Grant will help UK Cooperative Extension Service expand opioid prevention and recovery efforts

The University of Kentucky Cooperative Extension Service has received a two-year grant to further its statewide efforts in opioid prevention and recovery, Katie Pratt reports for UK.

The more than $1 million grant from the Substance Abuse and Mental Health Services Administration will allow the program to expand its efforts to Southern and Western Kentucky.

As part of the grant, the program will offer an Addiction 101 course to discuss the science behind addiction, including genetic and hereditary risk factors for developing addiction disorder. Pratt reports that the course will be geared toward health-care workers, extension agents and community leaders and will be led by Alex Elswick, UK extension specialist for substance use prevention and recovery.

“We want to remove the stigmas associated with addiction, so health care workers and community members feel more comfortable and equipped to help those struggling with opioid use addiction and recovery,” Elswick told Pratt.

Other grant programs will include administering an evidence-based substance abuse program for middle-school students, called Botvin LifeSkills Training and an art program to provide individuals with a therapeutic outlet to express their feelings related to substance use and addiction, she writes.

In addition, Pratt reports that the extension program will be expanding its financial-education curriculum that specifically addresses money issues faced by those in recovery. The program, called "Recovering your Finances," was developed by Elswick and Kelly May, a UK senior extension associate. It is  being piloted in Mercer County and will be offered in Boyd, Bourbon, Knox and Leslie counties through a separate grant from the U.S. Department of Agriculture.

Pratt notes that many of these programs grant will build on the extension service’s existing programs to reduce opioid use and help recovery efforts, including efforts to teach gardening, nutrition and life skills to those in recovery, and support programs for families with a loved one with a substance-use disorder. Extension will also continue to offer support to local community health coalitions that address substance-use prevention and recovery, Pratt reports.

“The Kentucky Cooperative Extension Service is currently recognized as a leader among the land-grant university system for outreach efforts targeting substance use prevention and recovery,” Jennifer Hunter, assistant director for family and consumer sciences extension and one of the co-leaders on the grant, told Pratt.  “We are excited to be able to continue to expand our educational efforts and enhance the level of resources available at the community level.”

Pushback makes Trump back off electronic-cigarette flavor ban

The industry organized opposition to the flavor ban, (Photo: Dylan Hollingsworth, Bloomberg News)

President Trump has decided not to go through with the ban on electronic-cigarette flavors that he announced more than two months ago, report Josh Dawsey and Laurie McGinley of The Washington Post.

"On Nov. 4, the night before a planned morning news conference, the president balked," the reporters write. "Briefed on a flight to a Lexington, Ky., campaign rally, he refused to sign the one-page 'decision memo,' saying he didn’t want to move forward with a ban he had once backed, primarily at his wife’s and daughter’s urging, because he feared it would lead to job losses, said a Trump adviser who spoke on the condition of anonymity to reveal internal deliberations."

Trump reversed himself "because of worries that apoplectic vape shop owners and their customers might hurt his reelection prospects, said White House and campaign officials. He also believed job losses tied to the ban would cost him as he sought to trumpet economic growth," the Post reports.

"Whether or when the administration will unveil a new policy to combat underage vaping is now unclear," the paper reports. "Given Trump’s record of zigzags, some officials cautioned the president could reverse course again. Or he might back some ban on flavored e-cigarettes that exempts vape shops. Others said the White House might pursue a different tack altogether by endorsing legislation that would raise the minimum federal age for buying tobacco products to 21 from 18, or take other steps to try to prevent teens from getting access to the products. Some bet the anti-vaping effort is dead, though, especially because the administration could argue the youth vaping problem has been greatly eased by Juul Labs’ recent decision to stop selling its popular mint-flavored nicotine pods."

'Stop using this criminal-justice hammer to address a public-health nightmare,' state justice and public safety secretary says of drugs

By Melissa Patrick

Kentucky Health News

ASHLAND, Ky. – At a day-long workshop for journalists on covering substance abuse and recovery, state Justice and Public Safety Secretary John Tilley said it's time to "stop using this criminal-justice hammer to address a public-health nightmare."

Justice Secretary John Tilley at workshop

Tilley said some in Kentucky are still trying to eliminate syringe exchanges that prevent spread of disease and other risks from dirty needles, and others want to limit the programs to one-for-one exchanges, which doesn't support the goal of the program to reduce the spread of HIV and hepatitis C among intravenous drug users.

He said a "needs-based model" is by far the most effective model to meet this goal, but some who opposed it when it was adopted in 2015 "still have it in for that policy."

Tilley, a Democrat, was instrumental in getting syringe-exchange programs in a big anti-heroin bill when he was chair of the state House Judiciary Committee. Late in the year, Republican Gov. Matt Bevin named him justice secretary. He has often been mentioned as a possible holdover with Democratic Gov.-elect Andy Beshear.

Tilley, 50, spoke at Covering Substance Abuse and Recovery: A Workshop for Journalists, sponsored by the University of Kentucky's Institute for Rural Journalism and Community Issues and Oak Ridge Associated Universities.

He told the journalists at the Marriott Delta Hotel that it is time to stop criminalizing substance-use disorders, and that it is long past time to take a public-health approach that focuses on recovery and treatment.

He said the only logical explanation for the state's prison population growing from 3,000 in 1970 to more than 24,000 today, or 702 percent – when the state's population has only grown by 39% – is "the war on drugs." 

