Monday, May 13, 2024

Food-as-medicine effort at UK gets a boost from new endowment

Alison Gustafson (UK photo by Sabrina Hounshell)
By Christopher Carney

One of the first two Gatton Foundation endowed professors at the University of Kentucky is Alison Gustafson, who directs the Food as Health Alliance. The endowment, from a $100 million gift by the late Bill Gatton, will provide funds to developing and expanding food-as-medicine programs across the state.

The money will help build capacity for health-care providers to get key services for diet-sensitive patients who are at risk of food insecurity. Gustafson is also developing and expanding community partnerships, offering approved food-as-medicine programs to those who qualify, and building a referral and network hub that will give patients a connection to services regardless of location. 

“Our team will be conducting expansion efforts for screening and referral, capacity building among community groups, outreach, UK Cooperative Extension training and research projects to better serve Kentuckians experiencing food insecurity,” Gustafson said. 

Gustafson is a professor in the Department of Dietetics and Human Nutrition in the Martin-Gatton College of Agriculture, Food and Environment and the College of Nursing. Under terms of the gift from the Bill Gatton Foundation, distinguished faculty get resources to continue meaningful research, extension and instructional programs related to advancing UK’s land-grant mission. 

The Food as Health Alliance was launched at UK in 2023 to boost health and well-being in the state through the combined application of agricultural, medical, and nutritional resources. Gustafson works to bring together clinical and community research to address the dual challenges of food insecurity and diet-related chronic diseases that many Kentuckians face.

Gustafson earned a doctoral degree in nutrition epidemiology from the University of North Carolina and a master's degree in public health from Boston University. As a master's student, she spent a year in Zimbabwe working with AIDS orphans. She has worked in local and state health departments, focusing on community health for disadvantaged populations. 

The other Gatton endowed chair, Tiffany Messer, will get support for student training and success, water-quality needs assessments, and low-cost water-quality treatment options. She is an associate professor of biosystems and agricultural engineering in the college.

Health-care industry is most at risk from cyberattack, study says

Health care is increasingly more at risk of cyberattacks than other industries, according to a recent study by Soax, a data-collection platform, reports Cara Smith of Inside Health Policy.

As cyberattacks against Change Healthcare and Ascension, a 19-state hospital system, "disrupted the health-care industry, lawmakers, doctors, payers and other stakeholders are scrambling to prevent future cyberbreaches to protect the health-care system," Smith reports.

"The health-care industry is the most vulnerable sector, topping the ranking with 809 data-violation cases in 2023. This is a staggering surge in incidents from the prior year, with cases totaling 343 in 2022 -- a 136% increase, the study found. Further data revealed that these cases affected 56 million victims."

For the study, Soax used data from the Identity Theft Resource Center, and it says "the health-care industry should be on high alert," Smith reports.

May is Bladder Cancer Awareness Month, and Kentucky ranks high; UK doctor explains it, and how to detect and manage it

Illustration by irkus Creative, iStock/Getty Images Plus
By Dr. Zin W. Myint
University of Kentucky

Kentucky has one of the highest rates of new cancers in the U.S., with bladder cancer in the top 10 list of new diagnoses. Understanding the signs, risk factors and preventive measures is important for early detection and management.

What are the symptoms and signs? The most common symptom of bladder cancer is the presence of painless blood in urine. If you notice blood in your urine, don't ignore it and go to your doctor right away. Other signs to look out for are more frequent urination and an increased urge to urinate, especially accompanied by pain or discomfort. Persistent pain in the lower back or pelvic region that only gets worse over time is also a symptom.

What can increase the risk of developing bladder cancer?
  • Smoking is the biggest risk factor. Tobacco smoke contains many harmful chemicals that can damage the bladder lining, increasing the risk of developing cancer.
  • Exposure to certain industrial chemicals such as paint, dye, metal processing and petroleum products.
  • Family history and genetics. If your family has a history of bladder cancer, you should be tested if you notice any of the symptoms above.
  • Some chemotherapy drugs and medications are linked to bladder cancer increased because they can irritate the bladder.
  • Environmental factors, including drinking water contaminated with arsenic.
  • Chronic urinary tract infections may contribute to bladder cancer development as chronic inflammation causes damage to the protective layer of cells lining the bladder.
  • A personal history of bladder cancer is also a risk factor, due to its high recurrence rate.
  • Other risk factors include chronic indwelling urinary catheter or history of radiation to the pelvic area.
Is there a screening for bladder cancer? We do not screen for bladder cancer in the general population because current studies do not show sufficient benefit.

How can you reduce risks? Reducing the risk of bladder cancer stars with adopting healthy lifestyle choices and minimizing exposure to known risk factors:
  • Quitting smoking is one of the most effective ways to reduce the risk of bladder cancer, creating a healthy bladder lining. We highly advocate for smoking cessation, and individuals who smoke should be actively encouraged to pursue cessation treatments, which may include medication and counseling. It is advisable to engage in discussions with your healthcare provider to explore effective methods for quitting smoking and receive personalized support tailored to your needs.
  • Minimize or avoid chemical exposure and take safety precautions when working with chemicals that are known to be harmful. For instance, remember to wear gloves while using potent cleaning agents at home as numerous chemicals can permeate the skin. If you’re employed in a refinery setting, prioritize the use of protective gear. Similarly, if you’re a painter, ensure to work within well-ventilated areas to minimize exposure to potentially harmful substances.
  • Stay hydrated. Drinking plenty of water throughout the day is vital for maintaining bladder health, reducing the risk of urinary tract infections, and facilitating the swift elimination of toxins from your system.
Zin W. Myint, M.D., is a medical oncologist at UK Markey Cancer Center.

Sunday, May 12, 2024

Falling immunization rates pose threats to Kentucky and the rest of nation; immunization climate remains 'turbulent,' observer says

Foundation for a Healthy Kentucky photo
By Melissa Patrick
Kentucky Health News

The immunization crisis in Kentucky is not just a Kentucky issue, but is happening nationwide.

"It's not going to take long before we see the effects of falling rates of immunizations. We're seeing some decrease across the board, again, from coast to coast, border to border," said Dr. Christopher Bolling, who represented the Kentucky Chapter of the American Academy of Pediatrics on a May 8 webinar hosted by the Foundation for a Healthy Kentucky titled “Tackling the Immunization Crisis.”

Bolling said many people have a "false view" that nothing will happen because of these falling immunization rates because it's been so long since we've seen the illnesses that they protect against.

As a recent example, on May 7, the Lexington-Fayette County Health Department reported another cases of pertussis, or whooping cough. It was the city's third case since late April. Since April 1, cases have also been confirmed in Boyd, Jessamine, Logan, Pulaski and Warren counties.

Brice Mitchell, spokesperson for the state Cabinet for Health and Family Services, told Kentucky Health News that there were 84 confirmed cases of pertussis in Kentucky in 2023, and 32 confirmed so far in 2024 -- about the same rate, but dependent on confirmations that may be delayed.

Looking forward during the webinar, Bolling said it's important to not let the controversies surrounding the Covid-19 vaccine influence people's decisions to get vaccinated against other diseases.

"We really do not want to see it start affecting other vaccines as well," he said. 

Looking at Kentucky's vaccination rates, he said that with the exception of young children's diphtheria, tetanus and pertussis vaccines, Kentucky's vaccination rates are lower than the national averages. 

