Thursday, October 6, 2022

Traditional Medicare can't cut short nursing-home stays, but Medicare Advantage plans can, and they are doing just that

CDC photo
"Health care providers, nursing-home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home," Susan Jaffe reports for Kaiser Health News. 
 
Half of the nearly 65 million people in Medicare have Medicare Advantage, an umbrella term for private health plans that are alternatives to the traditional government program, They must cover, at a minimum, the same benefits as traditional Medicare, including up to 100 days of skilled nursing care each year, Jaffe reports. But the Advantage plans "have leeway when deciding how much nursing home care a patient needs."

“In traditional Medicare, the medical professionals at the facility decide when someone is safe to go home,” Eric Krupa, an attorney at the Center for Medicare Advocacy, a nonprofit law group that advises beneficiaries, told Jaffe. “In Medicare Advantage, the plan decides.”

Jaffe offers several examples of nursing-home patients who were told by their Medicare Advantage insurer that they would have to go home before their medical team deemed them well enough to do so. 

One of those patients was Paula Christopherson, 97, who was in a skilled nursing facility in St. Paul, Minn., recuperating from a fall. Daughter Amy Loomis told Jaffe that the facility gave Christopherson a choice: pay several thousand dollars to stay, appeal the company’s decision, or go home: “This seems unethical.”

Christopherson ended up staying and appealed UnitedHealthcare's  decision to deny an additional five days of care in the nursing home. Upon returning home, she got a bill for nearly $2,500 from the facility and that it took repeated appeals before United Healthcare reversed its decision, Jaffe reports. 

Jaffe explains how Advantage plans work: "The federal government pays Medicare Advantage plans a monthly amount for each enrollee, regardless of how much care that person needs. This raises “the potential incentive for insurers to deny access to services and payment in an attempt to increase profits,” according to an April analysis by the Department of Health and Human Services’ inspector general. Investigators found that nursing-home coverage was among the most frequently denied services by the private plans and often would have been covered under traditional Medicare." 

She adds that HHS's "Centers for Medicare & Medicaid Services recently signaled its interest in cracking down on unwarranted denials of members’ coverage. In August, it asked for public feedback on how to prevent Advantage plans from limiting “access to medically necessary care.”" 

Experts told Jaffe that nursing homes and Medicare Advantage plans have "reverse incentives" when it comes to making a profit; nursing homes make more when a patient has an extended stay, while Medicare Advantage plans are incentivized to deny or restrict coverage to increase their profits.  

Dr. Rajeev Kumar, vice president of the Society for Post-Acute and Long-Term Care Medicine, which represents long-term care practitioners, told Kaiser Health News that the problem has become “more widespread and more frequent." He added, “It’s not just one plan. It’s pretty much all of them.”

Kumar told Jaffe that with the spike in Medicare Advantage enrollment, disagreements between insurers and nursing home medical teams have increased. 

"UnitedHealthcare spokesperson Heather Soule would not explain why the company limited coverage for the members mentioned in this article. But, in a statement, she said such decisions are based on Medicare’s criteria for medically necessary care and involve a review of members’ medical records and clinical conditions. If members disagree, she said, they can appeal," Jaffe reports. 

Jaffe reports that CMS could not provide data on how many beneficiaries had their nursing home care cut off by their Advantage plans or on how many succeeded in getting the decision reversed.

To make fighting the denials easier, the Center for Medicare Advocacy created a form to help Medicare Advantage members file a grievance with their plan.

Study: Smoking increases risk of viral and respiratory infections, including a coronavirus; supports tobacco control to curb Covid-19

A new study shows that smoking increases the risk of viral infections and respiratory illnesses, including one type of the coronavirus, this supporting efforts to curb tobacco use as a way to thwart Covid-19.  

The University of California, Davis Comprehensive Cancer Center study, published in the Nicotine and Tobacco Research journal, found that current smokers have a 12% increased risk of a laboratory-confirmed viral infection and a 48% increased risk of being diagnosed with respiratory illnesses. These results did not vary by type of virus, including a coronavirus.

“Past research has shown that smoking increases the risk of Covid-19 disease severity, but the risk of infection had been less clear,” UC Davis tobacco researcher and lead author of the study Melanie Dove said in a news release. “Our study findings show smokers have an increased risk of viral infection, including a coronavirus and respiratory illness.”

In combination with past findings, the researchers note that findings from this study support "urgent recommendations to increase tobacco control efforts for countering Covid-19," says the release. 

These findings are especially important to Kentucky, where 23.4% of adults smoke and the state continues to have some of the highest rates of new Covid-19 cases. For help to quit smoking, the state runs a  1-800-QUIT-NOW hotline that offers free tobacco cessation services. 

Data for the study came from a re-analysis of the British Cold Study, a 1986-1989 study that exposed 399 healthy adults to one of five "common cold" viruses, including a strain of the coronavirus that existed prior to the novel coronavirus that causes Covid-19. 

The data showed that current smokers had an increased risk of respiratory viral infection and illness, with no significant difference across the types of viruses. It also showed that the increased association for the mild, common coronavirus that they tested did not reach statistical significance, which the researchers  said was likely due to the small sample size.

"These findings are consistent with known harms caused by smoking to immune and respiratory defenses and some observational evidence of increased Covid-19 infection and disease progression in current smokers. . . . The relative risks from this study can provide an estimate of the strength of associations that can be used to guide tobacco control decisions," says the release. 

The researchers note that one of the  main limitations of this study is that the mild common coronavirus that they tested may have different biological and health effects than other coronaviruses, including the one that causes Covid-19, which means the the findings may not be generalizable to other coronaviruses.

“These findings may have implications for addressing tobacco use at the population level as a strategy for preventing Covid-19 infection,” Elisa Tong, senior author and UC Davis internal medicine professor, says in the release.

Wednesday, October 5, 2022

Kentucky among 6 states with 2022 Medicaid Innovation Award

Dept. for Medicaid Services graphic
Kentucky’s Medicaid program has received a national award for enrollment innovations it implemented during the Covid-19 pandemic.

The Medicaid Innovation Award from the Robert Wood Johnson Foundation and the National Academy for State Health Policy recognizes states for demonstrating creativity, leadership and progress in their programs despite significant public health challenges in recent years.

“We are honored to be one of only six states to receive this recognition,” Gov. Andy Beshear said in a news release. “Team Kentucky is committed to continuing this progress to make our commonwealth a better place for our people to live full, healthy lives for generations to come.”