Tilley, a lawyer and former television journalist who has worked for three decades in criminal justice, said it's past time to take a different approach. He said the legislature has adopted none of the 23 recommendations by the Criminal Justice Policy Assessment Council.

"I think it's high time that we quit tweaking and we begin with a new model," he said. "And the most simple way I can put it is that we stop using this criminal-justice hammer to address a public-health nightmare."

He said the state needs to start funding things that will provide a better return on investment, such as better community supervision for the 50,000 people who are either on probation or parole, and increased access to drug treatment and programming such as job-skills training.

Kentucky has 135,000 children who have been affected by incarceration, more than any other state, and the "vast majority" of the nearly 10,000 children in the foster-care system have had a parent in prison, he said, adding that the state ranks third for per-capita incarceration of women.

Tilley also talked about the challenges of recovery and addiction, pointing to a Harvard University study that found it takes a person with a drug addiction four or five tries at treatment over eight years to gain one year of sobriety.

"There's an idea that we should give folks a second chance," he said. "Well, what we know by the very nature of addiction is that it is a disease of relapse. So why would we just give someone a second chance?"

He said many of the state's judges need more education about addiction, along with more resources. For example, he said that while he is a big fan of pre-arrest diversion, for that to work, crisis-stabilization locations are needed for people who are in distress. "The idea that putting someone in jail is a lifesaver is such a fallacy," he said.

He also called for reform of state criminal-justice laws, saying 1,500 people in Kentucky are serving state prison time solely for simple possession alone, not trafficking, and the state has the most liberal and misused definition of trafficking, "any transfer." He told of a woman who is serving five years for giving someone two pills.

"We can hold people accountable without state prison time," he said. "Justice doesn't always equal punishment."

He said the focus needs to be on prevention, getting rid of the demand for the drugs – because no matter how many traffickers Kentucky puts in jail, as long as there is demand, another trafficker will follow.

He asked, "Why don't we remove the criminal justice system and let public health and let our medical professionals and our treatment professionals and our mental health professionals try to dig us out of this mess?"

Tilley ended his discussion on a positive note, pointing out that while the rest of the nation saw a 5% reduction in its drug overdose deaths, Kentucky's drop was 15%. Tilley attributed much of this drop to the state's aggressive harm-reduction efforts, including its wide distribution of naloxone, a drug that reverses the effect of overdoses,

He added that the partnership between the Cabinet for Health and Family Services and the criminal justice system has been recognized nationwide. "When you pull back the curtain," he said, "there are so many stories to tell."

March of Dimes gives Ky. D-minus for high rate of pre-term births; maternal deaths spike; new collaborative will work on such issues

By Melissa Patrick
Kentucky Health News

Childbirth, which should be one of life's most joyous occasions, has become more deadly for Kentucky mothers, and remains problematic for many Kentucky babies because it comes too early.

One in nine Kentucky babies are born prematurely, so many that the March of Dimes gave the state a D-minus on its 2019 Premature Birth Report Card. And the rate of Kentucky women who died as a result of pregnancy complications nearly doubled from 2017 to 2018.

A baby is premature if born before 37 completed weeks of pregnancy, which is four weeks short of full term. In 2018, Kentucky had 6,109 pre-term births, 11.3 percent of live births. The national average is 10%, a rate that has risen four years in a row.

Because important growth and development happens in the last weeks of pregnancy, pre-term babies are at an increased risk of neurological disorders, intellectual disabilities, and respiratory and digestive problems. They are also more likely to have vision and hearing problems. Complications from being born early is the main overall cause of newborn death, the March of Dimes says.

Pre-term babies are also more at risk for long-term challenges, including chronic diseases such as heart disease, high blood pressure and diabetes, says University of Kentucky HealthCare.

November is Prematurity Awareness Month. The cause of about half of premature births is unknown, but the March of Dimes says there are common risk factors, the strongest being a history of pre-term birth, multiple pregnancy and certain uterine or cervical conditions.

Other factors in the mother that can increase risk include being underweight or overweight, diabetic or older than average for a mother; smoking or using drugs during pregnancy; or having preeclampsia, a type of high blood pressure that some women get during or right after pregnancy.

Kentucky has one of  the highest rates of smoking during pregnancy in the nation, with nearly 18% of pregnant women in the state smoking cigarettes at some time during their pregnancy. The national rate is 6.9%, according to the United Health Foundation's health rankings.

This year's March of Dimes report also looks at several factors that are linked to adverse maternal and infant health outcomes, such as whether a mother has health insurance or prenatal care or if they live in poverty. It also looks at racial disparities in pre-term birth, beyond the aforementioned factors.

In Kentucky, 7% of women between 15 and 44 were uninsured, and 18.6% of them lived in poverty. Among those who were pregnant, 14% received inadequate prenatal care. The pre-term birth rate among African American women in Kentucky is 30% higher than the overall state rate.

In addition to the increasing rates of pre-term birth, the report notes that more than 22,000 babies a year in the U.S. die before their first birthday. That's about two babies every hour.

Number of maternal deaths nearly doubles

The report also says that a woman in the U.S. dies from pregnancy complications about every 12 hours, and more than 60% of those deaths are preventable.

Kentucky's maternal mortality rate nearly doubled in 2018, said Dr. Connie White, deputy commissioner for clinical affairs in the state Department for Public Health. In 2017, the state had 39 maternal deaths, with substance abuse a factor in 62% of them; in 2018, that number increased to 76, with at least half related to substance abuse, according to death certificates.