In particular, Bolling pointed to Kentucky's low measles-mumps-rubella vaccination rate. He said Kentucky's rate is 90.1%, the national rate is 93.1% and the level to achieve herd immunity is 95%. 

"So we are susceptible," he said. Herd immunity is the level needed to protect people who can't or won't be vaccinated for various reasons.

Bolling offered suggestions for health-care providers and others for how to talk to people about immunizations and fight misinformation. He said it's important to always remember that behavior changes must be self-motivated.

"The choices they make are going to be based on their own values, their own standards, and their own understanding," he said. "So you really want to evoke within them things that are going to help them make good decisions." 

Kelly Taulbee, director of communications and development at Kentucky Voices for Health, called the current climate around immunizations a "turbulent space." 

"Something to keep in context is you have entire families that don't talk to each other anymore, friends that have lost connection simply because of the positions they took during the pandemic on immunizations," she said. 

Taulbee stressed that the importance of keeping an eye on policies that would hurt the state's immunization rates, pointing to eight bills that were filed in the 2024 legislative session that did not pass. 

Jessy Sanders, health communicator program manager for the Kentucky Rural Health Association's Immunize Kentucky Coalition, announced their upcoming events. Symposiums will be held in Hazard May 17, Somerset Aug. 8 and Paducah Aug. 23, and the 2024 Immunization Summit will be held Oct. 9. 

AMA president-elect, from Louisville, lays out his ideas for getting more physicians in rural areas, reforming prior authorization

By Melissa Patrick
Kentucky Health News

With about 46 million people in the U.S. living in rural areas and new research showing they are more likely to die early from the five leading causes of death than their urban counterparts, the American Medical Association is sounding the alarm. 

AMA President-elect Bruce Scott (AMA photo)
"Rural health is America's health," Dr. Bruce Scott of Louisville, AMA president-elect, told reporters in a May 9 press conference in conjunction with the National Rural Health Association annual conference in New Orleans. "We need policymakers to understand that the American Medical Association is deeply concerned about the ever-widening health disparities between urban and rural communities. disparities that are at the root of why rural Americans suffered disproportionately high rates of heart disease, cancer, stroke, respiratory illness, diabetes, and unintentional injuries." 

Scott, who is board-certified in both otolaryngology and facial plastic surgery, served as the Kentucky Medical Association's president in 2018-19. He will become AMA president in June. 

Scott pointed to several environmental, economic and social factors factors that put people who live in rural communities at a higher risk of death from these often preventable conditions. But the AMA's focus, he said, is on the health-care worker and the physician shortage and how this affects rural people's health. 

He added that these shortages are hitting rural areas the largest and are "creating health-care trends that are simply unacceptable. We need to reverse these trends for all individuals to live a long, healthy and active life."

Scott said rural areas have about 30 physician specialists for every 100,000 residents, compared to 236 per 100,000 in urban communities, and he noted that more than 130 rural hospitals closed from 2010 to 2021, with many more on the verge of closing today. 

Also, he said that in 2023, 65% of rural communities had insufficient access to primary-care physicians, including pediatricians. And, he said there are not enough residency spots to train doctors in rural areas. 

"History has shown us that residents, 80% of the time, tend to wind up practicing within 80 miles of where they've done the residency," Scott said. "So residency location becomes very important. In addition, medical schools are receiving fewer and fewer applicants from individuals from rural areas."

Call for Medicare reform

Scott said the AMA is working to build a stronger physician workforce, which he said starts with supporting physicians who are already in practice, to keep them practicing.

"AMA is focused on fixing the systemic issues of our health-care system that are known to be driving physician burnout, and contributing to early retirement and physicians leaving practice altogether," he said. "Highest among these problems are the broken Medicare physician payment system and the administrative burdens." 

The problem, said Scott, is that Medicare payments to doctors are not keeping up with inflation. He said that when adjusted for inflation, the payment rate to physicians has dropped 29% since 2001, and private payers and other insurers have linked their payments to the Medicare structure. 

"We need a system that is sustainable, predictable, and provides at least an annual inflation update that encourages patients choice rather than consolidation," he said. "We need Congress to act." 

Administrative burdens

Scott said physicians spend two hours on administrative work for every one hour with patients, contributing to burnout and hindering patient care. 

A key contributor to this is "prior authorization," which requires a physician to get approval from a third-party payer for care that the physician and patient have agreed on before it can be implemented.  

"On average, physicians complete 45 prior authorizations per week and it's even worse in primary care," Scott said. "The prior authorization process is overused, overly burdensome and wastes physicians' time. But I'm even more concerned about the fact that prior authorization hurts patients." 

He added, "We need Congress and payers and the administration to respond, because the result is that physicians are getting burned out and they're leaving practice, not because they don't want to practice medical care anymore, but because the system is making it more and more difficult for them to care for their patients." 

During the 2024 legislative session, Rep. Kim Moser, R-Taylor Mill, again filed a bill to address the prior authorization issue in Kentucky, but health insurers blocked it. It would have exempted from the process health-care providers who have had 90% or more of their claims approved. 

Scott said the AMA is "fighting for legislation fixes" to increase incentives for physicians to work in rural areas, to expand the number of residency spots, particularly in primary care and in rural areas, to make the pandemic's telehealth flexibilities permanent, and to allow qualified international medical graduates to keep practicing in America. 

Asked about the role of advanced-practice registered nurses and physician assistants to help increase access to care in rural areas, Scott said that "there is absolutely" a role for these "physician extenders" in a physician-led team model. 

"The AMA believes strongly in the concept of a physician-led medical team, where every component of the team is working to the highest level of their knowledge base and their experience," he said. "Now, we're not in favor of independent practice for nurse practitioners or PAs. We think that patients, no matter what ZIP code they happen to live in, deserve care by a physician." 

Saturday, May 11, 2024

Most Kentucky hospitals in national patient-safety ratings got 'C' grades again; state is 35th in share of hospitals with 'A' ratings

By Melissa Patrick
Kentucky Health News

Most of the Kentucky hospitals graded on a nonprofit group's twice-a-year report card for patient safety again got a C in the latest report. 

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small, so they are not rated by Leapfrog; it rated 62 Kentucky hospitals.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave 'A' ratings to 10 Kentucky hospitals; Kentucky's percentage of A grades, 16.4%, ranked it 35th among states. That was up two slots from the last report, when it ranked 37th. Leapfrog gave Bs to 19 Kentucky hospitals, Cs to 27 and Ds to 5.  

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections. 

The spring 2024 report showed 92% of U.S. hospitals have seen improvements in at least one of three infections associated with hospitals. Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 30%, central line-associated bloodstream infections decreased by 34% and catheter-associated urinary tract infections decreased by 30%. This good news comes after a six-year high for those infections was reported in the fall 2022 report. 

"While today’s results are promising, patient safety remains a crisis-level hazard in health care. Some hospitals are much better than others at protecting patients from harm, and that’s why we make the Hospital Safety Grade available to the public and why we encourage all hospitals to focus more attention on safety,” Leah Binder, president and CEO of The Leapfrog Group, said in a news release. 

She added, "According to a summary of peer-reviewed research published in British Medical Journal, an estimated 250,000 people a year die of preventable errors and infections in hospitals, which makes patient safety problems the third leading cause of death in the United States." 

