Friday, May 31, 2024

Bill to help Pikeville hospital turned into a law that will help other rural hospitals after UK saw it as a threat and rewrote the bill

State Sen. Phillip Wheeler discussed his SB 280
 on KET's "Kentucky Tonight." (Screenshot from KET)
By Melissa Patrick
Kentucky Health News

State Sen. Phillip Wheeler of Pikeville says one of the most consequential pieces of legislation passed by state lawmakers this year is a bill he sponsored to funnel more money to rural hospitals in Kentucky. 

Senate Bill 280 allows certain rural hospitals that get at least 35% of their revenue from Medicaid to get the same enhanced Medicaid reimbursement rate as the University of Kentucky or the University of Louisville

The hospitals are defined as those that have a trauma center and offer clinical rotations for doctors, nurses and other medical professionals who are in training.

"It kind of levels out that playing field," Wheeler told Kentucky Health News. "And it does this without placing any additional liability for matching funds on the General Fund by allowing local communities to assess a provider tax against the medical provider." Such taxes are applied to revenues of health-care facilities, typically to get more government matching money.

Asked if his bill will keep rural hospitals from closing, Wheeler said, "I wouldn't be so bold as to say that this is the only solution. I think you need to take a multifaceted approach and providing these hospitals with the ability to compete and the funding they need to develop this specialized care is one piece of the puzzle."

Wheeler, a Republican who represents Elliott, Johnson, Lawrence, Martin and Pike counties, said the higher reimbursements will allow rural hospitals to provide a higher level of care, especially when it comes to specialty services. And this, he said, will increase access to care for rural communities. 

"Not only does that make a huge difference to the patients being served, but it also will result in a much larger increase in investment in health care in those communities," he said. "And . . . especially in a lot of rural areas, including where I live in the 31st Senate District, health care has essentially become our largest industry. I mean, the largest employer in my district, by far, is Pikeville Medical Center with over 3,000 employees." 

Wheeler said he didn't think anyone would be harmed by this law, noting that he resolved concerns voiced by UK HealthCare, which has clinical rotations at King's Daughters Medical Center in Ashland, which it recently purchased.

Path to "good public policy" 

Mark Birdwhistell, UK HealthCare's vice president for health system administration and chief of staff, explained that UK and UofL receive enhanced Medicaid reimbursements because they are Level I trauma centers that agree to care for the "sickest of the sick" patients in the state and also house the state's primary educational programs for medicine and dentistry.

UK HealthCare VP Mark Birdwhistell
He said the impetus of SB 280 and its companion bill SB 281, which was not heard in committee, came about when UK bought King's Daughters, which allowed the Ashland hospital to get the higher Medicaid reimbursement. 

The original SB 280 would have given Level II trauma centers -- Pikeville has the only one in the state -- the same enhanced Medicaid rate as UK and UofL. SB 281 said UK and UofL could only take that enhanced Medicaid reimbursement in clinics or hospitals that operated in the county of the educational facility, limiting UK's enhancement to Lexington.

"Both of these had unintended consequences," Birdwhistell said, so UK could not support the bills in their original form. He said they would have left UK with lower Medicaid payments for services provided in any hospital that it has an agreement with to provide care, such as Hazard Appalachian Regional Healthcare. In addition, he said UK has practices in other counties, such as Bowling Green and Manchester, that get enhanced Medicaid payments.   

"That would have been devastating if that had come to fruition," said Birdwhistell, who was state health secretary in 2006-07. Later adding, "It would have significantly reduced funding and would have eventually compromised good patient care in the commonwealth."

That's because the state has to get ongoing approval from the federal government for the special Medicaid payment plans, one for public universities and another for private hospitals. And, he said, if these two pieces of legislation had passed in their original format, it would have triggered an amendment to the current plans, possibly putting them at risk. 

Driven by this concern, Birdwhistell said he suggested that the bill keep the existing enhanced Medicaid plans but have a different solution allowing a third way for hospitals to get the enhanced payments. 

"We moved it from a potential where we would not be able to get as much federal Medicaid money in the state to a new program that has the potential of pulling in additional reimbursement and an incentive to focus on access and improved outcomes, improved patient outcomes," he said. 

The revised bill that passed allows an opportunity for hospitals to get comparable reimbursement to what the universities get if they meet the criteria to do so, and Birdwhistell. And this, he said, accomplishes the goal of creating a more "level playing field."

Further, he said SB 280 allows the opportunity for additional Medicaid payments for care provided by other health-care workers, such as advance-practice registered nurses, dentists and social workers. It also says that pediatric teaching hospitals are able to get the additional Medicaid reimbursements for services to patients under 18. 

"So I think we ended up with good public policy that has the potential of improving access and  patient outcomes for the Medicaid population," Birdwhistell said.

He added later, "I think it is transformative because it has the potential of aligning people's incentives around an increased increased physician workforce, opening up additional access, appointment availability. And thirdly, aligning around access and quality." 

Birdwhistell said six or seven hospitals will likely qualify for the enhanced Medicaid payments in the first wave of hospitals. He said the goal is to get the plan submitted to the Centers for Medicaid and Medicare Services by Aug. 1 and for payments to be approved by January 2025. 

A news release from the governor's office said it estimates that 43 Kentucky hospitals meet the requirements of the new plan, dubbed the Kentucky Medicaid Assistance Program. The plan is contingent upon approval from CMS. Wheeler said they have "very good indicators" that it will be approved. 

Why SB 280 is important

Donavan Blackburn, president and chief executive officer of Pikeville Medical Center, said he'd been working on this bill for the last year and a half "to address the inequality and disparity between us and urban hospitals," which have a greater share of patients with commercial insurance, which pays higher rates. 

He pointed out that his Level II trauma hospital accepts patients from 48 other hospitals in the region who need a higher level of care and that 77% of them are either on Medicaid or Medicare. He said Pikeville Medical Center "serves the sickest of the sick and the most financially challenged in the nation." 

And while he said his hospital could be likened to UK or UofL when it comes to the services it provides, it is not a state-owned hospital or a teaching hospital. The hospital has an agreement with the University of Pikeville and four nursing schools to provide clinical rotations. 

In particular, he said it's his mix of payers that makes SB 280 so important because this extra money will allow the high level of care provided by the hospital to continue. 

"And what that extra payment means is, is that programs like our children's hospital, like our trauma center, like our specialties and subspecialties, endocrinology, rheumatology, all those different specialties that we're able to offer here in our community can stay in our community," he said. "Which means that not only people have access to care, but it prevents a diagnosis that if it goes untreated, becomes advanced, which costs actually the state and federal government even more."

Further, he said it will allow the hospital to retain jobs in health care, which is the top economic driver in the region. 

Blackburn said the success of SB 280 will be evident if they are able to "keep those service lines open and to keep making investments and advancements and to be able to keep up with all the other markets. . . . It's about advancement and sustainability." 

First naxolone shipment under settlement with drug maker arrives

Teva Pharmaceuticals' generic naloxone
Kentucky Health News

Nearly 8,000 doses of naloxone, which reverses the effects of drug overdose, were delivered to Kentucky this week as part of a settlement with Teva Pharmaceuticals, Attorney General Russell Coleman announced.

