CDC Director Mandy Cohen joins Bloomberg News reporter Riley Griffin to discuss new Covid-19 guidance, the fentanyl crisis and maternal healthcare in America.

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Increased attention to harmful race-based clinical algorithms—equations and decision-making tools that misuse race as a proxy for genetic or biologic ancestry¹—has led to the reconsideration of these algorithms in many medical specialties. Most such algorithms were developed or endorsed by medical specialty societies, ensuring their widespread use. [JAMA Network]

Advocacy to eliminate the misuse of race in clinical algorithms has grown from grass-roots efforts to organized, coalition-based efforts² supported by numerous medical societies. The American Medical Association (AMA) has specifically called for eliminating the misuse of race in clinical algorithms and implementing strategies to redress related harms.³ This call aligns with a growing movement to advance reparative approaches, which appropriately use race as a social construct, to identify and redress harms.⁴

Given the influence of medical societies in developing and legitimizing clinical algorithms, as well as anecdotal reports of societies’ efforts to eliminate harmful algorithms from use, we surveyed societies on their activities related to this and other equity issues. This article presents descriptive findings on organized medicine’s efforts to eliminate harmful race-based clinical algorithms.

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Adolescents who use substances have more psychiatric symptoms than peers who do not use.^1,2 There are, however, conflicting findings on whether various substances have unique or nonspecific associations with co-occurring psychiatric symptoms.^2,3 Similarly, dose dependence of these associations and presence of increased psychiatric symptoms among adolescents with infrequent use are debated.¹ With increasing rates of adolescent mental health–related problems, particularly suicide,^4,5 clarification on these issues is needed to inform screening, prevention and intervention, and policy.⁶ We examined associations between common substances and psychiatric symptoms among adolescents. [JAMA]

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The recently adopted federal guidance that shortens isolation recommendations for COVID-19 does not apply to Illinois health facilities, the Department of Public Health reiterated Monday. [Health News Illinois]

A spokesman for the agency referred to the Centers for Disease Control and Prevention notice released on Friday, which said the guidance is intended for a general audience. Nothing in the language supersedes accommodations required under federal civil rights laws.

The federal agency said Friday it now suggests those with a respiratory illness can return to normal activities when their symptoms improve over 24 hours and they no longer have a fever without using fever-reducing medication. They’re encouraged to continue taking steps to curb disease spread during the following five days, like wearing a mask.

Previously, the CDC recommended those testing positive for COVID-19 stay at home for five days. The new guidance brings a unified approach to a range of common respiratory viruses, like COVID-19, flu and respiratory syncytial virus, or RSV, according to the federal agency.

IDPH said Friday it will adopt the guidance going forward.

The CDC offers separate guidances for healthcare settings related to COVID-19, flu and general infection prevention and control.

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1. Margins for health systems improved in 2023 after a disastrous 2022. At the end of 2022, it looked like we would see massive health system failures. Systems rebounded in 2023 far better than many of us expected. The median hospital margin was -0.5% in January 2023 and 2.3% by year's end, according to Kaufman Hall. [Becker's Healthcare Review]

There is still much variation between systems' 2023 results, with Mayo Clinic reporting a 6% operating margin for example and Cleveland Clinic at 0.4% or Kaiser Permanente at 0.3%. It should be noted that while systems improved overall through 2023, the median margin is still too thin for comfort and 40% of U.S. hospitals continue to lose money from operations, with more than a dozen hospitals and health systems closing or filing for bankruptcy or otherwise reducing services in the last year.

2. The physician shortage in primary care and specialties is getting worse. The Association of American Medical Colleges issued a forecast in 2019 that the U.S. will face a shortage of up to 124,000 physicians by 2033. Numerous data points, albeit delayed, can paint a picture of how we are trending in the trajectory toward that end date, although more data — such as a national estimate of annual physician turnover — would certainly help the cause. 

