plans were most likely to be canceled in households in which individuals intended to take classes in certificate or associate’s degree programs. Lower-income households also were more likely to have individuals who canceled their postsecondary plans in response to the pandemic. The analysis can be obtained here.

Equity-Minded Faculty Workloads: What Can And Should Be Done Now

Recent social movements have revealed the systemic ways that racism and sexism remain entrenched in academic cultures. Faculty workload is taken up, assigned, and rewarded in patterns, and these patterns show important yet overlooked areas where inequity manifests in academe. Faculty from historically minority groups are disproportionately called upon to do diversity work and mentoring, while women faculty do more teaching and service. These activities are vital to the functioning of the university, yet are often invisible and unrewarded, leading to lower productivity and decreased retention. The COVID19 pandemic, which disproportionately has affected the lives and careers of women and faculty from historically minority groups, makes calls for equity-minded workload reform critical. A report from the American Council on Education summarizes findings and insights learned from the Faculty Workload and Rewards Project (FWRP), a National Science Foundation ADVANCE-funded action research project. The FWRP worked with 51 departments and academic units to promote equity in how faculty work is taken up, assigned, and rewarded, drawing from theories of behavioral economics and the principles of equity-mindedness. The report then makes recommendations for how academic units can promote workload equity by identifying the following six conditions linked to equitable workloads: Transparency, Clarity, Credit, Norms, Context, and Accountability. The report can be obtained here.

2021 Federal Health Insurance Exchange Weekly Enrollment

According to a report from the Centers for Medicare & Medicaid Services (CMS), approximately 8.3 million individuals selected or were re-enrolled automatically in plans using the HealthCare.gov platform during the 2021 Open Enrollment period. That’s about the same number as last year, although two fewer states are using the federally facilitated platform for 2021 enrollment. While the number of new consumers declined by 3.6%, the number actively renewing coverage increased by 13.2% and the number automatically re-enrolled increased by 4.4%, increasing total plan selections by 7% of all plan selections during the 2020 Open Enrollment Period. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov. The final snapshot reports new plan selections, active plan renewals, and automatic renewals. It does not report the number of consumers who paid premiums to effectuate their enrollment. The report, which shows plan selections in each of the 36 states using HealthCare.gov under the Affordable Care Act for 2021 open enrollment that began on November 1 and ended December 15 can be obtained here.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

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looks at some major appropriations that were enacted for fiscal year 2021. Read More

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

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Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
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2021 Federal Health Insurance Exchange Weekly Enrollment Read More

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Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

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January 20, 2021

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

January 20, 2021

COVID-19 Trends Among Individuals Aged 0–24 Years, United States

According to the January 13, 2021 issue of the CDC’s Morbidity and Mortality Weekly Report, studies consistently have shown that children, adolescents, and young adults are susceptible to SARS-CoV-2 infections. Children and adolescents have had lower incidence and fewer severe COVID-19 outcomes than adults, but cases among these groups have increased since summer 2020, with weekly incidence higher in each successively increasing age group. Trends among children and adolescents aged 0–17 years paralleled those among adults. Risk for disease introduction and transmission among children in child care centers and elementary schools might be lower than for high schools and institutions of higher education. To enable safer in-person learning, schools and communities should implement fully and adhere strictly to multiple mitigation strategies, especially universal and proper mask wearing, to reduce both school and community COVID-19 incidence to help protect students, teachers, and staff members from the disease.

Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation

Atrial fibrillation (AF) is an arrhythmia with a major impact on public health due to its increasing prevalence in aging populations and its association with adverse outcomes, including stroke and heart failure (HF), with more than a doubling of mortality risk. The effect of alcohol on AF risk has remained ambiguous since there is inconsistent evidence on the relation of alcohol intake with incident AF at lower doses. As reported in the January 13, 2021 issue of the European Heart Journal, researchers assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts. In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention. Compared to drinking no alcohol at all, just one alcoholic drink a day was linked to a 16% increased risk of AF over a median follow-up time of nearly 14 years.

HEALTH TECHNOLOGY CORNER

Targeting Cartilage EGFR Pathway For Osteoarthritis Treatment

There currently is no cure for osteoarthritis (OA), but a group of scientists believe they have discovered a method through which a simple knee injection could potentially stop the disease's effects. Researchers previously found that mice with cartilage-specific epidermal growth factor receptor (EGFR) deficiency developed accelerated knee OA. To test whether the EGFR pathway can be targeted as a potential OA therapy, investigators constructed two cartilage-specific EGFR overactivation models and showed that they could target a specific protein pathway in mice, place it in overdrive, and halt cartilage degeneration over time. Building on that finding, they were able to demonstrate that treating mice with surgery-induced knee cartilage degeneration through the same pathway could reduce the cartilage damage and knee pain dramatically via the state of the art of nanomedicine. Findings were published in the journal Science Translational Medicine on January 13, 2021.

Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens

The microbiota shields the host against infections in a process known as colonization resistance. How infections themselves shape this fundamental process remains largely unknown. Scientists from five institutes of the National Institutes of Health show in an article published in the January 15, 2021 issue of the journal Cell that gut microbiota from previously infected hosts display enhanced resistance to infection. This long-term functional remodeling is associated with altered bile acid metabolism leading to the expansion of taxa that utilize the sulfonic acid taurine that helps the gut recall prior infections and kill invading bacteria, such as Klebsiella pneumoniae (Kpn). Taurine is found naturally in bile acids in the gut. The poisonous gas hydrogen sulfide is a byproduct of taurine and low levels of it allow pathogens to colonize the gut, but high levels produce enough byproduct to prevent colonization. Supplying exogenous taurine alone is sufficient to induce this alteration in microbiota function and enhance resistance.

return to December 2020 - January 2021 trends

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SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

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looks at some major appropriations that were enacted for fiscal year 2021. Read More

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points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

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lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
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Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
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2021 Federal Health Insurance Exchange Weekly Enrollment Read More

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Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

GENTRIFICATION IMPACTS ON HEALTH

Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

Kristen Truong

January 20, 2021

DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

January 20, 2021

Some welcome news arrived for higher education in the form of an added $23 billion in relief aid stemming from the $900 billion coronavirus-relief package that was passed by Congress in December 2020. This amount is in addition to the $14 billion in direct aid to public and private higher education institutions that was furnished through the Coronavirus Aid, Relief, and Economic Security (CARES) Act last March. The assistance is aimed at offsetting new costs that colleges and universities have assumed that are associated with the implementation of online learning and coronavirus prevention measures. Many institutions also have been devastated financially by steep declines in auxiliary revenue derived from tuition as a result of declines in enrollment and also from related sources involving campus housing, dining operations, and campus facility rentals to outside groups.

As the year 2021 opened in January, there are no signs that the pandemic is declining. New mutations are proving to be more transmissible and the number of fatalities and hospitalizations from the disease have attained record levels in many states across the nation in recent weeks. The availability of vaccines is a hopeful sign, but the number of individuals who have been fortunate enough to receive them is paltry in comparison to the size of the overall U.S. population. When the day arrives that student enrollment reaches pre-pandemic levels, it appears reasonable to suppose that students could face higher out-of-pocket costs as institutions raise tuition to fill any revenue gaps. That possibility means that the federal government will be called upon to provide financial assistance to enable students from disadvantaged backgrounds to benefit from participation in higher education offerings.

Federal Aid To Higher Education In 2021

Page two of this issue of the newsletter lists funding made available under the Consolidation Appropriations Act, 2021 (P.L. 116-260) for a variety of activities. Some items not listed on that page, which have a bearing on higher education are as follows:

$754 million for the Health Resources and Services Administration (HRSA) Title VII Health Professions And Title VIII Nursing Workforce Development Programs.

$15 million for the HRSA Health Careers Opportunity Program (HCOP), a federally funded grant that provides students from economically or educationally disadvantaged backgrounds an opportunity to develop the skills needed to compete successfully for, enter, and graduate from health professions schools.

$51.5 million for the HRSA Scholarships for Disadvantaged Students Program, which provides scholarships to full-time, financially needy students from disadvantaged backgrounds, who are enrolled in health professions and nursing programs.

An additional $35 billion for the Higher Education Relief Fund directed towards public institutions and public and private Historically Black Colleges and Universities (HBCUs).

A change in how eligibility for Pell Grants is determined means an additional 555,000 students will qualify for Pell Grants each year and 1.7 more million students will qualify to receive the maximum Pell award annually. The subsidy on interest for some federal student loans is being expanded. Approximately $1.3 billion in capital loans owed to the federal government by HBCUs is being forgiven.

Another important provision will make it easier for students to fill out the Free Application for Federal Student Aid (FAFSA) form. After several years of work in Congress to achieve this result, simplification will benefit an estimated 20 million families who fill out these complicated forms every year. Reducing FAFSA from 108 questions to 36 will remove a major barrier to helping more low-income students pursue higher education.

return to December 2020 - January 2021 trends

More December 2020 - January 2021 TRENDS Articles

SIR ISAAC AND THE WHOLE BIRD

Discusses political polarization and new opportunities to produce bipartisan solutions for physical and mental health problems. Read More

117TH CONGRESS IS UNDERWAY

looks at some major appropriations that were enacted for fiscal year 2021. Read More

HEALTH REFORM DEVELOPMENTS

points out how the incoming Biden administration may undo certain policies of the previous administration and indicates some mechanisms for doing so. Read More

DEVELOPMENTS IN HIGHER EDUCATION

lists some funding made available by the enactment of the Consolidated Appropriations Act, 2021 and also refers to additional financial assistance provided in a separate coronavirus-relief package. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID-19 Trends Among Individuals Aged 0-24 Years, United States
Alcohol Consumption, Cardiac Biomarkers, And Risk Of Atrial Fibrillation
Targeting Cartilage EGER Pathway For Osteoarthritis Treatment
Infection Trains The Host For Microbiota-Enhanced Resistance To Pathogens Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

When Back To School Meets Stay At Home
Equity-Minded Faculty Workloads: What Can And Should Be Done Now
2021 Federal Health Insurance Exchange Weekly Enrollment Read More

PERSONAL RESPONSIBILITY AND SOCIAL DETERMINANTS

Examines the issue of how personal behavior and social determinants interact to influence health status. Read More

GENTRIFICATION IMPACTS ON HEALTH

Pertains to a discussion regarding whether the gentrification of urban neighborhoods is a net benefit or is harmful. Read More

More March 2021 TRENDS Articles

HEALTH CARE COMPLEXITY AND UNCERTAINTY

AMERICAN RESCUE PLAN BECOMES LAW

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

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