In October, Teva agreed to pay the state more than $71 million over 13 years, resolving allegations that the company’s marketing and promotional practices fueled the opioid-overdose crisis. In addition to the cash payments, Teva agreed to provide more than 23,000 units of naloxone.

The shipment, the first of four expected this year, went to facilities in Louisville, Florence, Ashland, Paducah and Frankfort. The Opioid Commission is partnering with the Cabinet for Health and Family Services as well as the Kentucky Pharmacists Association for distribution.

“Naloxone is a critical lifeline for Kentucky families struggling with addiction,” Coleman said in a news release. “Equipping first responders, health professionals and treatment providers with this all-important medication can help save lives for Kentuckians on the road to recovery.”

Half of all opoid-settlement funds go to local governments. The state's half is distribited by the Kentucky Opioid Abatement Advisory Commission is responsible for the distribution, part of the attorney general's office. On Tuesday, June 4,, the commission will award its next round of grants.

Kentuckians can find out how to get free naloxone near them at Naloxone is also sold under the brand name Narcan by Emergent Solutions Inc.

Today is World No Tobacco Day; youth group coordinated by UK pharmacy student aims for tobacco-free future for Kentucky

Members of the #iCANendthetrend Youth Advistory Board and
and UK coordinator Griffin Nemeth pose with Gov. Andy Beshear
outside the state Capitol. (UK College of Pharmacy photo)
By Rosa Mejia-Cruz
University of Kentucky

On this World No Tobacco Day, May 31, the importance of educating and engaging youth in tobacco use prevention cannot be overstated. The theme of this year's observance, "Protecting children from tobacco industry interference," emphasizes the vital role young people play in promoting healthier lifestyles and positive community change.

According to the World Health Organization, an estimated 37 million youths aged 13–15 use tobacco globally, with children surpassing adults in elecgtronic-cigarette usage in all regions. 

Griffin Nemeth, a student at the University of Kentucky College of Pharmacy and coordinator for the #iCANendthetrend Youth Advisory Board, exemplifies the significant impact young people and pharmacists can have in this public-health mission.

Nemeth's involvement in tobacco prevention began his sophomore year of undergraduate studies through his role as a college facilitator with #iCANendthetrend, a youth e-cigarette prevention and empowerment initiative. Project Director Melinda Ickes, a professor in the UK College of Education, worked with students to bring a near-peer prevention approach to decrease initiation of tobacco use by youth, support those who are already dependent on tobacco, and ensure that student voices are at the forefront of prevention and policy advocacy.

Since 2019, the team has reached more than 20,000 Kentucky youth. The advisory board, a group of 10 high school advocates from across Kentucky, fosters a generation of changemakers dedicated to educating peers, community members and policymakers about the negative health outcomes of vaping and tobacco use.

“I am thrilled to see young people engage in something they traditionally haven't been involved in, especially in the policy sphere,” said Nemeth. “Witnessing our Youth Advisory Board advocate for their communities and interacting with local leadership is immensely rewarding."

A key element of Nemeth's work is the comprehensive, yearlong training program he helps coordinate for younger Kentuckians. Each summer, new members of the Youth Advisory Board gather at UK for an in-person training session, followed by bimonthly virtual meetings throughout the year. This training includes online modules, skill-building opportunities and sessions led by near peers who are part of #iCANendthetrend. Each year, the Youth Advisory Board selects a project to work collaboratively on throughout the year to equip them with the knowledge, skills and confidence to effectively support their goals.

The #iCANendthetrend program's efforts have earned significant recognition. The Campaign for Tobacco-Free Kids named the board the 2024 Group Advocates of the Year, highlighting the critical contributions of youth in tobacco prevention and the necessity for ongoing support.

Pharmacists are uniquely positioned to support tobacco cessation efforts. With most people in the U.S. living within five miles of a pharmacy, trained pharmacists can bridge the gap in treatment resources, particularly in rural areas.

"Even if patients are unsure they want to begin treatment, pharmacists can ask, advise and refer, which can make a significant difference for a patient who might otherwise continue to smoke for years until a severe health condition develops,” Nemeth said. “Pharmacists can play a crucial role in early intervention.”

As Nemeth advances in his pharmacy studies, he remains committed to advocacy. He envisions a future where his role as a pharmacist intersects with his passion for public health. "There's a significant health disparity in tobacco prevention and use, especially in Kentucky. Learning about the science and treatment in pharmacy school has further prepared me as an advocate," Nemeth explained.

For those looking to reduce or quit tobacco use, pharmacists offer invaluable support. Many pharmacies provide resources and counseling for smoking cessation, including nicotine replacement therapies and other medications to manage withdrawal symptoms. Pharmacists can also offer personalized advice and support, making it easier for individuals to navigate their cessation journey.

World No Tobacco Day 2024 is a call to action for health care providers, communities and individuals to support tobacco prevention and cessation efforts. By combining the power of youth advocacy, the accessibility of pharmacists and the collaboration of health-care providers, educators, policymakers and community leaders, Kentucky can move toward a tobacco-free future. This comprehensive approach, which includes prevention, education, policy advocacy and accessible treatment resources, is essential for ensuring healthier lives for generations to come.

Kentuckians are invited to virtual June town-hall meetings on helping families with complications from substance use

By Sarah Ladd
Kentucky Lantern

Kentuckians with ideas to improve outcomes for children placed in foster care because of substance use complications will get the chance to share them during a series of town halls this June, the Administrative Office of the Courts announced Wednesday.

Registration is required for the four virtual town halls, which Citizen Foster Care Review Boards are hosting on June 3, 5, 11 and 14.

“Community input is vital to identifying needs in each area of the state,” the AOC said in the release. “Due to confidentiality, specific cases will not be discussed.”

The town halls will seek to answer the following questions, and findings will be reported back to the Citizen Foster Care Review Board:
  •  Do families and children in your community have equitable and timely access to substance use disorder assessment and treatment services?
  • What are the barriers to accessing treatment for substance use disorder?
  • What solutions could be identified to remedy barriers to access and treatment and lead to resilience and recovery?
The four town hall dates and locations are as follows: 

June 3, 11 a.m.-noon CT/12-1 p.m. ET. Register for this town hall at if you live in Allen, Ballard, Barren, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Crittenden, Daviess, Edmonson, Fulton, Graves, Grayson, Hancock, Hardin, Hart, Henderson, Hickman, Hopkins, LaRue, Livingston, Logan, Lyon, Marshall, McCracken, McLean, Meade, Metcalfe, Muhlenberg, Nelson, Ohio, Simpson, Todd, Trigg, Union, Warren or Webster Counties.

June 5, 11 a.m. – noon CT/12-1 p.m. ET. Register for this town hall at if you live in Adair, Bath, Bell, Boyd, Breathitt, Carter, Casey, Clay, Clinton, Cumberland, Elliott, Floyd, Green, Greenup, Harlan, Jackson, Johnson, Knott, Knox, Laurel, Lawrence, Leslie, Letcher, Lewis, Magoffin, Marion, Martin, McCreary, Menifee, Monroe, Montgomery, Morgan, Perry, Pike, Powell, Pulaski, Rockcastle, Rowan, Russell, Taylor, Washington, Wayne, Whitley or Wolfe Counties.

