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
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.

Sunday, September 25, 2022

Most Kentucky counties don't have enough primary-care doctors

Kentucky Department for Public Health map, adapted by Kentucky Health News
Most of Kentucky's rural counties and some of its metropolitan areas have too few primary-care doctors and they are leaving faster than they can be replaced, Sarah Ladd reports for the Louisville Courier Journal. All told, 94 percent of the counties in a state with poor health outcomes don't have enough doctors. 

"Experts say primary-care doctors can help people get ahead of health problems before they turn into emergencies, and the shortage is exacerbating problems in a state that already ranks high in the nation for diabetes deaths, heart disease, obesity and cancer, among other things," Ladd reports. 

Reasons given for the shortfall are myriad, including the pandemic causing more retirements, doctors choosing higher paying specialty fields instead of primary care, and medical-school graduates going to other states.

Experts told Ladd that part of the solution is investing in educating physicians in and from the underserved areas.

"We're trending in a dangerous direction here if we don't have a big intervention soon," Ashley Gibson, director of workforce development with the Kentucky Primary Care Association, told Ladd. One solution, she and Molly Lewis, interim CEO of the association, offered is creating pipelines to get Kentuckians educated in health professions and then back to working in their own communities.

Lewis told Ladd that ideally 100% of Kentuckians would have a personal primary care doctor, but Ladd reports that CDC data shows that only about 74% of them said they did in 2020. 

Having a personal physician makes it more likely you will seek preventive care, be up to date on your care, be healthier overall healthier spend less money on health care, Lewis told Ladd: "If . . . you're creating access to primary health care, then you are reducing the need for more expensive types of health care services because you're able to diagnose, treat and prevent poor health outcomes."

Gibson said 40% of Kentuckians live in rural areas, but only 17% of the state's primary care doctors practice in those places.

Kentucky had 58 primary-care doctors per 100,000 residents in 2019, ranking it 45th in the nation, according to the American Academy of Family Physicians. Lewis noted University of Kentucky research that found the state ranked 44th in 2021, a bit better than 2019 but lower than its 2016 ranking of 40th. 

"Federal data show Kentucky had only 418 more primary care doctors in 2016 − the latest year for which such information is available − than it did in 1999, and repeatedly has had less than many of its neighboring states," Ladd notes. 

The problem is national. In 2020, the Association of American Medical Colleges predicted that by 2033, the nation would be short between 21,400 and 55,200 primary-care physicians.

In Kentucky,  a UK report said the state needs to add 237 physicians every year, which outpaces its estimated annual influx of 116, to hit the national median by 2025. 

Meeting this goal will be difficult, Gibson told Ladd, because more than half of Kentucky's medical school graduates leave the state to work. Lewis "said it could have something to do with students being from other states and moving to Kentucky only for their education," Ladd reports.

With the important exceptions of vaping and marijuana, substance abuse among U.S. teenagers has been going down

Past-month substance use by time and usage group, including parental supervision
(Graphs from study in Substance Use & Misuse journal; click the image for a larger version)

By Melissa Patrick
Kentucky Health News

Except for cannabis use and vaping, substance use among American teens is going down, according to a recent study.

Published in the peer-reviewed journal Substance Use and Misuse, the study examined data from more than half a million adolescents in 1991-2019 from the national Monitoring the Future survey to track trends in use of cigarettes, alcohol, cannabis, vaping of both nicotine and cannabis, and other substances for children in school grades 8 (13-14 years old), 10 (15-16) and 12 (17-18).

The researchers cross-referenced these habits against demographic factors such as level of social engagement, participation in structured activities, level of adult supervision, and employment. They further cross-referenced the patterns across race, sex, and parental education, along with other demographics.

The researchers said in a news release that while the reasons for the decrease in substance use among teens is not clear, it appears to correlate to a number of social factors, including increased parental monitoring and decreased partying and dating.

"Their findings found that low social engagement and participation in structured activities seemed to be the overall best predictors of substance abuse avoidance," the release said. "Conversely, substance abuse was higher overall in the highly social and highly engaged groups with less supervision. Time at a paid job was also a significant factor in increasing the chances of trying illicit substances."