White said the state is still reviewing patients' medical records for 2018, but the numbers are evidence that "We are failing as a system" of delivery hospitals and providers, which should prompt all to ask where that failure exists.

To tackle these problems, the state recently launched the Kentucky Perinatal Quality Collaborative. It will work toward reducing premature births, maternal mortality and neonatal abstinence syndrome, and improving maternal and infant health outcomes. "Perinatal" refers to care given before and after the birth of a child.

White said the collaborative will ask key questions: "Are we not getting people into treatment? Are we not connecting them?" she asked. "Are we not following up afterwards? Are we working with women who have had their children taken away from them? What are we doing to really wrap our arms around these women?"

White said the collaborative will also look at data and recommendations from a new Maternal Mortality Review Committee to create evidence-based interventions that all providers and delivery hospitals can implement.

"This quality collaborative can now take those recommendations and we hope start making inroads into decreasing Kentucky's maternal death rate," she said, adding later, "There are evidence-based things that we can do, but we need to all be rowing in the same direction."

The collaborative is funded by a three-year grant from the federal Centers for Disease Control and Prevention. White said there was a great "pent-up" need for this collaborative, shown by 78% of the state's 46 birthing hospitals being represented at the collaborative's Oct. 22 launch in Louisville. Those hospitals represented 91% of the state's births.

White said the state is applying to become part of the Alliance for Innovation on Maternal Health program, which has created "bundles" of evidence-based protocols and training modules to address many of the problems that contribute to poor maternal and child outcomes, such as hypertension, hemorrhage, and maternal opioid use. After the state becomes part of the program, these bundles would be available to all of the state's providers and delivery hospitals.

She noted that six counties in Kentucky offer the Sobriety Treatment and Recovery Teams program to help parents with addictions to keep their children out of foster care while keeping the child safe. The counties with START are Kenton, Jefferson, Boyd, Martin, Daviess and Fayette.

Federal ban on e-cig flavors appears to have stalled; new study shows e-cigs may be just as harmful to the heart as cigarettes

President Trump and his top health officials said in September that they were planning to place a ban on flavored electronic cigarettes, but the policy appears to have stalled.

Mitch Zeller, director of the U.S. Food and Drug Administration's Center for Tobacco Products, told senators Nov. 13 there was "no final answer" then about the proposed flavor ban, and repeatedly referred the questions to the White House.

"Opponents of strict regulation have made a public-health argument of their own: that vaping is far less harmful than cigarette smoking, and has enabled many former smokers to wean themselves off of tobacco products," Josh Wingrove and Gerald Porter Jr. report for Bloomberg. "Industry advocates have warned that a wide-ranging ban would close stores, put thousands of people out of work and drive adult vapers back to cigarettes."

The Trump administration now looks headed for a compromise plan that would not include the original proposal's full ban on all non-tobacco flavors, "a prohibition that vape stores have said would close their businesses," Bloomberg reports.

Health advocates recommend banning flavors in all tobacco products, including e-cigarettes, as a way to curb teen use of the products. The federal Centers for Disease Control and Prevention reports that most teens who use e-cigs use flavored varieties, start with such a variety, and say flavors are the primary reason for using them.

Electronic-cigarette use among Kentucky's teens nearly doubled between 2016 and 2018, with more than one in four high school seniors and one in seven 8th graders reporting use in 2018, according to the Kentucky Incentives for Prevention study.

Health advocates also push back on the vaping industries claims that e-cigarettes help smokers quit smoking.

"E-cigarettes are not an FDA-approved quit aid nor are they recommended as a smoking cessation method by the U.S. Preventive Task Force, CDC or other scientists," says the Kentucky Center for Smoke-free Policy's website. "In fact, a recent study shows that smokers who use e-cigarettes are significantly less likely to quit smoking than smokers who do not use e-cigarettes."

E-cigs as bad for heart as tobacco?

A recently published study from Cedars-Sinai Medical Center in Los Angeles shows that electronic cigarettes may be just as harmful to the heart, if not more, than traditional cigarettes.

The researchers compared blood flow to the heart of healthy, adult smokers after sessions of e-cig use or cigarette smoking. They measured the blood flow while the participants were at rest and also after they performed a handgrip exercise, which simulates physiologic stress, a news release says.

"In smokers who used traditional cigarettes, blood flow increased modestly after traditional cigarette inhalation and then decreased with subsequent stress. However, in smokers who used e-cigarettes, blood flow decreased after both inhalation at rest and also after handgrip stress," says the release.

"Our results suggest that e-cigarette use is associated with coronary vascular dysfunction at rest, even in the absence of physiologic stress," Dr. Susan Cheng, one of the researchers, said in the release. "These findings indicate the opposite of what e-cigarette and vaping marketing is saying about their safety profile."

Lung injuries from e-cigs continue

Meanwhile, as of Nov. 13, 2,172 cases of lung injury related to electronic cigarettes had been reported to the CDC; and 42 deaths had been confirmed in 24 states.

The CDC recently identified vitamin E acetate, which is often used as a thickening agent in e-cigarette products containing THC, as a "chemical of concern" in the national outbreak of related lung injuries. THC, short for tetrahydrocannabinol, is the psychoactive ingredient in marijuana.

Kentucky's numbers were last updated on Nov. 8, with 33 cases under investigation, three of them confirmed and 11 considered probable. Seven reported cases have been ruled out.

