A new analysis of nearly 3000 counties in the United States found that a poorer local food environment is associated with higher heart failure (HF) mortality at the county level. [Medscape]

Previous research has established that food insecurity increases the risk for worse health outcomes. But few studies have looked specifically at HF outcomes and much of the work was restricted to single metropolitan areas or health systems, which may not have captured the diversity and variance of access to food across the US, explained study author Keerthi Gondi, MD, University of Michigan in Ann Arbor.

Further fueling their desire to look at the population level was the acute rise in food insecurity with the COVID-19 pandemic, he noted....

The full paper, published online October 25 in Circulation: Heart Failure, includes 2956 countries with an average FI% of 13% and average FEI of 7.8.

Counties with an FI% above the national median of 13.7% had higher HF mortality than those below the national median (30.7 vs 26.7 deaths per 100,000 people; P < .001).

The association with mortality was stronger for heart failure than with non-HF cardiovascular disease and all-cause mortality, Gondi said. "This, I think, demonstrates a unique relationship between heart failure and food insecurity."

Full article here> 

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WHO published a report highlighting the first-ever list of fungal "priority pathogens" – a catalogue of the 19 fungi that represent the greatest threat to public health.  The WHO fungal priority pathogens list (FPPL) is the first global effort to systematically prioritize fungal pathogens, considering the unmet research and development (R&D) needs and the perceived public health importance. The WHO FPPL aims to focus and drive further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.

Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal medicines currently available, and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics and those that exist are not widely available or affordable globally.

Full article here> 

WHO Fungal Priority List Download copy here> 

Other info>

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Parents who need to take a child to the emergency room are facing agonizing waits in many parts of the United States because of a shortage of hospital beds. [CNN Health]

Hospitals across the country say they are being overwhelmed by an early surge in respiratory infections including RSV, influenza and enterovirus. As a result, pediatric hospital beds are more full now than they have been in the past two years, according to a CNN analysis of data from the US Department of Health and Human Services.

Full article here> 

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The Model List of Essential Medicines of the World Health Organization (WHO) highlights medicines considered the most effective, safe, and important for priority public health needs.

In the years since its first publication in 1977, the Essential Medicines List has shaped the diffusion and reimbursement of new medicines in health systems around the world. The list, which remains a voluntary guideline for national formularies, was established with the goal of making included therapies widely available and affordable. However, the selection of medicines for inclusion in the list has been increasingly complicated by the escalating prices of new drugs entering the market. [JAMA Network}]

With the publication of its 2021 list, which comprised more than 400 medicines, WHO for the first time explicitly acknowledged that several medicines, including checkpoint inhibitors for lung cancers, were not on the list—despite being highly effective—due to prohibitively high prices.1 In this Viewpoint, we propose restructuring the list to formally remove consideration of cost and cost-effectiveness from the expert committee reviews of clinical effectiveness, safety, and public health value and chartering a new framework for pooled global negotiation and procurement of costly medicines eventually included in the list.

The recent update of the Essential Medicines List resurfaced a long-standing tension with some medications between high costs and essential need for health systems and patients. The roots of the current controversy can be traced to the introduction of the first antiretroviral therapies in the late 1990s that were costly; until then, cost (specifically, experts’ judgment about the affordability for low-income countries) had a central role in the consideration of whether a therapy should be included in the list. Full article here> 

Download PDF here>

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Reimagining Children’s Rights in the US [JAMA Network] "The US remains the only country without a national framework for securing the rights and well-being of all children ages 0 to 17 years.1 "

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.

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. 

Read full article here>

Download six-page article here>

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We often hear talk from older generations about how much more difficult they had it when they were young -- and doctors are no exception. It's not uncommon to hear older physicians and younger physicians argue about whose training was more difficult. But how does medical school today actually compare with medical school in the past? Let's explore both sides of the argument to determine who had it tougher. [MedPage Today]

Video 

Full article here>

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Update on research on COVID and its long term implications. 

CONCLUSIONS AND RELEVANCE This study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.

