Hepatitis found among three more Lexington-area food workers

Lexington Herald-Leader graphic

Three more restaurant workers in the Lexington area have been found to have hepatitis A, but the state still has no food-borne cases of the disease more than 15 months into a statewide outbreak of then liver disease, health officials said.

"Anyone who ate in November at the Hardee’s at 2990 Richmond Road in Lexington, the Waffle House at 2347 Buena Vista Road in Lexington or the Waffle House at 4 Carol Road in Winchester may have been affected," Morgan Eads of the Lexington Herald-Leader reports, based on information from the Lexington-Fayette County Health Department.

The department said in a news release, “While it is relatively uncommon for restaurant customers to become infected with the hepatitis A virus due to an infected food handler, anyone who consumed food or drink at these locations during the stated time period is advised to get a hepatitis A vaccination.” It said the three employees won't return to work until they are medically cleared.

Hepatitis A can be transmitted from person to person by food or water contaminated by fecal material. Symptoms include fatigue, stomach pain, nausea, darkened urine and yellowed skin. The health department recommends getting vaccinated for the disease and carefully washing hands with warm water and soap after using the bathroom, and before making food and drinks.

Through Nov. 17, the outbreak had affected 2,769 Kentuckians, hospitalized 1,438 and killed 17, according to the state Cabinet for Health and Family Services.

Pikeville Medical Center creating children's hospital, expanding heart-care center, adding other facilities; total cost $52 million

Pikeville Medical Center announced Tuesday that it would spend $7 million to relocate and expand its inpatient pediatrics clinic into a children's hospital, and establish, expand or improve nine other facilities with price tags totaling $45 million. Officials said about 200 jobs would be created.

The hospital appears to be on a rebound. In June, CEO Donovan Blackburn laid off 130 employees, blaming mismanagement by former CEO Walter May, whom the board ousted in January. May, 81, died Nov. 2. He had overseen the growth of the former Pikeville Methodist Hospital into a medical center with 300 beds and more than 3,000 employees, who account for one-sixth of total wages in Pike County, reports Dan Klein of WSAZ-TV in Huntington, W.Va.

"We have everywhere from doctors to house-keeps, to valets, but our average rate is $60,000 a year," Blackburn told WYMT-TV in Hazard.

The number of beds planned for the children's hospital was not announced. The hospital said it is spending $32 million, supported by a federal loan, to expand its Heart and Vascular Institute. "We're one of the top heart institutions in the state by the mere numbers of operations," Blackburn said.

The other projects include new or expanded clinics in South Williamson, Martin and Whitesburg; a new network headquarters to manage services in more than 43 buildings; an expanded laboratory costing $7 million; a new primary care center; a remodeled second-floor atrium in the May Tower; and a coffee shop.

Romaine lettuce is OK to eat unless it was grown in the Central Coast region of California, federal agencies say

Romaine lettuce (Photo from Getty Images)

After urging Americans not to eat any romaine lettuce, two federal agencies have limited their warning to lettuce grown in the Central Coast region of California.

The Centers for Disease Control and Prevention and the Food and Drug Administration say romaine  grown elsewhere, or in greenhouses or hydroponically, has not been linked to the outbreak of E.coli bacterial infections.

The agencies advise consumers to check labels or store signs for the source of any romaine lettuce, and if you have already purchased romaine (or any lettuce mix containing it) and aren't sure where it was grown, throw it out and thoroughly clean your refrigerator.

No single grower, supplier or distributor has been identified as the source of the lettuce that caused the infections.

"CDC officials recommend that clinicians not prescribe antibiotics to anyone infected with this bacteria as some studies suggest that these drugs could increase a patient’s risk of developing a serious complication from the illness," Sheri Rudavsky reports for The Indianapolis Star.

Sexually transmitted diseases are on the rise, even as funding to prevent and treat them is declining

Health officials are worried about this strain of gonorrhea that
resists antibiotics. (Centers for Disease Control and Prevention  photo)

"Health officials are tracking record-breaking rates of sexually transmitted disease, including a resurgence of some infections which had been considered rare, such as gonorrhea and syphilis. These STDs are on the rise amid cuts to public health budgets dedicated to testing, prevention, and public outreach," Mary Meehan reports for Ohio Valley ReSource, which covers Kentucky, Ohio and West Virginia.