The research also found that "Cannabis use use increased among all groups, but especially among adolescent workers. Nicotine vaping increased the most among the highly social and engaged group that was less supervised. And cannabis vaping increased most among social but disengaged teens."

“Social settings where adolescents interact with peers (e.g., parties) provide opportunities for substance use, especially in the absence of adult supervision," said Noah Kreski of Columbia University, the study's lead author. “These social settings may produce peer pressure for adolescents to engage in substance use in order to fit in.”

The researchers suggest that such peer pressure may drive substance use among employed adolescents, largely because they interact with older teens and adults. Cannabis users especially appear to seek out other cannabis users, creating social circles where the drug plays a central role; the researchers said vaping is similarly correlated to social influence.

The authors suggest that a variety of peer-led and community-based programs may be effective in diminishing use across a broad spectrum of adolescent demographics. They also urge further examination of mental health conditions that may lead to substance abuse.

The researchers note several limitations to the study; the data was not comprehensive on how teens spent their time, and did not include data from 2020 and 2021, so it does not capture behaviors in the pandemic.

Across the sample examined, here are some further results from the study:
  • 15% respondents reported any past two-week binge drinking;
  • 27.4% drank alcohol in the past month;
  • About 14.7% of adolescents smoked cigarettes in the past month;
  • 12.6% reported any past-month cannabis use;
  • Over 8.64% reported past-month use of other substances;
  • 12.3% reported nicotine vaping and 6.2% reported cannabis vaping from 2017 onward.

Saturday, September 24, 2022

Abortion-rights supporters report raising more funds than backers of anti-abortion ballot measure; Lexington mayor opposes it

UPDATE, Sept. 30: The abortion-rights group is airing its first television advertisement, the Lexington Herald-Leader reports. Saturday, Oct. 1, the group supporting the amendment will have a rally at the state Capitol.

By Al Cross
Kentucky Health News

Abortion is on Kentucky's ballot. The state's portal for requesting an absentee ballot opened Saturday, Sept. 24, and the ballot will have this question:

Are you in favor of amending the Constitution of Kentucky by creating a new Section of the Constitution to be numbered Section 26A to state as follows: "To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion"?

Quotation marks have been added above to make the meaning clear, but a lot of time and money will be spent explaining the amendment and persuading voters to vote for or against it. Groups on either side have reported raising more than $2 million so far as of Sept. 9, the end of the latest reporting period.

Almost four-fifths of the money reported has been raised by Protect Kentucky Access, which opposes the amendment. It has reported raising just over $1,750,000 and spending almost $521,000.

Yes for Life, which supports the amendment, has reported raising almost $460,000 and spending just over $50,000 through Sept. 9.

In the latest reporting period, Yes For Life raised "an additional $111,000 from Right to Life affiliates, $94,000 from the Family Foundation, $72,000 from the Kentucky Baptist Convention and $64,000 from the Catholic Conference of Kentucky — the same four groups that made up nearly all of of Yes For Life's $85,000 of contributions last year," reports Joe Sonka of the Courier Journal.

Addia Wuchner, executive director of the Kentucky Right to Life Association and chair of Yes For life, "said its coalition started out with a handful of organizations but there's a 'groundswell' of more organizations taking up their cause," reports the CJ's Morgan Watkins.

Sonka writes, "The fundraising figures of the two groups are expected to significantly rise as the high-stakes referendum on abortion rights draws nearer, just as they did in Kansas this summer — where groups on both sides of a similar constitutional amendment spent more than $22 million," in almost equal amounts. The amendment, similar to the Kentucky proposal, lost by a 3-2 margin. The woman who ran the campaign against it is now running the Protect Kentucky Access campaign.    

Protect Kentucky Access raised most of its money after the U.S. Supreme Court's late-June decision overturning its 1973 Roe v. Wade ruling, which had created a constitutional right to abortion. Most of that money came from affiliates of Planned Parenthood, which gave $701,000 during the last reporting period, for a total of $936,000.

Other major givers to the abortion-rights group during the period included the American Civil Liberties Union, $300,000,; Families United for Freedom, a federal political committee, $250,000; and 34 individual physicians, $26,750. Several other contributors were from the health-care industry.

