Key Points

Question  What is the risk of postneonatal infant mortality among infants with neonatal opioid withdrawal syndrome (NOWS) diagnosis or born to individuals with opioid use disorder (OUD)? [JAMA Peds]

Findings  In this cohort study of 390 075 infants, after adjusting for maternal and infant characteristics, the risk of postneonatal infant mortality was significantly higher for those born to individuals with OUD or diagnosed with NOWS as compared with unexposed infants.

Meaning  In this study, maternal OUD and NOWS diagnosis were associated with an increased risk of postneonatal infant mortality.

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Read on-line article here> 

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Ground-breaking study provides national and state-level estimates of the economic burden of health disparities by race and ethnicity and educational levels. 

New research shows that the economic burden of health disparities in the United States remains unacceptably high. The study, funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health,  revealed that in 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, a 41% increase from the previous estimate of $320 billion in 2014. The study also finds that the total burden of education-related health disparities for persons with less than a college degree in 2018 reached $978 billion, about two times greater than the annual growth rate of the U.S. economy in 2018. [NIH

The findings from this study by researchers from NIMHD; Tulane University School of Public Health and Tropical Medicine, New Orleans; Johns Hopkins Bloomberg School of Public Health, Baltimore; Uniformed Services University, Bethesda, Maryland; TALV Corp, Owings Mills, Maryland; and the National Urban League were published in JAMA. 

This study is the first to estimate the total economic burden of health disparities for five racial and ethnic minority groups nationally and for all 50 states and the District of Columbia using a health equity approach. The health equity approach set aspirational health goals that all populations can strive for derived from the Healthy People 2030 goals. It establishes a single standard that can be applied to the nation and each state, and for all racial, ethnic, and education groups. It is also the first study to estimate the economic burden of health disparities by educational levels as a marker of socioeconomic status. 

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Newly inaugurated Chicago Mayor Brandon Johnson said Monday that ensuring access to mental healthcare will be a key priority for his administration. [Health News Illinois] “I want to make sure that no one ever has to suffer because they do not have access to mental health services,” Johnson said during his inauguration speech at the University of Illinois Chicago’s Credit Union 1 Arena. “And people have told us for too long, ‘It's a matter of life and death.’ So let's bring together the private sector, the public sector, the county, the state and the federal government to find the best solutions for delivering these services.” As part of that push, Johnson reiterated a plan to reopen the city’s mental health clinics that were closed in 2012 by then-Mayor Rahm Emanuel. That comes as Johnson plans to, at least initially, keep on the current city health leadership.  Public Health Commissioner Dr. Allison Arwady told WGN Radio last week that she and Johnson recently met and that she will be staying in her role for the foreseeable future. “I’m excited to work with the new administration,” Arwady said. “Public health is our primary focus — it’s not the political piece. But, of course, it’s important we can work with whoever the political leaders are.” Arwady, as well as Johnson's predecessor, Lori Lightfoot, have focused mental health efforts on supporting community mental health organizations working in the city's 77 neighborhoods. Johnson also said Monday Chicago must address the rise in immigrants coming to the city and meet their health and social needs. He did not go into specifics, but said Chicago is a welcoming city. “We don’t want the story to be told that we were unable to house the unhoused or provide safe harbor for those who are seeking refuge here, because there is enough room for everyone in the city of Chicago,” Johnson said. ###

Thirteen weeks into her pregnancy, 29-year-old Cloie Davila was so “pukey” and nauseated that she began lovingly calling her baby “spicy.” [KFF Health News}

Davila was sick enough that staffers at the local hospital gave her 2 liters of IV fluids and prescribed a daily regimen of vitamins and medication. This will be Davila’s third child and she hopes the nausea means it’s another girl.

Davila had moved back to her hometown of Clayton, New Mexico, so her kids could grow up near family — her dad, aunts, uncles, and cousins all live in this remote community of about 2,800 people in the northeastern corner of the state. But Clayton’s hospital stopped delivering babies more than a decade ago.

Aside from being sick, Davila was worried about making the more than 3½-hour round trip to the closest labor and delivery doctors in the state.

“With gas and kids and just work — having to miss all the time,” Davila said. “It was going to be difficult financially, kind of.”

Then, Davila spotted a billboard advertising the use of telehealth at her local hospital.

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Black and Hispanic patients with a disability had a tougher time getting medication to treat opioid use disorder (OUD) despite frequent contact with healthcare providers, Medicare claims data showed.

Within 180 days of an index OUD-related event, Black patients received a prescription for buprenorphine 12.7% of the time, Hispanic patients 18.7% of the time, and white patients 23.3% of the time, reported Michael L. Barnett, MD, of Harvard T. H. Chan School of Public Health in Boston, and colleagues.

Naloxone receipt followed a similar pattern, occurring after 14.4%, 20.7%, and 22.9% of index events, respectively, the authors reported in the New England Journal of Medicineopens in a new tab or window.

