Since October 2023, an average of 200 mpox cases have been detected every month. This is still a fairly low rate of transmission, but experts worry this could be a harbinger of a larger surge in the summer when travel and socializing pick up.  [The Hill]

Health experts monitoring the trend are calling for targeted action.  

“I would encourage them to continue to provide the information so that people have the information to make decisions about their preventative health care, and also to increase their communication efforts,” Brian Hujdich, executive director of the National Coalition for LGBTQ Health, told The Hill.  

The virus spread through the social networks of men who have sex with men during the summer of 2022, and it still appears to mainly be spreading through this demographic. 

According to Hujdich, the continued presence of mpox in the U.S. reflects the inequitable access that different communities have to immunization. He attributed this to the fact that the mpox vaccine was only available through public health agencies up until recently, meaning factors such as distance from a clinic or supply stood in the way. 

The federal government has signaled an awareness of the current trend, with an interagency initiative promoting mpox vaccination in the works. 

“CDC is collaborating with federal partners and advocacy groups to think about summer opportunities to promote vaccine awareness and uptake, as well as to increase awareness of ongoing mpox risks in the United States,” a Centers for Disease Control and Prevention (CDC) spokesperson told The Hill in a statement. 

“The ‘Summer of Pride’ Initiative for LGBTQI+ Events started in 2023, and will continue into 2024. It is being developed out of HHS’s Office of the Assistant Secretary for Health.  Planning is in the early stages." 

###

By Asif, Hassaan BS¹; McNeer, Jennifer L. MD, MS²; Ghanayem, Nancy S. MD, MS³; Cursio, John F. PhD⁴; Kane, Jason M. MD, MS

Research funded by The Portes Foundation.

Dr. Jason Kane, MD, MS is a Fellow of the Institute of Medicine of Chicago. 

OBJECTIVES: 

To characterize trends in noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) use over time in children with hematologic malignancy admitted to the PICU with acute respiratory failure (ARF), and to identify risk factors associated with NIV failure requiring transition to IMV.

DESIGN: 

Retrospective cohort analysis using the Virtual Pediatric Systems (VPS, LLC) between January 1, 2010 and December 31, 2019.

SETTING: 

One hundred thirteen North American PICUs participating in VPS.

PATIENTS: 

Two thousand four hundred eighty children 0–21 years old with hematologic malignancy admitted to participating PICUs for ARF requiring respiratory support.

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULTS: 

There were 3013 total encounters, of which 868 (28.8%) received first-line NIV alone (NIV only), 1544 (51.2%) received first-line IMV (IMV only), and 601 (19.9%) required IMV after a failed NIV trial (NIV failure). From 2010 to 2019, the NIV only group increased from 9.6% to 43.1% and the IMV only group decreased from 80.1% to 34.2% (p < 0.001). The NIV failure group had the highest mortality compared with NIV only and IMV only (36.6% vs. 8.1%, vs. 30.5%, p < 0.001). However, risk-of-mortality (ROM) was highest in the IMV only group compared with NIV only and NIV failure (median Pediatric Risk of Mortality III ROM 8.1% vs. 2.8% vs. 5.5%, p < 0.001). NIV failure patients also had the longest median PICU length of stay compared with the other two study groups (15.2 d vs. 6.1 and 9.0 d, p < 0.001). Higher age was associated with significantly decreased odds of NIV failure, and diagnosis of non-Hodgkin lymphoma was associated with significantly increased odds of NIV failure compared with acute lymphoid leukemia.

CONCLUSIONS: 

For children with hematologic malignancy admitted to the PICU with ARF, NIV has replaced IMV as the most common initial therapy. NIV failure rate remains high with high-observed mortality despite lower PICU admission ROM.