The CDC recommends that for now at least, no one should use electronic cigarettes or products containing THC; no one should buy any e-cigarette product off the street, particularly those with THC; and no one should modify or add any substances to e-cig products that are not intended by the manufacturer.

The CDC also says that because the cause or causes of these lung injuries is unknown, the only way to assure that you are not at risk is to refrain from use of all e-cigarette products.

Celebrate National Rural Health Day on Thursday, Nov. 21, with a week of events starting Monday

The Federal Office of Rural Health Policy is planning a week of events to observe National Rural Health Day on Thursday, Nov. 21.

Monday, Nov. 18: From 9:30 a.m. to 12:30 p.m. ET, the National Institutes of Health will hold a seminar on the state of rural health in the U.S. at the main NIH campus in Bethesda, Maryland. For those who can't attend, the event will be videocast online here.

Nov. 19: From noon to 1 p.m. ET, The Health Resources and Services Administration will hold a webinar on addressing the opioid crisis in rural areas as it relates to women who are pregnant or have infants born addicted to opioids. Register here.

From 2 to 3 p.m. ET, the HRSA will host a Twitter chat on mental-health issues of agriculture workers. Find the chat using the hashtag #AgMentalHealth.

From 3:30 to 4:45 p.m. ET, the HRSA will host a webinar on suicide prevention in farm and ranch communities. Join the webinar here.

Nov. 20: From noon to 1 p.m. ET, the Rural Health Information Hub and the Norc Walsh Center for Rural Health Analysis will hold a webinar to discuss the new Rural Chronic Obstructive Pulmonary Disease Toolkit. Register here.

From 1 to 2 p.m. ET, the Centers for Disease Control and Prevention and the HRSA will hold a webinar aimed at rural health providers on improving antibiotic prescribing practices in critical-access hospitals. Register here.

From 2 to 3 p.m. ET, the HRSA will host a Twitter chat on rural substance-use-disorder issues. Find the chat by searching for the hashtag #RuralSUD.

From 6 to 10:15 p.m. ET, HRSA will host a virtual job fair aiming to bring more health-care providers to rural areas. Learn more here.

Nov. 21: From 9:45 a.m. to 3 p.m. ET, HRSA will celebrate National Rural Health Day in its D.C.-area office, including roundtables, lectures, and interactive sessions. The event will be livecast online.

At 1 p.m. ET, the Rural Health Information Hub will host a Twitter chat on how rural health organizations can access funding. Find the chat with the hashtags #RuralHealthChat and #PowerofRural.

From 2 to 3 p.m. ET, the National Organization of State Offices of Rural Health will air The Providers, a documentary about rural health-care providers, and lead a live discussion about it. Find out more here.

More action needed to protect patients from antibiotic-resistant infections, which kill an American every 15 minutes, CDC says

Cover of CDC report; to download it, click here.

More action is needed to protect Americans from antibiotic-resistant infections, 2.8 million of which occur in the U.S. each year, killing more than 35,000 people, one about every 15 minutes, says the federal Centers for Disease Control and Prevention.

On top of that, 12,800 people died from an infection that is not drug-resistant but is "caused by the same factors that drive antibiotic resistance—antibiotic use and the spread of germs," the CDC said in its report, Antibiotic Resistance Threats in the United States, 2019. "The number of people facing antibiotic resistance is still too high. More action is needed to fully protect people."

Hospitals are a main battleground in the fight. The word "hospital" appears 188 times in the 148-page report, which was issued days after the Leapfrog Group's latest rankings of patient safety at hospitals nationwide, including 50 in Kentucky. The most common grade, on an A-to-F scale, was a C, and the report showed that many hospitals had difficulty dealing with resistant infections.

The University of Louisville Hospital got a D overall in the Leapfrog Group's patient-safety ratings and was rated poorly in dealing with one of the major antibiotic-resistant infections, Methicillin-resistant staphlycoccus areus (MRSA), and C. diff, an infection related to the use of antibiotics. Click to enlarge.

The report's foreword, by CDC Director Robert Redfield, sums up the history of antibiotics in personal terms: "In March 1942, Mrs. Anne Miller of New Haven, Connecticut, was near death. Infectious germs had made their way into her bloodstream. Desperate to save her, doctors administered an experimental drug: penicillin, which Alexander Fleming discovered 14 years earlier. In just hours, she recovered, becoming the first person in the world to be saved by an antibiotic. Rather than dying in her thirties, Mrs. Miller lived to be 90 years old.

"Today, decades later, germs like the one that infected Mrs. Miller are becoming resistant to antibiotics. You could have one in or on your body right now—a resistant germ that, in the right circumstances, could also infect you. But—unlike the bacteria that threatened Mrs. Miller—the bacteria may be able to avoid the effects of the antibiotics designed to kill them. Unfortunately, like nearly 3 million people across the United States, you or a loved one may face an antibiotic-resistant infection."

The use of antibiotics has a self-defeating element: the growth of genetically different bacteria and fungi that have mutated into forms that are resistant to the antibiotics or picked up resistance traits from other germs through mobile genetic elements. Also, antibiotic use encourages development of Clostridioides difficile, or C. diff., a bacterium "that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon," says the Mayo Clinic. The CDC report says 223,900 cases of C. diff. occurred in 2017, killing at least 12,800 Americans.

"Dedicated prevention and infection control efforts in the U.S. are working to reduce the number of infections and deaths caused by antibiotic-resistant germs, but . . . CDC is concerned about rising resistant infections in the community, which can put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients," the CDC said in announcing the report. "The emergence and spread of new forms of resistance remains a concern."