The Centers for Disease Control and Prevention reported 2.4 million new cases of STDs in 2017; about 40 percent of those were among people aged 15 to 25. In some Ohio Valley communities, chlamydia infections rose more than 200 percent and gonorrhea rose 1,000 percent or more between 2011 and 2017, Meehan reports.

The surge among younger people could stem from a greater likelihood to engage in risky sexual behavior. Jim Thacker, spokesperson for the Madison County Health Department, told Meehan that people born after the AIDS epidemic was largely contained may be less fearful about STDs. And the availability of effective, long-term birth control might make young adults and teens less prone to use condoms, he said.

Some of those affected by STDs are much younger than teens: according to a recent CDC report, more infants are dying after catching syphilis from their mothers during birth. Syphilis is easily treated with antibiotics, but an untreated pregnant woman has up to an 80 percent chance of passing it on to her baby during birth, Meehan reports. The number of babies born with syphilis increased from 362 in 2013 to 918 in 2017, mostly in Southern and Western states.

Matt Prior, spokesperson for the nonprofit National Coalition of STD Directors, told Meehan that STDs are a public health crisis often hitting areas already hurting from the opioid epidemic, such as Appalachia.  Meehan reports, "As rates go up, Prior said, funding has gone down. So while STDs have increased by 30 percent in the last five years to reach an all-time high, the amount of federal money for prevention and education has consistently gone down since 2003. Prior says that federal funding is critical for states like Kentucky, West Virginia and Ohio."

Prior told Meehan, "The federal STD prevention line is the only line or funding streams these states have so it is really the first and last line of defense."

2017 Kentucky law to allow mentally ill to be ordered into treatment under certain circumstances isn't being used

Faye Morton, left, joined other supporters of Tim's Law, named
for her son, to push for it in 2017. (Photo: John Cheves, Herald-Leader)

"Nobody is using a heralded 2017 state law that was intended to help hundreds of Kentuckians with serious mental illness break the perilous cycle of homelessness, jail and involuntary hospitalization," John Cheves of the Lexington Herald-Leader reports, based on interviews with court officials.

"Tim’s Law, which the legislature passed despite a veto by Gov. Matt Bevin, "created a petition process so that district court judges can order seriously mentally ill people, under certain specific conditions, into supervised outpatient treatment, including medication, counseling and enrollment in public assistance," Cheves notes. The law is named for Tim Morton, "a Lexington man who was hospitalized for psychiatric treatment dozens of times over 36 years, often involuntarily and in police handcuffs, because he did not recognize that he had schizophrenia."

So why hasn't the law been used? Cheves reports, "Part of the problem is a lack of public awareness, court officials said. But the legislature also failed to provide any money for more staff at community mental health agencies or courthouses, or — since respondents are entitled to a lawyer to represent them at hearings — public defender’s offices. All of these state-funded institutions already are struggling with their current caseloads. In fact, tucked into the nine-page law is a short note stating that it won’t take full effect until 'adequate funding' is made available." Also, "Some of the seriously mentally ill do not have responsible adults in their lives ready to intercede."

Read more here: https://www.kentucky.com/news/politics-government/article221640600.html#storylink=cpy

“It breaks my heart, it really does,” Faye Morton, Tim’s mother, told Cheves. “We’re very aware of the lack of interest in this.”

Jefferson District Judge Stephanie Pearce Burke told Cheves, “The petitions are going to have to be initiated by the hospitals — by Central State and Eastern State,” which need to identify people who are frequently admitted “and then get the process started for us before their patients are discharged from an involuntary stay so we can find a better way to handle this.”

Regional mental-health agencies could play a role, Cheves reports: "Bluegrass.org, a publicly funded nonprofit that provides mental health services in Lexington, is ready to receive Tim’s Law respondents for treatment, but funding “is very tight” already, said Don Rogers, chief clinical officer. Mountain Comprehensive Care Center, a sister agency in Eastern Kentucky, has a $500,000, four-year federal grant that could be tapped, if anyone in that area ever files a Tim’s Law petition, said project manager Martin Meade."