More>

###

Our story begins 160 years ago, during the Civil War era. Elizabeth Blackwell, MD, the first woman to earn a medical degree in the U.S., had graduated only 15 years earlier, in 1849. Blackwell was exceptional; most institutions at the time barred women from higher education and professional work. With a few exceptions, women largely couldn’t vote, take legal action, or own property. [Chicago Health]

Life looks vastly different for women in the U.S. now, though many states have banned access to sexual and reproductive medical care for women. And while more women are practicing medicine today, they remain devalued among their male counterparts by nearly every metric and measurement, including pay equity and leadership roles.

“Getting consultants and patients to believe that I, as a young woman, hold the same amount of knowledge as someone more senior-appearing and masculine-presenting is often challenging, regardless of how many times I assure them that I am indeed a physician,” says Nikki Alberti, MD, an emergency and internal medicine resident at the University of Illinois Chicago. “I truly believe that as the number of women in medicine continues to rise, this culture change will happen.”

More>

Department of Public Health Director Dr. Sameer Vohra made the case for his agency’s proposed budget for the next fiscal year during a recent public hearing. [Health News Illinois]

The $1.7 billion spending plan includes new funding for maternal health, a major upgrade to the department's public health data systems and additional regulatory staff.

That’s along with continued investments in HIV/AIDS mitigation, reproductive health access and pediatric mental health. 

“Our FY 25 budget builds upon our achievements and sets us on a path for a healthier Illinois,” Vohra told lawmakers. 

Gov. JB Pritzker prioritized maternal health in his budget address. He wants to send $4 million to IDPH for, among other things, grants for community-based birth centers. The budget also calls for $15 million in state funds to modernize the agency’s public health data systems to better prevent disease outbreaks and $6 million to hire 100 new healthcare facility surveyors.

###

The worried father stood watch throughout the night Monday as his 5-year-old suffered through a strong fever. He put rags on her forehead, forced her to drink sips of water and tried to calm her down. [Chicago Tribune]

The Venezuelan man said he had pleaded for help from staff that night at the city-run migrant shelter on Ogden Avenue where they are staying, but he was told he’d have to pay for the ambulance himself.

“Because I don’t have a work permit or any money, I didn’t have any way to pay for it,” said the man who didn’t want to share his name out of fear of being kicked out of the shelter for talking to reporters.

On Tuesday afternoon, he said his daughter tested positive for tuberculosis, apparently one out of a “small number” of confirmed tuberculosis cases in migrants at city-run shelters. 

More> 

###

Nirmatrelvir–ritonavir (Paxlovid [Pfizer]) is used as first-line therapy for nonhospitalized persons with Covid-191 on the basis of the results of the Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients (EPIC-HR) trial, which showed that this medication reduced the risk of hospitalization or death by 88%.2 The EPIC-HR trial enrolled adults who had not received a SARS-CoV-2 vaccine and who were at high risk for progression to severe Covid-19. Given those results, the question arose as to whether nirmatrelvir–ritonavir conferred a benefit in persons who had been vaccinated or who did not have risk factors for severe disease. [New England Journal of Medicine]

More> 

###

Poverty is among the most fundamental determinants of child well-being. Decades of rigorous studies illustrate its powerful and lasting effects on health and social outcomes.¹ Healthy and capable adults are foundational to any well-functioning society. Intergenerational poverty (in which low-income children remain low-income as adults) places a heavy burden on individuals, families, and society. Although child poverty decreased during the COVID-19 pandemic, it more than doubled recently due to expiration of multiple, wide-ranging federal relief programs,² demonstrating that policies to promote child well-being are effective at reducing poverty. Understanding the causes of intergenerational poverty and implementing programs/policies to reduce it would yield high payoffs for children and the nation. [JAMA Network] 

This Viewpoint summarizes a report from the National Academies of Science, Engineering, and Medicine (NASEM) released in September 2023 in response to a Congressional mandate to address intergenerational poverty.³ “Reducing Intergenerational Poverty” was written by an interdisciplinary committee of experts and practitioners. It tackles 4 tasks: (1) describing patterns of intergenerational economic mobility, (2) summarizing drivers of intergenerational poverty, (3) identifying policies/programs to reduce intergenerational poverty, and (4) highlighting high-priority gaps in data and research. Across these topics, the committee was encouraged to consider racial or ethnic disparities.

