June 17, 2021

DEVELOPMENTS IN HIGHER EDUCATION

June 17, 2021

Occupants of the White House can change whenever an election occurs. Regardless of whether a presidential administration is Democrat or Republican, its members tend to focus on many of the same issues that characterize the sphere of higher education. Now that President Biden’s team is firmly established at the U.S. Department of Education, an effort will be made not only to undo various policies implemented during the Trump administration, but also to place greater emphasis on topics which it perceives as being essential.

Efforts to make changes will include altering Title IX regulations installed by former Education Secretary Betsy DeVos regarding sexual misconduct at schools and colleges. Another topic that has attracted an increased amount of attention in recent months in various states is the issue of transgender students and their desire to play scholastic sports on women's teams. For-profit colleges’ policies also will come under review since the previous administration either scaled back or eliminated rules involving “gainful employment” regulations that were formulated during the Obama administration.

Mandatory Requirements Involving Vaccinations And Mask Wearing

Many colleges and universities around the nation are faced with the more immediate task of deciding which safety policies need to be in place as students return to campus this coming fall. The kinds of questions posed by academic administrators include whether to require or just recommend that students be vaccinated. Related matters entail which vaccines have been fully approved by the U.S. Food & Drug Administration. Compared to individuals age 65 and older, college age students are at less risk of: being infected by the coronavirus, experiencing deadly symptoms if they do contract the disease, and spreading it after becoming infected. A debatable proposition advanced by some critics of vaccination policy is whether any student who already has antibodies from COVID-19 should be vaccinated at all.

Beginning with the appearance of this disease, individuals of all ages were required to wear masks. Campus administrators have to decide which procedure to mandate. Current guidance from the Centers for Disease Control & Prevention stipulate that wearing masks is optional only for individuals who are fully vaccinated. Part of the uncertainty is whether to require that masks be worn indoors or should the same restriction apply to outdoors on campus? A related consideration is whether football stadiums be open to fans who can fill every available seat or should the number be limited because of social distance policies?

International And Domestic Student Enrollment Trends

The Institute of International Education on June 10, 2021 released the findings of its fourth survey in the organization’s COVID-19 Snapshot Survey Series, examining the effects of the COVID-19 pandemic on international educational exchange to and from the United States. The new survey data find that U.S. institutions are focusing on bringing students back to campus, with 86% planning some type of in-person study in fall 2021. None of the reporting institutions intends to offer virtual instruction only. Mirroring this finding, 90% of institutions plan to offer in-person study to international students. For that group, applications are up 43% for the 2021-2022 academic year, almost double the increases reported one year ago by institutions.

Meanwhile, the National Student Clearinghouse Research Center provided a final tally of the enrollment decline in higher education experienced during the spring term of 2021. Total college enrollment declined 3.5% percent from a year earlier, a shortfall of 603,000 students, which is seven times worse than the reduction one year earlier. Male student enrollment was down 5.5%, or 400,000 students, from a year ago compared with a drop of only 2%, for women, or 203,000 students. Although enrollment fell in almost every undergraduate major tracked by the research center, psychology, and computer and information science were among the few bright spots at four-year institutions. Enrollment in those majors was up 4.8% percent and 3%, respectively, from a year ago.

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Kristen Truong

June 17, 2021

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

June 17, 2021

Rural-Urban Disparity In Mortality In The U.S. From 1999 To 2019

According to an article in the June 8, 2021 issue of the Journal of the American Medical Association, less is known about recent trends in rural-urban differences in age-adjusted mortality rates (AAMRs) overall in the U.S. So, investigators analyzed all deaths occurring in the U.S. using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2019. Rural residents experienced greater mortality and the disparity between rural and large metropolitan areas tripled from 1999 to 2019. Even though there were reductions in AAMRs for all ages, there was a 12.1% increase in the AAMR for rural residents aged 25 to 64 years, which was driven by an increasing AAMR among Non-Hispanic White individuals. Non-Hispanic Blacks, however, had greater AAMRs across all three U.S. Census–categorized areas than all other racial/ethnic groups. These trends could be exacerbated further by rural hospital closures and the COVID-19 pandemic.

Less Traffic, Fewer Collisions, Increased Motor Vehicular Deaths In 2020

Many individuals started working from home in March 2020 because of COVID-19, removing a commute from their daily routine. Yet, motor vehicle deaths in 2020 are estimated to be the highest since 2007 despite the decrease in miles driven, and surveys show that dangerous driving behaviors actually have increased during the pandemic. The National Safety Council (NSC) estimates that 42,060 passengers died on U.S. roads in 2020, which is an 8% increase over 2019. Despite a 13% decline in vehicle-miles traveled, the preliminary estimated rate of death on U.S. roads rose 24% year over year, which is the largest increase measured since 1924, nearly a century. While there have been fewer drivers on the road, data from traffic analytics firm Inrix show a speed increase in the country’s most congested urban areas during 2020. Data show that compared to 2019, the rate of collisions in the U.S. decreased by 30% in 2020, but according to The Travelers Cos. Inc.’s 2021 Travelers Risk Index, dangerous driving behaviors also have increased.

HEALTH TECHNOLOGY CORNER

Brain Areas Involved In Seeking Information About Bad Possibilities

The term “doomscrolling” describes the act of endlessly scrolling through bad news on social media and reading every worrisome tidbit that materializes. Similarly, specific areas and cells in the brain become active when an individual is faced with the choice to learn or hide from information about an unwanted aversive event, such as a punishment that cannot be prevented. As reported in a study described on June 11, 2021 in the journal Neuron, researchers at Washington University School of Medicine discovered that by examining the anterior cingulate cortex (ACC) and the ventrolateral prefrontal cortex (vlPFC), attitudes toward punishment and reward information are not tied strictly to each other. Individuals with similar preferences for reward information can have strikingly different attitudes toward punishment information. Although the investigation studied monkeys, understanding the brain’s neural circuits underlying uncertainty may lead to better therapies for conditions, such as anxiety and obsessive-compulsive disorder.

Astronomy Meets Pathology In Developing Predictive Biomarker Signatures For Immuno-Oncology

The discovery of new predictive biomarkers is critical to improving an ability to (1) predict whether a patient is likely to respond to available drugs and (2) guide treatment decisions for advanced metastatic cancers using immunotherapy. Platforms that can elucidate the spatial relationship between immune system cells and the tumor are critical to this endeavor. According to an article published on June 11 in the journal Science, recent advances in multiplex immunofluorescence (mIF) have made it possible to map the tumor microenvironment across an entire tissue section mounted on a microscope slide with single-cell resolution. An innovative approach has been developed at Johns Hopkins University to analyze large mIF datasets using celestial object–mapping algorithms to identify optimized predictive phenotypic signatures rapidly. This interdisciplinary platform, called AstroPath, makes use of immunology, pathology, computer science, and astronomy to lay the foundation for rapid, efficient biomarker discovery.