Read more here: https://www.kentucky.com/news/politics-government/article221640600.html#storylink=cpy

Op-ed aims to inform adults about dangerous new e-cigarettes that writers say are aimed to hook a new generation on nicotine

In an effort to inform Kentucky adults about the dangers of the latest electronic cigarette devices, called mod-pods, Ben Chandler and Dr. Pat Withrow write in an op-ed for the Lexington Herald-Leader: "We encourage parents, teachers and others who work with youth to recognize them for what they are: highly effective nicotine delivery devices designed to hook a new generation."

Photo by The Sentinel-Echo, London, Ky.

Chandler is president and CEO of the Foundation for a Healthy Kentucky and Withrow is outreach director at Baptist Health Paducah.

The most popular mod-pod right now is the Juul, which looks like a large USB flash drive, and can even be plugged into a computer's USB port to charge. The authors note that knock-offs like the MarkTen Elite and the Suorin Air Pod Vaporizer are also a growing market.

Teens love them because that they are easily concealed, come in thousands of flavors (including bubble gum), don't create an odor when used, and can be personalized with "skins," which the authors call "another effective youth marketing tactic." Many of them can also be adapted to vape marijuana and other drugs.

"You may think they’ve yet to hit your home, classroom or community," they write, but add that that's likely not the case.

New data from the federal Centers for Disease Control and Prevention shows that electronic cigarette use among high-school students increased 78 percent in the past year and middle-school use went up 48 percent -- increases that the authors say coincide with the introductions of the mod pods. The U.S. Food and Drug Administration has called this upsurge an epidemic.

"Our concern is that the explosive popularity of these latest e-cig designs will reverse all the progress we’ve made in reducing smoking and related disease and death over the last 50 years," the authors write. "Kentucky already remains behind the rest of the nation in curbing tobacco use. So it behooves parents, teachers and others who work with kids to understand this dangerous new trend."

Chandler and Withrow explaining exactly what these mod-pod e-cigarettes are: battery-powered tobacco devices that heat nicotine, with pods that contain propylene glycol, other chemicals and the flavorings. When heated, the combination of nicotine, particulate matter, heavy metals and gas vapor creates an aerosol. This aerosol is inhaled into the lungs and quickly circulates into the brain.

A Juul pod contains the same amount of nicotine as in a pack of 20 cigarettes (200 puffs) -- though most teens report that they don't know there is nicotine in these devices. Multiple studies also show that kids who vape are more likely use regular cigarettes.

"We believe there’s no reason to put nicotine in these devices except to create new customers who, quite literally, can’t quit," Chandler and Withrow write. "In addition to being addictive, nicotine and other substances harm the developing brain which continues to mature until the age of 25."

The authors note that the experience is "much smoother and more addictive than previous generations of e-cigs and vapes." In fact, a Truth Initiative study found that 80 percent of 15 to 24-year-olds who try Juul continue to use the product. Use of these mod-pods has become so pervasive that teens now say they are "Juuling" instead of "vaping," they write.

They conclude: "Bottom line? There are absolutely no redeeming benefits for our youth to begin using nicotine e-cigarettes. So don’t be fooled. The latest e-cig devices pose significant health hazards for today’s youth."

Another reason to not ignore hearing loss: Study shows it will likely cost you more in health-care expenses

Untreated hearing loss in older adults affects more than just their ability to communicate. It can also increase their health-care expenses.

Medical News Today photo

A Johns Hopkins Bloomberg School of Public Health study found that older adults with untreated hearing loss pay an average of 46 percent more -- or $22,434 more -- for health care over a decade, compared to those who have no hearing loss.

“Knowing that untreated hearing loss dramatically drives up health-care utilization and costs will hopefully be a call to action among health systems and insurers to find ways to better serve these patients,” lead author Nicholas Reed said in a news release.

Reed is a member of the core faculty of the Cochlear Center for Hearing and Public Health at the Bloomberg School and an instructor of audiology in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine.

The study, published in JAMA Otolaryngology-Head and Neck Surgery, saw differences as early as two years after diagnosis, with the patients who had untreated hearing loss showing a 26 percent increase in total health-care costs, more than half the difference found after 10 years. Of the 46 percent increase after 10 years, an average $20,403 of it was incurred by the patient's health insurer and $2,030 by the patient in out-of-pocket costs, the study found.

