How was her night?” or “What questions or concerns do you have?” These common open-ended questions are often directed to caregivers (parents, family members, or guardians) of hospitalized children at the start of family-centered rounds. While these questions meet a lot of best practices for family-centered rounds, such as being open ended and starting with caregiver input, the level of caregiver engagement following these questions varies greatly. For example, while one parent might answer “fine,” another might describe symptoms and events in detail, including their opinions and preferences on their child’s care. This variability in participation is important given the critical role of caregivers in preventing medical errors, aligning goals of care, and optimizing pediatric hospital outcomes. [JAMA Network]

The current approach to communication during family-centered rounds operates under the assumption that patients and families will feel safe and empowered to participate when given the opportunity. However, this pretense fails to address how systemic inequities and lived experiences of individuals may influence interactions with health care systems. Several recent studies have demonstrated Black, Latinx, and other racial and ethnic minoritized groups feel less comfortable and empowered speaking up on family-centered rounds.¹ While individual clinician biases and differences in communication likely contribute to this inequity, factors beyond that single encounter may also play a role. Indeed, factors both within the health care system (eg, past discrimination by clinicians, lack of language accessibility in the form of interpreters or signage, lack of diverse representation of clinicians and staff) and outside of the system (eg, racism, stigma, acculturative stress, social needs) can influence caregiver-clinician communication. Thus, even if medical teams use standardized and bias-free communication, family engagement and participation may not be equal across patients from different backgrounds.² Without awareness of the structural factors that influence such communication, clinicians may interpret caregiver differences in communication in ways that reinforce stigma and stereotypes.

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The US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children’s Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children’s rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children’s rights. [JAMA Network] 

Observations  Seven findings about advancing children’s rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children’s rights. High-potential strategies for catalyzing advancement of children’s rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children’s movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges.

Conclusions and Relevance  Children’s rights provide a powerful, synergistic framework for child health professionals—in partnership with youth and other leaders—to increase equity and protect the rights and well-being of all children in the US.

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The US Food and Drug Administration (FDA) has approved over-the-counter sales of the overdose reversal agent Narcan (naloxone, Emergent BioSolutions). Greater access to the drug should mean more lives saved. However, it's unclear how much the nasal spray will cost and whether pharmacies will stock the product openly on shelves. [Medscape]

Currently, major pharmacy chains such as CVS and Walgreens make naloxone available without prescription, but consumers have to ask a pharmacist to dispense the drug.

"The major question is what is it going to cost," said Brian Hurley, MD, MBA, president-elect of the American Society of Addiction Medicine. "In order for people to access it they have to be able to afford it," he told Medscape.

"We won’t accomplish much if people can't afford to buy Narcan," said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing, in a statement. Still, he applauded the FDA.

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The recent study by Hoffmann et al¹ and accompanying editorial by Carroll and Hayes² paint a sobering picture of the mental health system and access to care. We would like to make a few comments in response. [JAMA Network]

First, it is important to note that the while the study by Hoffmann et al focused on mental health conditions and the suicide rate, many adolescents and even younger children may require care for primary or co-occurring substance use disorders, developmental disabilities, and physical health conditions.³ Co-occurring conditions may exacerbate access to care challenges.

Second, it is important to note efforts to implement needed changes, such as the 988 Suicide & Crisis Lifeline and recently released National Guidelines for Child and Youth Behavioral Health Crisis Care. These efforts are directly relevant to some of the challenges noted by the above authors.

Third, while money cannot be the sole metric by which to judge the nation’s commitment to supporting those with behavioral health conditions and their families or caregivers, nor serve alone as a panacea for every conceivable challenge, the importance of sustainable, ongoing, and adequate funding at the federal, state, local, tribal, and territorial levels should not be dismissed or neglected. Together, mental health and substance use account have historically accounted for 6% to 7% of total health spending, which likely does not reflect overall needs for care as identified by Hoffmann et al¹ and many others.⁴

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The racial gap in overdose deaths is not a new phenomenon, but according to new research out of the UCLA David Geffen School of Medicine, those racial health disparities got even worse starting in 2018 and extending into 2020.

Given the heterogeneity of drug overdose deaths during that period, the researchers recommended tailored public health interventions. [Patient Engagement HIT]

The US has been under assault by the opioid crisis for some time, but these latest figures paint a far grimmer picture than statistics could have indicated, the researchers said.

The team looked at drug overdose death data from the National Vital Statistics System from between 2013 and 2020, looking at four drug categories: psychostimulants, like methamphetamines; heroin; natural and semi-synthetic opioids, like prescription painkillers; and synthetic opioids, like fentanyl.

Nationwide and across demographics, overdose deaths from any of those drugs increased during the study period, with the researchers highlighting a significant jump in 2020 past what historical trends could have predicted.

“The third wave of drug overdose deaths began in 2013 with the arrival of fentanyl on the illicit drug market,” Maria R. D’Orsagna, PhD, one of the study’s authors, stated publicly. “Although overdose deaths have steadily increased since then, the pandemic year 2020 saw a significant rise of fatalities in many states.”

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The Health Resources and Services Administration (HRSA), which has contracted with the United Network for Organ Sharing (UNOS) to run the Organ Procurement and Transplantation Network for 37 years, announced it will invite organizations to bid for contracts for different parts of the transplant system’s functions. [US News]

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network [OPTN] to save the lives of their loved ones who experience organ failure,” HRSA Administrator Carole Johnson said in a news release announcing the change. “At HRSA, our stewardship and oversight of this vital work is a top priority. That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN."

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The nation’s healthcare workforce still is trying to recover from the COVID-19 pandemic nearly three years after it began as labor shortages stress hospitals and clinicians, spurring increased burnout among staff ranging from nurses to executives. [Healthcare Dive]

In addition, healthcare workers across the country have waged strikes to gain higher pay and optimal staffing conditions in employment contracts, while resident physicians increasingly have been involved in labor organizing.

These labor trends will continue posing challenges to health systems this year as facilities work to get back to pre-pandemic operations and stem labor costs that rose last year, experts say.

Ongoing staffing shortages and use of temporary labor...

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Although life expectancy in industrialized countries has lengthened over the past century, increases in US life expectancy ceased after 2010, a trend attributed to rising mortality rates among individuals aged 25 to 64 years.¹ Although midlife mortality rates increased over the past decade, mortality rates among children and older adults continued to decrease. The COVID-19 pandemic altered this trend and resulted in a sharp increase in mortality among older adults, an unsurprising outcome. However, pediatric mortality rates also increased, and COVID-19 contributed little to this surge. This increase in all-cause pediatric mortality has ominous implications. A nation that begins losing its most cherished population—its children—faces a crisis like no other. [JAMA Network] 

A close examination of mortality data for 1999-2020 and provisional data for 2021 spells out the problem.^2,3 Between 2019 and 2020, the all-cause mortality rate for ages 1 to 19 years increased by 10.7%, and it increased by an additional 8.3% between 2020 and 2021 (Figure, A).^2,3 These increases, the largest in decades, followed a period of great progress in reducing pediatric mortality rates. Although most of the upsurge in pediatric mortality was attributable to deaths among older children (ages 10-19), all-cause mortality in younger children (ages 1-9) also increased in 2021 (by 8.4%).³ Infants (<1 year) were the only age group that experienced no significant increase in mortality. 

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