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A USA TODAY analysis of Medicaid data for the 60 most used psychiatric drugs showed a growing number of people sought mental health treatment and medication during the pandemic as it pushed people into isolation and dismantled support systems.  [USA Today]

The analysis also revealed a lingering effect of the pandemic: Mental health-related prescriptions rose further in 2022, up 12% from 2019, outpacing the less than 1% growth in overall prescriptions. That includes prescriptions for generic Zoloft, the most common antidepressant medication, which rose 17% over the same period. 

More than half of these drugs saw an increase in prescriptions since 2019, and the steepest increase was among ADHD drugs: Concerta and generic Adderall. 

Full article here> 

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Question  Does exposure to mRNA COVID-19 vaccination during pregnancy increase the risk of adverse events in newborn infants? [JAMA Network]

Findings  In this population-based cohort study from Sweden and Norway that included 94 303 infants exposed to COVID-19 vaccination during pregnancy and 102 167 control infants born between June 2021 and January 2023, vaccination during pregnancy was associated with lower odds of neonatal intracranial hemorrhage, cerebral ischemia and hypoxic-ischemic encephalopathy, and neonatal mortality.

Meaning  In this large population-based study, vaccination of pregnant individuals with mRNA COVID-19 vaccines was not associated with increased risks of neonatal adverse events in their infants. 

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Gov. J.B. Pritzker’s proposed $23 million in funding to improve birth equity and maternal health outcomes for Black women would include grants for community health care providers and a $1 million pilot program to ensure low-income moms have diapers. [Sun-Times]

Pritzker highlighted the initiative on Monday at a former church on the South Side — the future home of the Chicago South Side Birth Center. Founded by Jeanine Valrie Logan, a midwife and advocate, the center will offer community-based health care and birth rooms.

The governor called the center a model for how Illinois can decrease Black maternal mortality. And Valrie Logan would be able to apply for a birth equity grant, part of a $4.4 million allocation the governor is seeking from the Illinois Department of Public Health.

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Experts from across four continents convened at the October 2023 RAISE (Responsible AI for Social and Ethical Healthcare) meeting to actively engage public and policy discourse and health care stakeholders in addressing concerns before policies crystallize into laws or regulations. [NEJM AI]

In the relentless pursuit of progress, humanity has engineered marvels that often pose complex questions and challenges for the societies that birth them. The recent integration of advanced large language models, such as ChatGPT and Bard, into both expert and public domains, is a quintessential example of such a dilemma.

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The Department of Healthcare and Family Services will extend its current contracts with Medicaid managed care organizations in the HealthChoice Illinois program for an additional year as new leadership settles in, Director Elizabeth Whitehorn said Friday. [Health News Illinois]

Whitehorn, who began the role in January, told members of the Medicaid Advisory Committee that the decision to postpone the procurement process by a year would give them the “appropriate time to ensure the process is designed to drive healthcare transformation.”

“We really value input from our stakeholders and our customers and believe that incorporating the feedback at the front end will lead to a better final procurement,” Whitehorn said.

The contracts are currently in the sixth year of an eight-year deal, she said. HealthChoice Illinois covers roughly 80 percent of all the state's Medicaid enrollees.

The focus for future contracts will include prioritizing behavioral health, maternal and child health, health equity and “accountability," Whitehorn said. 

That will include higher standards for performance metrics, financial withholds for both pay-for-performance and pay-for-reporting elements, and standardizing quarterly reviews of individual plan performances.

“We'll continue to grow the team and have some fresh perspective on how we work with our MCOs,” Whitehorn said. “I really hope this additional time will ensure the success of procurement for the agency, for the state and — most importantly — for our customers.”

The department is working on requests for proposals for a new fully integrated dual-eligible special needs plan, she said. That comes after the Centers for Medicare and Medicaid Services notified the state that it will not extend the Medicare-Medicaid Alignment Initiative demonstration program past 2025.

The program covers about 90,000 consumers who are dually eligible for Medicaid and Medicare.

The requests for proposals are expected to be released later this spring.

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