Health And Human Services Research Articles

Take It with a Grain (or More) of Salt: Why Industry-Backed Dietary Guidelines Fail Americans and How To Fix Them.

The U.S. Dietary Guidelines lack oversight and accountability. The result: Guidelines that reflect food industry interests instead of modern science. This deleterious guidance goes on to govern federally-subsidized food assistance programs and to influence dietary choices throughout the private sector and private life. Ultimately, the Guidelines significantly contribute to the endemic chronic disease they seek to address. The Guidelines Advisory Committee is notoriously rife with conflicts of interest, and thus most Guidelines scholarship has focused on reforming the Committee. But the 2015 and 2020 Guidelines show that these reforms are insufficient and agency-level change is necessary. In 2015, the Committee made several controversial recommendations related to red meat, ultraprocessed foods, sodium, and sustainability. Due to industry backlash, only the sodium recommendation survived in the final Guidelines published by the Secretaries of the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS). In 2020, the Secretaries, for the first time, predetermined a list of eighty topics that the Committee may consider. Absent from this list are the most contentious topics from previous years. There is little recourse because the Guidelines are not considered an agency action subject to the Administrative Procedure Act (APA), despite their vast impact on food assistance programs, healthcare practices, tort law, and more. This Note proposes two ways to bring the Guidelines within the APA’s coverage. The first is a litigation strategy, arguing that the D.C. District Court relied on erroneous reasoning when it held that the Guidelines are not an agency action subject to the APA. Second, this Note describes some ways that Congress could amend the Nutrition Act, the statute governing the Guidelines. Applying the APA to the Guidelines would allow for public participation and public challenge, greater transparency, and greater efficiency across agencies. Evidence-based Guidelines would improve overall health, reduce healthcare costs, and ensure that food assistance beneficiaries can access healthy foods. A robust set of Guidelines would improve public confidence in the recommendations and enable further food law reforms, such as amending the Farm Bill, that would make it easier for people to make healthy choices.

Community-Based Testing Sites for SARS-CoV-2 - United States, March 2020-November 2021.

Immediately following the March 13, 2020 declaration of COVID-19 as a national emergency (1), the U.S. government began implementing national testing programs for epidemiologic surveillance, monitoring of frontline workers and populations at higher risk for acquiring COVID-19, and identifying and allocating limited testing resources. Effective testing supports identification of COVID-19 cases; facilitates isolation, quarantine, and timely treatment measures that limit the spread of SARS-CoV-2 (the virus that causes COVID-19); and guides public health officials about the incidence of COVID-19 in a community. A White House Joint Task Force, co-led by the Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA), created the Community-Based Testing Sites (CBTS) program working with state and local partners (2). This report describes the timeline, services delivered, and scope of the CBTS program. During March 19, 2020-April 11, 2021, the CBTS program conducted 11,661,923 SARS-CoV-2 tests at 8,319 locations across the United States and its territories, including 402,223 (3.5%) administered through Drive-Through Testing, 10,129,142 (86.9%) through Pharmacies+ Testing, and 1,130,558 (9.7%) through Surge Testing programs. Tests administered through the CBTS program yielded 1,176,959 (10.1%) positive results for SARS-CoV-2. Among tested persons with available race data,* positive test results were highest among American Indian or Alaska Native (14.1%) and Black persons (10.4%) and lowest among White persons (9.9%), Asian persons (7.3%), and Native Hawaiian or Other Pacific Islanders (6.4%). Among persons with reported ethnicity, 25.3% were Hispanic, 15.9% of whom received a positive test result. Overall, 82.0% of test results were returned within 2 days, but the percentage of test results returned within 2 days was as low as 40.7% in July 2020 and 59.3% in December 2020 during peak testing periods. Strong partnerships enabled a rapid coordinated response to establish the federally supported CBTS program to improve access to no-charge diagnostic testing, including for frontline workers, symptomatic persons and close contacts, and persons living in high-prevalence areas. In April 2021, the CBTS Pharmacies+ Testing and Surge Testing programs were expanded into the Increasing Community Access to Testing (ICATT) program. As of November 12, 2021, the CBTS and ICATT programs conducted approximately 26.6 million tests with approximately 10,000 active testing sites. Although the CBTS program represented a relatively small portion of overall U.S. SARS-CoV-2 testing, with its successful partnerships and adaptability, the CBTS program serves as a model to guide current community-based screening, surveillance, and disease control programs, and responses to future public health emergencies.