The spring 2024 report also showed some improvements on patient experience measures compared to fall 2023. The release notes that these measures worsened during the pandemic and have still not returned to pre-pandemic levels. These measures look at things that have a direct impact on patient safety outcomes, including nurse communication, doctor communication, hospital staff responsiveness, communication about medicine and discharge information. 

"Patient experience is very difficult to influence without delivering better care," Binder said, "so these findings are encouraging."

The Leapfrog site offers details on the measures for each hospital under the heading Infections. It also provides detailed information under headings titled Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. The information is provided in an easy-to-read, color-coded scale that indicates how the hospital is performing.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation.

Top Scores

Hospitals getting As were Baptist Health La Grange, Baptist Health Lexington, Deaconess Henderson Hospital, Georgetown Community Hospital, Meadowview Regional Medical Center in Maysville, the Medical Center at Bowling Green, Saint Joseph-London, St. Elizabeth Healthcare-Edgewood, T.J. Samson Community Hospital in Glasgow, and TriStar Greenview Regional Hospital in Bowling Green.  

Screenshot of page for Georgetown Community Hospital
Georgetown Community Hospital received an A after getting six consecutive Cs.

Baptist Health Lexington has received an A grade for 13 consecutive grading periods. Deaconess Henderson moved up from a B grade in the fall 2023 report. The rest in this top group also received As in the fall. 

Shifts up and down

Four Kentucky hospitals moved down to a B after getting an A on the last report, including Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital and Norton Women's & Children, all in Louisville. 

Five Kentucky hospitals moved up to a B after getting a C on the last report, including Baptist Health Deaconess Madisonville, Baptist Health Richmond, Harrison Memorial Hospital in Cynthiana, Middlesboro ARH Hospital and the University of Kentucky Albert B. Chandler Hospital

Other hospitals with B grades are Baptist Health Louisville, Baptist Health Paducah, Clark Regional Medical Center in Winchester, Owensboro Health Muhlenberg Community Hospital in Greenville, Saint Joseph East in Lexington, St. Elizabeth Healthcare-Fort Thomas, St. Elizabeth Healthcare-Florence, U of L Health Shelbyville Hospital, UK HealthCare Good Samaritan Hospital and Blanchfield Army Community Hospital in Fort Campbell. 

Five Kentucky hospitals moved up from a D to a C: Hazard ARH Regional Medical Center, Jackson Purchase Medical Center in Mayfield, Jewish Hospital in Lexington, Kentucky River Medical Center in Jackson and UofL-Sts. Mary and Elizabeth Hospital

Three hospitals moved down from a B to a C: Kings Daughters Medical Center in Ashland, Monroe County Medical Center in Tompkinsville and Whitesburg ARH Hospital

The remaining 19 hospitals with a C all got Cs on the last report card too. 

Taylor Regional Hospital in Campbellsville moved down from a C to a D and Jennie Stuart Health in Hopkinsville moved up to a D after being the only hospital in the fall 2023 report to get an F. 

Other hospitals with D grades are Highlands ARH Regional Medical Center in Prestonsburg, Murray-Calloway County Hospital and Pikeville Medical Center

No Kentucky hospitals got an F on this report. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded. 

Online vision retailer Warby Parker will pay Ky. civil penalty for letting 69 Kentuckians to take its online vision test, illegal in Ky.

Image on Warby Parker's "Get a Prescription" page
Kentucky Health News

Warby Parker, an online retailer of prescription glasses, contact lenses and sunglasses, has agreed to pay at least $55,200 to the Commonwealth of Kentucky for allowing 69 Kentuckians to take its online vision test, contrary to state law, Attorney General Russell Coleman's office said in a news release Friday.

Coleman's office alleged that from July to October 2021, 69 Kentuckians were improperly given Warby Parker’s online test. "When the attorney general’s Office of Consumer Protection alerted Warby Parker of the problem, the company cooperated with the investigation and took the test offline," the release said. "Following a voluntary settlement process, Warby Parker will be penalized $138,000. If there are no further violations for five years, the amount will be reduced to $55,200."

The "Get a Prescription" page on Warby Parker's website says the online vision test is available to people who "reside in an eligible state, due to state-level regulations," and disqualifies residents of Alaska, Connecticut, the District of Columbia, Georgia, Idaho, Kentucky, New Mexico, South Carolina, South Dakota, Washington and West Virginia, using their two-letter postal abbreviations.

Kentucky consumers may complain about a business operating in the state to Coleman’s office at https://www.ag.ky.gov/Resources/Consumer-Resources/Consumers/Pages/Consumer-Complaints.aspx.

Friday, May 10, 2024

17 Ky. schools have free online mental health wellness course

Kentucky Health News map; for a larger version, click on it
More than 1,500 students in 17 Kentucky schools recently gained access to a free digital course on mental wellness, provided by the Medicaid program of Anthem Inc., one of the health insurers that manages the federal-state health program in Kentucky.

"The announcement comes during Mental Health Awareness month and as more adolescents, especially girls, report depressive symptoms," notes Sarah Ladd of the Kentucky Lantern.

The 17 schools in the program are Clay County Middle School, Daviess County High School, Estill County High School, Grant County Middle School, Graves County High School, Grayson County Middle School, Hazard Middle School, Henderson County High School, Bazzell Middle School in Allen County, Jenkins Independent School in Letcher County, Lewis County Central Elementary School, Marion County High School, Murray Middle School in Calloway County, Ohio County Middle School, Owensboro Middle School, Russell High School in Greenup County and Webster County High School.

The program has been launched in these schools and will continue into the 2024-25 academic school year, according to Quin Welch, media contact for Anthem Medicaid.

Understanding Mental Wellness” is a course for students in grades 8, 9 and 10. It has six 15-minute lessons, according to Blackbaud, the digital-services firm that designed the course. 

Anthem says the course exposes students “to the experiences of others in order to develop awareness and empathy, reduce stigma, and provide facts on the prevalence and symptoms of mental health conditions.”

Students then “explore their own mental health, identify challenges they may face, and develop concrete strategies for managing those challenges while increasing their awareness of resources and empowering them with the knowledge, skills, and language necessary to identify and support a peer in need or at risk.”

Ladd reports, "Online previews of the course show a tour of mental health through the program, starting with a lesson on what mental health is and ending with the chance to create a personal wellness plan.

"Since the onset of Covid-19, mental health has worsened. In 2021, the Centers for Disease Control and Prevention found that sadness and hopelessness had increased from pre-pandemic levels, especially for teen girls. In 2017, 41% of female high school students and 21% of male high school students felt sad or hopeless. By 2021, those statistics were at 57% and 29%, respectively."

“Young people need resources and education from trusted sources to protect their mental health,” said Leon Lamoreaux, market president for Anthem Medicaid. He said the program “will help us reach students from all over the Commonwealth and equip them with tools and strategies that will make a positive difference in their lives for years to come.”

Tom Davidson, the CEO of Everfi, said the goal of the program is to help “those who are impacted by mental-health challenges, those who want to build and maintain positive mental health and those who have the opportunity to positively impact the mental health of a friend or peer.”

Thursday, May 9, 2024

Parkinson's disease: Its symptoms, causes and management

Photo illustration by Pornpak Khunatorn, iStock/Getty Images Plus
By Dr. Zain Guduru
University of Kentucky

Parkinson's disease is a progressive neurological disorder that affects movement. Named after Dr. James Parkinson, who first described it in 1817, this condition currently affects millions of people worldwide. While there is no cure for Parkinson's disease, understanding its symptoms, causes and management strategies can significantly improve the quality of life for those living with the condition.