Linda Gorton (Herald-Leader photo by Ryan C. Hermens)
Lexington Mayor Linda Gorton, a nurse by profession for 40 years, wasn't on the list, but she announced Thursday that she would vote against the amendment because health-care decisions should be between a patient and a doctor. 

“The government has no business in that exam room,” Gorton said. “That is why on Nov. 8 I am voting ‘No’ on Amendment 2 and I want you to do the same.”

Gorton made her announcement in a video on the Facebook page of her campaign for re-election as mayor. The race is nonpartisan but she is a registered Republican. Her opponent, Councilman David Kloiber, is a Democrat.

"Kloiber, a first-term councilman who runs his family’s foundation, has said if he is elected, he would direct police not to investigate doctors, health care providers or women for abortions," reports Beth Musgrave of the Lexington Herald-Leader. "Kloiber has also said he would make sure the city’s health insurance covers abortions out of state. Gorton has said she can’t tell police what laws to enforce and what laws not to enforce, saying that’s a dangerous precedent.

Democratic Gov. Andy Beshear, who generally supports abortion rights but opposes late-term abortions, has said voters should reject the amendment because it includes no exceptions for rape, incest or saving the life of the pregnant woman.

Beshear's stand reflects public opinion as measured by a poll of 475 Kentuckians who were surveyed from June 8 to July 6. (Roe v. Wade was overturned June 24, but Politico revealed the essence of the decision May 2.)

Courier Journal graph; error margin calculated and added by Kentucky Health News

If Kentucky voters approve the amendment Nov. 8, it would render moot a case that the Kentucky Supreme Court is scheduled to hear Nov. 15: an appeal of a Louisville judge's injunction blocking the state's "trigger law" that outlawed almost all abortions as a result of the U.S. Supreme Court's decision. That decision also revived a state law that bans abortions if the fetus has a heartbeat, about six weeks into a pregnancy.

In issuing the injunction, Jefferson Circuit Judge Mitch Perry said the laws violate the rights to privacy, self-determination and religious freedom established by the state constitution and court decisions based on it. But the injunction was vacated by Court of Appeals Judge Larry Thompson of Pikeville, who said abortions performed while the case is pending "cannot be undone." A divided state Supreme Court let Thompson's ruling stand.

Only three of the seven justices (Robert Conley of Russell, Debra Lambert of Somerset and Laurance VanMeter of Lexington) fully concurred; the majority was made by Justice Michelle Keller of Fort Mitchell, who concurred in the result only and wrote a separate opinion, and Justice Shea Nickell, who joined in that opinion.

Keller, a registered independent who was appointed by then-Gov. Steve Beshear in 2013, is on the nonpartisan ballot against Republican state Rep. Joe Fischer, who sponsored the trigger law. Both are from Fort Mitchell.

Friday, September 23, 2022

UK Extension program to address farmer suicide and other mental-health issues expands to include young people and nurses

Farmer Dinner Theater helps farm families discuss mental health and suicide issues, through dramatic performances by local youth. (Photo by Steve Patton, UK Agriculture Communications)
An initiative that was originally designed to address farmer suicide has expanded to address mental health issues and suicide among young people and nurses, Jordan Strickler reports for the
University of Kentucky. The initiative is called BARN, for "Bring Action Right Now." 

The initiative includes the Farmer Dinner Theater, initially designed to bring farm families together to discuss mental-health issues affecting their communities through dramatic presentations starring local community youth. The program encourages an open dialogue about mental health and reassures farmers and their families that it is OK to seek treatment if needed, Strickler reports.

“The BARN program delivered in Kentucky has helped increase awareness about mental health challenges, farm stress and suicide prevention in Kentucky,” said Paul Norrod, extension specialist for rural health and farm safety and instructor in the UK College of Nursing, told Strickler. “Dinner theater attendees have stated that mental health challenges can affect anyone and that it is important to talk about them in the community to help prevent suicide.”

The theater offers reenactments based on real-life situations that farm families may have faced and exposes farmers and their families to a variety of proven mental-health interventions, ranging from basic suicide intervention resources to breathing techniques.