June 11, 11 a.m.-noon CT/noon-1 p.m. ET. Register for this town hall at if you live in Bullitt, Fayette or Jefferson counties.

June 14,11 a.m.-noon CT/noon-1 p.m. ET. Register for this town hall at if you live in Anderson, Boone, Bourbon, Boyle, Bracken, Campbell, Carroll, Clark, Estill, Fleming, Franklin, Gallatin, Garrard, Grant, Harrison, Henry, Jessamine, Kenton, Lee, Lincoln, Madison, Mason, Mercer, Nicholas, Oldham, Owen, Owsley, Pendleton, Robertson, Scott, Shelby, Spencer, Trimble or Woodford counties.

Thursday, May 30, 2024

Expert panel finds screen use impairs the sleep health of youth; National Sleep Foundation offers advice to reduce impact

Getty Images photo via Stony Brook University
Kentucky Health News

An expert look at research around screen use at bedtime, which has ballooned since the emergence of smartphones in 2007, found that pre-bedtime use of the devices impairs the sleep health of children and adolescents. 

The international panel of sleep experts, led by Professor Lauren Hale of Stony Brook University in New York, were selected by the National Sleep Foundation. After assessing 574 peer-reviewed published studies on screen time and its effects on children, adolescent and adult sleep, the panel created a consensus statement about digital screen use and sleep, says a university news release

The consensus statement, titled “The Impact of Screen Use on Sleep Health Across the Lifespan: A National Sleep Foundation Consensus Statement,” is published in Sleep Health, the journal of the NSF. 

The release said the consensus found that "on general, screen use impairs sleep health among children and adolescents; the content of screen use before sleep impairs sleep health of children and adolescents, and behavioral strategies and interventions may attenuate the negative effects of screen use on sleep health." 

“Upon review of the current literature, our panel achieved consensus on the importance of reducing pre-bedtime digital media to improve sleep health, especially for children and adolescents,” Hale said in the release. “We also identified the gaps in the literature and the need for future research.”

The NSF offers recommendations for best practices to reduce the impact of screen use on sleep, including: 
  • Near bedtime, avoid material thay is stimulating or upsetting
  • Have early, regular, and relaxing bedtime routines without screens
  • Set time limits on screen use, especially in evening and at night
  • Talk with kids about how using tech and screens can impact sleep
  • Model appropriate nighttime screen use for children

Wednesday, May 29, 2024

UK has a new group to research infectious diseases, including treatment and prevention through community engagement

By Lindsay Travis
University of Kentucky

A new partnership between researchers at the University of Kentucky will combat the threat of infectious diseases through research directed at prevention and treatment.

The CURE-KY team: Front row left to right: Vincent Venditto,
Steven Van Lanen, Ilhem Messaoudi, Rebecca Dutch. Back
row: Feng Li, David Burgess, Beth Garvy, Richard Greenberg.
Not pictured: Krystle Kuhs. (UK photo by Jeremy Blackburn)
The Consortium for Understanding and Reducing Infectious Diseases in Kentucky (CURE-KY) will foster multidisciplinary collaborations to address the burden of infectious diseases in the state and beyond.

“I am thrilled by the boundless possibilities our collaborative efforts promise at the University of Kentucky,” said Ilhem Messaoudi, founder of CURE-KY and chair of the Department of Microbiology, Immunology, and Molecular Genetics in the College of Medicine. “With a steadfast commitment to advancing knowledge and fostering transdisciplinary alliances, we aim to propel infectious-disease research to new heights, creating a healthier Kentucky and nurturing future scientific leaders.”

She added, “We have an excellent team of scientists here at UK and on our leadership team. Together we can tackle infectious diseases from an array of perspectives to make a difference in the health of our community.”

CURE-KY grew from, and took most of its acronym from, UK’s Covid-19 Unified Research Experts Alliance. It has experts from the College of Medicine, College of Public Health, College of Pharmacy, Martin-Gatton College of Agriculture, Food and Environment and the Markey Cancer Center.

It will focus on research in five areas: microbial pathogenesis; vaccines, therapeutics and antimicrobial resistance; public health and community engagement; animal health; and engineering and systems. IT will also work to address vaccine hesitancy and misinformation to foster trust between Kentuckians and the scientific community.

“From studying prevention, control and understanding transmission dynamics to assessing risk, promoting health equity and engaging communities in disease-control efforts, this work is critical toward our goal of creating a healthier Kentucky,” said Public Health Dean Heather Bush.

Dr. B. Mark Evers, Markey director, said “Kentucky is home to the highest cancer rates in the country, including several cancers caused by infectious diseases such as HPV and hepatitis C. . . . By better understanding and combating diseases that can lead to cancer, CURE-KY will contribute to this mission and make progress toward our ultimate goal of conquering cancer in the commonwealth.”

More information about CURE-KY and upcoming events is on on its website.

Kentuckians’ access to mental-health care lags behind the nation. Paying providers more would help, psychologists say in report.

By Sarah Ladd
Kentucky Lantern

Kentuckians are far more likely to pay out of pocket for mental and behavioral health services than for surgical or other medical care, except for care in outpatient facilities, where the state is doing better than most states. 

This insight comes from a recent American Psychological Association report, which examined health-insurance claims made by millions of Americans who sought care. The report showed that as Covid-19 peaked in the state, the number of Kentuckians forced to go out of their insurance network for acute inpatient care also increased.

Eric Russ
Eric Russ, the executive director of the Kentucky Psychological Association, told the Lantern the actual numbers are likely higher than the report reflects because not everyone who seeks out-of-network care will file an insurance claim.

Overall, the report shows that Americans were 10.6 times more likely to go out of their insurance network for psychological care than they were for medical care. The paper cites lower reimbursement rates for mental health care providers as a major culprit.

The report’s findings are “gravely disappointing,” Arthur C. Evans Jr., CEO of the APA, said in a statement. “The federal parity law, the Mental Health Parity and Addiction Equity Act, passed in 2008 and it has still not achieved its goal of equitable access to care for mental health patients.”

“The fact that so many patients are forced to go out of network to receive mental health and substance use care is unacceptable,” said Evans.

The report recommends that states and health-insurance plans expand their behavioral-health networks by raising reimbursement rates, “as they do for medical/surgical providers.” Having access to more in-network providers, the report says, would ease the financial burden on patients who now, if they cannot afford to pay out of pocket, may go without care.

Covid-19 was ‘a sledgehammer’

The report showed that from 2019 to 2021, out-of-network use of inpatient behavioral-health care increased from 2.5% to 4.0% in Kentucky. That’s much higher than the 0.4% reported in 2019 and 0.2% in 2021 for medical and surgical care.