The findings "add to a growing body of research from Johns Hopkins and elsewhere showing the detriments of untreated hearing loss, which include a higher risk of dementia and cognitive decline, falls, depression and lower quality of life," says the release. It notes that hearing loss affects 38 million Americans, a number that’s expected to double by 2060. One in three Americans between 65 and 74 has hearing loss, and two-thirds of adults 70 and older have a clinically significant loss.

Nearly 700,000 Kentuckians have hearing loss, or about 16 percent of the commonwealth's citizens, according to the Kentucky Commission on the Deaf and Hard of Hearing. Click here to see how many people in your county have hearing loss.

How the study was done, and what might be done in response

Using data from OptumLabs Data Warehouse, the researchers identified more than 77,000 patients with likely age-related untreated hearing loss, excluding those who used a hearing aid or whose hearing loss was secondary to another condition.

An in-depth analysis found that after 10 years, "Patients with untreated hearing loss experienced about 50 percent more hospital stays, had about a 44 percent higher risk for hospital readmission within 30 days, were 17 percent more likely to have an emergency department visit and had about 52 more outpatient visits compared to those without hearing loss," the release says. And of the extra $22,434 in total health care costs, only about $600 was due solely to hearing loss-related care.

The study did not indicate why untreated hearing loss drives up health-care costs, but the release notes that a companion paper using the same data found that hearing loss is independently associated with "significantly greater" incidence of disease.

"For example, compared to those without hearing loss, those with untreated hearing loss had 3.2 more dementia diagnoses, 3.6 more falls and 6.9 more depression diagnoses per 100 people over 10 years.
Over 10 years, those with untreated hearing loss had an estimated 50 percent greater risk of dementia, 40 percent greater risk of depression, and almost 30 percent higher risk for falls compared to those without hearing loss," says the release.

“We don’t yet know if treating hearing loss could help prevent these problems,” Jennifer A. Deal, co-author and assistant scientist in the Bloomberg School’s Department of Epidemiology, said in the release. “But it’s important for us to figure out, because over two-thirds of adults age 70 years and older have clinically significant hearing loss that may impact everyday quality of life."

Deal also said poor communication could play a role in the higher costs for patients with hearing loss, noting that they may have trouble communicating their symptoms or hearing what their provider is saying about their care. One solution, she said, is increased access to "amplification devices," which the release notes will become more readily available in 2020, when a federal law authorizing certain types of over-the-counter hearing aids will go into effect.

The study was done in collaboration with AARP, the University of California San Francisco, and OptumLabs.

Study finds genes linked to body's use of cholesterol and fat, and risk for heart disease, also increase the risk for Alzheimer's

A study of more than 1.5 million people found that some of the genes that increase the risk for heart disease also increase the risk for Alzheimer's disease. It might mean, eventually, that managing cholesterol and fat in the diet could lower some people's risk for Alzheimer's.

Illustration by Michael Worful

The study, published in the journal Acta Neuropathologica, looked at the differences in the DNA of people with factors that contribute to heart or Alzheimer's disease and identified 90 points across the genome that were associated with risk for both diseases. It is the largest genetic study of Alzheimer's disease, according to the news release.

“These findings represent an opportunity to consider repurposing drugs that target pathways involved in lipid metabolism,” the medical term for the storage of fats or their breakdown for energy, said Celeste M. Karch, senior co-author and an assistant professor of psychiatry at Washington University School of Medicine in St. Louis. “Armed with these findings, we can begin to think about whether some of those drugs might be useful in preventing or delaying Alzheimer’s disease. . . . We really need to think about these risks more holistically.”

The findings are important for Kentucky. Nearly 7 percent of the state's adults have some form of heart disease, and around 70,000 Kentuckians 65 and older have been diagnosed with Alzheimer's. Heart disease is the second leading cause of death in Kentucky, and Alzheimer's is sixth.

Researchers from Washington University and the University of California, San Francisco focused on specific risk factors for heart disease, such as obesity, Type 2 diabetes and high cholesterol, to see if any of those well-recognized risk factors for heart disease also were genetically related to risk for Alzheimer’s.