What is to be done? "Public-health prevention programs targeting resistant germs can and have worked to slow spread and save lives, but more needs to be done," the report says. "The U.S. and global community must scale up these effective strategies and develop new strategies to prevent infections and save lives. In the United States, infection prevention activities have proven effective in slowing the spread of resistant germs. This includes:

• Strategies to decrease spread within healthcare settings (e.g., implementing hand hygiene)
• Vaccinations
• Implementing biosecurity measures on farms
• Responding rapidly to unusual genes and germs when they first appear, keeping new threats from spreading

With the holiday season just ahead, it's more important than ever to get this year's flu shot, state health department says

Mayo Clinic photo

The state Department for Public Health is pushing Kentuckians to get their flu shots, since the holiday season is approaching.

“People will be traveling and families will gather together, increasing the potential for exposure to the flu,” said Dr. Angela Dearinger, the state health commissioner. “We are strongly urging anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers.”

The health department has reported 384 laboratory-confirmed flu cases across the state since Aug. 4.

"Flu can be very contagious," the department noted in a press release. "It takes about two weeks for the vaccine to become fully effective, so it is very important to get the flu shot as soon as possible."

The federal Centers for Disease Control and Prevention recommends flu shots for everyone six months of age and older. People who are strongly encouraged to get a shot because they may be at higher risk for complications or negative consequences include:

• Children aged six months through 59 months (less than 5 years)
• Women who are or will be pregnant during the influenza season
• Persons 50 years of age or older
• Persons with extreme obesity (body mass index of 40 or greater)
• Persons aged six months and older with chronic health problems
• Residents of nursing homes and other long-term care facilities
• Household contacts (including children) and caregivers of children less than five years old, particularly contacts of children less than six months old and adults 50 and older 
• Household contacts and caregivers or people who live with a person at high-risk for complications from the flu
• Health-care workers, including physicians, nurses, and other workers in inpatient and outpatient-care settings, medical emergency-response workers such as paramedics and emergency medical technicians), employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients

"It is especially important for pregnant women to be vaccinated before or during pregnancy," the news release says. "Antibodies cross the placenta and provide immunity to infants up to six months of age, when the infant is eligible to receive their dose of flu vaccine. Last season in Kentucky, there were infants less than one month old that had the flu."

The health department said getting vaccinated is especially important because the U.S. has its longest flu season ever last year, with more than 647,000 flu-related hospitalizations and more than 61,000 people deaths. Kentucky had 194 flu-related deaths, including two children.

"The flu vaccine has been changed to better protect against the types of flu that were seen last season," the news release says. "The flu vaccine is especially important in light of the longest flu season the nation experienced last year. . . . Both the CDC and manufacturers of the flu vaccine report that there are no shortages of vaccine. Vaccination can be given any time during the flu season, but providers are encouraged to administer the vaccine as soon as possible. Medicaid, Medicare and most private health-insurance providers cover flu vaccination as a preventive service."

Dearinger said, “Vaccination is the best tool we have to prevent the flu. It is also extremely important to take simple preventive steps to avoid the flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze and stay home when you are sick.”

The health department reports flu activity to the CDC. The report is updated on Fridays and is posted online at https://healthalerts.ky.gov/Pages/FluActivity.aspx."The report consists of laboratory-confirmed cases of influenza that are defined by molecular virus testing and positive virus culture test results," the release says. "Rapid-positive influenza tests are not included in this report, but are used as an indicator of flu-like illness circulating across the state."

Rural weekly reports on increasing tick-borne allergy to red meat

Map shows cases entered by site users and is not verified. For a larger version of the map, click on it.

A tick-borne allergy to red meat is becoming more common, the Adair County Community Voice reported Oct. 31, in a pair of front-page stories: one on the main front and the other leading its occasional Health and Wellness section.

The allergy is caused by a sugar molecule called alpha-gal. Anna Buckman writes, "Dr. Kourtney Gentry Gardner, an allergist-immunologist in Bowling Green, diagnoses about five people a month with the alpha-gal allergy, and it’s becoming increasingly more common, she says."

Close-up of the Lone Star tick, which
is much larger when it is full of blood.

People who are bitten by the Lone Star tick, especially those bitten repeatedly, are at risk of "having allergic reactions to the molecule, which is found in most mammalian or red meat," Buckman notes. "It is relatively new to the allergy world," having been identified in scientific literature only 10 years ago.

Buckman deals with the science but brings the story home by writing about some local victims, illustrating the varying manifestations of the allergy:

"Tiffany Bean can no longer hang out at summer gatherings where friends grill burgers because, following a tick bite, she developed a food allergy so severe that she even has reaction being around the fumes of cooked beef. . . . Rick Wilson is also allergic to red meat but can eat dairy products. He only had occasional reactions when he was still consuming red meat."

Joshua Wethington (Adair Co. Community Voice photo)

"Five-year-old Joshua Wethington doesn’t like dairy-free pizza, but that’s the only kind he can have. Because of a tick bite at some point in his short life, he is so allergic to red meat that allergists recommended removing dairy from his diet because it is a byproduct of cows." Joshua’s mom, Dana Wethington, told Buckman, “I’m having a hard time getting him to eat things because it doesn’t taste the same to him.”