In 2021, Kentuckians were 17.2 times more likely to get out-of network care for behavioral health than they were for medical or surgical care. But the percent of Kentuckians going out of network for outpatient behavioral care care decreased from 2019 to 2021 — 11% to 5%.

“One thing we’ve seen out of Covid is an increase in behavioral health needs,” Russ said. Even before the pandemic, there was an increased need for mental health support. “And then Covid just took a sledgehammer to everybody’s mental health.”

Because there were not enough in-network providers, Kentuckians had to look elsewhere for help, a burden Russ said “falls harder on minority populations.”

“Structural discrimination puts minority populations at an increased risk of mental-health issues generally,” he said. “And then the clinical field tends to be a pretty white-dominated field,” which makes it more difficult to find providers who are culturally competent to treat someone from a particular background or identity.
Lack of access is ‘demoralizing’

Usually when people seek care for a mental-health issue, they’ve often already been struggling for a while, Russ said.

“Usually they’ve been feeling down, depressed, anxious, having relationship problems, having eating disorders for quite a long time before they even start seeking treatment,” he said. “When you start looking, finally ready to get help, and then call your insurance company or call your primary-care provider and say, ‘Hey, where do I go?’ And they give you a list of providers and everybody’s full and you can’t get in — that’s incredibly demoralizing.”

This can add to the stigma that already surrounds mental health issues, Russ said. It can also put people’s well being in jeopardy while they wait for help. This can be worse for people with conditions like ADHD (attention deficit hyperactivity disorder), who may already struggle with organization and time management.

Kentucky is doing slightly better than other states in some categories, the data show. 

In particular, the report shows Kentucky was among the states where outpatients were least likely to seek out-of-network behavioral health care, compared to medical-surgical care in such facilities, with only 13 states having a better score than Kentucky in this category.  But Kentuckians were still twice as likely to seek out-of-network behavioral-health care in an outpatient facility as they were to go out of network for outpatient medical-surgical care. 

Kentucky also showed slightly better scores than 12 other states when it came to getting out-of-network behavioral-health care, compared to medical-surgical care for inpatient facilities (17.2 times)  and for office visits with a clinician (4.9 times).  

“No one is doing well,” though, Russ said. “We have room to go before we have something that looks like real parity between our mental-health and medical systems.”

Kentucky Health News contributed to this story. 

Monday, May 27, 2024

Ky. Hospital Association presents awards at annual convention

Nina Eisner, Lexington (KHA photos)
Kentucky Health News

The Kentucky Hospital Association honored several health-care leaders in the state at its annual convention in Lexington on May 21.

KHA’s highest honor, the Distinguished Service Award, was presented to Nina Eisner and Charles Lovell for untiring and exceptional service.

Eisner has served in clinical and administrative health-care positions for 45 years. In 2002, she became CEO of The Ridge Behavioral Health System in Lexington, She has been a strong advocate for Kentucky’s psychiatric hospitals and their patients and is a long-serving KHA trustee and has served in many other roles with KHA, the association said in a news release.

Charles Lovell, Barbourville
Lovell has been part of the Kentucky and Tennessee health-care landscape for the past 45 years. After serving as an emergency-room nurse in Memphis, he became CEO of several Tennessee and Kentucky hospitals, coming to Kentucky in 2003, to run Caldwell County Hospital in Princeton. He helped build a replacement hospital to serve Caldwell and Lyon counties.

In 2015, Lovell became community CEO at Barbourville ARH Hospital, which added many services and was the 2023 Knox County Chamber of Commerce Business of the Year. Lovell himself was the chamber's Man of the Year. Lovell has also held many roles with the KHA, chairing its Board of Trustees in 2013-14.

KHA’s Award of Excellence, given to individuals who have made significant contributions to health care in Kentucky, was presented to State Rep. Danny Bentley, R-Russell. 

Bentley, a pharmacist, has represented House District 98 (Greenup County and part of Boyd County) since 2017. He is known for helping his neighbors with health issues, and as a legislator helped pass measures that helped rural hospitals.

The KHA Health Care Governance Leadership Award, for individuals who have had a positive and sustainable impact on the quality of care in their communities through their work as hospital trustees, was presented to Gavin Roberts, chair of the Owensboro Health Board of Directors. The hospital is Owensboro’s largest employer, and Roberts has chaired the Owensboro Chamber of Commerce.

Sunday, May 26, 2024

Kentucky gets a 'D' grade on second annual report card on maternal mental health, a bit worse than the national average

By Melissa Patrick
Kentucky Health News

Kentucky received a D grade on the second annual report from the Policy Center for Maternal Mental Health, moving up from a D-minus in last year's report card. The national grade was D-plus; D was the most common grade, and 23 states had grades higher than Kentucky's.

“Maternal mental health is core to the health and well-being of women and families. Our report cards provide state government and advocacy leaders with a tool for identifying areas of opportunity and the ability to track annual progress,” Joy Burkhard, executive director of the policy center, said in a news release from the Milken Institute School of Public Health at George Washington University, which supported creation of the report cards.

“We are particularly hopeful about one of the new measures added this year, which tracks how often women are being screened for these disorders,” Burkhard said. ”Asking about symptoms is the first step toward diagnosis and treatment.”

The report notes that two things changed in Kentucky to improved the state's grade, however slightly. The state now meets the recommended maternal-mental-health prescriber ratio for the perinatal population and has a perinatal quality collaborative that prioritizes maternal mental health (a new category).  

The 2024 report cards include 18 measures that are divided into three key domains: Providers and Programs, Screening and Screening Reimbursement, and  Insurance Coverage and Treatment Payment. 

Kentucky met six of the 18 measures on the report card, with most of them in the Insurance Coverage and Treatment Payment domain, for things like expanding Medicaid, extending Medicaid coverage to one year after birth, and the ability to submit claims to proivate insurers for pre- and post-birth maternal mental-health treatment.

Kentucky got a D for providers and programs, an F for screening and screening reimbursement, and a C for insurance coverage and treatment payment.

What's Kentucky doing? 

Kentucky has several groups working on this issue, including a mental-health initiative in the state Department for Public Health, called the Maternal Mental Health Collaborative, and the Kentucky Perinatal Quality Collaborative, an effort of hospitals, doctors, nurses, public-health experts and others.

Another group working on this issue is the Mind the Gap Kentucky Coalition, which includes Postpartum Support International along with a host of other members, led by Nikki Boyd, the director of maternal infant health initiatives with the March of Dimes

"One thing all the groups involved in maternal mental health are doing is being sure to work together, to share resources and reduce unnecessary duplication of effort across the board," Marcie Timmerman, executive director of Mental Health America Kentucky, said in an email. 

In 2023, the legislature passed Senate Bill 135 to require the Cabinet for Health and Family Services to make information on postpartum depression and a postpartum assessment tool available on its website. It also required the cabinet to develop and implement a collaborative program aimed at improving the quality of prevention and treatment of postpartum depression.

In 2024, legislators passed a multifaceted bill dubbed the "Momnibus" as part of Senate Bill 74. It was originally House Bill 10, sponsored by Rep. Kim Moser, D-Taylor Mill. The Momnibus portion of this bill came out of a working group of Republican and Democratic women in the House and the Senate. 