HHS study finds increases in BH care through telehealth

A new report from the U.S. Department of Health and Human Services (HHS) found that massive increases in the use of telehealth helped maintain some health care access during the COVID‐19 pandemic, with specialists like behavioral health providers seeing the highest telehealth utilization relative to other providers.

Feds focus on naloxone and fentanyl test strips, blame COVID‐19 for OD increases

Last week, the federal Centers for Disease Control and Prevention (CDC) announced that the predicted overdose death count for the 12‐month period ending April 2021 is more than 100,000. That's one death every five minutes, said Rahul Gupta, M.D., director of the Office of National Drug Control Policy (ONDCP), at a Nov. 17 press briefing with the heads of the CDC, the National Institute on Drug Abuse (NIDA), the Drug Enforcement Administration (DEA), the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

COVID-19 vaccination coverage among hospital-based healthcare personnel reported through the Department of Health and Human Services Unified Hospital Data Surveillance System, United States, January 20, 2021-September 15, 2021

To protect both patients and staff, healthcare personnel (HCP) were among the first groups in the United States recommended to receive the COVID-19 vaccine. We analyzed data reported to the U.S. Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System on COVID-19 vaccination coverage among hospital-based HCP. After vaccine introduction in December 2020, COVID-19 vaccine coverage rose steadily through April 2021, but the rate of uptake has since slowed; as of September 15, 2021, among 3,357,348 HCP in 2,086 hospitals included in this analysis, 70.0% were fully vaccinated. Additional efforts are needed to improve COVID-19 vaccine coverage among HCP.

Disparities in national and state estimates of COVID-19 vaccination receipt and intent to vaccinate by race/ethnicity, income, and age group among adults ≥ 18 years, United States

IntroductionCOVID-19 morbidity and mortality has disproportionately affected vulnerable populations such as minority racial/ethnic groups. Understanding disparities in vaccine intentions and reasons for vaccine hesitancy are important for developing effective strategies for ameliorating racial/ethnic COVID-19 inequities. MethodsUsing six waves of the large, nationally representative Census Bureau’s Household Pulse Survey data from January 6-March 29, 2021 (n = 459,235), we examined national and state estimates for vaccination intent, defined as receipt of ≥ 1 dose of the COVID-19 vaccine or definite intent to be vaccinated, by race/ethnicity with stratification by household income and age group. In separate logistic regression models, we also examined the interaction between race/ethnicity and household income, and race/ethnicity and age group, and its association with vaccination intent. Lastly, we examined reasons for not vaccinating by race/ethnicity. ResultsVaccination intent differed by racial/ethnic group, household income, and age group nationally and by Health and Human Services (HHS) region and state. A significant interaction was observed between race/ethnicity and household income (F(8,72) = 4.50, p < 0.001), and race/ethnicity and age group (F(8,72) = 15.66, p < 0.001). Non-Hispanic Black adults with lower income (<$35,000) and younger age (18–49 years) were least likely to intend to vaccinate. Similar disparities across racial/ethnic groups were seen across most HHS regions and states. Concerns about possible side effects and effectiveness were significantly higher among all minority groups compared to non-Hispanic White adults. ConclusionDisparities in vaccination intent by racial/ethnic groups underscore the need for interventions and recommendations designed to improve vaccination coverage and confidence in underserved communities, such as younger and lower income racial/ethnic minority groups. Efforts to reduce disparities and barriers to vaccination are needed to achieve equity in vaccination coverage, and ultimately, to curb COVID-19 transmission.

Pharmacy technician-administered immunizations: A five-year review

In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.