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Kristen Truong

June 17, 2021

HOME CARE IN THE HEALTH SPECTRUM

Kristen Truong

June 17, 2021

Donald Berwick, former president of the Institute for Healthcare Improvement who also served as acting administrator of the Centers for Medicare & Medicaid Services (CMS) during the Obama administration, indicated in a webinar on value-based care sponsored by the Duke Margolis Center for Health Policy on June 10, 2021 that “the reliance on hospitals is one of the biggest mistakes in design we have -- home is the hub. Anything the Center for Medicare and Medicaid Innovation (CMMI) can do to advance the shift of the center of care to home and community is good.” Assuming that a widespread transformation of that nature is on the horizon, there will be significant impacts on the workforce needed to provide health and health-related social services. A related aspect is the extent to which technology will play a role in efforts to address the requirements of patients with multiple chronic ailments. The U.S. population not only is experiencing a growth in the number of individuals aged 65 and older, but many of them also will live alone and will require various forms of assistance if an aim is to enable them to continue to exist independently.

One element in the technological armamentarium is the employment of robots as assistive devices. The entire May 2021 issue of the journal Cyberpsychology, Behavior, and Social Networking was devoted to this topic. A rationale for doing so is that pandemic living has blurred the boundary between what is “real” and what is “virtual,” merging the computer-generated and the physical in a tightly woven web. Although research about technology development during this pandemic is only just now becoming available, an observable truth is that COVID-19 has increased a reliance on technology, and that likely includes robots. While in 2018, global sales of consumer robots totaled an estimated $5.6 billion, the market is expected to more than triple to $19 billion by the end of 2025 because robotics are perceived as going from a nascent industry to a more robust presence in furnishing patient care. A major objective is to manufacture social robots able to engage with humans and to provoke an emotional connection so that interactions between the two will feel much more like a relationship with a “someone” rather than a “something.”

A common belief is that robots eventually will become sophisticated enough that they will be indistinguishable from humans, but this assumption begets two questions. First, is existing theorizing about interpersonal, human-human relationships applicable to studying human–robot relationships? Secondly, given the present state of knowledge, should human-robot interaction designers’ goal be to mimic them? Among the topics discussed in this journal issue is the notion of peer pressure on human risk-taking behavior. The results of one investigation show both possible benefits and perils that robots might pose to human decision-making. Although increasing risk-taking behavior in some cases has obvious advantages, it also could have detrimental consequences that only now are beginning to emerge. An example of a possible negative outcome is whether robots could increase risky behaviors such as smoking and substance abuse. Clearly, any possible happenings of that nature should be avoided vigorously.

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Kristen Truong

May 18, 2021

IMPACT OF MARRIAGE, DIVORCE, AND WIDOWHOOD ON HEALTH STATUS

Kristen Truong

May 18, 2021

Marriage, divorce, and widowhood each represent significant events in the lives of anyone who has ever been married, but they especially are prevalent among the older population. Older adults have rich marital histories that reflect both partnership and loss over their lifetime, according to a U.S. Census Bureau report entitled, “Number, Timing, and Duration of Marriages and Divorces: 2016” that became available on April 22, 2021. Divorce is not the only marital disruption that older adults face, however, because they also disproportionately constitute a large percentage of those who become widows or widowers in a given year. Among adults age 15 or older who became widowed in the preceding 12 months, 71% of men and 69% of women were 65 or older, although this age group comprises only 19% of all individuals in the 15 or older age group. Widowhood is particularly common among older women compared to older men due to differences in life expectancies. Women on average live longer than men. Among those 75 years or older who had ever married, 58% of women and 28% of men had experienced the death of a spouse in their lifetime, making this stage of life particularly difficult. The proportion of individuals who currently are widowed is relatively lower than for those widowed at one point because some respondents who lost a spouse eventually remarried, becoming "currently married" instead of "currently widowed." Nonetheless, differences between the sexes persist among those 75 years or older: 54% of women and 20% of men were currently widowed at the time of interview.

Women in particular face major challenges in being able to live with independence and dignity as they age. With longer lives, higher rates of disability and chronic health problems and lower incomes than men on average, many women need long-term care services without having the resources to pay for them. Apart from their own health problems, some women also serve as primary providers of long-term care for an older relative. The vast majority of both paid formal long-term care workers and unpaid informal caregivers are women. Millions of older women cannot afford to pay for long-term care services because of low income. A major factor affecting income is marital status. Married couples have higher incomes than single persons. Older women are much more likely than older men to live alone, meaning that they have no other individual in their household to help with daily activities and pay for services to address unmet health and health-related social needs.

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COGNITIVE EPIDEMIOLOGY, INTELLIGENCE, HEALTH, AND DEATH

Kristen Truong

May 18, 2021

Cognitive epidemiology as a separate line of inquiry emerged in the early 2000s. Its purpose is to study how and why individual differences in intelligence (especially when measured in childhood or young adulthood) associate with later differences in health, illness, and death. An article published in the April 2020 issue of the journal Nature Human Behaviours examines how an understanding of the association between intelligence and health/mortality has been refined with the advent of new, population-scale data and genetic tools. The manuscript looks at the associations between intelligence and, in turn, all-cause mortality, specific causes of mortality, physical illnesses, and health-related biomarkers. Possible causes of the observed associations (education, health behaviors and literacy, and genetics), are not mutually exclusive.

Although the causes underlying the associations between intelligence and health/mortality remain an open question, research over the past decade has provided results and fingerposts for further progress. As a way of obtaining a clearer understanding, the authors discuss how intelligence relates to specific causes of death, diseases/diagnoses, and biomarkers of health through the adult life course. They examine the extent to which mortality and health associations with intelligence might be attributable to differences in education, other indicators of socioeconomic status, health literacy, and adult environments and behaviors. Finally, they discuss whether genetic data provide new tools to understand parts of the intelligence–health associations. Social epidemiologists, differential psychologists and behavioral and statistical geneticists, among others, contribute to cognitive epidemiology. Any advances that occur will do so by building on a common cross-disciplinary knowledge base.