The public-health emergency Beshear declared in March 2020 made the Department for Medicaid Services change how it enrolled its participants. That included the implementation of a fast track to Medicaid enrollment and eligibility. This expedited application process allowed screeners to identify if applicants were also eligible for other types of help, such as food assistance

“In the early days of the pandemic, hundreds of thousands of working Kentuckians suddenly lost their employer-sponsored health insurance," Emily Beauregard, executive director of Kentucky Voices for Health, said in the release. "When faced with an unprecedented public-health crisis, Medicaid leaders pivoted quickly to provide temporary coverage through Medicaid presumptive eligibility. Their innovative approach to outreach and enrollment saved lives and provided the financial security workers and families needed to get back on their feet. It's an essential part of our safety-net that is there to catch us when we least expect we'll need it."

release from the foundation says the state won its Enrollment Innovations category because "Kentucky implemented a range of measures during the Covid-19 pandemic to simplify Medicaid enrollment and increase access to coverage including targeted, data-driven marketing and outreach; a simplified application; and coordination with other state agencies."

“We are so pleased to recognize state Medicaid programs that have creatively addressed significant challenges over the past few years to meet the needs of their residents,” Hemi Tewarson, executive director at the National Academy for State Health Policy, said in the release. “We hope these state efforts can provide ideas and inspiration for other states.”

Other states honored at the academy's annual conference in Seattle were Arizona, California, North Carolina, Minnesota and West Virginia.

Kentucky Medicaid covers more than 1.6 million people, more than half of them children covered under Medicaid or the Kentucky Children’s Health Plan. Approximately 625,000 Kentuckians are covered under Medicaid expansion under the Patient Protection and Affordable Care Act, passed in 2010 and implemented in 2014.

Norton Children's Hospital gets $15 million for diabetes institute

Norton Children’s Hospital and the Lift a Life Novak Family Foundation today announced the creation of the Wendy Novak Diabetes Institute

The foundation has given the hospital $15 million as the starting point of a $60 million plan to expand diabetes care for children and adults, as well as build the top diabetes institute in the country, a news release. The institute will enhance services already available through the current Wendy Novak Diabetes Center. 

Nearly half a million children and adults in Kentucky have Type 1 or Type 2 diabetes, a rate of 14%, making Kentucky the eighth worst in the nation, according to the Centers for Disease Control and Prevention. 

The goal of the Wendy Novak Diabetes Institute is to become a national center of excellence by expanding and elevating diabetes care across the region, while helping children and adults with diabetes manage their conditions, and making it easier for patients to transition from pediatric to adult care. 

 “We are confident that with the strategic partnership with Norton Children’s and Norton Healthcare, and the outstanding leadership of Dr. Kupper Wintergerst, one of the most renowned endocrinologists in the world, we can continue to climb the rankings and become the best practice institution others will want to emulate,” David Novak, founder of the foundation, said in the release. “We see this impacting not only Louisville, but the world.” 

One of the first initiatives of the institute will be to provide more patient support through expansion of the diabetes education program. "Living with diabetes is an enormous burden, and educators are able to help each child and adult face every one of life’s challenges.” Wintergerst said in the release. 

Wendy and David Novak with daughter Ashley
(Photo by Pat McDonogh, The Courier Journal)
Wintergerst is a pediatric endocrinologist with Norton Children’s Endocrinology, which is affiliated with the University of Louisville School of Medicine, where he is the Wendy L. Novak Chair of Pediatric Diabetes Care and Clinical Research.

Norton Healthcare says it provides care for more than 69,000 patients with diabetes, spanning 137 counties in Kentucky and Southern Indiana. About 1,400 of the patients are children, says the release.

Looking forward, the Norton Children’s Hospital Foundation and Norton Healthcare Foundation have committed to raising another $12 million for a total $27 million investment. So far, $2 million has been raised. In the coming years, the goal is to raise additional funds to reach the $60 million vision.

The Lift a Life Novak Family Foundation was established in 1999 through a charitable trust by David and Wendy Novak. It funds innovative, high-impact projects that are led by passionate leaders committed to outstanding execution. Wendy Novak has had Type 1 diabetes since she was 7 years old, reports Maggie Menderski of the Louisville Courier Journal.

Tuesday, October 4, 2022

Poor oral health in children is not just from too many sugary foods; education, income and environment all play roles

CDC photo
While brushing your teeth is important to maintaining good oral health, dental-health experts say it's not the only thing responsible for poor oral health, especially when it comes to children in Appalachia, where sugar is usually blamed.

"It’s a common misconception that consuming sugary foods and beverages is the only cause of tooth decay. While that is undoubtedly a problem, there’s much more to good oral health," Daniel W. McNeil and Mary L Marazita write for The Conversation, a site for journalistic writing by academics. "It includes consistent brushing and flossing; eating healthy foods, like fresh fruits and vegetables; avoiding tobacco products; and wearing mouth guards while playing certain sports. Regular visits for dental care are also critical, as they provide an opportunity for cleanings and preventive care." 

McNeil and Marazita, who run the University of Pittsburgh's Center for Oral Health Research in Appalachia, say the region's poor oral health stems from a combination of factors beyond tooth brushing and other personal hygiene.

Poor oral health, they write, is more common among "people who have less formal education or lower incomes, marginalized ethnic and racial groups and those living in more rural areas, such as Appalachia," which has one of the highest rates of oral health problems in the nation. And among these groups, oral health issues tend to show up at younger ages. 

Other than education, behavioral and social influences, reasons for poor oral health can include genetic influences that dictate a preference for sweet foods, mouth bacteria that can lead to oral diseases, environmental factors such as air quality, access to healthy foods, the cost of dental care, access to transportation to and from the dentist, access to school-based programs, water quality and whether one lives in a community with fluoridated water, which can keep cavities from forming.

McNeil and Marazita note that cavities are the most common chronic disease in children, despite being preventable and that "more than 40% of children have tooth decay when they start kindergarten. . . . Dental problems in kids can lead to missed school, pain and embarrassment about visible decay, and missing or crooked teeth." 

They write that parental and caregiver role modeling can greatly influence children's oral health habits. Examples include drinking water instead of sugary beverages, eating a healthy diet, practicing good dental hygiene habits and expressing a positive attitude about going to the dentist. 

The article offers several other suggestions to improve oral health, saying one of the best things parents or caregivers can do is to take their child to the dentist.  

"The American Academy of Pediatric Dentistry and other professional health organizations recommend that children see an oral health care provider before age 1 or at the emergence of the first tooth," they write. "Access to dental treatment, especially preventive care, has been shown to improve oral health in families and their communities."

McNeil and Marazita also call for system-level changes that ensure routine dental care is affordable and accessible to everyone. They also call for integrating oral health practices into schools and educational programs, saying this will benefit all children regardless of their family's socioeconomic status.

Monday, October 3, 2022

New Covid-19 cases in state fell by almost half last week, but over half were among youth, and Ky. has the top rate among the states

New York Times map, adapted by Ky. Health News; for the interactive version, with data, click here.
By Melissa Patrick
Kentucky Health News

New coronavirus cases plummeted in Kentucky last week, but for the first time, cases in people 18 and younger were more than half of a week's total. And Kentucky's new-case rate remains first among the states.