What is Parkinson's disease? PD primarily affects the brain's nerve cells responsible for producing dopamine, a neurotransmitter involved in movement regulation. As these cells degenerate or become impaired, dopamine levels drop, leading to the characteristic symptoms of PD.

Symptoms of Parkinson's disease:
  • Tremors: Involuntary shaking, usually starting in the hands or fingers.
  • Bradykinesia: Slowed movement and difficulty initiating movement.
  • Muscle rigidity: Stiffness in the limbs or trunk, causing difficulty with movement.
  • Postural instability: Impaired balance and coordination, leading to falls.
  • Non-motor symptoms: These can include depression, anxiety, cognitive changes and sleep disturbances.
Causes of Parkinson's disease: The exact cause of PD remains unknown, but it's believed to involve a combination of genetic and environmental factors. Some potential factors that may contribute to the development of PD include:
  • Genetic mutations: Certain genetic mutations have been linked to an increased risk of Parkinson's disease.
  • Environmental factors: Exposure to toxins like pesticides, herbicides and heavy metals may increase the risk.
  • Age: The risk of Parkinson's disease increases with age, typically affecting individuals over the age of 60.
  • Brain changes: Abnormal protein deposits in the brain, such as alpha-synuclein, are associated with Parkinson's disease.
Managing Parkinson's disease: While there is no cure for PD, several treatment options can help manage its symptoms and improve quality of life:
  • Medications: Dopamine replacement medications, such as levodopa, can help alleviate motor symptoms.
  • Physical therapy: Exercise programs designed to improve flexibility, balance, and mobility can be beneficial.
  • Speech therapy: Speech therapists can help with communication difficulties often associated with Parkinson's disease.
  • Deep brain stimulation: In advanced cases, DBS surgery may be an option to help control motor symptoms.
  • Lifestyle modifications: Eating a balanced diet, staying physically active, and managing stress can all contribute to better symptom management.
Parkinson's disease is a complex condition that requires a multidisciplinary approach to management. While there is no cure, early diagnosis and appropriate treatment can significantly improve the quality of life for individuals living with PD. By raising awareness, supporting research, and implementing effective management strategies, we can work towards a better understanding and treatment of Parkinson's disease.

Zain Guduru, M.D., is a neurologist with the Kentucky Neuroscience Institute and assistant professor in the University of Kentucky College of Medicine.

Tuesday, May 7, 2024

Stomach cancer: How to recognize the signs and reduce your risk

Illustration by peterschreiber.media via iStock/Getty Images Plus
By Dr. Joseph Kim
University of Kentucky

While stomach cancer was in the headlines not long ago with the sudden death of musician Toby Keith, the diagnosis is relatively rare. Stomach cancer now accounts for 1.4% of new cancer cases in the U.S., down from nearly 10% from 30 years ago.

With an average age at diagnosis of 68, stomach cancer is more common among older individuals. But it can happen to anyone, so it’s important to understand its symptoms, risk factors and steps you can take to lower your risk.

What are the signs and symptoms of stomach cancer? Early stage stomach cancer often has no symptoms. As the cancer progresses, patients may experience abdominal pain or discomfort, feeling bloated or full after eating small amounts, nausea or vomiting, unexplained weight loss, blood in the stool and difficulty swallowing.

What causes stomach cancer? There are not always clear risk factors for developing stomach cancer, but some factors tend to be associated with the onset of the disease. These include:
  • Heavy consumption of smoked, salted and processed meats
  • A diet low in fruits, vegetables and fiber rich foods
  • Smoking tobacco
  • Being overweight or obese
Other risk factors include gastroesophageal reflux disease (GERD), a family history of stomach cancer, Epstein-Barr virus and H. pylori bacterial infection.

What can I do to reduce my risk? While there is no guaranteed way to prevent stomach cancer, you can lower your risk by:
  • Eating a balanced diet with plenty of fruits, vegetables and whole grains. Limit processed meats and smoked or salty foods.
  • Maintaining a healthy weight through diet and exercise
  • Quitting smoking and limiting alcohol consumption
Can I get screened for stomach cancer? Routine screening isn't currently recommended for everyone. But if you have certain risk factors, like H. pylori infection or a family history of stomach cancer, talk to your doctor about screening options like upper endoscopy or blood tests.

While treatments have progressed in recent years, the five-year relative survival rate for stomach cancer is 35.7%. Early detection can make all the difference for better treatment outcomes, so don't hesitate to reach out to your health care provider if you experience any symptoms or have risk factors that warrant screening.

Joseph Kim, M.D., is a surgeon at the UK Markey Cancer Center.

Sunday, May 5, 2024

Kentucky Center for Smoke-Free Policy honors communities, groups and individuals who help create smoke-free communities

The Kentucky Center for Smoke-Free Policy at the University of Kentucky and the Kentucky Department for Public Health’s Tobacco Prevention & Cessation Program honored communities, groups and individuals from across the state who are leading the way to enact smoke- and tobacco-free policies at the 2024 Kentucky Tobacco Control Conference held April 23-24 in Lexington. 

“While tobacco use has decreased across the general population, disparities persist by geographic location, socioeconomic status, race, ethnicity, sexual orientation, gender identity, disability status, and mental health status,” Amanda Bucher, director of tobacco policy research and outreach in the College of Nursing at UK, said in a news release. “This is in part due to the tobacco industry’s targeted marketing of these populations. Our vision for a tobacco-free Kentucky must promote health equity and eliminate these disparities.”

Sydney Shaffer, the 2024 Smoke-free Youth
Advocate of the Year, poses with Lexington
Mayor Linda Gorton. (Photo by Tim Webb)
Sydney Shaffer, a high-school student from Scott County, received the Smoke-free Youth Advocate Award for excellence in promoting smoke-free policy and education about secondhand smoke. Shaffer has advocated for lung-health policies and youth-vaping prevention since losing her grandfather to lung cancer. She has spoken to policymakers about the importance of tobacco control policies at the local, state and national levels.

The Northern Kentucky towns of Corinth and Highland Heights received the Everette Varney Smoke-free Indoor Air Excellence Award for their "exceptional leadership" and collaborative efforts in promoting the health of their citizens by enacting comprehensive smoke-free workplace ordinances.

Dr. Timothy W. Mullett, medical director of UK's Markey Cancer Center Network, received the Lee T. Todd Jr., Smoke-free Hero Award for his courage, leadership, perseverance, and continuous commitment to smoke- and tobacco-free environments in the face of adversity.

Centre College received the Tobacco Free Campus Award for its exceptional leadership and collaborative efforts in promoting healthy campus environments by implementing a tobacco-free campus last year.

Jelaine Harlow, health-education coordinator for the Lake Cumberland District Health Department, received the Ellen J. Hahn Lifetime Achievement in Tobacco Control Award for an exceptional life devoted to leadership in advocacy and public service contributions in tobacco control.

Jessica L. Burris, UK Department of Psychology and Markey Cancer Center received the Timothy W. Mullett M.D. Lung Cancer Prevention Award for her leadership, devotion, and passion toward preventing lung cancer through policy change in tobacco control.