Among other things, the Momnibus ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period.

It also establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visitation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

"I'm not surprised by our report card here, but I am energized by the existence of more than one advocacy group, the commitment to improving maternal mental health by legislators who were involved in HB 10, which turned into SB 74, and by providers who are increasingly involved in this effort to improve and ultimately save lives," said Timmerman, of Mental Health America.

Boyd said the results of the report card drive a lot of work being done by the Mind the Gap Coalition and the state task force. 

"These are things that can't be done overnight," she said. "There's a lot of policy involved and a lot of across the aisle work that needs to happen for these to happen. . . . It's a good guide, a good metric to help us figure out what the needs are." 

Boyd said each measure on the report card needs to be considered related to the needs of the state. For example, the report card shows Kentucky does not have at least one inpatient maternal-mental-health treatment program, but does not consider that the state does not  have enough patient volume to support one. Places are available to provide this kind of care, but she said this is something the state should monitor. 

Boyd said she's excited that Kentucky is taking the reins on this issue. 

"Kentucky's really doing a good job around prioritizing this and doing small things to ensure that Kentuckians are getting access," she said. "So obviously, there's a long way to go, but  I think getting it started, it's a great, great start." 

National numbers and efforts

The national grade improved slightly from a D to a D+, with four states earning B grades, up from one in the 2023 report; 19 states receiving C grades, up from 10 in 2023; 24 states receiving D grades, down from 25 in 2023; and five states getting a failing grade, down from 15 in 2023.  

"The U.S. is failing mothers," says the report. 

On May 14, the U.S. Department of Health and Human Services released the Task Force on Maternal Mental Health's national strategy to address maternal mental health, calling it an "urgent public-health crisis." The news release said the U.S. has the highest maternal death rate among high-income countries and 22% of the deaths are related to suicide, drug overdose, mental-health issues and substance-use disorder. 

“Many of these tragic deaths can be prevented by eliminating health disparities and understanding the impact of mental health during pregnancy and in the first months as a parent,” said HHS Secretary Xavier Becerra. “We want to address the challenges people are facing, decrease stigma associated with these challenges, and improve access to support both inside and outside of the health-care system.”

The five pillars of the national strategy are: building a national infrastructure that prioritizes perinatal mental health and well-being, with a focus on reducing disparities; making care and services accessible, affordable, and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating, and partnering with communities; and lifting up the voices of people with lived experience, according to the news release.

Saturday, May 25, 2024

Eastern State Hospital is 200 years old; ex-patient, who says it saved his life, urges those who need mental-health care to get it

By Melissa Patrick
Kentucky Health News

This story mentions suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

Eastern State Hospital in Lexington, which is celebrating its 200th anniversary this month, is the oldest continuously operating state psychiatric hospital in the United States.

When Eastern State opened its doors as part of the old Fayette Hospital on May 1, 1824, it was just the second state psychiatric hospital in the nation, according to a University of Kentucky news release. 

“We believe that health care is a right for all Kentuckians; this includes access to mental-health resources,” said Lt. Gov. Jacqueline Coleman, who spoke at the official observance of the anniversary. “For 200 years, Eastern State Hospital has provided care for Kentuckians in need of help. The staff at Eastern State Hospital is knowledgeable and compassionate. They deserve to be called health-care heroes.”

Lexington lawyer Bruce Simpson – who received treatment at Eastern State following a suicide attempt in January 2023 – shared his personal story and thanked the staff who helped him at the anniversary celebration. Below is a YouTube video, produced by UK, of Simpson telling his story. 

The UK news release notes that after his evaluation at Eastern State, Simpson began medication for his illness and began ongoing therapy, which he says has vastly improved his health. 

“I said, ‘I’m fine’ a million times. I was not fine,” Simpson said in the release. “But we need to talk openly about mental-health treatment. If you have a stomach ache, you’re going to the doctor. If your heart is palpitating, you’re going to the doctor. But if you have depression, you’re just as likely to not see anyone or even acknowledge you have a problem. That is a cultural correction we need to make. Mental illness is just as legitimate as cancer, heart disease, broken bones and a stomachache.”

For Simpson, who said he had dealt with ideas of suicide for nearly four decades, the stay at Eastern State completely changed his life.

“The clarity of my thinking now is so much better than it’s ever been,” he said in the release. “Eastern State got me on a different track. I want people to know that it is the best place to be if you’re in serious struggles with mental health. I wish I had gotten treated 40 years ago, and I don’t want anyone to suffer 40 years like I did. If things get difficult, don’t be afraid of going to Eastern State.”

"I can't say enough about the care I received at Eastern State along with my fellow patients," he said at the event. "But we're entitled to the same courtesy, respect and treatment as someone that's completely mentally healthy as human beings. And an Eastern State Hospital, I have 100% certainty that that takes place and I applaud the staff and I thank you for saving my life."

Health and Family Services Secretary Eric Friedlander said Eastern State's history "mirrors the many astounding developments in mental-health treatment over the past two centuries, from long-term custodial care in the 19th century, to the advent of modern medications in the mid-20th century, and the present focus on evidence-based, recovery-oriented services. Today the staff of Eastern State provide state-of-the-art care in a state-of-the-art facility to meet its unwavering goal of enhancing the behavioral health and quality of life of the Kentuckians it serves."

At the event, Kelly Gunning, director of advocacy and policy for the National Alliance on Mental Illness Lexington, said in 2002 she understood why her youngest son was "horrified" to be admitted to Eastern State Hospital -- and it had nothing to do with the dedicated staff.

"But the place itself was so foreboding and so off putting and so scary that it was stigmatizing for the patients that had to go there," she said. "Together, we decided we were going to start a campaign to make it better." 

Eastern State Hospital (Photo provided)
The state opened a modern, 300,000-square-foot Eastern State facility on UK’s Coldstream Research Campus in 2013 that houses 195 acute care beds and provides critical, recovery-focused psychiatric care for adults from a 50-county region of the state.

In 2021, then hospital became the first state psychiatric facility to achieve Magnet status, the gold standard for nursing excellence.

Later this summer the hospital will open its new Emergency Psychiatric Assessment Treatment and Healing unit, known as EmPATH. This program will offer an individual-centered, evidence-based care model designed to address the increasing needs for inpatient and emergency psychiatric care across Kentucky, according to the release. 

Friday, May 24, 2024

Lexington has outbreak of whooping cough, which can be deadly for babies and prevented with vaccine that some adults need too

By Melissa Patrick

Kentucky Health News

An outbreak of whooping cough has been declared in Fayette County after nine cases have been confirmed by the local health department since late April.

Whooping cough, known medically as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing. It affects people of all ages but can be most serious in infants, young children and those with chronic diseases.

The disease is largely preventable by vaccination, but vaccination rates for pertussis and other diseases prevalent in childhood have been declining.

"All Central Kentucky caregivers should be on the lookout for signs and symptoms of pertussis, or whooping cough, while ensuring their kids are up to date on their vaccines or fully vaccinated with the booster," the Lexington-Fayette County Health Department said in a news release. 