The state's report for the Monday-to-Sunday reporting period said there were 3,979 new coronavirus cases, or 568 per day. That's 46% less than the 1,057 daily average and total of the week before. 

However, 2,168 of those new cases were among Kentuckians 18 and younger, making up 54% of the total and marking the first time this age group has represented the majority of new cases in the state.

Kentuckians in that age group are back to school, and vaccination rates in school-aged youth are among the state's lowest. State data shows these rates of full vaccination: 47% of those 16 and 17; 43% of those 12 to 15; 20% of those 5 to 11; and 2% of those 6 months to 4 years old.

The share of Kentuckians testing positive for the coronavirus in the last seven days was 7.7%, the lowest rate reported since the end of May. The figure does not include at-home tests. 

Hospital numbers also dropped again in this week's report. Kentucky hospitals reported 327 patients with Covid-19, down 71 from the week before; 39 Covid-19 patients in intensive care, down 23; and 20 of them on mechanical ventilation, down four. 

The statewide rate of new cases was 11.85 cases per 100,000 residents, down from 14.4 a week earlier. The top 10 counties on the state report were Letcher, 61.6 per 100,000; Knott, 49.2; Leslie, 49.2; Perry, 39.4; Owsley, 32.4; Green, 22.2; Marion, 21.5; Floyd, 20.5; Livingston, 20.2; and Washington, 20.1.

The New York Times ranks Kentucky's infection rate first among the states, showing a 5% increase in cases in the last 14 days. (Puerto Rico's rate is just slightly higher.) The Times says Wayne, Perry and Powell counties had the highest case rates in the nation in the last seven days. (The Times's figures differ from state figures because of differences in data gathering and processing.) 

The state attributed 61 more deaths to Covid-19 last week, pushing the the state's death toll above 17,000. The new total is 17,030.

Sunday, October 2, 2022

Report shows major workforce shortages in Kentucky hospitals, which they describe as 'the most critical shortage in recent history'

By Melissa Patrick
Kentucky Health News

Results from Kentucky's annual hospital workforce survey show critical labor shortages at hospitals across the state, with the highest vacancy rate among registered nurses and licensed practical nurses.  

The Kentucky Hospital Association's 2022 Workforce Survey Report looks at the non-physician hospital labor force in Kentucky. The report says 110 hospitals responded to the survey, including all 96 acute-care hospitals. 

The report, published in August, found 13,423 total vacancies in Kentucky hospitals, including 5,391 for RNs and LPNs combined, or more than one in five nursing positions. 

LPN positions had the highest vacancy rate, 25.5%, followed by RNs (21.9%) and certified nurse assistants (17.7%). Other top vacancies included respiratory therapists (17.7%), laboratory staff (14.2%), environmental services (13.7%) and social workers (13.7%). 

Urban hospitals were found to have larger vacancy rates than rural hospitals, at 18.3% and 13.8% respectively, but the report says both rates are "unsustainable."  

"The results showed the depth of the crisis in Kentucky. And so we can say that the commonwealth's hospitals are facing the most critical shortage in recent history," KHA President Nancy Galvagni said at a press conference. She added later, "Every region of the state is impacted by this issue."

Galvagni said one of the biggest concerns is that 53% of the nursing vacancies are in medical/surgical units, critical-care units and emergency departments, areas that are essential to providing patient care. 

Also, she said there is a shortage of experienced nurses, and 14% of the nursing workforce is nearing retirement age. 

"The data on the shortage of nurses is of huge concern, because the demand for nurses is steadily increasing," Galvagni said. "Kentuckians suffer from more chronic disease than most of the country. We regularly rank high in rates of cancer, lung disease, heart disease and diabetes. And with an aging population, there's going to be a demand for more hospital nurses to provide the care that is needed." 

Galvagni said costs associated with nursing shortages have been astronomical. The report says spending on short-term "travel nurses" rose from $88 million in 2019 to nearly $1 billion projected this year. And premium pay, which is pay provided above base salary and wages, has increased from $50 million in 2019 to nearly $400 million. 

"The skyrocketing increase in labor costs plus the ever rising inflation that everyone's facing, equals an unsustainable situation," she said. "As one of the biggest employers in the state and the safety net for life saving care, this could be devastating for every Kentuckian." 

Mike Sherrod, chief executive officer of Tristar Greenview Regional Hospital in Bowling Green, said some hospitals across the country have had to limit the services they provide due to the staffing crisis and skyrocketing costs and that Kentucky hospitals are trying to avoid that. 

"The reality is . . . we need more nurses, respiratory therapists, we need more lab techs and other trained individuals dedicated to health," he said. 

Galvagni also spoke to this concern, saying, "Each of us will be a patient at some point. . . . It doesn't matter how many beds a hospital has, if they're not enough professionals to staff them. Our hospitals will have no other choice than to reduce services."  

To address the nursing shortage in the short-term, many hospitals have offered sign-on bonuses, raises, extra overtime, premium bonuses, tuition reimbursement, and scheduling flexibility. 

Galvagni said the hospital association is working on solutions to increase the nurse workforce, including encouraging  middle- and high-school students to enter a health career; talking to higher-education systems about how to increase the number of graduates; and encouraging high schools to offer a LPN program, which would allow students to work immediately after graduation.

To address rising costs, the association also plans to ask lawmakers to increase the rate of payment for outpatient Medicaid patients in the state as it did for Medicaid inpatient services last year. Galvagni said KNA thinks the proposal will pass. 

"There is no one silver bullet to fix this problem," said Galvagni. "But the sooner we start, the better."

Kentucky adults have second highest obesity rate in nation, and children 10-17 in state have the top U.S. rate for that age group

By Melissa Patrick
Kentucky Health News

A new report says Kentucky has the second highest adult obesity rate in the nation, and Kentucky children aged 10 to 17 have the nation's highest rate for that age group.

The Trust for America's Health 19th annual report says four of every 10 Kentucky adults are obese. And 72.3 percent are either obese or overweight, third in the nation. Among the state's high-school students, 18.4% are obese and another 17.8% are overweight.

The report says the national adult obesity rate keeps rising, with 19 states having a rate over 35%, up from 16 in 2021. The report notes that a decade ago, no state had an adult obesity rate at or above 35%.

Map from Trust for America's Health report; click it to enlarge
From 2020 to 2021, Kentucky's adult rate increased 10 percent, 3.6 percentage points, from 36.6% to to 40.3%.

Kentucky's rate is just a bit lower than West Virginia's 40.6%. Alabama ranks third at 39.9%. The District of Columbia, Hawaii and Colorado have the lowest rates, ranging from 24.7% to 25.1%.