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OBTAINABLE RESOURCES

Kristen Truong

May 18, 2021

Improving The Utility Of Evidence Synthesis In The Face Of Insufficient Evidence

Healthcare decision makers strive to operate on the best available evidence. The Agency for Healthcare Research and Quality Evidence-based Practice Center (EPC) Program aims to support health care decision makers by producing evidence reviews that rate the strength of evidence. The evidence base, however, is often sparse or heterogeneous, or otherwise results in a high degree of uncertainty and insufficient evidence ratings. A workgroup comprising EPC Program members convened throughout 2020. Its members conducted interative discussions considering information from three data sources: a literature review for relevant publications and frameworks; a review of a convenience sample of past systematic reviews conducted by the EPCs; and an audit of methods used in past EPC technical briefs. Researchers concluded that throughout early scoping, protocol development, review conduct, and review presentation, authors should consider five possible strategies to supplement potential insufficient findings of benefit or harms. When there is no evidence available for a specific outcome, reviewers should use a statement such as "no studies" instead of "insufficient." The main reasons for insufficient evidence rating should be explicitly described. A White Paper can be obtained at https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/improving-utility-evidence-synthesis-white-paper.pdf.

Implementing High-Quality Primary Care

High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels. Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan from the National Academies Press with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs. The document can be obtained at https://www.nap.edu/login.php?record_id=25983&page=https%3A%2F%2Fwww.nap.edu%2Fdownload%2F25983.

Primary Care In The COVID-19 Pandemic

In a new report edited by authors from the Harvard Medical School Center for Primary Care, produced with support from the Milbank Memorial Fund and the CareQuest Institute for Oral Health, dozens of leading thinkers document and analyze the trends in primary care over the course of the pandemic, and make recommendations to primary care clinical team members, health care industry leaders, and policy experts. The authors: describe access to high-quality primary care during the COVID-19 pandemic in the United States and other parts of the world; determine opportunities for accelerating transitions to new payment and delivery models; and identify the care strategies, including anti-racist policies, that can best advance primary care equity. Care strategies focused on vulnerable populations can be adapted to logistical challenges if providers focus on an integrated experience delivered across multiple diverse disciplines through the same clinic infrastructure. The perspectives in this report are, therefore, ultimately optimistic, demonstrating that the resilience of populations to this pandemic and future ones can be bolstered by flexible, coordinated, and dedicated primary care providers. The report can be obtained at https://www.milbank.org/wp-content/uploads/2021/04/Book_Primary_Care_During_COVID_ebook_4-27-21.pdf.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

May 18, 2021

Emergency Departments For Bicycle-Related TBIs: United States, 2009-2018

Bicycling leads to the highest number of sport and recreation–related emergency department (ED) visits for traumatic brain injuries (TBIs) in the United States. Because bicycling continues to grow in popularity, primarily among U.S. adults, examining the strategies that mitigate the risk for TBI is important. According to the May 14, 2021 issue of the Morbidity and Mortality Weekly Report, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) to determine the incidence of EDs for bicycle-related TBIs during 2009–2018. An estimated 596,972 ED visits for bicycle-related TBIs occurred in the United States during the study period. Rates of ED visits were highest among adult males (aged ≥18 years) and among children and adolescents aged 10–14 years during 2009–2018. Overall, the rate of ED visits for bicycle-related TBIs decreased by approximately one half (48.7%) among children and by 5.5% among adults.

Medicare, Medicaid, Children’s Health Insurance Program Enrollment: 2020

Government involvement in the financing of health care is substantial. According to recent estimated average monthly data from the Centers for Medicare & Medicaid Services, in calendar year 2020: Medicare had a total of 62.8 million enrollees among whom 54.5 million are aged and 7.3 million are disabled. An additional breakdown shows that 37.7 million beneficiaries are enrolled in Original Medicare and the rest are in the Medicare Advantage Plan and the Prescription Drug Plan. Medicaid, a jointly administered federal-state plan, had a total of 76.5 million enrollees in Fiscal Year 2020. Major groups include: 6.4 million aged individuals, 11.0 blind and disabled persons, and 28.9 children—the largest single group numerically. Another 7.4 million individuals are enrolled in the Children’s Health Insurance Program (CHIP) on average each month based on the latest available data.

HEALTH TECHNOLOGY CORNER

Ventilating The Rectum To Support Respiration

The coronavirus pandemic has overwhelmed the clinical need for ventilators and artificial lungs, resulting in a critical shortage of available devices and endangering patients’ lives worldwide. As described in an article published on May 14, 2021 in the journal Med, inspired by organisms such as catfish that use intestinal air breathing, researchers at Tokyo Medical and Dental University show the effectiveness of an enteral ventilation approach in attaining systemic oxygenation in both rodent (e.g., mice) and porcine (e.g., pig) models. Intra-rectal delivery of a liquid form of O2 known as conjugated perfluorocarbon, a compound historically used in clinics for liquid ventilation through airway administration, is highly tolerable and efficacious in ameliorating severe respiratory failure. By repurposing the distal gut as an accessary breathing organ, enteral ventilation therapy offers an alternative paradigm as an adjunctive means to patients who are in critical need of respiratory support.

Opening A Window Into Alzheimer's Disease

According to new research by scientists at the UCSF Weill Institute for Neurosciences, retinal scans can detect key changes in blood vessels that may provide an early sign of Alzheimer's. An article published on May 11, 2021 in the journal Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring offers some important insights into how one of the most common Alzheimer's risk genes contributes to the disease. Researchers have indicated that the most prevalent genetic risk for Alzheimer's disease is a variant of the APOE gene, known as APOE ε4. Although it is not entirely clear how this variant increases risk of brain degeneration, it does appear to do so and the risk is modified by sex, race, and lifestyle. The results of the study reported in this article suggest that APOE ε4 affects capillary health in humans and that retinal capillary measures could serve as surrogates for brain capillaries, providing an opportunity to study microangiopathic contributions to neurodegenerative disorders directly in humans.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

May 18, 2021

The arrival of the coronavirus pandemic resulted in college and university campuses having to begin shutting down in March 2020. Many were able to do so without suffering painful losses of valuable forms of income derived from fees associated with tuition, dormitory living, provision of food services, and a variety of activities, such as rental of campus property in the summer and sales of tickets and concessions for football and basketball games. Not every institution was so fortunate, however, and have had to offset reductions in revenue by laying off personnel involved in teaching and administration. Worst of all, some smaller schools without endowments are confronted with the danger of having to close their doors permanently.

One means of offsetting a decline in revenue was to substitute in-class learning with instruction that is provided online. Schools that already offered courses in that manner were able to continue doing so without having to make any major adjustments. Institutions that were not in a similar position had to convert a great many courses that formerly were furnished exclusively in classrooms. Not all students and their families believed that these new products were valuable substitutes and they consequently have been unwilling to pay for them.