Male farmers died by suicide at rates twice as high as the national average in 17 states studied by the Centers for Disease Control and Prevention in 2012-15. That may be an understatement, Strickler writes, because the study didn't include some agricultural states.

In Kentucky, 109 Kentucky farmers died by suicide from 2004 to 2017, with those over 64 most at risk, Strickler reports. 

The BARN program is a joint program of UK's nursing college and the College of Agriculture, Food and Environment. It expanded in 2021 after a Kentucky Nurses Action Coalition innovation award allowed it to address mental-health issues and suicide among young people, with participation of 100 school nurses. The same training and tools will be used to address nurses' well-being. 

Janie Heath, president of the coalition and dean of the College of Nursing, told Strickler that anyone looking to improve their mental health and wellness can use strategies highlighted in the BARN programming, including: 
  • Staying focused on what can be controlled: For example, one cannot control the weather, but one can control how we react to or prepare for the weather.
  • Breathing: Focusing on breathing and practicing breathing exercises is a proven method for combating stress and refocusing your mind away from stressors.
  • Practicing gratitude: Take time each day to identify something to be thankful for, as this helps promote positive thinking and perspective. For example, being thankful for a sunny day, talking with a friend or spending time with a pet. 
  • Prioritizing time for ourselves: Prioritize “me time” at least once a day by taking the time to do something beneficial for yourself, such as reading, exercising or watching a favorite TV program.
  • Embracing resources: Use free and/or paid professional counseling, mental-health apps or other treatment that helps your mental wellness, especially if in a crisis situation. For example, call the new mental-health crisis hotline at 988 or the National Suicide Prevention Lifeline at 1-800-273-8255. Both are free and available 24/7. 
September is Suicide Prevention Month. In 2020, the Kentucky legislature declared the Wednesday of each National Farm Safety Week "Farmer Suicide Prevention Day," which was Sept. 21 this year.

Thursday, September 22, 2022

State launches campaign to promote vaccines for Covid-19, flu

By Melissa Patrick
Kentucky Health News

Working to get ahead of what is expected to be a severe flu and Covid-19 season, the state has started a campaign to encourage Kentuckians to get vaccinated against both viruses. 

The effort is part of a million-dollar partnership between the Foundation for a Healthy Kentucky and the state Cabinet for Health and Family Services. Funding for it came from the U.S. Department of Health and Human Services and Centers for Disease Control and Prevention.

Ben Chandler, president and CEO of the foundation, said the campaign messages were developed from insights gained from polls, focus groups and surveys of more than 1,100 Kentuckians from a wide variety of backgrounds.  

"Our goal is to educate and encourage Kentuckians to keep their guard up this flu and Covid season and get their Covid-19 vaccines and boosters as well as their flu shots," Chandler said at a press conference.

The hope of the campaign is that Kentuckians will learn information and then talk to their health-care provider about it.

"It's clear Kentuckians want to have a conversation with their own health-care provider to talk about their own individual risk and their family's risks, and then make a decision for themselves," he said.

The campaign includes videos, graphics, fact sheets and other resources that will be released over the next four months. The resources are free to anyone who works to help educate Kentuckians about the importance of these vaccines and can be found at
Chandler said one of the main concerns is that Kentuckians questioned whether getting the Covid-19 vaccine and boosters are necessary, since they don't always prevent you from getting sick or spreading the virus. 

He pointed to research showing that staying up to date with Covid-19 vaccines and boosters is the best way to avoid severe illness, hospitalizations and death. 

State graph, adapted by Ky. Health News; click on it to enlarge
Kentucky data shows that a person with a booster has a 12.9 times lower risk of dying from Covid-19 than someone who has not been vaccinated, Chandler noted. 

Also, he said nearly 450,000 Kentuckians have had "long Covid" and one study found that vaccinated people were 50% less likely to develop this syndrome. Another study found the vaccinated were 41% less likely to report lingering symptoms of the disease. 

"This is not to scare folks, but to remind them that there are still real consequences from contracting Covid," Chandler said. 

State Health Secretary Eric Friedlander encouraged Kentuckians to keep up the "good habits" that have decreased the spread of the coronavirus and the flu over the last few years, including social distancing, hand hygiene, wearing masks in indoor spaces and staying home if you are sick. He also encouraged Kentuckians to get vaccinated against Covid-19 and the flu. 