"These persistent increases in obesity rates underscore that obesity is caused by a combination of factors including societal, biological, genetic, and environmental, which are often beyond personal choice," says a news release from Trust for America's Health. "The report’s authors conclude that addressing the obesity crisis will require attending to the economic and structural factors of where and how people live.

Obesity is associated with a many different health conditions and is estimated to increase U.S. health-care spending by $170 billion every year, the Trust for America's Health report says. 

"Obesity increases the risk of a range of diseases for adults—including higher rates of complications and serious illness from Covid-19, as well as type 2 diabetes, high blood pressure, heart disease, stroke, arthritis, depression, sleep apnea, liver disease, kidney disease, gallbladder disease, pregnancy complications, and many types of cancer—and an overall risk of higher mortality," the report says. 

Kentuckians struggle with all of these conditions. Nearly 14% of the state's adults are diagnosed with diabetes and 40.3% are diagnosed with hypertension, ranking Kentucky fifth for both conditions. 

The report says Kentucky women's obesity rate is 40.9%, while men's rate is 39.8%, plus or minus 2.7 percentage points.

Obesity rates by county in 2018-20, the latest range available, are published by the Foundation for a Healthy Kentucky at kyhealthfacts.org.

Child obesity: When it comes to age, Kentuckians between 45 and 64 have the state's highest obesity rate, 46.2%. That's followed by those 25 to 44 (42.5%), 65 and older (35.3%), and 18 to 24 (28.2%). 

The rate for Kentuckians 10 to 17 is 23.8%, the nation's highest. Nationwide, nearly 20% of children between the ages of 2 to 19 are obese. "These rates more than tripled since the mid-1970s," the release says. "Black and Latino youth have substantially higher rates of obesity than do their white peers." 

Getty Images photo via University of Missouri
One way to help children and their families address childhood obesity is through an electronic health records that help doctors monitor body-mass index, the basic measure of obesity, according to a University of Missouri School of Medicine study.

The three-year study found that a tool called FitTastic was an effective in decreasing BMI in children, especially young children. It works by helping health-care providers communicate with families about five daily lifestyle behavior goals: At least one hour per day of physical activity, limiting screen time to two hours a day or less, three daily servings of low-fat milk or calcium, at least four servings of water instead of sugary drinks, and at least five servings of fruits and vegetables. 

“We found a nearly 20% more favorable BMI pattern in the FitTastic group compared to the control group when looking specifically at children who were either overweight or obese,” said the principal investigator, Dr. Amy Braddock. “The data was especially favorable for younger children, between the ages of 2 and 5 years old.”

Body mass index is calculated by dividing a person's weight in pounds by their height in inches times two, and then multiplied by 703. An adult is considered obese if their BMI is 30 or higher, and is considered severely obese if that level is 40 or above. Children's BMI are compared to other children of the same age and sex, since there are fluctuations in their growth and development. 

The Trust for America's Health report includes a detailed list of recommended policy actions to address the social and economic drivers that contribute to obesity. The actions can be implemented at the federal, state and local levels. They include:
  • Advance health equity by strategically dedicating federal resources to the efforts that reduce obesity-related disparities;
  • Decrease food insecurity while improving nutritional quality of available foods;
  • Change the marketing and pricing strategies that lead to health disparities;
  • Make physical activity and the built environment safer and more accessible for all;
  • Work with the healthcare system to close disparities and gaps from clinic to community settings
“The continued increase in rates of obesity across all population groups is alarming,” Dr. J. Nadine Gracia, president and CEO of Trust for America’s Health, said in the release. “Policies and programs to reduce obesity need to be implemented at a systems level. We must advance policies that address the community, institutional, and structural factors that are barriers to healthy eating and physical activity and that exacerbate health inequities.”

Data for the report is based in part on the Centers for Disease Control and Prevention's Behavioral Risk Factors Surveillance System, a continuous national poll.

Kentucky gets $3.6 million federal grant for youth suicide prevention, targets five rural counties in first round of funding

By Melissa Patrick
Kentucky Health News

Kentucky will receive a five-year, $3,675,000 grant to help reduce suicide among Kentuckians under age 25.

Kentucky is one of 10 recipients of Garrett Lee Smith Suicide Prevention grants, from the federal Substance Abuse and Mental Health Services Administration

Map by Kentucky Health News from Wikipedia base map
The grant programs will begin Sept. 30 in Clinton, Hart, Hickman and Lyon counties, which were selected based on suicide-attempt rates among middle- and high- school students.

The release says additional locations will be identified in the coming years.

The award is named after the son of former Oregon Sen. Gordon Smith. Garrett Lee Smith took his own life in 2004, just before his 22nd birthday. Sen. Smith proposed the Garrett Lee Smith Memorial Act, which recognized suicide as the third-leading cause of death among youth 10 to 24.

Kentucky also received the grant in 2006, 2011 and 2015.

“My administration has always prioritized quality, accessible mental-health care,” Gov. Andy Beshear said in a news release. “The Garrett Lee Smith Suicide Prevention grant will make it easier for Kentuckians to get the help they need and deserve.”

The release says that the funding, $735,000 a year for five years, will advance the Kentucky Strategic Allies Fostering Empowerment of Today’s Youth (KY SAFETY) project. The project will help identify youth at risk for suicide and connect them with care pathways. 

KY SAFETY will also implement Youth Mental Health First Aid programs; Question, Persuade, Refer (QPR) training, and applied suicide-intervention training in agencies that serve youth. More than 5,600 staff members of youth-serving agencies are expected to be trained in the five-year grant period.

The news release says a key project component will provide first responders with internet-equipped tablets for use during behavioral-health emergencies to help ensure near-immediate access to a clinician.

“Kentucky has a long history of working to reduce suicide risk,” said Eric Friedlander, secretary of the state Cabinet for Health and Family Services. “Finding new and innovative ways to reach our youth is essential to improving access to behavioral health services. Given that many of our counties are rural, the use of tablets and telehealth services represents a creative way to provide services as quickly as possible.”
The national suicide hotline number has changed.
“The goal of the grant is to support strategies that focus on the identification of youth at risk of suicide, build capacity of clinical service providers to assess, manage and treat that risk and improve the continuity of care and follow-up of youth receiving care for their suicidality,” Patti Clark, an agency assistant director and principal investigator for the project, said in the release. 

At his Sept. 29 news conference, Beshear also encouraged Kentuckians to call the state's new, confidential 988 suicide hotline if they are experiencing a mental-health crisis or considering suicide. He said there has been a 27% increase in crisis and suicide call volume since the change, and a 10% increase in text messages. He also said calls are being answered more quickly, and the abandoned-call rate is the lowest since July 2021. 