Another consideration is more of a downstream nature. Since March 2020, many students throughout the U.S. at elementary and high school levels have not been in classrooms for the latter part of the 2019-2020 academic year and almost all of the 2020-2021 school year. Prior to the pandemic, some students admitted to college typically are academically underprepared and must be provided with remediation services. Students who already were in their third year of high school in spring 2020 are graduating in virtual ceremonies either this month or will do so in June. Many of them may be even less prepared to enroll in college than previous cohorts of students that did so before the pandemic struck the nation.

Student Loan Tax Elimination Act

A chronic problem for many students and their families is mounting educational debt. Individuals at the postgraduate level who attend MBA programs, law chools, and medical schools may assume mountains of such debt, but they are in a favorable and enviable position to move into high paying jobs upon graduation. Less fortunate are those students who complete their formal education at the baccalaureate level with majors that lead to few, low remunerative forms of employment. Even worse off are students who drop out of school without ever completing a degree program, but who still managed to borrow substantial amounts of money for education purposes.

A common aspiration expressed by many Democrat candidates who competed to be nominated by their party for the 2020 presidential election was to address the problem either by forgiving all or a portion of this educational debt. A step in that direction is a bipartisan bill introduced on March 18, 2021 in Congress, the Student Loan Tax Elimination Act (S. 847), a measure designed to eliminate origination fees on all federal direct student loans disbursed on or after March 27, 2020. Presently, by taking as much as 4% of the proceeds of a federal student loan, a strong influence is placed on students regarding their decision whether to pursue and complete a degree program.

Similar legislation was introduced on June 3, 2019. Supporters of the bill view origination fees as reducing the amount of loan dollars disbursed to borrowers by 1% percent for Direct Stafford Loans and 4% for Direct PLUS Loans. This levy is considered to create confusion among students and increase costs for borrowers, who are responsible not only for repaying the withheld amount, but also the interest accruing on that amount. The result can be hundreds or thousands of additional dollars owed, depending on loan type, loan amount, and program length.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

May 18, 2021

As noted in the Quick STAT page of this issue of the newsletter, in calendar year 2020, the Medicare program had a total of 62.8 million enrollees. As described in an article published on April 27, 2021 in JAMA Network Open, overuse is defined as the delivery of tests and procedures that provide little or no clinical benefit, are unlikely to have an impact on clinician decisions, increase health care spending without improving health outcomes, or risk patient harm in excess of potential bene-fits.Estimates suggest that overuse contributes $75.7 billion to $101.2 billion to wasted U.S. health care spending annually. Results of a cross-sectional study involving 1,325,256 services performed at 3,351 hospitals show that measurements of low-value services using Medicare claims data can be applied to individual hospitals to compare their overall rates of overuse. The analysis revealed differences in overuse by hospital characteristics such as teaching status, region, and nonprofit status. Researchers found that hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse. Investigations of this nature are critical to developing remedies to curb unnecessary spending. A steady increase in the number of aged beneficiaries who become eligible to participate in the Medicare program means that a corresponding growth will occur in the amount of health services that must be provided for them. Constant efforts are needed to ensure that an ever growing amount of expenditures for such care is used effectively and appropriately. Biden Administration Begins Reversing Policies Established By The Previous AdministrationA common practice in recent years is for an incoming U.S. presidential administration to review health policies instituted by its predecessor administration and decide to reverse them. Along lines of efforts to prevent unnecessary spending in the Medicare program, the Biden administration decided to freeze an effort implemented by the Trump administration to create a new Medicare coverage and reimbursement pathway for “breakthrough” medical devices as its term drew to a close. A final rule known as the Medicare Coverage of Innovative Technology (MCIT) pathway that was published on January 14, 2021 in the Federal Register would have established a mechanism to provide national Medicare coverage for a period of four years after the date of U.S. Food & Drug Administration approval. The final ruling was to become effective on March 1 of this year. An argument opposed to implementing the rule is based on an assessment by the Biden team that the proposed acceleratedpathway fails to protect patients adequately or ensures that such breakthrough devices are effective or appropriate for the Medicare population Another illustration of an attempt to erase policies established by the preceding administration is that the Biden group will enforce legal protections against discrimination for gay and transgender patients seeking health care under the Affordable Care Act (ACA). During the Trump administration, a policy was implemented that aimed to define the scope of sex discrimination under the health law more narrowly than what was prescribed during the Obama Administration. The most recent ruling is based on a Supreme Court decision in 2020 that allows in a more expansive way the U.S. Department of Health & Human Services to interpret the antidiscrimination section of the ACA by forbidding bias “on the basis of race, color, national origin, sex, age or disability.” American Rescue Plan Act And The Affordable Care ActCongress passed the American Rescue Plan Act (ARPA) using what is known as the “budget reconcilia-tion process” that requires only a Senate majority rather than the sixty votes normally needed to over-come a filibuster. President Biden signed it into law on March 11, 2021. The aim of this legislation is to enable a temporary expansion of the ACA’s premium tax credits and to allow increases in federal financial incentives for states that have not yet done so to expand their Medicaid programs to low-income adults. A recent broadened enrollment period has resulted in an increase in the number of beneficiaries wanting to participate in this program. ARPA also provides incentives for the twelve states that have not yet expanded their Medicaid programs to all adults with incomes up to 138% of the federal poverty level.Meanwhile, the fate of the ACA will depend on a decision that soon will be made by the U.S. Supreme Court on a case that has attracted enormous interest in health policy circles.

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A MAJOR FOCUS ON GOVERNMENT SPENDING

Kristen Truong

May 18, 2021

Now that the current fiscal year is going to draw to a close on September 30, greater attention is being paid to Congressional appropriations. The House Appropriations Committee plans to mark up the 12 annual spending bills for fiscal year 2022 in June this year, ahead of floor votes that are scheduled for this July. Recent years have witnessed a failure to complete all necessary business pertaining to appropriations by the coming October 1. If that pattern repeats itself this year, then one or more stopgap spending measures will have to be relied upon as a means of avoiding a federal government shutdown of the federal government.

A new twist in the present arrangement goes to prove that many old and highly cherished notions truly die rather hard. While certain revered ideas can languish for lengthy periods of time, they can reappear with renewed vigor as evidenced by the rebirth of “earmarks,” an excellent illustration of a time-honored approach of dispensing funds appropriated by Congress. Earlier, wags with a penchant for unseasonable japery could hardly wait for former Democrat Senator William Proxmire from Wisconsin to issue his Golden Fleece Award every month between March 1975 and December 1988. The purpose of this dubious honor was to acknowledge “wasteful, ridiculous or ironic use of the taxpayers’ money.” A famous example was a $190 million bridge to a sparsely populated island in Alaska at a cost of $13,786 per local inhabitant.