Dr. Michael Gieske, diredctor of lung-cancer screening at St. Elizabeth Healthcare in Northern Kentucky, received the David B. Stevens M.D. Smoke-free Advocate of the Year Award for excellence in promoting secondhand smoke education and smoke-free policy.

The event was also sponsored by UK Healthcare, the Kentucky Health Collaborative, the Kentucky Asthma Management ProgramAetna Better Health of Kentucky, the Kentucky Office of Community Health WorkersAppalachian Regional Healthcare, the Kentucky COPD ProgramCHI Saint Joseph Health and Kentucky Voices for Health, a coalition of health-advocacy organizations.

Friday, May 3, 2024

2% fewer Ky. children were on Medicaid a year after pandemic re-enrollment began; total enrollment, including adults, dropped 9.5%

Top half of Georgetown University table, adapted by Ketucky Health News; to enlarge, click on it.
By Melissa Patrick
Kentucky Health News

Medicaid enrollment of Kentucky's children fell 1.6 percent since the continuous-coverage protections of the pandemic were lifted last year. That was one of the smallest declines in the nation.

Coverage of U.S. children fell 10% in the "unwinding" process, says the report from the Georgetown University Center for Children and Families, based on data from the Centers for Medicare and Medicaid Services.

Kentucky hasn't started the re-enrollment process for children yet because, unlike most states, it worked with the federal government to delay the restart of renewals for children until this September. So did North Carolina.

"The story of Georgetown's report is an incredible good news story that speaks to how well Kentucky did things for kids," said Priscilla Easterling, outreach coordinator for Kentucky Voices for Health, a coalition of health-care advocacy groups.

Nationwide, 4.16 million children were dropped from from Medicaid and the Children's Health Insurance Program, and most would likely still be eligible, says the report. The numbers do not reflect individual children, but the change in total enrollment, which fluctuates from month to month for various reasons.

In Kentucky, 10,477 fewer children were covered than the 648,865 who were enrolled in either Medicaid or KCHIP before the unwinding -- the gradual resumption of annual Medicaid coverage renewals. Renewals in Kentucky began in April 2023.

Overall, Kentucky's Medicaid rolls have declined 9.5 percent in the last year. The number enrolled in April was 1,561,400. County-by-county figures are available from the Cabinet for Health and Family Services.

Cabinet spokesperson Brice Mitchell told Kentucky Health News in an email that Kentucky was the first state to request and get approval to automatically grant children 12 months of continuous coverage, without needing to go through a renewal during the unwinding. 

"The state sought this flexibility to ensure our children kept access to the coverage they need and deserve," Mitchell said. 

The only way a child may be disenrolled during the 12-month continuous coverage period is if the child turns 19, a parent or guardian requests disenrollment, or if the child moves out of state, Mitchell said. 

Easterling said it is expected that the children's renewal period that begins in September will go smoothly since the state will have already processed the adult renewals. 

She also noted that it would be great if the state took advantage of an existing program that would allow continuous coverage for children up to age 3 as some other states have done.  

"We know that kids losing coverage and being uninsured negatively impacts their health and their family's finances, with the risk of big medical bills . . . that a family can't afford to pay," Easterling said.

Bird flu is bad for livestock; it's not a dire threat to most of us - yet

Getty Images
By Amy Maxmen
KFF Health News

Headlines are flying after the U.S. Department of Agriculture confirmed that the H5N1 bird flu virus has infected dairy cows around the country. Tests have detected the virus among cattle in nine states, mainly in Texas and New Mexico, and most recently in Colorado, said Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention, at a May 1 event held by the Council on Foreign Relations.

A menagerie of other animals have been infected by H5N1, and at least one person in Texas. But what scientists fear most is if the virus were to spread efficiently from person to person. That hasn’t happened and might not. Shah said the CDC considers the H5N1 outbreak “a low risk to the general public at this time.”

Viruses evolve and outbreaks can shift quickly. “As with any major outbreak, this is moving at the speed of a bullet train,” Shah said. “What we’ll be talking about is a snapshot of that fast-moving train.” What he means is that what’s known about the H5N1 bird flu today will undoubtedly change.

With that in mind, KFF Health News explains what you need to know now.

Who gets the bird flu? Mainly birds. Over the past few years, however, the H5N1 bird flu virus has increasingly jumped from birds into mammals around the world. The growing list of more than 50 species includes seals, goats, skunks, cats, and wild bush dogs at a zoo in the United Kingdom. At least 24,000 sea lions died in outbreaks of H5N1 bird flu in South America last year.

What makes the current outbreak in cattle unusual is that it’s spreading rapidly from cow to cow, whereas the other cases — except for the sea-lion infections — appear limited. Researchers know this because genetic sequences of the H5N1 viruses drawn from cattle this year were nearly identical to one another.

The cattle outbreak is also concerning because the country has been caught off guard. Researchers examining the virus’s genomes suggest it originally spilled over from birds into cows late last year in Texas, and has since spread among many more cows than have been tested. “Our analyses show this has been circulating in cows for four months or so, under our noses,” said Michael Worobey, an evolutionary biologist at the University of Arizona in Tucson.

Is this the start of the next pandemic? Not yet. But it’s a thought worth considering because a bird flu pandemic would be a nightmare. More than half of people infected by older strains of H5N1 bird flu viruses from 2003 to 2016 died. Even if death rates turn out to be less severe for the H5N1 strain currently circulating in cattle, repercussions could involve loads of sick people and hospitals too overwhelmed to handle other medical emergencies.

Although at least one person has been infected with H5N1 this year, the virus can’t lead to a pandemic in its current state. To achieve that horrible status, a pathogen needs to sicken many people on multiple continents. And to do that, the H5N1 virus would need to infect a ton of people. That won’t happen through occasional spillovers of the virus from farm animals into people. Rather, the virus must acquire mutations for it to spread from person to person, like the seasonal flu, as a respiratory infection transmitted largely through the air as people cough, sneeze, and breathe. As we learned in the depths of covid-19, airborne viruses are hard to stop.

That hasn’t happened yet. However, H5N1 viruses now have plenty of chances to evolve as they replicate within thousands of cows. Like all viruses, they mutate as they replicate, and mutations that improve the virus’s survival are passed to the next generation. And because cows are mammals, the viruses could be getting better at thriving within cells that are closer to ours than birds’.

The evolution of a pandemic-ready bird flu virus could be aided by a sort of superpower possessed by many viruses. Namely, they sometimes swap their genes with other strains in a process called reassortment. In a study published in 2009, Worobey and other researchers traced the origin of the H1N1 “swine flu” pandemic to events in which different viruses causing the swine flu, bird flu, and human flu mixed and matched their genes within pigs that they were simultaneously infecting. Pigs need not be involved this time around, Worobey warned.

Will a pandemic start if a person drinks virus-contaminated milk? Not yet. Cow’s milk, as well as powdered milk and infant formula, sold in stores is considered safe because the law requires all milk sold commercially to be pasteurized. That process of heating milk at high temperatures kills bacteria, viruses, and other teeny organisms. Tests have identified fragments of H5N1 viruses in milk from grocery stores but confirm that the virus bits are dead and, therefore, harmless.

Unpasteurized “raw” milk, however, has been shown to contain living H5N1 viruses, which is why the FDA and other health authorities strongly advise people not to drink it. Doing so could cause a person to become seriously ill or worse. But even then, a pandemic is unlikely to be sparked because the virus — in its current form — does not spread efficiently from person to person, as the seasonal flu does.