Iron Ladies: Variation in the Identification and Management of Iron Deficiency in Women with Bleeding Disorders

Background: Iron deficiency (ID) has negative clinical consequences on physical and cognitive abilities in adolescent and adult women. Women with heavy menstrual bleeding (HMB) are at particularly high risk for ID. Guidelines issued by the American College of Gynecology recommend obtaining a CBC and serum ferritin level to screen for ID in young women with HMB. Despite the high frequency of ID in women with HMB, there are no specific recommendations regarding screening in women with bleeding disorders (WBD), though 50% or more of this population may be affected by HMB. Information on the prevalence of ID and iron deficiency anemia in WBD is lacking. In addition, understanding of the optimal practice for iron supplementation has changed, with recent literature indicating less frequent supplementation improves iron absorption. We aimed to describe the screening practices for and management of ID in WBD through a survey of medical providers within hemophilia treatment centers (HTC).Methods: Electronic surveys were distributed by internet mail to medical providers who treat WBD within HTCs, based on membership rosters of the Hemostasis and Thrombosis Research Society and the American Thrombosis and Hemostasis Network. Data collected included indications for ID screening, laboratory measures for ID screening, iron supplementation in patients with ID (including route of administration, dose and dose frequency) and laboratory assessment to confirm iron repletion.Results: Responses were received from 62 medical providers. Providers reported seeing an average of 70 WBD/year (range 1-300), with ID identified in an average of 38 WBD/year (range 2-125). Screening for ID is completed in approximately 84.5% of WBD. Screening is a part of routine practice for 69.4% of providers, only 32.3% of respondents limit screening to women with HMB or other bleeding symptoms. Over 95% of providers utilize ferritin and hemoglobin to screen for ID. When ID is identified, oral supplementation is prescribed by 96.8% of those surveyed. The most used supplement is ferrous sulfate, with daily dosing employed by 54.8% of providers and alternate day dosing employed by 51.6% of providers. Oral iron dosing varies from 15mg to 325mg elemental iron per day (or 1-6mg/kg/day with weight-based dosing). Intravenous supplementation is prescribed by 80.6% of respondents. The most common indications include refractoriness to oral iron (75.8%) and non-compliance with oral iron (69.4%). The most recommended forms of IV iron are iron sucrose (43.5%) and ferric carboxymaltose (40.3%). Repeat labs are obtained to monitor iron repletion by 96.8% of providers, typically after three months of therapy, though the laboratory measures utilized vary widely.Discussion: All medical providers within HTCs report screening for ID in WBD, though not all WBD undergo screening. Notable variation is present in the formulation and dosing of iron supplementation used in patients with ID, as well as in follow-up practices. Given the prevalence of ID and its potential health burden, there is need for standardization of practices in screening of ID and iron replacement in WBD to promote early recognition and reduce the burden of disease in these women.This project was supported by funding through the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of HRSA H30MC2450 [Display omitted] DisclosuresRagni: Alnylam (Sanofi): Membership on an entity's Board of Directors or advisory committees; University of Pittsburgh: Research Funding; BioMarin Pharmaceutical: Membership on an entity's Board of Directors or advisory committees; Bioverativ (Sanofi): Membership on an entity's Board of Directors or advisory committees; Spark Therapeutics: Membership on an entity's Board of Directors or advisory committees; Takeda Therapeutics: Membership on an entity's Board of Directors or advisory committees.

CM for stimulant use disorder: No limit imposed by OIG

The oft‐stated assumption that the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) bans any gifts of $75 or more as a contingency in the treatment of stimulant use disorder is incorrect. From the Federal Register announcement: “Gifts that implicate the Beneficiary Inducements CMP that exceed these dollar limits are not prohibited but are analyzed on a case‐by‐case basis for compliance under the statute,” according to the OIG December 2020 Federal Register final rule (https://www.federalregister.gov/documents/2020/12/02/2020‐26072/medicare‐and‐state‐health‐care‐programs‐fraud‐and‐abuse‐revisions‐to‐safe‐harbors‐under‐the). “We highlight, however, that this nominal value guidance applies to the value of in‐kind items and services, not to the value of incentive payments in the form of cash or cash equivalents. In other words, cash and cash‐equivalent payments under $75 would not be covered by this guidance. Moreover, this guidance applies only with respect to the Beneficiary Inducements CMP and not to the Federal anti‐kickback statute. Furthermore, we are aware that some industry stakeholders may be under a misimpression that OIG prohibits contingency management program incentives above $75. There is no OIG‐imposed $75 limitation on contingency management program incentives. Rather, the Federal anti‐kickback statute may constrain the ability of individuals or entities to offer contingency management program incentives of any value to Federal health care program beneficiaries, depending on the facts of the arrangement. Moreover, in‐kind incentives above the $75 annual, aggregate limit, and all cash or cash‐equivalent incentives regardless of the amount, must be analyzed on the basis of their specific facts for compliance with the Beneficiary Inducements CMP.”