House Democrats recently unveiled a plan to restore earmarks under the new heading, “Community Project Funding,” thus ending a decade-long policy that forbade the practice. A proposal released by Rosa DeLauro (D-CT), Chairwoman of the House Appropriations Committee, would allow the inclusion of money in annual spending bills to benefit specific projects with the amount capped at 1% of discretionary spending, Lawmakers would be permitted to submit a maximum of 10 project requests, along with evidence to justify their requests from their communities. Funds could not be allocated, however, to benefit for-profit recipients. Joining in this renewal effort, the House Republican Conference has voted to restore earmarks and Senate appropriators also have released their plan to jettison the present ban.

Apart from the important work of introducing and passing necessary legislation, another key function performed on Capitol Hill is to conduct hearings. The Senate Committee on Health, Education Labor & Pensions did so on May 11, 2021. The event on “Efforts to Combat COVID-19” featured testimony by Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases; David Kessler, Chief Science Officer at the U.S. Department of Health and Human Services; Rochelle Walensky, CDC Director; and Peter Marks, Director of the Center for Biologics Evaluation and Research at the Food & Drug Administration. The following day, a hearing on the topic of “COVID-19 Variants and Evolving Research Needs” was held by the Subcommittee on Investigations and Oversight of the House Committee on Science, Space and Technology. Testimony was provided by experts from Columbia University, Yale University, Johns Hopkins University, and the Argonne National Laboratory.

Statements made at both hearings can be obtained from the websites of these committees in print and video formats.

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MINISCULE CREATURES OF HUGE IMPORTANCE

Kristen Truong

May 18, 2021

Each issue of this newsletter typically focuses on important topics, such as health care disparities and inequities that have disadvantageous impacts on individual and community health status in the United States. Occasionally, however, efforts are made to apprise readers of other developments that are not necessarily viewed as pertaining directly to the health sphere, but still have considerable potential to influence health outcomes.

Although comparatively small in number compared to other members of the animal kingdom, such as insects, human beings have exerted gargantuan effects on the health of the planet earth and its various assortment of inhabitants of vertebrates and invertebrates. The current geological age is known as the Anthropocene, a period during which human activity has been the dominant influence on climate and the environment. Increasingly, data are being generated around the world indicating a decline in biomass involving insects as a result of factors, such as habitat loss occurring when humans move to previously uninhabited locales and chronic exposure to pesticides. Insects play a vital role in a terrestrial food web that affects many species of birds, bats, reptiles, amphibians and fish, while also performing essential functions involving pollination, pest control, and nutrient recycling. A danger is considered to exist in the possibility that terrestrial and freshwater ecosystems will collapse without adequate numbers of insects.

The widespread adoption of artificial lighting at night (ALAN) is considered a growing threat to biodiversity in general and to nocturnally active insects in particular. Recent advances in external lighting technology, especially the increasing adoption of broad spectrum ‘white’ LEDs, suggest that impacts of ALAN on natural systems are likely to increase. The entire March 2021 issue of the journal Insect Conservation and Diversity is devoted to some recent investigations addressing the effects of ALAN on insects and their conservation. Approximately one-fifth of earth's land surface experiences appreciable levels of ALAN to illuminate roads, buildings, and other infrastructure. Although ALAN has enabled humans to increase the duration and diversity of work and leisure activities that would otherwise be curtailed by night‐time darkness, it has radically altered the nocturnal environment for many species of animal and plant life by disrupting the natural daily and seasonal light cycles.

Also, an article published on January 26, 2021 in the journal Conservation and Science discusses how an ever‐growing industry with high densities of wind turbines may have long‐lasting effects on insects and associated trophic links if negative impacts on these creatures are not considered during the erection and operation of this machinery. After collision, most insects leave a layer of organic detritus on the leading edge of blades, thereby disrupting the laminar airflow, causing a significant drop in power production. An interesting aspect is that energy production from renewable sources is increasing worldwide in an effort to reduce CO2 emissions. Although labeled as environmentally friendly, wind renewable energy sources are in direct conflict with biodiversity goals regarding insect conservation.

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PREVALENCE OF SOCIAL MEDIA ADDICTION

Kristen Truong

April 22, 2021

The cyber era makes it possible for individuals to interact with others not only face-to-face but also through social media platforms, such as Facebook and Instagram. As of July 2020, there were about four billion active social media users worldwide, with more than half of them involving Facebook. This usage has many advantages and opportunities for individuals to interact with one another any hour of the day and represents a vast source of pleasure. Conversely, problematic use of these forms of communication technology can be viewed as impairing users’ psychosocial functioning and well-being. For instance, some individuals may become engaged in Instagram to an extent that they feel distressed when they are unable to use it during workplace hours. This misuse is widely referred to as social media addiction, which may be considered a contemporary problem of global concern. Consequently, researchers all over the world are conducting studies to evaluate the pervasive nature of this situation. A challenge is that prevalence rates of social media addiction reported in the literature vary dramatically.

A meta-analysis aimed to synthesize the extant research systematically on prevalence is reported in the June 2021 issue of the journal Addictive Behaviors. Subgroup analysis and meta-regression were conducted to investigate whether the prevalence rates would differ by classification schemes, cultural values, and demographic factors. This approach involved 63 independent samples with 34,798 respondents from 32 nations spanning seven world regions. The prevalence estimates varied widely across studies and nations, from as low as 0% to as high as 82%. Nuanced analysis of this diverse body of findings indicates that the prevalence rates can be categorized into three main clusters by the classification scheme used. The first cluster with an overall prevalence of 5% includes studies adopting conservative schemes such as monothetic or strict monothetic classifications. The second with an overall prevalence of 13% includes studies adopting a cutoff for severe level or strict polythetic classifications. The third with an overall prevalence of 25% includes studies adopting relatively lenient cutoff for moderate level or polythetic classifications. The prevalence rate also varied by cultural region.

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OUTBREAKS OF “AGEISM” IN THREE NATIONS REGARDING COVID-19

Kristen Truong

April 22, 2021

The term ageism refers to stereotypes, prejudice, and discrimination directed towards individuals on the basis of their age. Moreover, like all forms of discrimination, ageism generates divisions and hierarchies in society and influences social position on the basis of age. Ageism also can result in various harms, disadvantages, and injustices, including age-based health inequities and poorer health outcomes. An article published in the April 2021 issue of The Journals of Gerontology Series B: Psychological Sciences and Social Sciences compares responses to coronavirus control in Australia, the United Kingdom, and the United States, where public ageism erupted over the social and economic costs of protecting older adults from COVID-19. Examples of denigrating language used to describe members of older age cohorts include “boomer remover,” “boomer doomer,” “grey shufflers,” and “moldy oldies.” Thirty-five newspapers, media websites, and current affairs magazines were the focus of this investigation: eight for Australia, 12 for the United Kingdom, and 15 for the United States. Searches were conducted daily from April to June 2020, using key words to identify age-related themes on pandemic control.