What should be done? A lot! Because of a lack of surveillance, the U.S. Department of Agriculture and other agencies have allowed the H5N1 bird flu to spread under the radar in cattle. To get a handle on the situation, the USDA recently ordered all lactating dairy cattle to be tested before farmers move them to other states, and the outcomes of the tests to be reported.

But just as restricting covid tests to international travelers in early 2020 allowed the coronavirus to spread undetected, testing only cows that move across state lines would miss plenty of cases.

Such limited testing won’t reveal how the virus is spreading among cattle — information desperately needed so farmers can stop it. A leading hypothesis is that viruses are being transferred from one cow to the next through the machines used to milk them.

To boost testing, Fred Gingrich, executive director of a nonprofit organization for farm veterinarians, the American Association of Bovine Practitioners, said the government should offer funds to cattle farmers who report cases so that they have an incentive to test. Barring that, he said, reporting just adds reputational damage atop financial loss.

“Outbreaks have a significant economic impact,” Gingrich said. “Farmers lose about 20% of their milk production in an outbreak because animals quit eating, produce less milk, and some of that milk is abnormal and then can’t be sold.”

The government has made H5N1 tests free for farmers, Gingrich added, but hasn’t budgeted money for veterinarians who must sample the cows, transport samples, and file paperwork. “Tests are the least expensive part,” he said.

If testing on farms remains elusive, evolutionary virologists can still learn a lot by analyzing genomic sequences from H5N1 viruses sampled from cattle. The differences between sequences tell a story about where and when the current outbreak began, the path it travels, and whether the viruses are acquiring mutations that pose a threat to people. The research has been hampered by the USDA’s slow and incomplete posting of genetic data, Worobey said.

The government should also help poultry farmers prevent H5N1 outbreaks since those kill many birds and pose a constant threat of spillover, said Maurice Pitesky, an avian disease specialist at the University of California-Davis.

Waterfowl like ducks and geese are the usual sources of outbreaks on poultry farms, and researchers can detect their proximity using remote sensing and other technologies. By zeroing in on zones of potential spillover, farmers can target their attention. That can mean routine surveillance to detect early signs of infections in poultry, using water cannons to shoo away migrating flocks, relocating farm animals, or temporarily ushering them into barns. “We should be spending on prevention,” Pitesky said.

OK, it’s not a pandemic, but what could happen to people who get this year’s H5N1 bird flu? No one really knows. Only one person in Texas has been diagnosed with the disease this year, in April. This person worked closely with dairy cows, and had a mild case with an eye infection. The CDC found out about them because of its surveillance process.

Clinics are supposed to alert state health departments when they diagnose farmworkers with the flu, using tests that detect influenza viruses, broadly. State health departments then confirm the test, and if it’s positive, they send a person’s sample to a CDC laboratory, where it is checked for the H5N1 virus, specifically. “Thus far we have received 23,” Shah said. “All but one of those was negative.”

State health departments are also monitoring around 150 people, he said, who have spent time around cattle. They’re checking in with these farmworkers via phone calls, text messages, or in-person visits to see if they develop symptoms. And if that happens, they’ll be tested.

Another way to assess farmworkers would be to check their blood for antibodies against the H5N1 bird flu virus; a positive result would indicate they might have been unknowingly infected. But Shah said health officials are not yet doing this.

“The fact that we’re four months in and haven’t done this isn’t a good sign,” Worobey said. “I’m not super worried about a pandemic at the moment, but we should start acting like we don’t want it to happen.”

Fact Check: Contrary to social-media posts, there is still no evidence that Covid-19 vaccines increase your risk of cancer

By Catalina Jaramillo
FactCheck.org

It has not been shown that Covid-19 vaccines cause or accelerate cancer. Yet opponents of the vaccines say a new review article “has found that Covid-19 mRNA vaccines could aid cancer development.” That statement is based mainly on misinterpretation of a study on mRNA cancer vaccines in mice.

Clinical trials, involving thousands of people, and multiple studies have shown that the mRNA Covid-19 vaccines from Pfizer/BioNTech and Moderna are safe. Hundreds of millions of doses have been administered under close monitoring systems that have found serious side effects are rare. Studies have also shown that the vaccines work very well in preventing severe Covid-19 disease and death, saving millions of lives across the globe.
 
There is no evidence to support a link between Covid-19 vaccines and cancer, as we’ve reported. Both the National Cancer Institute and the American Cancer Society have stated there’s no information that suggests COVID-19 vaccines cause cancer, make it more aggressive or lead to recurrence of cancer.

Yet, vaccine opponents falsely claim a review article published in April proves the contrary.

“A review in the International Journal of Biological Macromolecules has found that Covid-19 mRNA vaccines could aid cancer development,” reads an April 16 Facebook post by America’s Frontline Doctors, a group that has repeatedly spread misinformation about the pandemic -- and whose founder was sentenced to 60 days in prison for entering the U.S. Capitol during the Jan. 6 riot. Other posts made similar, baseless claims.

Messenger RNA, or mRNA, vaccines work by instructing a small number of a person’s cells to make specific proteins, which then prompt the body to mount an immune response. They use N1-methylpseudouridine, a modification naturally found in some RNA molecules, to allow the mRNA to deliver its message to the cell without being destroyed by an innate immune response.

The review paper being cited is based on other published articles and does not contain original research. Experts told us that it misleads by misinterpreting several studies and the role of N1-methylpseudouridine in vaccines. The authors also refer to an unreliable review article, written by authors known for spreading misinformation, that falsely claimed the mRNA Covid-19 vaccines impair the immune system and increase the risk of cancer, as we have explained.

One of the most important misrepresentations, and one that the authors heavily rely on, is based on the findings of a study on mRNA cancer vaccines in mice. The study looked at the efficacy of mRNA cancer vaccines with different degrees of N1-methylpseudouridine modification in a mouse melanoma model. According to the review, the study found that “adding 100% of N1-methyl-pseudouridine (m1Ψ) to the mRNA vaccine in a melanoma model stimulated cancer growth and metastasis, while non-modified mRNA vaccines induced opposite results, thus suggesting that Covic-19 mRNA vaccines could aid cancer development.”

But that’s not what the study found.

“Our results did not show, suggest or indicate that modified mRNA promotes tumor growth/metastasis,” Tanapat Palaga, professor of microbiology at the Chulalongkorn University in Thailand and the corresponding author of that study, told us in an email.

What the study actually showed is that both unmodified mRNA and modified mRNA induced immune responses against the tumor antigens, but only the unmodified mRNA reduced cancer growth and metastasis, while the modified mRNA didn’t. The study was published in 2022 and co-authored by Drew Weissman, who won the 2023 Nobel Prize with Katalin Karikó for discovering this mRNA modification that eventually led to the mRNA Covid-19 vaccines.

Dr. James A. Hoxie, an emeritus professor of medicine at the University of Pennsylvania and co-director of the Penn Institute of RNA Innovation (directed by Weissman), told us those findings are relevant for scientists who are studying ways in which mRNA cancer vaccines can elicit immune responses needed to prevent or delay cancer progression. (See “Social Media Posts Misinterpret Biden on mRNA Cancer Vaccines” for more information about mRNA cancer vaccines.)