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Considering the variability in how patients are treated in a hospital setting, we can all agree that their outcomes can be vastly different based on their ethnicity, resources, socioeconomic background, and beliefs. Two different people can come to the same hospital for the same procedure and have a completely different experience. [ MedPage Today]

A patient of mine named Mariela* was recently admitted to labor and delivery for the birth of her baby. She was a high-risk, Latina patient who spoke only Spanish. Luckily, I did not have to use an interpreter as I am certified to speak Spanish to patients.

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The Illinois Health Facilities and Services Review Board signed off Tuesday on a plan to build a $34.3 million behavioral health hospital in Peoria. [Health News Illinois]

The hospital, a joint venture between OSF HealthCare and New York-based US HealthVest, will include 100 beds and feature adult specialized inpatient and outpatient behavioral health services, including programs for drug abuse, dual diagnosis of mental health and substance use disorder, women’s trauma, veterans, and seniors.

Martina Sze, chief development officer for US HealthVest, said there has been an “access issue in central Illinois” related to behavioral health services, and it is only getting worse as other systems cut or reduce services.

Other advocates said many patients currently have to go to the Chicago area to access services, which creates further complications when traveling so far from their homes and families.

“We are pleased to relieve a major burden of having to travel so far to obtain needed care,” said Richard Kresch, CEO of US HealthVest.

Officials also defended the application from a review board analysis that found the area already exceeded the necessary number of acute mental illness beds, saying the number has not kept up with the growing demand for services — especially coming out of the COVID-19 pandemic.

Dr. Samuel Sears, director of behavioral health physician services at OSF HealthCare, told the review board he relates the current situation to veterans returning from combat, with individuals struggling to transition to a “different world” post-pandemic.

“We were able to build up an extra backlog from that time, along with all the problems that are bubbling to the surface,” Sears said.

The project is anticipated to be completed by the end of 2025.

In other business, the board approved a $388.8 million plan by Northwestern Medicine to add 84 medical surgical beds and 12 intensive care beds to its Lake Forest hospital. It also calls for the expansion and relocation of its emergency department.

Hospital President Marsha Oberrieder told the review board the project is necessary due to high inpatient utilization at the facility in recent years. She noted the total number of patients served by the hospital grew by 43 percent from 2019 to 2021, while the number of Medicaid patients grew by 186 percent over that time.

“One of the lessons learned from the COVID pandemic is that lower occupancy is essential in having the ability to manage unexpected surges,” Oberrieder said.

While the board signed off on the application, several members raised concerns about the high cost of a physical facility.

“I think this is an exorbitant cost,” said Dr. Audrey Lynn Tansley, who was the lone "no" vote on the plan. She and several other members suggested more funds be directed toward transition and outpatient care.

The project is expected to be completed by April 2028.

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Family income is associated with differences in children’s brain development and mental health. This can, in turn, affect later-life outcomes. But it isn’t known how broader social factors, such as the cost of living and the social safety net, can affect the strength of these associations. [NIH Research Matters]

The study suggests that social safety nets can help improve children’s brain development and mental health.

An NIH-funded research team, led by Dr. David Weissman at Harvard University, examined how these differences in children’s brain development and mental health vary across states with different costs of living and anti-poverty programs. To do so, they analyzed data on more than 10,000 children, ages 9-11, from 17 states in the Adolescent Brain Cognitive Development (ABCD) study.

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Poverty in early childhood correlates with lower school achievement and reduced earnings as an adult. It is also associated with differences in brain structure and electrical brain activity. Brain activity exhibits repetitive patterns at various frequencies. More low-frequency activity has been associated with behavioral, attention, and learning problems. Higher-frequency activity has been associated with better language, cognitive, and social-emotional scores. [NIH Matters]

The study adds to growing evidence that interventions to relieve poverty can affect how infants’ brains develop. Photo Juliya Shangarey 

Some evidence suggests that children from lower-income families tend to have more low-frequency activity and less high-frequency activity than those from higher-income families. But it’s not clear whether poverty causes these changes in brain activity or is merely associated with other factors that cause them.

To find out, researchers created the Baby’s First Years study, a randomized controlled trial of poverty reduction in early childhood. In this study, 1,000 low-income mothers of newborns received a cash gift for the first several years of their children’s lives. The size of the gift was randomly chosen to be either $333 or $20 per month. The mothers could spend the money in ways that made the most sense to them, with no strings attached.

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What is the effectiveness of the Parent-focused Redesign for Encounters, Newborns to Toddlers intervention, a model for well-child care that integrates a community health worker into preventive care services at well-child care visits?  [JAMA Network]

Findings  In this cluster randomized clinical trial including 914 parents with a child younger than 2 years of age, those in the intervention group had a higher score for parent-reported receipt of recommended anticipatory guidance during well-child visits vs the usual care group (mean score, 73.9 vs 63.3, respectively); however, emergency department use was similar in the intervention and usual care groups (37.2% vs 36.1%, respectively).

Meaning  Integrating a community health worker into well-child care visits to provide early childhood preventive care services can improve the care that children receive.

Full paper here> 

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