The latest Fayette County cases include one at Lafayette High School, one at St. Peter and Paul Catholic School and a community case involving a person in their 80s, according to the release.

Dr. Sean M. McTigue, medical director for pediatric infection prevention and control at Kentucky Children's Hospital, said symptoms of pertussis in children, adolescents and adults first look like an upper respiratory infection, including nasal congestion, runny nose and possible fever, and then lead to a "very intense and prolonged cough." 
"The cough is characterized by prolonged coughing fits that typically end with a loud “whoop” when catching breath afterwards," he said. "These coughing spells can be so intense that a patient may fracture ribs or rupture blood vessels in the eyes." 

The early symptoms of whooping cough can last for one to two weeks and the "coughing fits" usually last one to six weeks, but can last for up to 10 weeks, according to the Centers for Disease Control and Prevention. People are contagious from the start of symptoms and for at least two weeks after the coughing begins, says the CDC.

"Any school-age children with symptoms of pertussis should stay home from school and visit their health-care provider for evaluation, even if they have previously been vaccinated," said the release.

Some adults need vaccine boosters

While most of the Fayette County cases have been seen in adolescents, McTigue said, "Pertussis is more dangerous to young infants." 

"In young infants, pertussis more often presents with apnea," a sleeep disorder, he said. "This means that the infant stops breathing for a period of time. This can be long enough to cause severe damage or death if not noticed promptly. For this reason it is extremely important that all infants be vaccinated against pertussis." 

Between 2010 and 2020, the CDC reports, up to 20 babies died from pertussis each year in the United States.

It's recommended that pregnant women should get a single dose of the pertussis vaccine during every pregnancy, preferably at 27 through 36 weeks.

"Being vaccinated during pregnancy will allow the mother to pass antibodies along to the infant prior to delivery as another key part of prevention for the most vulnerable," said McTigue.

He added that it is also important for anyone in contact with infants to get a booster of the combined tetanus-diptheria-pertussis vaccine, known as Tdap.

"Because vaccination does not start until 2 months of life and is not completed until later, the best prevention also includes all contacts being vaccinated as well," he said. "This includes booster vaccines given every 10 years as Tdap, which has replaced the tetanus booster." 

The best way to prevent whooping cough is through vaccination. The childhood vaccine is called DTaP. Infants should receive a series of DTaP immunizations at 2, 4, and 6 months, with boosters at 15-18 months and 4-6 years. Children should then get a single dose of Tdap vaccine at 11 or 12. Boosters are required every 10 years to maintain efficacy.

"Achieving immunization rates greater than 95% is desirable to prevent the active transmission of vaccine-preventable diseases," Brice Mitchell, spokesman for the Cabinet for Health and Family Services, said in an email.

Kentucky's vaccination rates have fallen below that level.
Data from the School Immunizations Survey dashboard, which also includes data for each school, show that during the 2023-24 school year, 91% of the state's kindergarteners had received at least four doses of the DTaP vaccine; 85.6% of seventh graders had received at least one dose of Tdap; and 93.3% of 11th graders had received at least one dose of Tdap. 

All these rates have fallen since the Covid-19 pandemic; Kentucky seventh graders have had rates below 90% since the 2020-21 school year. 

The rates are even lower in the Kentucky Immunization Registry, which has vaccination data for residents of Kentucky counties aged 2, 6, 13, 17, and 65 or older. For 2022, the rates were:
  • 2-year-olds with 4 or more doses of DTaP: 63.9%
  • 6-year-olds with 4 or more doses of DTaP: 52.8%
  • 13-year-olds with at least one dose of Tdap: 63.4%
  • 17-year-olds with at least one dose of Tdap: 73.4%
  • Adults 65+ with at least one dose of Tdap: 31.3%
The latest available statewide vaccination rate among pregnant women was also low, Mitchell said: "During the 2021-2022 respiratory virus season, Tdap vaccination rates were 45.8% among pregnant women nationally, and 42.6% in the South region, where Kentucky is located."

So far in 2024, 46 confirmed cases of pertussis have been reported in Kentucky. Of those 46 cases, 22 have been confirmed since April 1 in the following counties: Fayette (12), and 1 case each in Boone, Boyd, Clark, Clay, Floyd, Jefferson, Jessamine, Logan, Pulaski and Warren, according to data provided by the Kentucky Department for Public Health.

Thursday, May 23, 2024

Drug-overdose death rates were more common among service-industry employees before pandemic, but not afterward

By Allison Rogers
University of Kentucky

Drug-overdose deaths spiked following Kentucky’s Covid-19 stay-at-home and business-closure orders in 2020, but the industries that suffered the most overdose deaths were surprising, according to research conducted by the Kentucky Injury Prevention and Research Center at the University of Kentucky College of Public Health.

In the years leading up to the study, Kentucky’s service-industry employees experienced the most drug-overdose deaths. However, workers outside service industries were more likely to die by drug overdose in the months following the Covid-related shutdowns of 2020, the researchers found.

The study was published in the peer-reviewed journal Injury Prevention in 2023 and funded by the National Institute of Occupational Safety and Health, part of the Centers for Disease Control and Prevention.

Graph by Kentucky Injury Prevention Research Center
Analyzing drug-overdose death certificates and toxicology tests from 2018 through 2021, researchers found a significant increase in deaths rates for both sectors. In 2019, the rate per 100,000 employees was 46.7 and 45.7 for service and non-service industries, respectively. In 2021, those rates were 76.2 and 81.9.

Service occupations with the highest drug-overdose death rates were restaurant wait staff (10%), cooks (7%), landscaping and groundskeeping workers (6%) and auto-service technicians and mechanics (6%). Among non-service-industry jobs, overdose deaths occurred most often among construction laborers (15%), carpenters (7%) and freight, stock and material movers and hand occupations (7%).

From 2018 through 2021, there were 1,789 drug overdose deaths among service-industry workers in Kentucky, compared to 2,838 for non-service workers.

Terry Bunn, lead author of the study and director of the injury-prevention center, said “Service-related industry employees may have been more resilient and adaptable to changes in employment status compared to non-service-related industries and could find employment in other essential industry sectors during the pandemic such as the home improvement and building materials industry and the grocery store industry sector.”

Fentanyl was the most commonly identified drug in overdose deaths in both industry groupings, with 44% of identified substances among service-related industry deaths and 48% of identified substances among non-service-related deaths. The second most common drug with elevated frequencies detected in drug-overdose deaths was methamphetamine, with 24% of identified substances among service-related industry deaths and 28% of identified substances among non-service-related industry deaths.

Bunn hopes the results will alert employers in all industries to the need for a plan to handle on-site drug overdoses and substance use. “It is important for businesses to know about local community resources for timely linkage to substance use disorder treatment and to recovery support services as well as availability of on-site naloxone,” she said.

Wednesday, May 22, 2024

Hospital association, state Department of Agriculture start 'Food is Medicine' effort to get more local food into Kentucky hospitals

Logo of the program
Kentucky Health News

The Kentucky Hospital Association and the state Department of Agriculture have started an effort to get more local food into Kentucky hospitals.