Despite divergent policies in the three countries, ageism took similar forms. Public responses to lockdowns and other measures cast older adults as a problem to be ignored or solved through segregation. Name-calling, blame, and “so-be-it” reactions toward age vulnerability were commonplace. Policies banning visits to aged care homes angered many relatives and older adults. Indefinite isolation for older adults was widely accepted, especially as a vehicle to end public lockdowns and economic crises. Based on this study, the following conclusions were reached. Older adults have and will continue to bear the brunt of COVID-19 as expressed in social burdens and body counts as the pandemic continues to affect victims around the globe. The rhetoric of disposability underscores age discrimination on a broader scale, with blame toward an age cohort considered to have lived past its usefulness for society and to have enriched itself at the expense of future generations.

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OBTAINABLE RESOURCES

Kristen Truong

April 22, 2021

Applying Systems Thinking To Regenerative Medicine

Regenerative medicine products, which are intended to repair or replace damaged cells or tissues in the body, include a range of therapeutic approaches such as cell- and gene-based therapies, engineered tissues, and non-biologic constructs. It often is challenging to characterize these products properly for a number of reasons, and there often is not a definitive correlation between what is measured and the clinical outcome for these complex products. A systems-focused approach can help better define the mechanistic parameters involved in the biological outcome and allows for the collection and use of more relevant data. Systems thinking is a multidisciplinary effort and can incorporate tools and knowledge from the fields of data science, biology, engineering, manufacturing, regulatory science, and clinical research and therefore requires the use of disparate data sources. Given these considerations, the Forum on Regenerative Medicine of the National Academies of Sciences, Engineering, and Medicine convened experts across disciplines for a two-day virtual workshop in October 2020 to explore systems thinking approaches and how they may be applied to support the identification of relevant quality attributes that can help optimize manufacturing and streamline regulatory processes for regenerative medicine. Workshop proceedings summarize key information and can be obtained here.

Shared Equity Leadership: Making Equity Everyone’s Work

Decades of programmatic efforts and interventions have failed to make a difference in the success of racially minoritized, low-income, and first-generation students, whose populations are increasing on college campuses. Higher education remains profoundly inequitable, and institutions have not made the transformational changes necessary to create truly inclusive environments and equitable outcomes for students. A prominent lever for change is campus leadership. According to a report from the American Council on Education (ACE), a description is provided on how broadly inclusive and collaborative approaches to leadership are necessary to achieve equitable outcomes. At the heart of shared equity leadership (SEL) is the notion of personal journey toward critical consciousness, in which leaders develop or strengthen a commitment to equity through their identity, personal experiences, or relationships, and learning. This paper reports on the results of a multiple-case study of leaders at eight institutions that are experimenting with shared approaches to equity leadership. It describes some emerging outcomes from the participating campuses, and offers recommendations for leaders interested in trying this approach. The report can be obtained here.

Black And White Patients In Hospitals With Worse Safety Conditions

Identifying and reducing racial disparities in the quality of health care is a necessary (if insufficient) step toward reversing the effects of systemic racism on racial health inequities in America. A study investigates differences in Black and White patient safety measures using complete hospital discharge records from 26 states in 2017 and further examines whether some differences in patient safety quality can be attributed to the hospitals into which they are admitted. Black patients experienced higher rates of adverse patient safety events on 6 of 11 patient safety measures, including 5 of 7 surgery-related patient safety measures. For 9 of 11 patient safety indicators, including 6 of 7 surgery-related patient safety indicators, Black patients were significantly less likely to be admitted into hospitals classified as“high quality” (i.e., hospitals best at minimizing patient safety risks based on the median value of each patient safety indicator). The findings suggest that current policies have been ineffective in addressing inequities in the quality of inpatient care. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

April 22, 2021

Childhood Disability In The United States, 2019

According to a report issued on March 25, 2021 from the United States Census Bureau, the percentage of children with a disability in the U.S. increased between 2008 and 2019, from 3.9% to 4.3%. The most common type of disability among children five years and older in 2019 was cognitive difficulty. In 2019, disability rates in the U.S. were highest among American Indian and Alaska Native children (5.9%) and lowest among Asian children (2.3%). Childhood disability rates were lower among foreign-born children (3.2%) than among native-born children (4.2%) and lower among native-born children with one or more foreign-born parents (3.1%), relative to native-born children with only native-born parents (4.5%). While children in poverty were more likely to have a disability than children above the poverty threshold in 2008 and 2019, the prevalence of disability significantly increased for both groups over this period. The highest prevalence rates were in the South and the Northeast and the lowest rate was in the West.

U.S. Births: Final Data For 2019

Data from the National Vital Statistics Report on March 23, 2021 from the CDC show that a total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15–44 in 2019. The birth rate for females aged 15– 19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20–34 and increased for women aged 35–44 for 2018–2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019. The percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019. Medicaid was the source of payment for 42.1% of all births in 2019. The rate of low birthweight essentially was unchanged from 2018 at 8.31%.

HEALTH TECHNOLOGY CORNER

Electronic Skin From Flexibility To A Sense Of Touch

Materials scientists represent another group engaged in efforts to defeat the coronavirus. A team at Northwestern University in Evanston, IL develops soft, flexible, skin-like materials with health-monitoring applications. According to an article published on March 23, 2021 in the journal Nature, one device that is designed to sit in the hollow at the base of the throat, is a wireless, Bluetooth-connected piece of polymer and circuitry that provides real-time monitoring of talking, breathing, heart rate, and other vital signs, which could be used in individuals who have had a stroke and require speech therapy. A previously unanswered question was whether the device also could be customized to spot symptoms of the coronavirus SARS-CoV -2. The short answer was ‘yes’. Some 400 of the devices are being used in Chicago to help identify early signs of COVID-19 in front-line health workers, as well as for disease monitoring in patients. Furthermore, the design has been tweaked to assess how coughing rates change in patients with COVID-19.