Saturday, October 1, 2022

Beshear's Medical Cannabis Advisory Committee finds massive support for legalizing medical marijuana; drug officers opposed

By Melissa Patrick
Kentucky Health News

An advisory committee appointed by Gov. Andy Beshear reported that most Kentuckians who submitted online comments support legalizing the medical use of marijuana, or cannabis, and that no one spoke against it at the four town-hall meetings the committee held across the state in July. 

“Polling suggests 90% of Kentucky adults support legalizing medical cannabis. Our team traveled the state to talk directly to Kentuckians, and they found our people do indeed overwhelmingly support it,” Beshear said in a press release. “I appreciate the work of those who participated, and I am taking this information into consideration as I analyze what steps I can take to legalize medical cannabis for those suffering from chronic, debilitating medical conditions.”

Beshear was likely referring to a Kentucky Health Issues Poll that found nine in 10 Kentucky adults favor legalizing marijuana for medical purposes. Nearly six in 10 said it should be legalized generally, but when asked if they favored legalizing it just for recreational purposes, only 49% did. 

The Medical Cannabis Advisory Committee's summary includes input from more than 3,500 Kentuckians, both online and from the town-hall meetings were held in Pike, Campbell, Franklin and Christian counties. The report also includes comments from Kentuckians, broken down into four categories: Health Care and Public Health, Criminal Justice and Legal, Advocacy Groups, and Opposition. 

The report says more than 150 Kentuckians attended the town-hall events ,with more than 70 speaking in favor of medical marijuana and no one in opposition. 

On the state's medical cannabis website, which allowed Kentuckians to submit comments, 98.64% of the 3,539 commenters supported legalizing medical cannabis and 1.36% opposed it. 

Medical Cannabis Advisory Committee map
Thirty-seven states, including five of Kentucky’s seven border states (Illinois, Missouri, Ohio, Virginia and West Virginia), the District of Columbia and four U.S. territories allow the use of medical cannabis. 

Beshear's release notes several key findings, including that marijuana can serve as an alternative to opioids, especially for chronic conditions; that Kentuckians are leaving the state to get medical marijuana where it is legal; and that marijuana helps relieve the symptoms of post-traumatic stress disorder in military veterans.

“Our nation is dealing with a critical crisis from the overuse of addictive opioids. The people we heard from are looking for pain relief that allows them to live useful, productive lives,” Ray Perry, co-chair of the committee and secretary of the state Public Protection Cabinet, said in the release. “We heard about family trauma stemming from unresolved pain and addictive painkillers. We also heard the frustration that politics deprives them of legal access to an efficacious treatment available to an overwhelming majority of Americans.”

The report also includes a list of issues and concerns raised by the Kentucky Narcotics Officers' Association in opposition of medical cannabis, as well as a summary of comments from the 46 online commenters in opposition. 

The officers voiced concerns about potency, stating that if cannabis is legalized for medical purposes, levels of its psychoactive ingredient, THC, will rise to the levels of recreational marijuana. They said more research is needed, and medical cannabis would lead to safety hazards in work and traffic. 

The leading objection of the online commenters opposed to medical cannabis was that it would lead to the legalization of recreational marijuana. 

Beshear said Sept. 22 that he would use the report to make decisions about how to go forward:"With that information, we'll be making final determinations on actions that we could take, but there will be some actions forthcoming."

The report said most of the recommendations to effectively legalize medical marijuana in Kentucky would require legislative action. That could remain a challenge. This year, a bill to legalize and regulate the use of medical marijuana passed the state House on a bipartisan 59-34 vote, but did not get a Senate vote.

Commission allocating opioid-settlement money meets in Pikeville, Ashland; will meet at 1 p.m. Tuesday in Frankfort

Kentucky Health News

The commission that is divvying up the state's half of the $480 million settlement with opioid manufacturers and distributors will meet at 1 p.m. Tuesday, Oct. 4, in Frankfort.

The Opioid Abatement Advisory Commission will meet in Suite 200 of the Capital Complex East, 1024 Capital Center Drive, where Attorney General Daniel Cameron has an office. He chairs the commission, and appointed its other members.

Executive Director Bryan Hubbard addresses the
Ashland meeting. (Photo: Matt Jones, Daily Independent)
The meeting is open to the public, and it will be livestreamed. The agenda includes a report from Executive Director Bryan Hubbard, comments from the public, and meetings of subcommittees.

The commission has had two meetings to hear from the public, in Pikeville and Ashland. "About a hundred people from all walks of life" turned out for the Ashland meeting Tuesday, Sept. 27, reports Henry Culvyhouse of The Daily Independent.

"A constant theme throughout the evening was the need for support in recovery through housing and transportation," Culvyhouse reports. "Brittany Herrington, of Pathways, said housing is needed in the worst kind of way, because people in early recovery typically can’t find stable housing or residential treatment centers with decent standards."

Coincidentally, the next day, state government announced a new website, FindRecoveryHousingNowKY.org, for people in treatment for substance-use disorder to find beds at recovery homes in their area. "People who visit the site can confidentially locate safe, affordable recovery housing openings based on their needs and personal situation, reports Tom Latek of Kentucky Today. "Users can narrow their search by location, rent amount, amenities, services, residence requirements, transportation options and more."

State Health Secretary Eric Friedlander said at the announcement, “When we talked to primary care physicians, we found out they don’t know where to send people to get help. We needed something in place that could quickly get people to recovery, because the one thing we know, when someone says, ‘Yes’ to recovery, we had better be able to say ‘Yes’ back to them.”

At the Ashland town hall, "Transitional living — a sort of soft landing for folks being released from jail, prison or out of rehab — was another concern," Culvyhouse reports. "Many times, people were lost in the shuffle and wound up back in the same environment where they used, only to start the cycle again."

The stigma of drug abuse remains a big barrier to treatment, doctors said. "One asked treatment centers to use federal regulations to redact certain portions of medical records so patients don’t have the stigma of being addicts when they go seek treatment for an ailment," Culvyhouse reports. "One described seeing a man die of a rotten tooth due to no provider touching him because of his addiction. Another woman lost a finger because doctors assumed she was drug-seeking, another doctor reported."

A woman who works for Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) "talked about the need for a support system for the children raised in the drug epidemic, stating she saw it first hand watching relatives shoot up when she was a child," Culvyhouse writes. Boyd County Coroner Mark Hammond visualized the local death toll from opioids, "stating 500 pairs of shoes would probably account for the dead he’s seen in his 11 years in office. At one point, Hammond got emotional, stating he was tired of all the death and the broken families. . . . Each member of the commission present shared their thoughts and opinions — the big takeaway was the answer wasn’t with Frankfort, but it was in the communities."

Half of the settlement goes to state government and half to local governments, which are supposed to set up their own allocation system.