“But that is a far cry from saying that the vaccine that was used to prevent Covid-19 disease causes cancer,” he said. Implying that by regulating the innate immune system, which is something scientists working in immunotherapies are trying to understand, “you’re leaving yourself open for cancer risk — that is ludicrous.”

Palaga told us, “I believe that the authors of this review article intentionally or [unintentionally] misinterpret our results and tried to twist the conclusion to support their agenda.”

There are no studies supporting a link between N1-methylpseudouridine and cancer in animals or mice, experts told us.

There is also no evidence mRNA Covid-19 vaccines impair, much less suppress, the immune system, as we’ve reported. In fact, the vaccines enhance immunity by teaching the immune system how to identify and fight the coronavirus.

N1-methylpseudouridine and its role in mRNA vaccines

To understand the role of N1-methylpseudouridine we have to look back at the history of mRNA vaccines.

Normally, when a cell encounters a foreign RNA, a molecule present in most living organisms and viruses, it activates a strong innate immune response against the molecule.

This was a problem for scientists trying to use mRNA as a therapeutic, since the goal was for the cell to receive the instructions carried by the mRNA and produce certain proteins. Until the mid-2000s, Karikó, Weissman and others observed that if they attached certain chemical modifications found in some kinds of natural RNA molecules, such as pseudouridine, into one of the four bases of mRNA, they could blunt that innate immune response and, at the same time, increase the mRNA’s capacity to translate its code for the cell to make the desired proteins.

Later, scientists found N1-methylpseudouridine, another modification naturally found in some kinds of RNA molecules, worked better than pseudouridine.

The modification is not “suppressing” the immune system, Hoxie told us — it just allows for certain parts of the immune system not to activate temporarily “in order to get the desired effect.”

Jordan L. Meier, senior investigator at the National Cancer Institute who has studied the role of N1-methylpseudouridine in Covid-19 vaccines, told us the authors of the review paper misrepresent what N1-methylpseudouridine, which is abbreviated as m1Ψ, does.

The review “incorrectly” confuses “m1Ψ’s ability to hide from the immune system with an ability to weaken or disable it,” he told us in an email.

To explain it, Meier compared the mRNA modification to a spy using a disguise in order to pass security guards.

“The authors are essentially suggesting that the disguise somehow makes the guards less able to do their jobs going forward,” he wrote. “In reality, once the disguised person is through, the guards remain just as vigilant and capable as before.”

The review, he added, doesn’t provide evidence that N1-methylpseudouridine “leaves the immune system any worse off for future threats.”
 
Misrepresented studies in the review paper

Similarly, the review misleads by cherry-picking or misrepresenting figures and tables of this and other papers.

For example, in the study by Palaga, Weissman and others using a mouse melanoma model (in which malignant cells from a tumor are given to a mouse), scientists found that relative to mice that received no vaccine (and instead received a saline solution) no increase in tumor growth or decrease in survival occurred when animals were vaccinated with a modified mRNA vaccine.

However, when animals received a vaccine containing unmodified mRNA, the study showed a decrease in tumor growth and an increase in survival compared with the control group that received the saline solution. In other words, the study found that the unmodified mRNA generated immune responses that decreased tumor growth and improved survival, while, similar to the control group, the modified mRNA had no effect on the tumor.

Table 1 of the review, however, incorrectly says the study found that the modified mRNA vaccine “increases tumor growth” and “decreases survival.”

Hoxie said, “This is simply not true and is a gross misrepresentation of the data that paper actually shows. The modified RNA had no effect on the tumor, and results using that vaccine were the same as using a saline solution.”

The tumor growth in mice receiving the modified mRNA was “increased relative to the unmodified vaccine, but it was identical to when there was no intervention,” Hoxie said. “Animals that received the modified mRNA vaccine died at the same rate and with the same amount of tumor as did animals that received the saline solution. The fact tumor progression in this model was reduced with the unmodified mRNA vaccine is the key point of this paper and indicated that in this model immune responses to unmodified mRNA may have anti-tumor activity, an important finding for the cancer immunotherapy field.”

The review also refers to a study that has been extensively misinterpreted to falsely claim that the Pfizer/BioNTech mRNA Covid-19 vaccine causes what vaccine opponents called “turbo cancer.” The study describes one mouse that died from a lymphoma after 14 mice were given a high dose of the vaccine. The review paper reproduces images from the study that show dissected mice and compares the organs of the mouse that died with one with a normal anatomy.

As we explained, and as the authors of that paper noted in an addendum, there is no such thing as “turbo cancer,” and, more importantly, the case report does not demonstrate a causal relationship between the lymphoma and the vaccine.

Meier told us the review also wrongly refers to a study published in 2016 to support its thesis that modified mRNA vaccines turn off an immune sensor known as RIG-I.

“In reality, this study only showed m1Y mRNAs are unable to activate RIG-I and did not test inhibition. In other words, what was shown was that m1Y is a strong camouflage, not that it is an immune suppressor,” he wrote.

FactCheck.org is a nonpartisan, nonprofit organization at the University of Pennsylvania that monitors the factual accuracy of public statements.

Thursday, May 2, 2024

Ky. nursing-home industry says Biden administration's rule mandating staffing levels for homes is 'impossible' to meet

Centers for Disease Control and Prevention photo
By Melissa Patrick
Kentucky Health News

A new law that sets minimum staffing requirements for federally funded long-term care facilities will require many of them to hire more nurses and nurse aides. It has been met with pushback from the nursing-home industry. 

Morgan Jemtrud, director of communications for the Kentucky Association of Health Care Facilities and the Kentucky Center for Assisted Living, told Kentucky Health News in an email that the staffing mandate is not attainable for several reasons, including the health-care workforce shortage. 

"The staffing mandate is impossible. CMS estimates it will cost around $300,000 per building (AHCA estimates more), but there is no funding to support the implementation of the rule," said Jemtrud. "Also, the required staff are simply not available. RNs are in demand across all health -care sectors, and no pipeline is being built to produce the number of RNs this rule requires." 

Jemtrud was referring to an analysis from the American Health Care Association, a nursing-home lobby, that says meeting the mandate would require nursing homes to hire more than 100,000 more nurses and nurse aides at an annual cost of $6.8 billion. The analysis also says 94% of nursing homes were not meeting at least one of the proposed staffing requirements.

New staffing requirements

The "Nursing Home Minimum Staffing Rule" requires all nursing homes that receive Medicare or Medicaid payments to provide 3.48 hours of direct nursing care per resident per day, including a defined number for registered nurses (0.55 per resident per day) and nurse aides (2.45 hours per resident per day). 

"This means a facility with 100 residents would need at least two or three RNs and at least 10 or 11 nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards," says a White House fact sheet about the rule.

It will also require facilities to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

The new staffing requirements will be phased in over three years, except at rural facilities, which will get up to five years. The law allows for some "limited, temporary exemptions" for facilities in areas with workforce shortages that demonstrate a good faith effort to hire the required staff. 

Within two years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, according to a Kaiser Family Foundation analysis. But the analysis says only 19% meet the defined number of hours required for RNs (.55)  and nurse aides (2.45) that is required under the full implementation of the law.  

“When facilities are understaffed, residents may go without basic necessities like baths, trips to the bathroom, and meals – and it is less safe when residents have a medical emergency,” said the fact sheet,  noting that it will also “ensure that workers aren’t stretched too thin by having inadequate staff on site.”