Genes that influenced metabolism of fats “were the ones that also were related to Alzheimer’s disease risk,” Karch said. “Genes that contribute to other cardiovascular risk factors, like body mass index and Type 2 diabetes, did not seem to contribute to genetic risk for Alzheimer’s.”

Dr. Rahul S. Desikan, co-senior author and an assistant professor of neuroradiology at UC San Francisco, added that while more research is needed, "The new findings suggest that if the right genes and proteins could be targeted, it may be possible to lower the risk for Alzheimer’s disease in some people by managing their cholesterol and triglycerides," says the release.

Ky. has a high premature birth rate, but 2 programs are reducing it; one stresses home visitations; the other uses data analysis

By Melissa Patrick
Kentucky Health News

One in nine Kentucky babies are born prematurely, one of the nation's highest rates – so high that the March of Dimes gave the state a "D" on its 2018 Premature Birth Report Card.

A baby is premature if born before 37 completed weeks of pregnancy, four weeks short of full-term. In 2017,  just over 11 percent of Kentucky babies were born preterm. The national average is just under 10 percent, a rate that has risen three years in a row.

Because important growth and development happens during the last weeks of pregnancy, preterm babies are at an increased risk of neurologic, respiratory and digestive problems. Complications from being born early is the main cause of newborn death, says the March of Dimes.

Preterm babies are also at risk for long-term challenges, including behavioral and social-emotional problems, learning difficulties, and increased risk of conditions like attention deficit-hyperactivity disorder and increased risk of Sudden Infant Death Syndrome. As adults, they are more likely to have chronic diseases such as heart disease, high blood pressure and diabetes, says UK Healthcare.

The March of Dimes says that while the cause of about half of premature births is unknown, there are common risk factors, including a multiple pregnancy (twins), smoking or drug use during pregnancy, being underweight, having diabetes or having preeclampsia, a condition that is characterized by high blood pressure and the presence of protein in the mother's urine.

What's Kentucky doing about it?

Several programs work to lower the number of preterm births in Kentucky.

One is a voluntary home-visitation program called Kentucky Health Access Nurturing Development Services. Kentucky's HANDS  serves first-time, high-risk mothers through local health departments. It received a $7.5 million federal grant in October.

The HANDS program provides assistance to overburdened parents from the prenatal period to the child's third birthday. It served about 4,000 people in more than 2,000 homes through nearly 56,000 home visits in 2017, according to a Cabinet for Health and Family Services news release.

Research published in the journal Maternal Child Health, shows that participants in the HANDS program had fewer preterm births and low-birthweight babies, and decreased incidences of child abuse and neglect, especially among those who received seven or more prenatal home visits.

The data shows the rate of preterm births among expectant mothers who received one to three prenatal visits was 12.1 percent, above the state's relatively high average, while the rate for those who received seven or more visits was 9.4 percent, below the national average. Similarly, the rate of low-birthweight babies dropped to 6.5 percent among mothers with seven or more visits, compared to 8 percent who had only one, two or three visits.

The study also found that women in the program had increased access to prenatal care and decreased maternal complications during pregnancy.

The home-visitation program provides the at-risk mother with a family support worker who tailors a plan to meet her needs, including linking participants to community services needed to support a healthy pregnancy and birth. And after the child is born, the program helps families nurture healthy growth and development in the child and teaches them how to create safe homes.

Courtney Embry, a nurse from the Grayson County Health Department, said a family support worker provides education about nutrition in pregnancy and can help expectant mothers sign up for the Women, Infant and Children nutrition program, help them find resources to quit smoking, or help them find transportation to get to their prenatal appointments.

"We see a lot of moms who don't have transportation, so therefore they are not actually getting to their OB appointments," she said. "So we will help them find transportation." She said they do that through community transportation programs, programs that offer gas vouchers or helping them to find employment.

"The HANDS acronym sums up what we do," said Shelly Lambert, director of early-childhood services for the Lincoln Trail District Health Department. "We are a helping hand for parents. We are there to support them, to help them, to nurture them and help with the development of their child."

Carter County HANDS coordinator Jana McGlone said one reason the program is so successful is because it explains the "why" of it all, Lisa Gillespie reported for Louisville's WFPL in October.