More>

###

Sendy Soto, a former official with the city’s Department of Housing and the co-chair of the housing committee in Johnson’s transition team, will take on the job next week. [WBEZ Chicago]

A leader in Mayor Brandon Johnson’s transition team was named Chicago’s first-ever chief homelessness officer on Monday.

Sendy Soto, a former official with the city’s Department of Housing and the co-chair of Johnson’s housing transition committee, will assume the role next week.

“My ask to each of you is simple: Share your ideas and hold me accountable,” Soto said Monday during the re-opening of an affordable housing complex in the Gold Coast. She officially starts next week.

“It is an immense honor to undertake this vital role on your behalf and gaining and keeping your trust is important to me.”

Among her first tasks will be developing a five-year plan in partnership with other city agencies to address the city’s homelessness crisis. But Soto did not offer up any specifics on how she would handle the issue.

Johnson created the position in October. It is funded by a grant from the Chicago Funders Together to End Homelessness.

Soto was a head of Johnson’s transition housing committee last year, which released a report during the summer that included recommendations for addressing and preventing homelessness. It set a goal of putting Chicago “on a path” to being a city “where housing is a human right,” though one of the steps — increase the real estate transfer tax and use the proceeds to address homelessness — was derailed when the Bring Chicago Home referendum was voted down last month.

More>

Food insecurity is a pervasive and persistent issue in the United States that disproportionately affects families with children and Black, Indigenous, and other people of color.¹ Food insecurity has been associated with psychological, cognitive, and behavioral health consequences in children, contributing to lifelong socioeconomic and health inequities.² Identifying pathways by which food insecurity affects children’s health is critical to informing intervention efforts to eliminate childhood food insecurity. We posit that toxic stress is a prominent pathway underlying food insecurity and children’s health and advocate for research, clinical, and policy approaches to better address the root causes of food insecurity and promote lifelong health. [JAMA Network]

Toxic stress refers to the biological response to experiencing a strong, frequent, or prolonged stressor without the buffering effect of a supportive environment. Risk factors of toxic stress have traditionally focused on adverse childhood experiences (ACEs) but have recently been expanded to include poverty, discrimination, and other chronic exposures.³ These experiences of adversity can lead to permanent changes in children’s brain structure and function, leading to impaired cognitive development, behavioral disorders, and sustained activation of the body’s stress responses, resulting in systemic inflammation and immune dysregulation.

More>

The majority of healthcare providers and payers are not ready to meet shifting health equity regulatory requirements, according to Ernst & Young's latest report. [Beckers Hospital Review]

To compile its "2024 Health Equity Outlook," the accounting firm surveyed 500 health equity leaders across stakeholder industries: providers, payers, life sciences, government, and nonprofit/community organizations. The respondent pool included 64 health systems, 14 physician groups, 11 hospitals, eight academic medical centers and three federally qualified health centers. Nearly 40% of respondents were directors, department leads or the equivalent, while 29% were C-suite executives and 28% were vice presidents. 

Most provider and payer respondents indicated that as of today, they could not meet health equity-related regulatory requirements introduced by CMS, the National Committee for Quality Assurance, The Joint Commission and the FDA last year. The new guidelines are multifaceted — asking hospitals to update various processes from data analytics to the C-suite — and the majority of providers say those upgrades are still a work in progress. 

The three new requirements that the most providers are able to meet today: improved language access (48% can meet this), a designated health equity executive leader (48%) and improved healthcare access (47%). However, the majority of providers are still developing or taking action on a defined plan to ensure future readiness — while a small percentage, 6% or less, report that they have no plan to meet each metric. 

More> 

###