Low-value care and excess out-of-pocket expenditure among older adults with incident cancer – A machine learning approach

ObjectiveTo evaluate the association of low-value care with excess out-of-pocket expenditure among older adults diagnosed with incident breast, prostate, colorectal cancers, and Non-Hodgkin’s Lymphoma. MethodsWe used a retrospective cohort study design with 12-month baseline and follow-up periods. We identified a cohort of older adults (age ≥ 66 years) diagnosed with breast, prostate, colorectal cancers, or Non-Hodgkin’s lymphoma between January 2014 and December 2014. We assessed low-value care and patient out-of-pocket expenditure in the follow-up period. We identified relevant low-value services using ICD9/ICD10 and CPT/HCPCS codes from the linked health claims and patient out-of-pocket expenditure from Medicare claim files and expressed expenditure in 2016 USD. ResultsAbout 29 % of older adults received at least one low-value care procedure during the follow-up period. Low-value care differed by gender, and rates were higher in women with colorectal cancer (32.7 %) vs. (28.8 %) and NHL (40 %) vs. (39 %) compared to men. Individuals who received one or more low-value care procedures had significantly higher mean out-of-pocket expenditure ($8,726 ± $7,214) vs. ($6,802 ± $6,102). XGBOOST, a machine learning algorithm revealed that low-value care was among the five leading predictors of OOP expenditure. ConclusionOne in four older adults with incident cancer received low-value care in 12-months after a cancer diagnosis. Across all cancer populations, individuals who received low-value care had significantly higher out-of-pocket expenditure. Excess out-of-pocket expenditure was driven by low-value care, fragmentation of care, and an increasing number of pre-existing chronic conditions. Policy StatementThis study focuses on health policy issues, specifically value-based care and its findings have important clinical and policy implications for Centers for Medicare and Medicaid Services (CMS) which has issued a roadmap for states to accelerate the adoption of value-based care, with the Department of Health and Human Services (HHS) setting a goal of converting 50 % of traditional Medicare payment systems to alternative payment models tied to value-based care by 2022.

HHS moves toward harm reduction for the first time

A new overdose prevention strategy announced by the Department of Health and Human Services (HHS) last week focused on, for the first time, harm reduction. There are four key target areas.

Most Colorado OTPs failed in recordkeeping: HHS OIG

According to an audit by the federal Department of Health and Human Services (HHS), about 79% of opioid treatment programs (OTPs, sometimes called methadone clinics) treating Medicaid patients failed to comply with federal and state requirements. The report from the HHS Office of Inspector General (OIG), released last week, found mainly that the state oversight of the OTPs was inadequate.

The Geriatrics Education and Care Revolution: Diverse Implementation of Age-Friendly Health Systems.