"A recent survey completed by representatives of 50 hospital systems across the state found that only about 2 percent of the hospital’s budget is spent on local food," a department news release said. "The overall average percentage of local food being served at these same hospitals was 15 percent."

In their “Food is Medicine” campaign, the department, KHA, eight health systems and other organizations "will study how hospitals can play a key role in prescribing food as medicine to patients by creating more access to healthier and local foods," the release said. They will:
· Look at the food a hospital is serving to patients;
· Create partnerships between hospitals and local farmers;
· Connect patients with resources to a consistent healthy food resource;
· Reach out to patients who need a special diet, such as diabetes patients, and who could benefit from having a resource to fresh food.

“Access to nutritious food is critical to maintain a healthy lifestyle,” Agriculture Commissioner Jonathan Commissioner Shell said. “Advocating that connection between food and health is essential to meeting the goal of less chronic disease and longer lifespans. But it’s more than a message about choosing the right foods, it’s also a message about expanding our food distribution networks within the agriculture industry.”

KHA President and CEO Nancy Galvangni said, "Kentucky’s hospitals work every day to improve the health of our citizens and this new collaboration between KHA and the Department of Agriculture will elevate ways in which hospitals throughout Kentucky can address the social drivers of health facing our commonwealth.”

Hollie Harris, president and CEO of Appalachian Regional Healthcare, said "As the largest provider of care in southeastern Kentucky, our responsibility goes beyond treating illness. We want to help people live healthier lives, and that starts with access to healthy foods. . . . We can create partnerships to address our state’s troubling health statistics and make fresh, locally grown foods more available in our communities."

High cost of new diabetes drugs, more popular in Ky. than any other state, deprives low-income people of effective treatment

Photo by George Frey, Bloomberg, via iStock/Getty Images, KFF Health News
Editor's note: At the end of 2023 Kentucky led the nation in the percentage of state population, 2.1%, who had received the new class of diabetes and weight-loss drugs.

By Renuka Rayasam
KFF Health News

For the past year and a half, Tandra Cooper Harris and her husband, Marcus, who both have diabetes, have struggled to fill prescriptions for medications they need to control their blood sugar.

Without Ozempic or a similar drug, Cooper Harris suffers blackouts, becomes too tired to watch her grandchildren, and struggles to earn extra money braiding hair. Marcus Harris, who works as a Waffle House cook, needs Trulicity to keep his legs and feet from swelling and bruising.

The couple’s doctor has tried prescribing similar drugs, which mimic a hormone that suppresses appetite and controls blood sugar by boosting insulin production, but those are also often out of stock. Even if they are available, their Affordable Care Act insurance burdens the couple with a lengthy approval process or an out-of-pocket cost they can’t afford.

“It’s like, I’m having to jump through hoops to live,” said Cooper Harris, 46, a resident of Covington, Georgia, east of Atlanta.

Supply shortages and insurance hurdles for this powerful class of drugs, called GLP-1 agonists, have left many people who are suffering from diabetes and obesity without the medicines they need to stay healthy.

One root of the problem is the high prices set by drugmakers. About 54% of adults who had taken a GLP-1 drug, including those with insurance, said the cost was “difficult” to afford, according to KFF poll results released this month. Patients with the lowest disposable incomes who are hit the hardest; they have few resources and often struggle to see doctors and buy healthy foods.

In the United States, Novo Nordisk charges about $1,000 for a month’s supply of Ozempic, and Eli Lilly charges a similar amount for Mounjaro. Prices for a month’s supply of different GLP-1 drugs range from $936 to $1,349 before insurance coverage, according to the Peterson-KFF Health System Tracker. Medicare spending for three popular diabetes and weight loss drugs — Ozempic, Rybelsus, and Mounjaro — reached $5.7 billion in 2022, up from $57 million in 2018, according to research by KFF.

The “outrageously high” price has “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the U.S. Senate Committee on Health, Education, Labor and Pensions, told Novo Nordisk in April.

The high prices also mean that not everyone who needs the drugs can get them. “They’re kind of disadvantaged in multiple ways already and this is just one more way,” said Wedad Rahman, an endocrinologist with Piedmont Healthcare in Conyers, Georgia. Many of Rahman’s patients, including Cooper Harris, are underserved, have high-deductible health plans, or are on public assistance programs like Medicaid or Medicare.

Many drugmakers have programs that help patients get started and stay on medicines for little or no cost. But those programs have not been reliable for medicines like Ozempic and Trulicity because of the supply shortages. And many insurers’ requirements that patients receive prior authorization or first try less expensive drugs add to delays in care.

By the time many of Rahman’s patients see her, their diabetes has gone unmanaged for years and they’re suffering from severe complications like foot wounds or blindness. “And that’s the end of the road,” Rahman said. “I have to pick something else that’s more affordable and isn’t as good for them.”

GLP-1 agonists — the category of drugs that includes Ozempic, Trulicity, and Mounjaro — were first approved to treat diabetes. In the last three years, the Food and Drug Administration has approved rebranded versions of Mounjaro and Ozempic for weight loss, leading demand to skyrocket. And demand is only growing as more of the drugs’ benefits become apparent.

In March, the FDA approved the weight-loss drug Wegovy, a version of Ozempic, to treat heart problems, which will likely increase demand, and spending. Up to 30 million Americans, or 9% of the U.S. population, are expected to be on a GLP-1 agonist by 2030, the financial services company J.P. Morgan estimated.

As more patients try to get prescriptions for GLP-1 agonists, drugmakers struggle to make enough doses.

Eli Lilly is urging people to avoid using its drug Mounjaro for cosmetic weight loss to ensure enough supplies for people with medical conditions. But the drugs’ popularity continues to grow despite side effects such as nausea and constipation, driven by their effectiveness and celebrity endorsements. In March, Oprah Winfrey released an hourlong special on the medicines’ ability to help with weight loss.

It can seem like everyone in the world is taking this class of medication, said Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But it’s kind of not as many people as you think,” she said. “There just isn’t any.”

Even when the drugs are in stock, insurers are clamping down, leaving patients and health care providers to navigate a thicket of ever-changing coverage rules. State Medicaid plans vary in their coverage of the drugs for weight loss. (Kentucky's does not.) Medicare won’t cover the drugs if they are prescribed for obesity. And commercial insurers are tightening access due to the drugs’ cost.

Health-care providers cobble together care plans based on what’s available and what patients can afford. For example, Cooper Harris’s insurer covers Trulicity but not Ozempic, which she said she prefers because it has fewer side effects. When her pharmacy was out of Trulicity, she had to rely more on insulin instead of switching to Ozempic, Rahman said.

One day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust the prescriptions for all 18 of the patients she saw because of issues with drug availability and cost, she said. One patient, insured through a teacher-retirement health plan with a high deductible, couldn’t afford to be on a GLP-1 agonist, Addison said.

“Until she reaches that deductible, that’s just not a medication she can use,” Addison said. Instead, she put her patient on insulin, whose price is capped at a fraction of the cost of Ozempic, but which doesn’t have the same benefits. “Those patients who have a fixed income are going to be our more vulnerable patients.”