"It looks like it's going to be a tough flu season," he said. "From what we see in the southern hemisphere, [which] is where it starts and it comes up here, it's going to be a challenge. And we really haven't had a flu season in the last couple of years." 

An news release from Rutgers University noted that as Covid-19 restrictions are lifted, flu cases are expected to rise, making it especially important for people to get vaccinated to prevent the nation's health-care system from being overwhelmed by influenza and the pandemic. 

That scenario already played out in Kentucky when the easing of Covid-19 restrictions caused an uptick in flu cases in March and April 2022, the first time that the flu peaked that late in the season since 1982,according to the foundation news release.

Nationwide, the release says, "The CDC’s preliminary figures from last season show 8 million to 13 million flu illnesses, 82,000 to 170,000 flu hospitalizations and 5,000 to 14,000 flu deaths. However, as precautions loosen, we are seeing rates rise. Pediatric deaths, for example, rose from one death in the 2020–2021 season to 33 this past season. In comparison, 199 children died from influenza in the 2019-20 flu season."

State Health Commissioner Steven Stack spoke on a video at the governor's weekly press conference about the importance of getting vaccinated and boosted against Covid-19 and the flu. 

"If you go in and get yourself protected against both of those illnesses at the same time, you will help keep yourself safe, your family and loved ones safe, you'll help keep al of us safe," he said. 

And for those who are still worried taking a Covid-19 vaccine, Stack pointed out that more than 612 million doses have been given in the U.S. "They're well proven, very highly safe and very, very effective and well-tolerated," he said. 

Further, Stack noted that the new booster that protects against the original virus and major Omicron variants has been updated using the technology that has been used all along, just as flu shots are updated each year. 

Everyone 6 months and older can be vaccinated for Covid-19 and the flu. Covid-19 boosters have been approved for people 12 and older and are available two months after a person has received their primary Covid-19 vaccine doses or two months after their last booster dose. Flu and Covid shots can be taken on the same day. 

Emily Beauregard, executive director of Kentucky Voices for Health, announced at the news conference that her organization will be expanding its "boots on the ground network" over the next two years to support communities facing barriers to vaccination and other basic needs. 

"The next phase of this will be to launch an ambassador program in 2023 to equip folks with the training and the tools that they need to do this work on the ground in their communities, because another thing that we've learned is that people want to get information and help from someone they know and trust," she said. 

Beauregard also pointed to the foundation's poll that found more than one in three unvaccinated Kentuckians are still open to getting the Covid-19 vaccination. 

"If we were to get every one of those Kentuckians vaccinated, that would be half a million people and could get us really close to herd immunity," she said. "It's a goal that I think we can reach." 

The state Department for Public Health, in coordination with state and local partners like KVH, has also launched a new toolkit for flu and Covid-19 vaccinations that provides a variety of resources, including printable informational materials and easy to access links for the latest information and vaccine guidance.

Latest CDC risk map shows the number of Kentucky counties at high or medium risk of Covid-19 dropped 24% in the past week

Centers for Disease Control map, adapted by Ky. Health News
By Melissa Patrick
Kentucky Health News

The weekly pandemic risk map for Kentucky improved again Thursday, as the number of counties at elevated risk of Covid-19 dropped 24 percent. 

Only a few Kentucky counties moved into higher risk categories on the latest Centers for Disease Control and Prevention risk map

Robertson County rose to the high risk category, shown in orange, from a medium risk, shown in yellow. Neighboring Bracken, Mason, Harrison and Montgomery counties rose to medium risk.  

And while all high-risk counties on this week's map were in Appalachian Kentucky, reflecting its status as a national hotspot that is keeping Kentucky's overall infection rate second in the nation, many counties in the region and adjoining areas dropped to medium risk this week. 

The CDC rated 52 counties at low risk, shown in green, up 21 counties from the prior week. It rated 46 counties at medium risk, an increase of one, and 22 at high risk, down 23, more than half. 

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 wearing 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.