Other differences: "Bean went from just having an itchy tick bite to having a stomach illness for hours or breaking out into a rash if she consumed anything with alpha-gal. She has lost 40 pounds due to the allergy," Buckman reports. "Joshua got hives all over his body every day that he consumed red meat. Wilson experienced severe itching and nearly passed out during one of his few reactions. Speak to three people with alpha-gal and you’ll discover one thing is certain: it’s complicated. The only similar experiences that Bean, Wilson and the Wethingtons have are the difficulty of living with the allergy and dealing with its affects when they go out publicly."

Bean told Buckman, “People don’t seem to take it seriously. You tell people that you have it and that you could die from it, and people are like, ‘Oh no, you can’t die from eating a hamburger or bacon.’ Well, yeah, you can.”

Alpha-gal victims use technology to help each other, including a smartphone app ("Is it Vegan?"), a Facebook groups (“The AlphaGal Kitchen” and “Alpha-Gal Support Kentucky”) and an interactive map that locates cases (above).

"Recommended by a member on a Facebook support group, the Munfordville Pool Hall and Grill is a relief to alpha-gal sufferers and also sets a great example for other restaurants for being allergy-friendly in general," Buckman writes. "The pool hall has designated one fryer where no red meat or cheese is prepared. They have designated skillets to cook foods for separate consumption because people with alpha-gal allergy can have a negative reaction from even the residue from a mammal product.

Pool-hall employee Justin Minton told Buckman that employees acted after notiing that several people in the community have the allergy. “Speaking from experience, going to Subway is pretty much the only place my grandpa can go,” Minton told Buckman.

Even though "people with alpha-gal are helping one another with useful information, Kandace Webster, an advance-practice registered nurse at T.J. Health Columbia Primary Care, "urges sufferers to seek professional guidance," Buckman reports.

Gov.-elect Beshear says he'll quickly rescind Gov. Bevin's Medicaid plan; Republicans are wary of legislating it back to life

Beshear claims victory (Reuters photo by Harrison McClary)

By Melissa Patrick
Kentucky Health News

Governor-elect Andy Beshear says he will rescind Republican Gov. Matt Bevin's Medicaid plan, which includes, among other things, highly controversial requirements for work and other "community engagement," and key Republicans in the General Assembly seem wary of trying to legislate such requirements over the Democrat's likely veto.

Beshear said in claiming victory Tuesday night, "In my first week in office I am going to rescind this governor's Medicaid waiver," the federal term for such plans. "Health care is a basic human right and my administration will treat it as such."

But the Republican-controlled legislature could pass the plan on its own, and override a Beshear veto. State Sen. Ralph Alvarado, a Winchester physician who was Bevin's running mate for lieutenant governor, didn't completely dismiss the possibility of legislating work requirements.

"All options are on the table, but it has only been three days since the election," Alvarado said in an e-mail Friday. "Legislative intervention would require significant coordination and consensus from legislators. It is also important to remember that Medicaid expansion, itself, was achieved through executive order and not through legislative approval."

Other Republican lawmakers were quicker to say that their super-majorities in the House and Senate shouldn't try to institute the waiver legislatively.

Meredith (WKYT-TV image)

"It's not a matter you want to spend your political capital on," because it wouldn't get that much return for the effort expended, said Sen. Stephen Meredith of Leitchfield, co-chair of the Medicaid Oversight and Advisory Committee and a former hospital administrator.

House Majority Floor Leader John "Bam" Carney of Campbellsville was likewise skeptical, but said GOP legislators would need to discuss it. "Even lots of Republicans have different opinions about Medicaid, with so many of their constituents on it," he said.

Under Bevin's proposal, most able-bodied Medicaid recipients would have had to work, volunteer, attend school or take job training at least 80 hours a month, and make monthly reports, in order to keep their benefits. Those who are primary caregivers or medically frail would be excluded.

The plan was aimed at those who gained coverage through the expansion of Medicaid to households with incomes earn up to 138 percent of the federal poverty line. It was approved through an executive order under then-Gov. Steve Beshear, the governor-elect's father, under the Patient Protection and Affordable Care Act, which will pay 90% of the expanded costs in 2020.

Steve Beshear could expand Medicaid without the involvement of the legislature because of a 1966 state law that requires the state to "take advantage of all federal funds that may be available" for the program, which began in 1965.

The law was the subject of legislation this year that would have given the secretary of the Cabinet for Health and Family Services full control over Medicaid funding, and the ability do do away with the expansion, Jason Dunn, policy analyst for Kentucky Voices for Health, said in an e-mail.

Republican lawmakers proposed to codify the work and community engagement requirements this year in House Bill 3, sponsored by House Speaker David Osborne of Prospect and Speaker Pro Tem David Meade of Stanford. It was introduced late in the session and failed to make it out of the House Health and Family Services committee, chaired by Rep. Kimberly Moser, R-Taylor Mill.

Moser, like Alvarado, did not dismiss the possibility of legislating the work and community engagement requirements. "We are still reviewing the options," she said in an e-mail. "We need to continue to improve health care delivery for the citizens of our Commonwealth."

HB 3 would have also placed restrictions on other public benefits. It spurred creation of a legislative panel called the Public Assistance Reform Task Force, which has been discussing such programs.

Health advocates argue that work and community engagement requirements, along with co-payments and premiums, would create barriers to care that would lead to large reductions in enrollment. Arkansas was the first state to implement such rules; before its plan was vacated by the same federal judge who blocked Bevin's plan, 18,000 people lost coverage, often from failure to report.