Journal of the American Geriatrics SocietyVolume 69, Issue 12 p. E31-E33 Geriatrics Education and Innovation (GErI) Corner The Geriatrics Education and Care Revolution: Diverse Implementation of Age-Friendly Health Systems Erin E. Emery-Tiburcio PhD, Corresponding Author Erin E. Emery-Tiburcio PhD erin_emerytiburcio@rush.edu orcid.org/0000-0002-6878-3369 Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA Correspondence Erin E. Emery-Tiburcio, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 710 S. Paulina St., Suite 431, Chicago, IL 60612, USA. Email: erin_emerytiburcio@rush.eduSearch for more papers by this authorMarla Berg-Weger PhD, Marla Berg-Weger PhD School of Social Work, Saint Louis University, Saint Louis, Missouri, USASearch for more papers by this authorErica K. Husser PhD, Erica K. Husser PhD College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this authorNina Tumosa PhD, Nina Tumosa PhD Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Fairlee, Vermont, USASearch for more papers by this authorRobyn L. Golden LCSW, Robyn L. Golden LCSW Department of Social Work and Community Health, Rush University Medical Center, Chicago, Illinois, USASearch for more papers by this authorMichelle H. Newman MPH, Michelle H. Newman MPH Department of Social Work and Community Health, Rush University Medical Center, Chicago, Illinois, USASearch for more papers by this authorJohn E. Morley MB, BCh, John E. Morley MB, BCh Department of Medicine, Saint Louis University, Saint Louis, Missouri, USASearch for more papers by this authorJenny M. Knecht-Fredo MSN, Jenny M. Knecht-Fredo MSN College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this authorJudith E. Hupcey EdD, Judith E. Hupcey EdD orcid.org/0000-0003-2171-0979 College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this authorDonna M. Fick PhD, Donna M. Fick PhD orcid.org/0000-0002-6777-1913 College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this author Erin E. Emery-Tiburcio PhD, Corresponding Author Erin E. Emery-Tiburcio PhD erin_emerytiburcio@rush.edu orcid.org/0000-0002-6878-3369 Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA Correspondence Erin E. Emery-Tiburcio, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 710 S. Paulina St., Suite 431, Chicago, IL 60612, USA. Email: erin_emerytiburcio@rush.eduSearch for more papers by this authorMarla Berg-Weger PhD, Marla Berg-Weger PhD School of Social Work, Saint Louis University, Saint Louis, Missouri, USASearch for more papers by this authorErica K. Husser PhD, Erica K. Husser PhD College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this authorNina Tumosa PhD, Nina Tumosa PhD Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Fairlee, Vermont, USASearch for more papers by this authorRobyn L. Golden LCSW, Robyn L. Golden LCSW Department of Social Work and Community Health, Rush University Medical Center, Chicago, Illinois, USASearch for more papers by this authorMichelle H. Newman MPH, Michelle H. Newman MPH Department of Social Work and Community Health, Rush University Medical Center, Chicago, Illinois, USASearch for more papers by this authorJohn E. Morley MB, BCh, John E. Morley MB, BCh Department of Medicine, Saint Louis University, Saint Louis, Missouri, USASearch for more papers by this authorJenny M. Knecht-Fredo MSN, Jenny M. Knecht-Fredo MSN College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this authorJudith E. Hupcey EdD, Judith E. Hupcey EdD orcid.org/0000-0003-2171-0979 College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this authorDonna M. Fick PhD, Donna M. Fick PhD orcid.org/0000-0002-6777-1913 College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USASearch for more papers by this author First published: 08 October 2021 https://doi.org/10.1111/jgs.17497 The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. The views expressed by Nina Tumosa in this article are solely the opinions of the author and do not necessarily reflect the official policies of the Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA), nor does mention of the names of HHS or HRSA imply endorsement by the U.S. Government. Funding information: Geriatrics Workforce Enhancement Program, Grant/Award Numbers: U1QHP33075, U1QHP28716, U1QHP28715 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume69, Issue12December 2021Pages E31-E33 RelatedInformation

Healthy People 2030 Leading Health Indicators and Overall Health and Well-being Measures: Opportunities to Assess and Improve the Health and Well-being of the Nation.

Context:Released by the US Department of Health and Human Services (HHS) every decade since 1980, Healthy People identifies science-based objectives with targets to monitor progress and motivate and focus action. Healthy People 2030 is the current iteration of the Healthy People initiative.Program:Healthy People 2030 includes 3 sets of measures—Healthy People 2030 objectives, Leading Health Indicators (LHIs), and Overall Health and Well-being Measures (OHMs). Collectively, these components of Healthy People 2030 drive progress toward the initiative's vision of “a society in which all people can achieve their full potential for health and well-being across the life span.”Implementation:The Healthy People 2030 LHIs and OHMs were developed with input from multiple subject matter experts and launched in December 2020. Designed as an entry point for users interested in improving the health of their communities and selected for their ability to improve health and well-being, the LHIs will be assessed annually. As broad, global outcome measures of overall health and well-being, the OHMs will be assessed at least 3 times before 2030.Evaluation:The 23 LHIs are a subset of Healthy People 2030 core objectives that have been selected to drive action toward improved health and well-being. LHIs are intended to help organizations, communities, and states across the nation focus resources and efforts to improve the health and well-being of all people. The OHMs include 8 broad, global outcome measures of overall health and well-being that help assess progress toward the Healthy People 2030 vision. The Healthy People 2030 OHMs include the addition of a measure of overall well-being.Discussion:Together with the Healthy People 2030 objectives, the LHIs and OHMs provide a plan of action to improve the health and well-being of the nation through a framework for assessing progress, addressing health disparities and social determinants of health, and advancing health equity.