CDC map, adapted by Kentucky Health News
Mainly to guide health-care facilities, the CDC also publishes a transmission levels map that ranks the Covid-19 spread in each county in one of four levels, from low to high. None are rated at low community transmission this week. Carlisle and Todd counties have moderate transmission, 13 counties have substantial transmission and the rest have high transmission.

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.

The maps were released late Thursday. Gov. Andy Beshear said at his regular midday-Thursday press conference that Covid-19 cases appear to be declining in Kentucky, based on last week's maps and Monday's weekly report from the state Department for Public Health.

"We are at the very least in a plateau, if not in that decline," Beshear said, adding later, "We are probably a week away from being able to say that we are seeing less spread of Covid throughout the commonwealth." 

Asked if he agrees with President Biden's statement, aired Sunday, that the pandemic is over, Beshear said, "Obviously, if you look at the charts, Covid is still here." He also pointed to the World Health Organization's statement last week that the end of the pandemic is "in sight."  

But WHO Director-General Tedros Adhanom Ghebreyesus said Thursday, “We have spent two and a half years in a long, dark tunnel, and we are just beginning to glimpse the light at the end of that tunnel. It is still a long way off, and the tunnel is still dark with many obstacles that could trip us up if we don’t take care. We all need hope that we can – and we will – get to the end of the tunnel and put the pandemic behind us. But we’re not there yet.”

Wednesday, September 21, 2022

UK creates Cannabis Research Center, following new state law

Cannabis research at UK (UK photo by Arden Barnes)
By Elizabeth Chapin
University of Kentucky

The University of Kentucky is home to a new center that will advance research on the medical use of cannabis.

The UK Cannabis Center will conduct research on the health effects of cannabis, including its risks and benefits when used to treat certain medical conditions.

Based in the College of Medicine’s Center on Drug and Alcohol Research, the center will build on cannabis research already taking place at UK and expand the profile of clinical cannabis research.

Established by House Bill 604 of the 2022 legislative session, the center is intended to accelerate research on cannabis that is relevant to the health and well-being of Kentuckians. The law provides the center with a $2 million appropriation over the next two years.

House Bill 136, a measure to legalize medical marijuana in Kentucky, failed to make headway in the state Senate after passing the House. As Kentucky considers legalizing the use of medical marijuana, research conducted at the new center will help educate medical providers, legislators and citizens on the risks and benefits of the use of cannabis and cannabinoids.

“The legislature is interested in having us explore the conditions for which medical cannabis might be useful, as well as the most effective dosing and route of administration for each condition,” said Shanna Babalonis, director of the Cannabis Center.

Babalonis, an assistant professor in the Department of Behavioral Science, is increasingly recognized as a leader in the cannabis field and an expert on the topic of medical cannabinoids. She has three active National Institutes of Health grants, totaling nearly $3.5 million, aimed at examining cannabis-opioid interactions, cannabis effects in those with opioid use disorder and the effects of cannabis on simulated driving performance.

“The new center will allow us to expand our clinical research, particularly focusing on medical conditions that may be helped by medical cannabis,” Babalonis said.

In addition to clinical studies, the center will engage in preclinical research on new and innovative applications and analysis of public health data.

HB 604 requires UK to apply to the U.S. Drug Enforcement Administration for a license to grow and cultivate cannabis. If approved, the center will be able to conduct agricultural research pertaining to optimal growing conditions.

UK President Eli Capilouto recently appointed a multidisciplinary team of UK faculty members that will oversee the research center’s work and finances. The 12-member board includes an executive or steering committee that will work with Babalonis to establish the center’s research goals and agenda and make key financial decisions, and an advisory board to help guide and provide feedback on the center’s progress and overall direction.

The executive/steering committee is Center for Drug and Alcohol Research Director Sharon Walsh, Linda Dwoskin, Dr. Peter Akpunonu, Dr. Laura Fanucchi, William Stoops and Joshua Lile. The advisory board includes Patricia Rippetoe Freeman, Danelle Stevens-Watkins, Joseph Chappell, Dr. Susanne Arnold, Dr. Michelle Lofwall, and James Matthews. The non-M.D.s have Ph.D.s.

The board is working to determine the center’s research goals and agenda. The center will hold an annual symposium to present research findings and will also invite outside experts to report on cutting-edge, high-impact research.