The first version of Bevin's plan estimated that after five years, Medicaid would have 95,000 fewer members than it would without it—largely because of noncompliance, including lack of reporting. "This is paperwork and it is intended to tear health care away from people," Beshear, the state attorney general, said in a debate with Bevin.

The governor argued that "able-bodied" Medicaid beneficiaries need some "skin in the game" and that it is a form of "bigotry" to assume that able-bodied people should be "babied." He claimed that hundreds of thousands of people in the expansion choose not to work.

Studies have indicated that most people who would be affected by the community-engagement rules are already meeting them. One study, based on polling, found that 97% were already meeting the requirements; another, based on claims data, showed that 64% were.

Dustin Pugel, an analyst for the Kentucky Center for Economic Policy, said what this comes down to is that federal law and the courts have said Medicaid is a program that is designed to provide medical assistance, and after Beshear withdraws the waiver, "that is exactly what we'll have."

"We're talking about hundreds of thousands of people who can take a deep sigh of relief after this is over because now they're going to be able to get to a doctor when they need to without barriers," Pugel said.

Bevin is 5,189 votes behind Beshear in unofficial returns. He has refused to concede and has asked for a recanvass of the vote, which is scheduled for Thursday, Nov. 14. A recanvass is a re-tabulation of numbers gleaned from precincts and absentee votes.

50 Kentucky hospitals get semi-annual ratings on how well they protect patients from infections, injuries and other safety issues

More Kentucky hospitals are doing better at protecting patients from infections, injuries and other in-hospital threats, according to the latest national rankings, on an A-to-F scale. The ratings improved slightly from the spring; two additional hospitals got As, and fewer got Cs and Ds.

However, two of the University of Kentucky's hospitals dropped to a D, as did Sts. Mary & Elizabeth Hospital in Louisville, which is being renamed U of L Health – Mary & Elizabeth Hospital after its purchase by the University of Louisville.

Louisville's Jewish Hospital, which will also get a U of L prefix as part of the university's purchase of some KentuckyOneHealth units, got an F on patient safety in the latest rankings by the Leapfrog Group, a nonprofit watchdog organization.

Other Kentucky hospitals with Ds were the Hazard ARH Regional Medical Center and Highlands Regional Medical Center in Prestonsburg.

Methodist Hospital of Henderson, which got an F in the spring, got a C, the most common grade for the 50 Kentucky hospitals rated. Most of Kentucky's 125 hospitals were not rated, since rural hospitals with "critical access" status don't have to report quality measures to the federal government.

Leapfrog bases its grades on data about "infections; surgery and safety problems; error-prevention practices; and metrics on doctors, nurses and staff to determine its rankings and grades twice a year," the Lexington Herald-Leader notes. Leapfrog says its data come from the Centers for Medicare & Medicaid Services (CMS), its own surveys and other sources.

One tab rating The Medical Center at Bowling Green,
which got a C overall, breaks down how it did on infections.
(For a larger version of the chart, click on the image.)

The Leapfrog site offers details on each of the measures under headings titled infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses & hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing.

UK's Albert B. Chandler Hospital and Good Samaritan Hospital got Ds this fall after Cs in the spring. "In other rankings, UK does very well," the Herald-Leader notes. "Chandler Hospital was ranked as the No. 1 regional facility in Kentucky by U.S. News and World Report and has been for four years.

Dr. Mark Newman, UK’s executive vice president for health affairs, told the Herald-Leader, “Like many academic medical centers, UK HealthCare serves a disproportionate number of patients with complex medical needs, which is not accurately represented by Leapfrog. . . .The quality of care and safety of our patients is of utmost importance at UK HealthCare and we continue to invest in substantial resources to continually improve in these areas.”

Chandler Hospital's rating cited surgery problems such as objects left in patients' bodies; surgical wounds that split open; death from serious treatable complications; collapsed lungs; serious breathing problems; and dangerous blood clots. It also got lower marks for antibiotic-resistant infections and surgical-site infection after colon surgery. "Dangerous bedsores and patient falls/injuries also were issues," the Herald-Leader notes. "Good Samaritan received below-average scores in many of the same areas."

The Centers for Disease Control and Prevention reports that the U.S. has about 35,000 deaths a year from drug-resistant infections. That's one about every 15 minutes, CNN notes.

Jewish Hospital also had problems with infections, surgery, bedsores patient falls and injuries, and communication with patients. U of L Health told the Courier Journal that the ratings of some of its hospitals (U of L Hospital got a D, as usual) didn't reflect "the complex nature of the patient cases they handled or the high-risk population they serve," CJ reporter Morgan Watkins writes.

U of L "noted that some of the information Leapfrog took into account dates back to early 2016," when its hospital was managed by KentuckyOne Health. "The university resumed control of U of L Hospital in mid-2017 and officially acquired Jewish and other Louisville-based KentuckyOne facilities on Nov. 1."

Chief Medical Officer Jason Smith said, "Since 2018, U of L Hospital has reported almost perfect compliance with the Leapfrog Safe Practices. We have reviewed our publicly reported data since July 2017, and utilizing the Leapfrog Group’s own calculator for scoring with that data, our calculated grade would have been a C."
On the positive side, two Kentucky hospitals earned As for the first time: Flaget Memorial Hospital near Bardstown and Jewish Hospital-Shelbyville. The other As went to Baptist Health Lexington, Clark Regional Medical Center in Winchester, Georgetown Community Hospital, Cynthiana's Harrison Memorial Hospital, Louisville's four Norton Healthcare hospitals, and the St. Elizabeth Healthcare hospitals in Edgewood, Florence and Fort Thomas.