Tuesday, May 21, 2024

Repeat Covid-19 shots help ward off variants, even other viruses

Photo illustration
Kentucky Health News

The virus that caused the Covid-19 pandemic is still here, sending thousands of Americans to hospitals each week and regularly spinning off new variants that can evade immune defenses, so public-health agencies recommend annual updates of vaccinations.

Some scientists have worried that the success of the first vaccines may undermine the utility of annual updates, much as the annual flu shot can interfere with immune responses in subsequent years, but a new study shows that Covid-19 vaccines don't do that, and actually "promote the development of broadly inhibitory antibodies," says a news release from Washington University School of Medicine in St. Louis, where the study was conducted.

Everyone who is 65 and over, or has medical conditions that make them more vulnerable, is advised to get a Covid-19 booster this spring.

The study, available online in the peer-reviewed scientific journal Nature, shows that people repeatedly vaccinated for Covid-19 — initially getting shots aimed at the original SARS-CoV-2 variant, followed by boosters and updated vaccines targeting variants — generated antibodies capable of neutralizing a wide range of virus variants and even some distantly related coronaviruses.

"The findings suggest that periodic re-vaccination for Covid-19, far from hindering the body’s ability to recognize and respond to new variants, may instead cause people to gradually build up a stock of broadly neutralizing antibodies that protect them from emerging SARS-CoV-2 variants and some other coronavirus species as well, even ones that have not yet emerged to infect humans," the release says.

“The first vaccine an individual receives induces a strong primary immune response that shapes responses to subsequent infection and vaccination, an effect known as imprinting,” said Dr. Michael S. Diamond, senior author of the study. “In principle, imprinting can be positive, negative or neutral. In this case, we see strong imprinting that is positive, because it’s coupled to the development of cross-reactive neutralizing antibodies with remarkable breadth of activity.”

Imprinting is the natural result of how immune-system memory works. A first vaccination triggers the development of memory immune cells. When people receive a second vaccination quite similar to the first, it reactivates memory cells elicited by the first vaccine. These memory cells dominate and shape the immune response to the subsequent vaccine.

The study suggests that regular re-vaccination with updated Covid-19 vaccines against variants might give people the tools to fight off not only the variants represented in the vaccines, but also other variants and related coronaviruses, possibly including ones that have not yet emerged.

“At the start of the Covid-19 pandemic, the world population was immunologically naïve, which is part of the reason the virus was able to spread so fast and do so much damage,” said Diamond, a professor of molecular microbiology, pathology and immunology. “We do not know for certain whether getting an updated Covid-19 vaccine every year would protect people against emerging coronaviruses, but it’s plausible. These data suggest that if these cross-reactive antibodies do not rapidly wane — we would need to follow their levels over time to know for certain — they may confer some or even substantial protection against a pandemic caused by a related coronavirus.”

Monday, May 20, 2024

Korean study finds former smokers who use e-cigarettes or vapes have higher risk for lung cancer than ex-smokers who don't

Photo by Steve Helber, The Associated Press
Kentucky Health News

Former cigarette smokers who use electronic cigarettes or vaping devices may be at higher risk for lung cancer than former smokers who don’t vape, according to new research in South Korea.

“This is the first large population-based study to demonstrate the increased risk of lung cancer in e-cigarette users after smoking cessation,” said Dr. Yeon Wook Kim of Seoul National University, corresponding author of the study published at the 2024 international conference of the American Thoracic Society (ATS).

E-cigarettes are promoted as an aid to smoking cessation, but "There is little knowledge about the long-term consequences of vaping, and epidemiological evidence for the association between e-cigarette use and lung cancer is lacking," said an ATS news release.

"Biological studies suggest the possible dangers of e-cigarettes, including pulmonary toxicity and lung cancer. E-cigarettes and heating elements have been shown to contain carbonyl compounds (such as formaldehyde, acetaldehyde, acrolein and diacetyl) and toxic metals (such as chromium, nickel and lead), which are known to be carcinogenic. These toxins are also present in conventional cigarettes."

Kim said, “Our results indicate that when integrating smoking cessation interventions to reduce lung cancer risk, the potential harms of using e-cigarettes as an alternative to smoking must be considered.”

To determine the risk to former smokers, the researchers looked at the records of more than 4.3 million Koreans with a history of conventional smoking who participated in the Republic of Korea’s National Health Screening Program in 2012-14 and 2018. They conducted follow-up in December 2021.

"They found that 53,354 individuals had developed lung cancer," or 1.24%, and 6,351 died from it, or 0.147%, the release says. "Ex-cigarette smokers who had quit five years or more and used e-cigarettes were at greater risk of lung cancer-related death than ex-smokers who had quit five years or more and hadn’t used e-cigarettes. For smokers who had quit less than five years, those who used e-cigarettes were found to have both a higher risk of both lung cancer and lung cancer mortality than non-e-cigarette users."

The researchers also looked at people aged 50 to 80 with a smoking history of 20 or more pack-years , because in the U.S. they would be likely be referred for lung cancer screening under American guidelines. "Ex-smokers in this group who had quit smoking for five years or more and used e-cigarettes reported a higher risk of both lung cancer and lung cancer-related death than those who didn’t use e-cigarettes," the release says. "In addition, ex-smokers who used e-cigarettes and had quit smoking less than five years before had a higher comparative risk of lung cancer.

The authors conclude, “Clinicians must highlight the potential harmful effects of alternative e-cigarettes use when integrating smoking-cessation interventions, to reduce lung-cancer risk.”

Study: E-cig use raises risk of early development of asthma 252%

Studies show vaping may contribute to the development of asthma. (Image from Very Well Health) 
Kentucky Health News

There is a significant link between vaping and asthma in adults, according to a new study published in the Journal of the American Medical Association Network Open.

The study found that adults who did not have any asthma symptomps at the beginning of the study and reported e-cigarette use in the past 30 days increased their risk of developing asthma at an earlier age by 252%.

“While previous studies have reported that e-cigarette use increases the risk of asthma, our study was the first to examine the age of asthma onset,” said first author Adriana Pérez, professor of biostatistics and data science at the University of Texas-Houston School of Public Health. “Measuring the potential risk of earlier age of asthma onset as it relates to past 30-day e-cigarette use may help people from starting use or motivate them to stop.”

The study used data from the Population Assessment of Tobacco and Health Study, a national longitudinal study of tobacco use and how it affects the health of adults and youths in the U.S.

“The findings of the study underscore the need for further research, particularly regarding the impact of e-cigarette use on youth and its association with early age of asthma onset and other respiratory conditions,” Pérez said in a news release. The study says the lack of youth impact "could be due to a lack of statistical power."

"Pérez said the study highlights the need to address the health burden of asthma, which results in $300 billion in annual losses due to missed school or workdays, mortality, and medical costs according to the Centers for Disease Control and Prevention," the release says. "Tobacco regulations, prevention, intervention campaigns, and cessation programs are needed to prevent early age of asthma onset due to e-cigarette use, the authors wrote."