Download full paper here

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 A pair of new studies shine a light on how overcrowding and staffing shortages may be impacting emergency department (ED) wait times and patient care access. [Patient Engagement HIT]

The studies, based on EHR data from across the country, were published in JAMA Network Open by researchers from the VA Ann Arbor Healthcare System, the University of Michigan Institute for Healthcare Policy and Innovation, and Yale University.

In the first study, researchers examined how hospital occupancy, the percentage of occupied staffed inpatient beds, was associated with long ED wait length or boarding times.

Between January 2020 and December 2021, researchers found that boarding times were greater than four hours nearly 90 percent of the time when occupancy was greater than 85 percent.

... By December 2021, median boarding times were over nine hours at the five percent of hospitals with the greatest occupancy.

The Joint Commission, a national accrediting body for hospitals, stressed that boarding times over four hours is a patient safety concern.

Full article here>

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Healthcare’s cross-sector collaboration on health equity work is something that Jay Bhatt, MD, the executive director of Deloitte’s Center for Health Solutions, hasn’t seen at a level like this before. The work to give everyone an equal opportunity for health and well-being is happening across the care continuum, with a renewed focus on retail health clinics and other alternative care sites coming to the fore. [Patient Engagement HIT]

“We’re creating more access points and putting opportunities to address drivers of health,” Bhatt, who’s also the executive director of the Deloitte Health Equity Institute, told PatientEngagementHIT in a Zoom call. “We're seeing grocers and retailers partner with community health centers and other care settings to enable access to care in the context of addressing healthy behavior and shopping and food security as well as connection to other social service agencies.”

Alternative care sites, such as retail health clinics, urgent care clinics, telehealth, and virtual health options, create more front doors through which patients can get medical care. And when looking at traditionally marginalized groups, especially Black and Brown populations, this is important.

Full article here>

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A guest post from members of the planning team for the Pathways to Prevention (P2P) Workshop on Achieving Health Equity in Preventive Services (Antoinette Percy-Laurry, Carrie N. Klabunde, Melissa C. Green Parker, Pamela L. Thornton, LeShawndra N. Price, and Rick A. Berzon) and the ODP’s portfolio analysis team (Charlene A. Liggins and Cristan A. Smith)

Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death, disability, and health care spending in the United States. Many chronic conditions can be prevented, delayed, or caught and treated early. However, despite the progress in research and clinical care, many Americans continue to receive less than recommended preventive health care; this is especially the case for communities that experience a high burden of disparities in chronic diseases. This means not everyone has an equal opportunity to be as healthy as possible. [NIH Office of Disease Prevention] 

In 2019, we organized the P2P Workshop: Achieving Health Equity in Preventive Services to assess the state of the science on equity in the use of clinical preventive services and develop a research agenda for moving the field forward.

After the workshop, we brought together representatives from eight NIH Institutes and Offices and seven federal agencies for a Federal Partners Meeting to discuss agency activities and resources relevant to the workshop and create an action plan. Participants identified opportunities for federal agencies to address many of the workshop panel’s recommendations (PDF), organized around four cross-cutting themes:

1. Integration of Services and New Delivery Models
2. Need for Innovative Methods
3. Community Engagement and Systems Approaches
4. Workforce and Training.

As we progress through that action plan, we’ve come to recognize that increasing the use of implementation science in the work done by the NIH, our federal partners, and researchers in the field will be a critical part of making progress toward health equity in preventive services.

Why focus on implementation science to improve health equity?

Applying implementation science concepts and methodologies has proven successful in increasing the adoption of many evidence-based practices. Implementation science identifies factors that make it harder or easier to achieve the uptake of evidence-based clinical innovations. We believe that linking health equity research with implementation science offers new possibilities for addressing the workshop panel’s recommendations and improving the use of evidence-based clinical preventive services.

What research is the NIH currently supporting in this area?

To better understand the ways in which implementation science is already being used to advance health equity research—and where it is still lacking—we conducted a brief review of the NIH’s research grant portfolio (PDF) using the NIH RePORTER database.

See full article here> 

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