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Trends in HIV infections, hurdles to RSV care, & are we talking too much about teen mental health?

May 24, 2023
Reporter, Morning Rounds Writer
Good morning. Today we have a decline in HIV infections, a correlation in Canada between neighborhood income and serious birth outcomes, and a look at why it might be challenging to get RSV vaccines and treatments to patients they're meant to help.

public Health 

HIV rates are declining more for some than others

There's good news in the latest CDC figures on HIV incidence in the U.S., but the 12% drop in new infections from 2017 to 2021 obscures some more discouraging findings. Young gay and bisexual men drove the decline among 13- to 24-year-olds, but disparities persist among Black and Latino boys and men. For white males of this age, the decline was 45%, compared with 36% for Hispanic or Latino and 27% for Black males. 

The rates mirror differences in who takes pre-exposure prophylaxis. While Black and Latino people account for the highest rates of new infections, they were prescribed PrEP at much lower rates than white people in 2021. In more hopeful news, transmission of HIV from mother to child has continued to decline and new infections dropped the most in the South, where rates of HIV infection are highest. Read more from STAT's Ambar Castillo.


health inequity

Moving to a higher-income neighborhood linked to fewer maternal and newborn deaths

Here's word from STAT's Usha Lee McFarling: It's well known that residing in a low-income neighborhood is detrimental to birth outcomes. A new analysis published yesterday in JAMA Network Open shows that people living in very low-income neighborhoods who moved to a higher-income neighborhood after their first pregnancy were less likely to die or lose their newborns during their second. The study of nearly 100,000 women was conducted in Ontario, Canada, where there is universal health care. 

The authors said more research was needed to understand the reasons for the improvements, which might include lower crime rates, more access to green space, cleaner air, healthier food, and less chronic stress. The authors called for more research to "determine whether financial incentives or enhancement of neighborhood factors can reduce adverse maternal and perinatal outcomes."


in the lab

Searching for the molecular mechanism of pain in someone who doesn't feel it

Scientists hoping to alleviate chronic pain are turning to someone who never feels pain at all, heals rapidly, and rarely feels anxiety or fear. You may have heard of Jo Cameron, a woman in Scotland who in 2013 experienced no pain from surgery on her hip or hand, a condition that leads to its own perils. Since then her rare genetic mutation, dubbed FAAH-OUT (seriously), combined with a more common mutation in the FAAH gene have been scrutinized for clues. 

A new study in Brain published yesterday says that when FAAH-OUT turns down the expression of FAAH, enzyme activity levels are significantly reduced in molecular pathways involved with pain, mood, and healing. The researchers applied genome-editing tools to cell lines, finding more than 1,000 other genes turned up or down, in hopes of future drug development. "The FAAH-OUT gene is just one small corner of a vast continent, which this study has begun to map," study author Andrei Okorokov said in a statement.



Closer Look

Protecting babies against RSV sounds like a miracle, but hurdles stand in the way

stat_522Maria Fabrizio for STAT

RSV can be a nightmare for infants, their parents, and hospitals. The respiratory infections are ubiquitous, but most damaging and sometimes deadly to the very young and the very old, who can't shrug their illnesses off as nasty colds. After years of research, vaccines and monoclonal antibody treatments are finally nearing the finish line of FDA approval, including a vaccine administered during pregnancy that protects babies in the first few months of life and an antibody injection to shield them in their first year.

But hurdles stand in the way of bringing the promise of these products to patients. The barriers aren't posed by the virus but by bureaucracy, health systems that don't interact with one another, and steep costs. And then there's the challenge of overcoming vaccine hesitancy in pregnancy. STAT's Helen Branswell explains.


public health

Autopsy rates continue their downward trend

Screen Shot 2023-05-23 at 2.42.09 PMNational Center for Health Statistics, National Vital Statistics System, Mortality

True confession: I am a faithful reader of obituaries (and recommend "The Dead Beat," an homage to obit writers). I'm fascinated by portraits of lives lived — and what ended them. Which may explain why this report on falling and changing autopsy rates caught my eye. For its analysis, the National Center for Health Statistics followed rates from 1972 through 1994 and from 2003 through 2020, blaming budgetary restrictions for the gap and changes in hospital accreditation standards for the overall decline. 

By 2020 — the first Covid year — autopsies hit a low of 7.4% of deaths. In the more recent period, rates were highest for people age 15 to 24 and for causes such as homicide (98.7%). There were other differences: In 1972, 79% of autopsies were performed for deaths due to diseases and 19% for external causes such as assault. By 2020, 37% of autopsies were performed for diseases and 60% for external causes.


mental health

Opinion: Maybe we're talking about teens' mental health too much, not too little

Enough with the awareness campaigns, already? It's a serious question, asking if weeks and months devoted to mental health are permeating young people's consciousness to a harmful degree. The campaigns' motivation is noble, grounded in the idea that people must identify mental health problems before treatment can be effective. But does it work? Maybe not, psychologist Lucy Foulkes writes in a STAT First Opinion. She cites a British study showing that while campaigns improved attitudes toward people with mental illness and encouraged them to seek help, it's not clear they got what they needed, thanks to long wait lists.

Foulkes offers a provocative interpretation: "Some of these people are seriously unwell and badly need help," she writes. But "I think the current conversation about mental health might be encouraging people to interpret their difficulties as mental health problems when they're not, in a way that's actively unhelpful for the individual." Read more


If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.


This week on the "First Opinion Podcast," First Opinion editor Torie Bosch talks with Sanjay Basu about "screen and refer" systems and how to bring a bit more humanity back to health care. Listen here.


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What we're reading

  • From birth to death: Black Americans and a lifetime of disparities, Associated Press
  • Sought out by science, and then forgotten, New York Times
  • Opinion: Will AI soon diagnose politicians' mental health conditions from afar? STAT
  • Learning to treat long COVID could help those struggling with chronic fatigue syndrome, too, Boston Globe
  • Achieve Life Sciences drug helps smokers quit in trial but would face stiff competition if approved, STAT

Thanks for reading! More tomorrow,


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