A Comparative Systematic Review and Meta-Analysis of 3 Routes of Administration of Epidural Injections in Lumbar Disc Herniation

The Best Practices in Pain Management from the U.S. Department of Health and Human Services (HHS) describes interventional techniques as part of a continuum. Epidural injections are commonly utilized modalities in managing low back and lower extremity pain. Epidural injections were initially administered in 1901 where the first descriptions of caudal epidural with local anesthetic for low back pain appeared. Since then, multiple developments have occurred. Currently, epidural injections are provided by caudal, interlaminar, and transforaminal approaches. The comparative effectiveness of each modality has been studied. However, comparative assessment has been sparse. To assess the efficacy of 3 routes of administration of epidural injections for lumbar disc herniation. A systematic review and meta-analysis of randomized controlled trials (RCTs) of transforaminal, interlaminar and caudal epidural injections in managing chronic low back and lower extremity pain due to lumbar disc herniation. RCTs with a placebo control or an active control design, performed under fluoroscopic guidance, with at least 6 months of follow-up are included. The outcome measures were pain relief and functional status improvement. Significant improvement was defined as 50% or greater pain relief and functional status improvement. Data extraction and methodological quality assessment were performed. Evidence was summarized utilizing principles of best evidence synthesis. A total of 21 trials were included. Of these, 7 studied caudal epidural injections, whereas transforaminal epidural injections were studied in 12 trials, and lumbar interlaminar epidural injections were studied in 10 trials, which all met inclusion criteria. Based on qualitative and quantitative analysis, which included conventional dual-arm and single-arm analysis for interlaminar epidural injections, and single-arm analysis for caudal and transforaminal epidural injections, and the approach to the epidural space, there is Level I evidence for local anesthetic and steroids, Level II for local anesthetic alone for transforaminal and interlaminar approaches, and Level II for the caudal approach with steroids or local anesthetic alone for short- and long-term relief. There is a paucity of literature with intermediate or long-term relief of at least 6 months with appropriate outcome parameters. Conventional dual-arm meta-analysis was feasible only for interlaminar epidural injections. Epidural injections with local anesthetic and steroids showed Level I evidence for transforaminal and interlaminar approaches, whereas with local anesthetic alone Level II evidence was demonstrated. In contrast, caudal epidural injections showed Level II evidence with local anesthetic with steroids or local anesthetic alone.

Backsliding in underage drinking prevention: Federal Report to Congress

Despite what seems to be a downward trend in youth drinking, recent developments related to the pandemic could easily shift behavior in the opposite direction, a Report to Congress from the Department of Health and Human Services (HHS) has warned.

Determinants of workplace perceptions among federal, state, and local public health staff in the US, 2014 to 2017

BackgroundThe governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce.MethodsWorkforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response.ResultsIn 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p < .0001); and 62% vs 52% in HHS (p < .0001). Among state staff, intent to leave increased from 22 to 31% (p < .0001), but fell in 2017 from 33 to 28% for HHS (p < .0001). Correlates of intent to leave included low job satisfaction, pay satisfaction, and agency type. Federal entities saw the highest proportion respondents that indicated they would recommend their organization as a good place to work.ConclusionsWhile intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women.

Benchmarking healthcare quality in the United States

The COVID-19 pandemic has brought the quality of healthcare in the United States under increased scrutiny. The Agency for Healthcare Research and Quality (AHRQ) within the United States Department of Health and Human Services (HHS) is charged with improving the safety and quality of the US healthcare system. The purpose of this study is to benchmark healthcare quality in the United States using data provided by AHRQ. The study consists of quality measures compiled by AHRQ that are utilised by the 48 contiguous states comprising the United States along with Alaska, Hawaii and the District of Columbia. The measures are set against achievable benchmarks to assess US healthcare quality at the national, regional, divisional and state levels. The results of this study show that the Northeast region has the highest average number and percentage of healthcare quality benchmarks achieved in the United States. At the divisional level, New England leads the country in healthcare quality. An analysis at the state level reveals that Maine is the leader in healthcare quality in the Northeast region, Wisconsin and Iowa in the Midwest region, Delaware in the South region, and Colorado in the West region. The results of this study can be used by policymakers at the national, state and local levels to target healthcare quality improvement initiatives in the United States.