The most common grade was a C, given to 20 hospitals. The 10 with B grades are Owensboro Health, Glasgow's T.J. Samson Community Hospital, the three CHI Saint Joseph Health hospitals in Lexington and London, Baptist Health Paducah and Mercy Health Lourdes in Paducah, and Whitesburg ARH Hospital.

Community forum in Louisville addresses teen use of e-cigs

By Melissa Patrick
Kentucky Health News

Kentucky students led a community forum about the epidemic of electronic cigarette use among teens at DuPont Manual High School in Louisville Nov. 6.

Claire Ramsey of Henry County led the discussion at Manual.

"Many students and their parents think that e-cigs or vapes are safe, but they are not, especially for students and young adults. And there just isn't enough research yet to know whether they're safer than cigarettes for adults," said Claire Ramsey, a Henry County seventh-grader who led the discussion.

Ramsey gave the audience a short lesson about the different e-cigarette products and accessories on the market, including a special hoodie designed to hide the device and allow the person to inhale the aerosol through what appeared to be the hoodie draw-string.

A panel of experts presented a range of e-cigarette topics as they related to youth, including some that addressed the specific health dangers to youth, marketing tactics that target youth, an update on vaping-related lung disease, and policies to decrease youth use of e-cigs.

Dr. Aruni Bhatnagar of the University of Louisville told the group of about 70 that nicotine is especially harmful to teens and young adults because it can harm developing brains. He said it is associated with a decrease in impulse control, affects attention and learning capacity, changes the chemistry of their brains and can prime adolescent brains for addiction to other drugs. Research also shows, he said, that teens who use e-cigs are more likely to start smoking regular cigarettes.

E-cigarette use among Kentucky's teens nearly doubled between 2016 and 2018, with more than one in four high school seniors and one in seven 8th graders reporting use in 2018, according to the Kentucky Incentives for Prevention study.

One Juul Labs pod has as much nicotine as a whole pack of cigarettes and many teens go through several pods a day. Juul is one of the most popular brands of e-cigarettes among teens.

Ben Chandler, CEO of the Foundation for a Healthy Kentucky, which hosted the event, listed several policy measures that it will support in the legislative session that begins in January, including taxing e-cigarettes just like cigarettes; raising the age to buy tobacco products and e-cigs to 21; and increasing state funding for smoking prevention and cessation to $10 million, up from $3.8 million.

Asked about cessation products for teens, the panelists said there are no validated cessation programs and protocols for teens who are using e-cigarettes, and a great need for them.

Some resources for teens who are looking to quit include:

• Truth Initiative text message program: Text DITCHJUUL to 88709 or visit https://truthinitiative.org/research-resources/quitting-smoking-vaping/quitting-e-cigarettes.
• Not On Tobacco (NOT), a 10-week, voluntary program for small groups of teens aged 14-19: https://www.lung.org/stop-smoking/helping-teens-quit/not-on-tobacco.html.
• Become a Smoke-Free Teen: Quit Vaping explains tools to help you quit and how to use them, from the U.S. Department of Health and Human Services: https://teen.smokefree.gov/.

Dr. Sara Moyer, Louisville's director of health, noted that the Louisville health department has no age restrictions on its smoking-cessation classes.

Vitamin E acetate may be the culprit

The Centers for Disease Control and Prevention said Nov. 8 that vitamin E acetate, an additive sometimes used in e-cig products, may be to blame for the national outbreak of related lung injuries.

The CDC found vitamin E acetate in all of the samples taken from 29 patients who were sickened by e-cigs in 10 states. THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana, was detected in 82% of the samples, and nicotine was detected in 62% of the samples.

"This is the first time that we have detected a potential chemical of concern in biological samples from patients with these lung injuries," says the CDC. "These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs."

Several other studies have linked cases of EVALI, which stands for "E-cigarette or Vaping product-use Associated Lung Injury," to vitamin E acetate in products containing THC.

That said, the CDC says it's not able to attribute all of the cases of the lung injuries to one compound or ingredient, and there may be more than one cause of the outbreak.

"While it appears that vitamin E acetate is associated with EVALI," CDC said, "evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI."

As of Nov. 5, 2,051 cases of lung injury related to electronic cigarettes had been reported to the CDC, and 39 deaths had been confirmed in 24 states.

Of the 1,364 patients on which the CDC has age data, 14 percent were under 18 years old; 40% were aged 18 to 24; 25% were 25-34; and 21% were 35 and older.

The CDC reports that among 867 patients who reported e-cigarette use in the previous 30 days, 86% reported using products with THC; 34% reported exclusive use of THC-containing products; 64% reported using products with nicotine; and 11% said they used only nicotine-containing products.

In Kentucky, 33 cases are under investigation, with three of them confirmed and 11 of them considered probable. Seven reported cases have been ruled out.

The CDC recommends that for now at least, no one should use electronic cigarettes or products containing THC; no one should buy any e-cigarette products off the street, particularly those with THC; and no one should modify or add any substances to e-cig products that are not intended by the manufacturer. It also says that because the cause or causes of these lung injuries is unknown, the only way to assure that you are not at risk is to refrain from use of all e-cigarette or "vaping" products.