Friday, September 30, 2022

Two Kentucky hospitals, in Lexington and Prestonsburg, each lose $2.4 million in very different lawsuits over 'patient dumping'

Baptist Health Lexington (Photo for The Courier Journal by Jack Weaver)
Highlands ARH Medical Center, Prestonsburg
Two Kentucky hospitals have recently lost lawsuits that charged them with “patient dumping,” generally defined as discharging patients who are uninsured or unable to pay – or refusing to admit them in the first place, reports Andrew Wolfson of the Louisville Courier Journal.

The judgments were virtually the same, but the cases were very different.

On Aug. 31, a Floyd County jury awarded $2.4 million to Ashley Shepherd, "who claimed Highlands ARH Medical Center retaliated against her after she refused to go along with an alleged scheme to boot out suicidal, psychotic and homicidal patents when their insurance coverage expired, usually after three days," Wolfson reports. "Shepherd, a behavioral therapist, said she was directed by supervisors at the hospital in Prestonsburg to persuade patients they were no longer psychotic, suicidal or homicidal so they could be discharged when they could no longer pay or their insurance coverage ran out."

Shepherd, a 36-year-old single mother, testified in a deposition, “I was told this is not a hotel.” ARH denied the charges, but the jury said it should pay $2 million in punitive damages.

On Sept. 13, a federal jury in Louisville "awarded $2,395,000 to tow-truck operator William “Tully” Williams, 65, whom Baptist Hospital Lexington turned away when he was transported there by EMS suffering from a dangerous type of heart attack" on Final Four weekend in April 2015, Wolfson reports. "The hospital said it had to 'divert' heart-attack patients because it didn’t have any cardiothoracic surgeons on call. . . . He had to be loaded back into an ambulance and taken to another hospital down the road. . . . His lawyer, Hans Poppe, said the hospital committed a 'reckless comedy of errors,' including failing to advise local ambulance services of its plans."

Williams sued Baptist Health after the federal government found that the hospital violated the Emergency Medical Treatment and Labor Act by failing to screen and stabilize Williams before sending him to the University of Kentucky hospital a mile away, Wolfson reports. The law allows fines of up to $100,000, or lets patients sue for more.

Baptist Health attorneys argued that the delay was "only a few minutes, but its own medical expert conceded it didn’t meet the standard of care," Wolfson reports. The jury's verdict included $1.85 million in punitive damages, which are designed to discourage similar conduct by the defendant and others. The case was tried by District Judge Claria Horn Boom.

Shepherd's attorney, Jerry Patton of Prestonsburg, told Wolfson that his client's award “sends a message to health-care providers who bear tremendous responsibility for the treatment and care of psychiatric patients that the law must be followed, and above all patient safety and care is paramount to any and all other considerations, including profit.”

Appalachian Regional Healthcare's chief legal officer, Cristi R. Lee, gave Wolfson a statement: “Patient care is always the top priority in all ARH locations, regardless of that patient's ability to pay. Additionally, processes are in place to encourage all staff to make their voices heard should they want to suggest opportunities for improvement or have any concerns while working in our facilities.”

"She noted the case, tried before Judge Thomas Smith, involved one claim related solely to Shepherd’s employment and there were no claims of medical negligence," Wolfson reports. "She said ARH was disappointed with how the law was applied and has asked Smith to overturn the verdict."

In the other case, Baptist Health spokeswoman Kit Fullenlove Barry told Wolfson that the diversion of Williams said was a “rare and unusual occurrence. . . . While we are surprised and disappointed with the verdict, we are pleased that Mr. Williams received the care he needed and is doing well.” Baptist "said it later hired a consultant to train employees how to comply with the law," Wolfson reports.

Thursday, September 29, 2022

CDC's Ky. risk map is largely green, but 11 counties are still at high risk and the state's infection rate ranks first in the nation

CDC map, adapted by Kentucky Health News
By Melissa Patrick
Kentucky Health News

The number of Kentucky counties at high risk of Covid-19 was cut in half last week, with only two counties moving into a higher risk category. 

Harrison and Magoffin counties moved to the high risk category, shown in orange, from a medium risk, shown in yellow. 

All 11 of the high-risk counties on this week's map, except Harrison, are in the area served by the Appalachian Regional Commission.

The CDC rated 51 counties at medium risk, five more than the week before, and 58 at low risk, up by six. Low-risk counties are shown in green.

In high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC also has a transmissions levels map that shows the level of virus spread in each county, at one of four levels. It says Hickman County has low transmission and 12 counties have moderate levels. The rest have either substantial or high levels of transmission. This data is largely used by researchers and health-care facilities, but it also shows why Kentucky's infection rate is again first in the nation, according to The New York Times. 

State officials say Kentuckians should use the risk map, which is based on new coronavirus cases, hospital admissions and hospital capacity, to guide their preventive measures.

Reflecting on last week's CDC report and the state's weekly report, released Monday, Gov. Andy Beshear said at his weekly press conference that the state has seen four weeks in a row of a decline or plateau and that "it's the best looking map we've had in a while." This week's map, released later Thursday, is even better.

Beshear also encouraged Kentuckians to get the new booster shot that protects against the major Omicron subvariants, again warning that "Since the vaccines became available, 93 percent of all Covid deaths have been amongst unvaccinated individuals. . . . If you are willing to get that booster, please go out and schedule it." 

Asked under what circumstances he is still wearing a mask, Beshear first said people should consider wearing a mask depending on where they are and what the color of the county is on the risk map. Further, he said it should depend on your vaccination status and your overall health.

"Those are all things that people should consider," he said. "I will tell you that I have not worn a mask often in the past several months. I have worn one on an airplane --  just thinking . . .of my own risk perspective, I get sick every time I'm on an airplane, much less from from Covid -- and in an airport." 

Respiratory viruses are increasing among children, and are occurring earlier than usual; one can cause a debilitating condition

CDC graph shows share of outpatient visits for respiratory illnesses, by week of the year.
By Melissa Patrick
Kentucky Health News

With common respiratory viruses on the rise among children, doctors are concerned that the viruses are showing up earlier in this year, says Dr. Lindsay Ragsdale, chief medical officer at Kentucky Children's Hospital.

In addition to increases of rhinovirus and enterovirus, which cause the common cold, Ragsdale said the hospital is seeing upticks in Respiratory Syncytial Virus, or RSV, which normally shows up between November and February.

"This is very unusual, compared to [a] decade's worth of epidemiologic data," Ragsdale said. "We normally see a winter surge in kids, and now we're seeing it starting in July this year."

Norton Children's Hospital in Louisville is reporting similar unseasonable spikes in RSV, Aprile Rickert reports for WFPL, saying that the hospital has admitted 66 patients with the respiratory virus, more than double the 32 at this time last year.