Genome-Wide Programmable Transcriptional Memory By CRISPR-Based Epigenome Editing

The epigenome plays a central role in many diseases, from viral infection to cancer. This entity consists of proteins and small molecules that latch onto DNA and control when and where genes are switched on or off. A general approach for heritably altering gene expression may lead someday to powerful epigenetic therapies. The endeavor involves modifying CRISPR's basic architecture to extend its reach beyond the genome. According to a paper published April 9, 2021, in the journal Cell, researchers at UC San Francisco and the Whitehead Institute describe a novel CRISPR-based tool called "CRISPRoff," which allows scientists to switch off almost any gene in human cells without making a single edit to the genetic code. The researchers also show that once a gene is switched off, it remains inert in the cell's descendants for hundreds of generations, unless it is switched back on with a complementary tool called CRISPRon, that also is described in the paper. This approach doesn't involve any DNA edits and is likely to be safer than conventional CRISPR therapeutics.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

April 22, 2021

Regardless of which political party controls the White House and the two chambers of Congress, an enormous amount of activity occurs every year in the form of proposed legislation, regulatory directives from governmental agencies, and Executive Orders by the President of the United States. A vast assortment of law firms, lobbying organizations, and interest groups participate in the quest to achieve desired policy outcomes. The new Biden Administration is up and running at full speed and can be expected to pursue not only its preferred objectives, but also to push back against policies implemented during the previous Administration that it does not view favorably. The topic of sexual harassment in the educational sector furnishes an apt illustration of such activities.

Dating back to 2011, the Obama Administration issued an informal letter that defined sexual harassment as a form of sex discrimination actionable under Title IX. A follow-up letter in April 2014 provided additional guidance on schools’ responsibilities under Title IX to address sexual violence as a form of sexual harassment. Opponents criticized the letters for undermining due process rights for involved parties. Multiple court cases then were launched that aimed at striking down campus procedures resulting from this guidance. The Trump Administration joined the controversy by having the U.S. Department of Education issue a final rule in May 2020 to address the responsibilities of college campuses and K-12 schools under Title IX of the Education Amendments of 1972. The rule aimed to ensure protections for sexual assault survivors and require thorough investigations of sexual assault incidents. It also was designed to align Title IX requirements with court precedents and provide fundamental protections for due process.

On March 8, 2021, President Biden issued an Executive Order directing the Department to review and consider suspending, revising, or rescinding the Department’s rule entitled “Nondiscrimination on the Basis of Sex in Education Programs or Activities Receiving Federal Financial Assistance.” This issue of sexual harassment and violence has attracted considerable attention in recent years. For example, listening sessions about the contents of this rule began in 2017, which was followed by the Department’s release of that proposed rule in November 2018. The next year and a half led to the Department’s receiving and reviewing more than 224,000 public comments, and the Office of Management and Budget conducted 102 stakeholder meetings. The final rule in May 2020 specified how recipients of Federal financial assistance covered by Title IX, including elementary and secondary schools, along with postsecondary institutions, must respond to allegations of sexual harassment, including sexual assault. The rule amounted to 2,033 pages, which include the regulation itself, the Department’s legal rationale, and its response to thousands of public comments.

Valuable Services Provided By Governmental Data Gathering Agencies

Political party affiliation and personal ideology often combine to produce assessments about the value of government in the lives of the citizenry. An old joke involves being unwittingly trapped in one’s vehicle in a traffic jam and unable to see what is ahead to explain its cause. A liberal Democrat might conclude that what is needed to remedy the situation is to have a cop at the disruptive scene, while a conservative Republican might conclude that the mess is because there is a cop up there. A general truism in American life is that Democrats often look favorably upon increasing the amount of governmental activity to deal effectively with chronic problems, such as uneven allocation of health care and educational services, while Republicans may be more inclined to view the government as the cause of such problems rather than the cure. Often lost in these debates is a recognition that a function governmental agencies perform quite well, especially at the federal level, is to collect data that inform the implementation of sound public policies. A good example is the Integrated Postsecondary Education Data System (IPEDS) developed by the National Center for Education Statistics. This entity serves as the primary source of information about U.S. higher education institutions. An example of a useful IPEDS tool is a Trend Generator to view trends on most frequently asked subject areas including: Enrollment, Completions, Graduation Rates, Employees and Staff, Institutional Revenues, and Financial Aid.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

April 22, 2021

Health Reform initiatives constitute the equivalent of a conceptual three-legged stool: increase access to health care through the provision of insurance coverage, lower the ever-rising rate at which health expenditures grow, and improve health care quality. Regarding the issue of quality, a story in the April 17-18, 2021 issue of the Wall Street Journal highlighted the fact that no commercial airline in the U.S. has had a fatal crash since 2009. During that 12-year period, U.S. airlines have accomplished an astonishing feat. They carried more than eight billion passengers without a fatal crash. Numbers of this sort once were considered unimaginable, even among the most optimistic safety experts. This achievement was the result of a sweeping safety reassessment amounting to a revolution in thinking sparked by a small group of senior federal regulators, top industry executives, and pilots-union leaders after a series of high-profile fatal crashes in the mid-1990s. Health care is an entirely different industry, but it represents a sector that is no stranger to loss of life and injury through errors made in providing care. A good question is whether comparable lessons can be learned that will produce a turnaround similar to what the air travel sector has been able to accomplish.

The Role Of Government In Enhancing Health Care Safety

Health systems and clinicians increasingly are becoming aware of new federal rules that mandate offering patients access to the notes clinicians write in electronic health records (open notes). Taking effect on April 5, 2021, these rules enact the bipartisan 21st Century Cures Act by aiming to increase interoperability and ensure greater transparency in health care. According to an article published in April 2021 in The Joint Commission Journal on Quality and Patient Safety, many patients reading notes following office visits are enthusiastic about this new experience, citing several benefits that have clinical significance. They report remembering more details of encounters, feeling more in control, being better able to manage their care, and completing tests and referrals more effectively. Forty percent of patients share notes they read with others, and family care partners who access these notes report in even higher percentages than the patients themselves that it can help ease the burdens of care management. As the open notes practice evolves, it can expect to be associated with clinical improvements, for example, a majority of patients who read their notes reported understanding their medications better, and 15% reported improved adherence to their medicines.

The Centers for Medicare & Medicaid Services play an enormous role in the provision and financing of health care services. Among its many essential functions, each year it identifies hospitals that will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program because they had higher rates of infections and patient injuries. The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures, and other complications that occur in hospitals, which might have been prevented. Medicare reduces every payment by 1% for those hospitals over the course of the federal fiscal year, which runs from the beginning of each October to the end of September of the following year.

A Public Option For Health Insurance In The Nongroup Marketplaces

Some Members of Congress have proposed introducing a federally administered health insurance plan, or “public option,” to compete with private plans in the nongroup marketplaces established by the Affordable Care Act. A new report from the Congressional Budget Office (CBO) describes key design considerations and some of their major implications. The agency explains how those design choices would affect the: public option’s premiums; private insurers’ premiums and participation in the market-places; health insurance coverage in the United States; and federal outlays and revenues. The insurance risk of the public option would be borne by the federal government by having it bear financial responsibility for medical claims covered by the plan. Certain design choices could, for example, result in a public option that used the federal government’s ability to set administered prices and its purchasing power to offer marketplace enrollees a lower-premium plan with a broad provider network. Such a plan would most likely encourage a significant number of individuals to enroll in the public option. Other design choices could be made to establish a public option that was similar to private plans in premiums and provider networks.