Brice Mitchell, spokesperson for the state Cabinet for Health and Family Services, told Kentucky Health News in an email that the administration is reviewing the federal rule and its impact. 

"Medicaid funds 70% of all long-term care in the state and there is ongoing work to expand a nurse career ladder to help increase recruitment," Mitchell said. "At this time, we are unable to determine the number of Kentucky nursing homes that don’t meet the new federal rules." 

Pushback on the new mandate

Denise Wells, executive director of the Nursing Home Ombudsman Agency of the Bluegrass, said her group was "very pleased" with the 24-hour RN requirement, but didn't think the minimum hours per resident per day went far enough.

She said  the 24/7 RN requirement is important because the acuity level of patients has increased over the years, meaning patients need more assistance with their activities of daily living than ever before. And, she said, "Medical emergencies don't just happen for eight hours of the day; they can happen 24 hours a day." 

Wells said they were disappointed in the hours per resident per day only being 3.48 because research shows that the minimum care that an average resident needs is 4.1 hours per day.

"And that is simply to avoid negative health outcomes," she said. "It's not to live their best lives, it's not to have the greatest quality of life, it's just to have that minimum care provided." 

Wells called the new staffing rules a "good first step." 

"We are trying to make sure that the message is that this is not the ceiling; that it's a floor," said Wells. "It's the absolute minimum, but facilities should be staffing higher than this. . . . Nursing homes are required to staff to sufficient levels to meet resident needs, and so if they have residents that their care plan indicates that they need more than the 3.48 hours per day, then the facility needs to staff to meet that need." 

Jemtrud with KAHCF and KCAL was asked about the financial impact of the rule. She said Kentucky nursing homes are already financially strained and there are no funds to help meet the new requirements. 

"Before this rule, 79.9% of Kentucky facilities are in distress or at risk of financial distress using the Altman Z-score," Jentrud said, citing a formula used to determine a company's risk of bankruptcy.

"CMS estimates the total cost of the final rule at about $4.3 billion per year, but AHCA continues to estimate the cost above $6 billion per year," she said. "There are no funds from Medicare, Medicaid, or other payers to increase payment rates to providers for any of the rule requirements." 

Wells, asked how facilities can address the health-care workforce shortage, said her group prefers to call it a "job quality crisis" caused by low pay, poor conditions and little support.  She pointed to reports from the National Consumer Voice for Quality Long-Term Care that have showed how nursing homes hide profits, and saif there is not enough transparency in how Medicaid and Medicare dollars are used these facilities. 

KFF Health News also points to researchers who are "skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors."

In a lengthy statement from the American Hospital Association, Stacey Hughes, AHA executive vice president, said, in part, "CMS’ one-size-fits-all minimum staffing rule for nursing homes creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements."

The American Health Care Association issued a statement in opposition of the mandate and said the industry will keep pressing Congress to overturn the regulation. 

“While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care,” Mark Parkinson, CEO of the AHCA, said in a statement. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”

The mandate also implements stronger transparency measures to ensure nursing home residents and their families know when a nursing home is using an exemption, according to the fact sheet.  

Guthrie expresses concern

Jemtrud said industry associations will "continue to reach out to Congress where there’s been bipartisan support for helpful legislation." 

"Providers have been hosting legislators for visits within their facilities to share firsthand the challenges they’re facing," she wrote. "Also, the AHCA/NCAL Congressional Briefing scheduled June 3-4 will allow members to discuss their concerns directly with members of Congress on Capitol Hill." 

On Tuesday, U.S. House Republicans at a House Energy and Commerce health subcommittee voiced their concerns about the new staffing mandate. 

The subcmmittee chair, Republican Rep. Brett Guthrie of Kentucky's Second District, said he was "extremely concerned" about the mandate along with the 80/20 rule which requires agencies that provide home- and community-based services to spend 80% of their Medicaid payments on compensation for workers who directly provide care. 

Guthrie said both rules "threaten access to long term care services for Medicaid beneficiaries by setting arbitrary staffing and pay standards. . . . This approach simply won't work." He added later, "These rules come at a time where we have seen more than 500 nursing home facilities close since the start of the pandemic and where we have 150,000 fewer long-term care workers than we did before 2020."

Wednesday, May 1, 2024

New official recommendation: Women should start every-other-year mammograms at age 40; some groups favor annual scans

Photo illustration from Medical News Today
By Carla K. Johnson
Associated Press

Regular mammograms to screen for breast cancer should start younger, at age 40, according to an influential U.S. task force. Women ages 40 to 74 should get screened every other year, the group said.

Previously, the task force had said women could choose to start breast cancer screening as young as 40, with a stronger recommendation that they get the exams every two years from age 50 through 74.

Tuesday's announcement by the U.S. Preventive Services Task Force makes official a draft recommendation announced last year. It was published in the Journal of the American Medical Association.

“It’s a win that they are now recognizing the benefits of screening women in their 40s,” said Dr. Therese Bevers of MD Anderson Cancer Center in Houston. She was not involved in the guidance.

Other medical groups, including the American College of Radiology and the American Cancer Society, suggest mammograms every year — instead of every other year — starting at age 40 or 45, which may cause confusion, Bevers said, but “now the starting age will align with what many other organizations are saying.”

Breast-cancer death rates have fallen as treatment continues to improve. But breast cancer is still the second most common cause of cancer death for U.S. women. About 240,000 cases are diagnosed annually and nearly 43,000 women die from breast cancer.

The nudge toward earlier screening is meant to address two vexing issues: the increasing incidence of breast cancer among women in their 40s — it’s risen 2% annually since 2015 — and the higher breast cancer death rate among Black women compared to white women, said task force vice chair Dr. John Wong of Tufts Medical Center in Boston.

“Sadly, we know all too well that Black women are 40% more likely to die from breast cancer than white women,” Wong said. Modeling studies predict that earlier screening may help all women, and have “even more benefit for women who are Black,” he said.

Here are more details on what’s changed, why it’s important and who should pay attention.

When should I get my first mammogram? Age 40 is when mammograms should start for women, transgender men and nonbinary people at average risk. They should have the X-ray exam every other year, according to the new guidance. Other groups recommend annual mammograms, starting at 40 or 45.

The advice does not apply to women who’ve had breast cancer or those at very high risk of breast cancer because of genetic markers. It also does not apply to women who had high-dose radiation therapy to the chest when they were young, or to women who’ve had a lesion on previous biopsies.

What about women 75 and older? It’s not clear whether older women should continue getting regular mammograms. Studies rarely include women 75 and older, so the task force is calling for more research.

Bevers suggests that older women talk with their doctors about the benefits of screening, as well as harms like false alarms and unnecessary biopsies.

What about women with dense breasts? Mammograms don’t work as well for women with dense breasts, but they should still get the exams.

The task force would like to see more evidence about additional tests such as ultrasounds or MRIs for women with dense breasts. It’s not yet clear whether those types of tests would help detect cancer at an earlier, more treatable stage, Wong said.

Does this affect insurance coverage? Congress already passed legislation requiring insurers to pay for mammograms for women 40 and older without copays or deductibles. In addition, the Affordable Care Act requires insurers to cover task-force recommendations with an “A” or “B” letter grade. The mammography recommendation has a “B” grade, meaning it has moderate net benefit.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.