These increases in respiratory viruses in children are happing all over the country, prompting the Centers for Disease Control and Prevention to issue a health advisory alerting clinicians that there has been a surge in pediatric patients with severe respiratory illness requiring hospitalization. The CDC notes a rise in three respiratory viruses: rhinovirus and enterovirus and a more severe version of enterovirus called D68 or EV-D68, which can cause a rare polio-like paralysis in children.

The vast majority of children fully recover from EV-D68, but it can result in a rare complication called acute flaccid myelitis, or AFM. "Children with AFM may have weakness in one or more limbs, difficulty walking, and pain in the neck or back. Most require hospitalization, and about half are admitted to intensive care," write epidemiologists Katelyn Jetelina and Caitlin Rivers in Jetelina's newsletter, Your Local Epidemiologist

The CDC notes that outbreaks of AFM appear every two years, but it skipped 2020, likely due to efforts to prevent spread of Covid-19. But with the increase in the EV-D68 strain this year, the agency encourages clinicians to consider it as a possible cause of acute respiratory illness and to assess children for AFM.

The newsletter also included a CDC graph showing a rise in outpatient visits for respiratory illness, which includes symptoms of fever plus cough or sore throat, especially among those under age 4. "It’s normal to see an increase in cold and flu illness each year, but this is occurring ahead of the normal winter schedule," they write.

Lindsay Ragsdale, M.D.
Ragsdale said the increase in respiratory illness in children is likely because they haven't been getting normal immune system exposures because we have been social distancing and masking during the pandemic, so now exposures are happening in a different way.

Jetelina and Rivers agreed: "The drawback is that the population immunity normally maintained through regular cold and flu seasons eroded, leaving more people (especially kids) without recent immunity."

That said, Ragsdale stressed that most kids are pretty resilient and that the ones who need hospitalization often have an underlying lung disorder or have other health conditions that make them more fragile.

"So even though they've gotten these infections, the vast majority of them can stay home and just do symptomatic care," she said.

Another concern, she said, is that this early influx of respiratory illness will overlap with the incoming flu season and a possible Covid-19 surge this winter.

"That will cause some capacity challenges . . . for our Children's Hospital admissions," she said. "But we are working really hard to expand to new units and to make sure that we have room for every child that needs care. . . . I am worried that we're already seeing a high number of infections, but we're making plans."

Ragsdale encouraged families to seek medical care for their children with a respiratory illness if their child is dehydrated, is having trouble breathing or has prolonged fevers. Otherwise, she encouraged families to keep their child at home if they are sick, especially if they have a fever, to keep their hands washed and for the whole family to get their flu and Covid-19 vaccine.

"We do anticipate having a pretty significant flu season," she said. "We're glad to see the Covid numbers coming down, but again, we don't know what's going to happen this winter and vaccines are effective to prevent those infections."

Wednesday, September 28, 2022

Bedbugs, long thought to pose no risk to human health, produce large amounts of inflammatory histamines, UK researchers find

Bedbugs in an entomology lab (Photo by Matt Barron, UK)
By Haley Simpkins
University of Kentucky

Bedbugs produce large amounts of histamine that may pose risks to humans, entomologists at the University of Kentucky and North Carolina State University have discovered in a study. 

Histamines are naturally produced chemical compounds that may cause inflammation and alert the immune system to threats. They can cause allergic reactions, rashes and respiratory problems. A previous study showed links between excess histamines and headaches, gastrointestinal issues, irregular heart rate and asthma, especially in people with histamine intolerance.

Sudip Gaire, a post-doctoral scholar in the UK Department of Entomology, and Zach DeVries, assistant professor of entomology, led the latest study. It looked at levels of histamines excreted by bedbugs across the bugs’ different life stages, different populations and varying lengths of time, and the effects that feeding on blood had on the bugs’ histamine production levels.

The study, recently published in The Journal of Medical Entomology, showed bedbugs can produce large amounts of histamine. It found that a hypothetical infestation of 1,000 bugs could produce up to 40 milligrams a week, more than 2 grams per year without even considering natural population growth of the infestation.

“That's an amount you can actually see, and we don't see that with any other containment,” DeVries said. “When we talk about pesticides, allergens, any other thing in our home that some invading organism is producing, it's always on microscopic levels, not something where you could actually hold it in your hand.”

Scientists typically haven't considered bedbugs a great risk to human health, aside from their bites, because they are not known to carry pathogens. However, high-level histamine production reveals a potential risk. While scientists don’t know the specific health impacts of histamine produced by non-human animals, DeVries, Gaire and their fellow entomologists do suspect that it may have negative clinical effects.

“It’s not only the fact that they’re producing histamine, but they’re producing it right next to where you spend the most time, generally speaking, within our homes, which is in our beds or sleeping areas,” DeVries said.

The research also has social-justice implications, DeVries said: “Anybody can get bedbugs, but it’s only those who have the means and resources who can actually get rid of the problem. There is a significant portion of the population who either don't have the money or the resources to do this, and so they're left to deal with bed bugs on their own. So, we have disadvantaged communities, who are not only having to deal with bed bugs, but maybe dealing with the health ramifications of them as well.”

One important discovery of the study was that blood-fed bed bugs produced “significantly higher” amounts of histamine than those feeding on saline or those that were starved. “Blood is the primary factor for histamine production, but we don’t know how exactly they are producing the histamine,” Gaire said.

Gaire said close exposure to histamine is also a concern for agriculture. Bedbugs are common in poultry houses, and previous studies have found histamines reduce egg production.

DeVries and Gaire said that while their study answered important questions, scientists need to do more research before sounding an alarm. DeVries received funding for the study through his 2019 National Institutes of Health Director’s Early Independence Award, which will fund similar future studies through 2024.

Tuesday, September 27, 2022

Traditional orthodontics remain popular, but the sale of invisible braces boomed during pandemic, and a 'high-stakes war' is on

Photo from healthline.com
As invisible braces offered by Invisalign and direct-to-consumer companies like SmileDirectClub become more popular, the firms are in a "high-stakes war" with traditional orthodontists over how best to straighten your teeth, Nathan Bomey reports for Axios.

The new products are taking traditional orthodontists' profits, pitting them "against new upstarts against state dental boards, with millions of dollars in marketing and legal bills piling up along the way," Bomey reports.

Invisalign and consumer-direct companies like SmileDirectClub offer clear-plastic aligners that progressively straighten your teeth. The aligners can also be removed as needed. 

The difference between these two companies is that Invisalign involves in-person oversight from a dentist or orthodontist while consumer-direct companies allow users to obtain their teeth aligners through an online process that largely does not require office visits. Bomey reports, "Invisalign costs about $5,000 to $6,000 per case," while "SmileDirectClub typically costs a few thousand less." 