MP23-05 ASSESSMENT OF PATIENT PERSPECTIVE ON BENEFIT AND RISK (B-R) ASSOCIATED WITH HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) FOR THE ABLATION OF PROSTATE TISSUE IN MEN WITH LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (MP23)1 Sep 2021MP23-05 ASSESSMENT OF PATIENT PERSPECTIVE ON BENEFIT AND RISK (B-R) ASSOCIATED WITH HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) FOR THE ABLATION OF PROSTATE TISSUE IN MEN WITH LOCALIZED PROSTATE CANCER Olufemi Babalola, Geoffrey Sonn, Minhaj Siddiqui, and Charles Viviano Olufemi BabalolaOlufemi Babalola More articles by this author , Geoffrey SonnGeoffrey Sonn More articles by this author , Minhaj SiddiquiMinhaj Siddiqui More articles by this author , and Charles VivianoCharles Viviano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002014.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The FDA cleared HIFU for prostate tissue ablation in 2015. This study aims to explore patient preferences regarding the known benefit and important adverse events associated with HIFU for prostate ablation in men with prostate cancer. METHODS: Eligible subjects were treatment-naïve men with a physician confirmed diagnosis of localized prostate cancer (Gleason 6 or 7). A Discrete Choice Experiment (DCE) was used to evaluate patients’ B-R tradeoffs for prostate HIFU outcomes via an online survey. The outcomes of interest were: erectile dysfunction (ED), urinary incontinence (UI), and biopsy result after treatment. Content was based on a literature review, as well as clinical and regulatory knowledge, of HIFU for prostate ablation. Subjects were asked to choose a preferred treatment option in 9 different choice tasks. Each choice task includes a pair of hypothetical treatment profiles that have similar attributes (outcomes) with varying levels (see figure). RESULTS: 165 subjects with a mean age of 65 completed the survey. Preliminary results show patients are willing to trade off among treatment outcomes. The maximum acceptable risk (MAR) indicates that respondents are willing to accept a 1.59%-point increase in ED for a 1%-point increase in favorable biopsy. The minimum acceptable benefit (MAB) indicates that patients are willing to accept a 0.63%-point increase in favorable biopsy for a 1%-point increase in ED associated with HIFU. In addition, the MAR for UI shows that respondents are willing to accept a 1.86%-point increase in UI for a 1%-point increase in favorable biopsy. The MAB indicates that patients are willing to accept a 0.54%-point increase in favorable biopsy for a 1%-point increase in UI. CONCLUSIONS: Incorporation of patient preference information into device regulatory decision making is one of the strategic goals of the Center for Devices and Radiological Health at the FDA. Our results may help inform design and regulatory decision making for current and future prostate tissue ablation devices with limited benefit data by providing information from the patient perspective. Source of Funding: This project was supported by the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award (U01FD005946; U01FD005978) totaling $146,080 with 100 percent funding by FDA/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by FDA/HHS, or the U.S. Government © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e402-e402 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Olufemi Babalola More articles by this author Geoffrey Sonn More articles by this author Minhaj Siddiqui More articles by this author Charles Viviano More articles by this author Expand All Advertisement Loading ...

At HHS: SAMHSA changes, and Mark Weber retiring

Miriam Delphin‐Rittmon, M.D., former commissioner of the Connecticut Department of Mental Health and Addiction Services, was confirmed as assistant secretary for mental health and substance use at the federal Department of Health and Human Services (HHS) in June; she now leads the Substance Abuse and Mental Health Services Administration (SAMHSA). Nancy Navarretta, deputy commissioner of the Connecticut Department of Mental Health and Addiction Services, will be the agency's acting commissioner until the governor appoints a permanent commissioner.