“Their doc might say, ‘You need to take your prenatal vitamin,’ but he may not tell them, ‘OK, this is why you should take this’,” McGlone told Gillespie. “When they get that understanding and knowledge, it makes them want to do it more."

CDC photo

Another effort to reduce preterm births in Kentucky is a Passport Health Plan program that uses a maternity-analytics platform to identify at-risk mothers. Passport manages the care of more than 310,000 Kentuckians on Medicaid. The analytics were developed by Lucina Health, a Kentucky-based obstetric data management firm.

In just six months, Passport was able to identify 85 percent of its high-risk pregnant mothers during their first two trimesters and provide them with a personalized care plan designed to reduce their risks, according to a Lucina news release. It says the program has reduced early deliveries by 13 percent, earning Passport millions of dollars.

"Identifying and communicating with at-risk mothers as soon as possible is critical to reducing preterm birth rates in the United States," the release says. "Reducing preterm birth, a national public health priority, can be accomplished by implementing strategies that target modifiable risk factors and provide access to care with potentially high social and financial impact."

November is Prematurity Awareness Month.

Beshear sues 9th opioid maker, says it makes him the most aggressive attorney general, based on number of suits

Filing his ninth lawsuit against a maker of drugs that have contributed to the opioid epidemic, Attorney General Andy Beshear said "This lawsuit makes Kentucky the most aggressive state in pursuing these companies in the nation."

The lawsuit, against Arizona-based Insys Therapeutics, "alleges the company exacerbated Kentucky’s opioid epidemic by placing profits over the health of Kentuckians," a news release from Beshear's office said. "Kentucky now leads the nation in the number of individual opioid lawsuits filed by an attorney general." Some suits by other attorneys general have multiple defendants.

Beshear announces suit (Photo by Josh James, WUKY Radio)

The Hardin County suit claims the company fraudulently persuaded physicians to prescribe Subsys, a fentanyl-based mouth spray, to treat chronic pain. The Food and Drug Administration allows the drug only for "breakthrough pain in cancer patients," the release said. The suit "alleges the company accomplished its scheme by fraudulently acquiring insurance coverage approvals, giving kickbacks to doctors, and incentivizing its salesforce to engage in unlawful and deceitful conduct. The lawsuit cites numerous company emails and promotional materials that describe the company’s alleged illegal behavior."

Beshear, who is seeking the Democratic nomination for governor in the May primary election, is not the first law-enforcement official to go after Insys. His release notes, "Between 2016 and 2017, federal prosecutors indicted and arrested Insys founder John Kapoor and several Insys executives alleging they conspired to bribe prescribers, many of whom operated pain clinics, to prescribe Subsys off-label. . .. Insys’ illegal and deceptive marketing practices were described in detail in a 2018 U.S. Senate report."

"Insys defended its promotion of Subsys against similar charges in New York, saying it made up a 'very small percentage' of opioid prescriptions in that state," Josh James reports for Lexington's WUKY. The company told the Palm Beach Post, in response to being added to a lawsuit in Florida, that it is about "allegations of misdeeds by former employees," and the firm has new management and staff.

The release said "Beshear has sued three national opioid distributors, Pennsylvania-based AmerisourceBergen, Ohio-based Cardinal Health and San Francisco-based McKesson Corp., which together are responsible for supplying 85 percent of opioids in Kentucky; distributor and retail pharmacy Walgreens; and pharmaceutical manufacturers Johnson and Johnson, Mallinckrodt, Endo Pharmaceuticals and Teva. Beshear’s office has won fights to keep four of his current opioid lawsuits in Kentucky courts. Three of the four additional suits are also pending in state court."

CDC says don't eat any romaine lettuce while it investigates a multi-state outbreak of E.coli infections related to it

The Centers for Disease Control and Prevention is advising Americans to not eat any romaine lettuce, and retailers and restaurants to not sell it, while it investigates the multi-state outbreak of Shiga toxin-producing E.coli infections that have been linked to the lettuce.

CDC photo

The CDC warning includes all types of the lettuce, including whole heads, hearts, bags of pre-cut romaine and salad mixes that contain it. If you are unsure, the CDC says, "Do not eat it, and throw it away. It also suggests washing and sanitizing drawers and shelves where romaine was stored.