The American Association of Orthodontists has discouraged the use of direct-to-consumer orthodontics and has issued a consumer alert on its website that cautions: "Orthodontic treatment involves the movement of biological material, which could lead to potentially irreversible and expensive damage such as tooth and gum loss, changed bites and other issues if not done correctly." 

Bomey reports that while sales boomed during the pandemic for Invisalign and SmiledirectClub, they have since "trailed off over the past year, bruising manufacturers' stock prices."  

And after years of legal battles and aggressive marketing, SmileDirectClub is in "particularly rough financial shape,"  Bomey reports. And in an effort to increase opportunities for grown, SmileDirectClub has attacked state dental boards, which it views as protecting the orthodontics industry, he wriets. 

All that said, Jefferies analyst Brandon Couillard, who tracks the teeth alignment industry, told Axios that traditional braces are still used in about eight in 10 cases, including in most children -- leaving lots of room for the aligner industry to grow. 

University of Pikeville names Dr. Pamela Sparks-Stein as the first dean of its dental school, the third in Kentucky

Pamela Sparks-Stein
The University of Pikeville has named Pamela Sparks-Stein as the first dean of its College of Dental Health, Kentucky's new dental school.

"Among several strong candidates, Dr. Sparks-Stein stood out for her incredible alignment to the mission of the University of Pikeville,”  UPike President Burton Webb said in a news release. “Her compassion and empathy will help her create the kind of dental school where care for the underserved is central to our identity, where the health of the public is paramount, and where quality care is an absolute necessity.”

Sparks-Stein comes to UPike from the University of Kentucky College of Dentistry, where she serves as division chief of dental public health. Prior to her roles in education, she was in private practice in Kentucky for 13 years. 

“I am a public-health dentist and my heart has a passion for helping vulnerable and underserved populations,” Sparks-Stein said in the release. “My years of working with grants and projects in Eastern Kentucky have shown me there are so many wonderful partners who are willing to help, making it a great place to forge partnerships that will allow us to make a true impact in central Appalachia.”

Sparks-Stein received her dental degree and and master’s of public health degree from UK.

The UPike College of Dental Health is the third dental school in Kentucky and was made possible from a $25 million gift from an anonymous donor's family foundation. The other two dental colleges are at UK and the University of Louisville. 

It's Blood Cancer Awareness Month; many blood cancers such as leukemia can be highly treatable if they're caught early

A blood sample is taken. (Photo by Dusan Petkovic, Getty Images Plus)
By Reshma Ramlal
University of Kentucky

Because many cancers in the blood can be highly treatable if caught early, there is an urgent need to raise public awareness of the signs and symptoms of the disease.

Blood cancers include leukemia, lymphoma and myeloma. They form in bone marrow, where blood is made, or in the lymphatic system that fights infections. Blood cancers affect both children and adults, and account for almost 10% of new cancer cases in the U.S. each year.

While the prognosis, or chance of recovery, depends on many factors including the type of blood cancer, survival rates have significantly improved. With modern treatment, patients with chronic myeloid leukemia can have close to normal life expectance. Elderly patients with acute leukemia, which was previously rapidly fatal, are now living one to three years from their diagnosis, and cellular therapy (involving a patient’s own cells or donor cells) is capable of offering a cure for some types of lymphomas and acute leukemias.

Symptoms: Because there is no screening test for early detection of blood cancers, people don’t typically know something is wrong until they develop symptoms. That’s why it’s especially important to learn to recognize the symptoms and be aware of any changes in your body.

People who have had prior chemotherapy or radiation or a prior toxic chemical exposure are at increased risk of developing blood cancers. Common blood cancer symptoms include:
  • fever
  • drenching night sweats
  • persistent fatigue and weakness
  • bone or joint pain
  • unexplained weight loss
  • swollen lymph nodes, liver and spleen
  • easy bruising or bleeding
If you are experiencing any of these symptoms, bring it to the attention of a health-care professional right away. It could save your life.

Treatment: Opttions vary by diagnosis as well as stage of the disease and include chemotherapy, targeted therapies, radiation therapy, immunotherapy, stem-cell transplant and blood transfusion.

The Hematology and Blood & Marrow Transplant and Cellular Therapy Program at UK HealthCare treats all blood-related diseases. Clinical trials and research studies underway at UK Markey Cancer Center can give blood-cancer patients additional treatment options and the best chance for survival.

Monday, September 26, 2022

New cases of Covid-19 in Kentucky continue to decrease, but cases among young people are up and the east remains hot

New York Times map, adapted by Kentucky Health News
By Melissa Patrick
Kentucky Health News

Every metric of the pandemic in Kentucky fell last week, but while the number of new coronavirus cases was dropping, the number of those in Kentuckians 18 and younger increased by almost a third. 

The state's report for the Monday-to-Sunday reporting period said there were 7,402 new cases, or 1,057 per day. That's 19% less than the 1,308 daily average recorded the week before.  

But 2,748 of those new cases were among Kentuckians 18 and younger. That was 37% of the total, one of the highest weekly figures for this group and 31% more than the prior week's 18-and-younger figure.

State data shows there is a lot of room to increase vaccination rates in this age group, with only 43% of those 16 and 17 fully vaccinated; 43% of those 12-15; 20% of those 5-11; and 2% of those 6 months to 4 years old.

The share of Kentuckians testing positive for the coronavirus in the last seven days was 9.01%, the lowest rate reported since the end of May. This figure does not include at-home tests. 

Hospital numbers, a key to determining risk from the virus, dropped again. Kentucky hospitals reported 398 Covid-19 patients, down 58 from the week before; 62 Covid-19 patients in intensive care (down 13); and 24 of those patients in need of mechanical ventilation (down 5). 

The statewide incidence rate of new cases was 14.4 cases per 100,000 residents, down from 20.1 a week earlier. The top 10 counties were all in Appalachia: Perry, 55.5; Knott, 46.3; Leslie, 43.4; Powell, 42.8; Owsley, 38.8; Letcher, 35.1; Greenup, 35; Menifee, 33; Breathitt, 31.7; and Wayne, 31.6.

Kentucky still has one of the highest case rates in the nation, with Eastern Kentucky still a hotspot. The New York Times ranks Kentucky's seven-day new-case rate third highest among states, even with a 42% drop in cases in the last 14 days. New Jersey and North Carolina rank barely ahead of Kentucky.

The Times says Perry County has the second highest rate in the nation and that Harlan and Breathitt counties are ranked No. 9 and No. 10. Wayne, Rowan, Boyd, Clay, Morgan, Letcher, Carter, Powell, Johnson and Floyd counties are also in the top 25 nationally. (The Times figures differ somewhat from state figures because of differences in data gathering and processing.) 

The state attributed 67 more deaths to Covid-19, bringing the state's death toll to 16,969.