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BIDEN ADMINISTRATION PROPOSED BUDGET

Kristen Truong

April 22, 2021

The Biden Administration submitted on April 9, 2021 an overview of the President’s request for fiscal year 2022 discretionary funding. This preliminary budget indicates proposed top-line funding for departments and agencies, including a proposed $769 billion in nondefense discretionary spending, which would represent a 16% increase over FY 2021. Later this spring, a more detailed budget request is expected to be released. Overall, the discretionary budget would restore non-defense discretionary funding to 3.3% of GDP, roughly equal to the historical average over the last 30 years, while providing robust funding for national defense and other instruments of national power, including diplomacy, development, and economic statecraft that enhance the effectiveness of national defense spending and promote national security.

Over the years, many budget proposals submitted to Congress by each President often are pronounced dead on arrival. Members of both chambers usually have their own favorite ideas regarding which priorities should be funded. Major differences also characterize what Democrats and Republicans hope to be achieved through spending. Some proposed highlights for legislators to begin considering for FY 2022, which begins on October 1 of this year are as follows.

The NIH would receive $51 billion, including $6.5 billion to establish a new Advanced Research Projects Agency for Health (ARPA-H) with an intended focus on cancer, diabetes, and Alzheimer’s disease.
The CDC would be awarded $8.7 billion, which represents the largest budget authority increase in approximately 20 years.
The Department of Education would obtain $102.8 billion, a 41% increase over the 2021 enacted level.

April 8, 2021 marked the introduction in the U.S. House of Representatives of the Student Loan Forgiveness for Frontline Health Workers Act (H.R. 2418). The bill was referred to the Committee on Education and Labor, and the Committees on Financial Services, and Ways and Means. The purpose of this legislation is to alleviate the burden of student loan debt resulting from medical/professional health care training for frontline health workers who have made significant contributions to the ongoing health response against COVID-19.

Since the March 2021 issue of this newsletter was distributed, ASAHP has joined several other organizations in issuing statements that: (1) oppose efforts currently being pursued in several states to suppress voting by qualified voters, (2) urge Congress to provide $1.51 billion for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs for FY 2022, and (3) request Congress to double the maximum Pell Grant and index the grant to inflation to ensure its value does not diminish over time.

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THE HEALTH WORKFORCE: AN IMPLICIT ASSUMPTION

Kristen Truong

April 22, 2021

Whenever major health legislation becomes law, such as the Patient Protection and Affordable Care Act of 2010, all too frequently the focus almost exclusively is on providing health insurance coverage and slowing the rate of increase in health care expenditures. An implicit assumption is that if every individual in the U.S. population was given a health insurance card, major health problems essentially might disappear. Unfortunately, provision of health care requires the presence of a sufficient cadre of competent practitioners. This fact is an important element in the overall equation that does not always receive the amount of attention warranted.

A sine qua non of sound policymaking is the existence of high quality data. Pockets of relevant health information exist, but they may be restricted to professions, such as medicine and what is obtainable in certain states. For example, since 2015 the Association of American Medical Colleges (AAMC) has commissioned annual reports of national physician workforce projections prepared by independent experts. The purpose of doing so is threefold: update and improve workforce projections; present new analyses that reflect physicians and key issues, such as the evolving health care system and the changing demographic composition of the workforce; and identify future directions for research. Not many other kinds of health professions are able to capitalize on having information of this nature.

At the state level, data derived from decennial censuses by the U.S. Census Bureau make it possible to determine demographic shifts. State out-migration patterns may result from the flight of youth seeking improved employment prospects elsewhere, while leaving behind jurisdictions that have a growing proportion of older persons characterized by experiencing one or more chronic health problems. Few states are capable, however, of tracking increases or declines in the number of different health professional groups that provide clinical services for patients needing care. The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill serves as an example of an academic resource that benefits state legislators and health department officials in addressing workforce concerns.

Some contributors to ASAHP’s Journal of Allied Health occasionally may be searching for suitable topics for the submission of articles. Suggestions of possible future manuscripts that might be of interest to the journal’s readership are: issues involving recruitment and retention of both faculty and students; supply and distribution of selected health professionals in rural areas; roles filled by various personnel in the provision of healthcare services; identification of gaps in workforce data availability by profession and projected time periods needed to promote improved data collection and reporting; how roles have adapted to fewer in-person visits and more use of distance technology and ways in which changes are being influenced by regulatory and payment policies; redeployments, furloughs, and layoffs, among other work status changes for health care personnel across different settings during a pandemic and other emergency situations; and skills needed to use telehealth by the health workforce effectively in primary care.

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FUTURE TIME PERSPECTIVE IN MID–TO-LATER LIFE

Kristen Truong

March 22, 2021

Future time perspective (FTP), or the way individuals orient to and consider their futures, is considered fundamental to motivation and well-being. Given FTP’s relevance to healthy adaptation, recent work has described its contributing factors, especially age, health, and personality. Yet, the extant literature is plagued by inconsistent FTP conceptualizations and sample characteristics. Specifically, although relationships between FTP and its contributors seem dependent on both FTP conceptualization and sample life-span stage, much existing literature emphasizes differing FTP conceptualizations and young adult samples, complicating cross-study conclusions. As reported in the March 2021 issue of The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, a study was conducted that explored the ways in which age, health, and personality simultaneously contribute to FTP in mid-to-later life with machine-learning techniques.

Until now, no studies regarding how these factors jointly contribute to FTP have been conducted and it is unclear as to whether complex interactions exist among these predictors in their relation to FTP. Personality, especially neuroticism, extraversion, conscientiousness, and agreeableness, had the most influence on FTP. Age and health were not among the most salient FTP contributors in mid-to-later life. Furthermore, decision tree analyses uncovered interactive effects of personality. Several profiles of neuroticism, extraversion, and conscientiousness were linked with differing FTP levels. Although current literature has indicated that FTP, age, and health are inextricably tied, these results indicate that there is more variability to be explained in FTP, perhaps especially when looking within specific age groups.

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HEALTH TECHNOLOGY CORNER

More May 2021 TRENDS Articles

MINISCULE CREATURES OF HUGE IMPORTANCE

A MAJOR FOCUS ON GOVERNMENT SPENDING

HEALTH REFORM DEVELOPMENTS