The warning comes after 32 people in 11 states have become sick from eating the contaminated product. None of the cases have been in Kentucky. Also of concern, Canada has reported 18 people infected with the same strain of E.coli. The illnesses range from Oct. 8 to Oct. 31 and no deaths have been reported.

The CDC notes that symptoms of Shiga toxin-producing E.coli vary, but often include severe stomach cramps, diarrhea (often bloody), vomiting, and sometimes a low-grade fever. Most people will get better in five to seven days, but others can have severe, life-threatening infections. The illness can start anywhere from one to 10 days of infection.

If you believe you have an E.coli infection, call your health-care provider, write down what you ate in the week before you got sick, report your illness to the health department, and be prepared to answer questions about your illness.

The current outbreak is not related to another recent multistate outbreak of E.coli related to romaine lettuce, says the CDC.

Trial of lawsuit challenging legislature's attempted ban of most common type of second-trimester abortion ends after five days

A five-day trial over a Kentucky law that bans the most common method of second-trimester abortion is over. U.S. District Judge Joseph McKinley, who heard the case without a jury, did not hear closing arguments, but asked the lawyers to submit written statements within 45 days and said he would rule after reviewing them. Meanwhile, Gov. Matt Bevin's administration is not enforcing the law.

The procedure is called "dilation and evacuation," or D&E, and involves dilating the cervix and removing the fetus using suction and surgical tools. About 500 women underwent this procedure last year at the state's only abortion clinic, the EMW Women's Surgical Center in Louisville, Deborah Yetter reports for the Louisville Courier Journal.

State Rep. Addia Wuchner spoke to abortion foes outside
the U.S. Courthouse in Louisville Nov. 13, as trial began on
the suit challenging her legislation. (CJ photo by Matt Stone)

The legislation to ban the procedure at 11 weeks or after, except in medical emergencies, was filed by Rep. Addia Wuchner, R-Florence. It passed the Senate 31-5 and the House 75-13. The state was enjoined from enforcing it after the American Civil Liberties Union filed the lawsuit challenging its constitutionality.

Generally, a D&E is done after the 14th week of pregnancy. Earlier in pregnancy, a woman can take a medication to induce an abortion, or undergo a procedure in which suction is used to remove the contents of the uterus.

"Supporters of the law called the procedure, in which the fetus is removed with instruments, 'gruesome and brutal'," Yetter reports. "Opponents of the law say it would prohibit a safe and medically proven procedure, barring for many women in Kentucky their right to terminate a pregnancy."

Yetter reports that Bevin General Counsel M. Stephen Pitt said in his opening statement that women seeking the procedure could go out of state, or EMW doctors could comply with the law, which requires them to inject a solution to kill the fetus first, before performing the procedure.

The ACLU lawyers said Kentucky can't dodge a constitutional obligation by telling women to go out of state and the "proposed fetal demise procedure is unnecessary and brings risk of infection and complications including cardiac arrest to the patient," Yetter reports.

"ACLU lawyer Alexa Kolbi-Molinas said in her opening statement that none of the 'fetal demise' methods proposed by the state are medically acceptable, describing them as 'invasive, unfeasible, unreliable and in some cases, experimental.' Dilation and evacuation, she said, 'is the safest method that can be used' after the 14th week of pregnancy'," Yetter writes.

In September, Rewire reported, "Dilation and evacuation bans have been signed in nine states: Alabama, Arkansas, Kansas, Kentucky, Louisiana, Mississippi, Oklahoma, Texas, and West Virginia. Laws banning D&E procedures have been blocked or temporarily enjoined in seven states: Alabama, Arkansas, Kansas, Kentucky, Louisiana, Oklahoma, and Texas."

Also this week, a law to ban almost all abortions after 15 weeks of pregnancy was blocked in Mississippi, with U.S. District Judge Carlton W. Reeves writing that it disregards the 14th Amendment's "promise of due process and defied the United States Supreme Court's existing precedents on abortion rights," Alan Blinder reports for The New York Times.

“With the recent changes in the membership of the Supreme Court, it may be that the state believes divine providence covered the Capitol when it passed this legislation,” Reeves wrote. “Time will tell. If overturning Roe [v. Wade] is the state’s desired result, the state will have to seek that relief from a higher court. For now, the United States Supreme Court has spoken.”