Smoke from Canadian wildfires prompts warnings for Kentuckians, especially those who are working outdoors

By Sarah Ladd
Kentucky Lantern

Poor air quality from Canadian fires prompted a warning Thursday about potential negative health effects for Kentuckians.

Air pollution can negatively affect a person’s health, according to Rachel Keith, an associate professor of medicine at the University of Louisville and the director of human studies at the university's Envirome Institute.

“We know that what goes into your body and what’s around your body has as much if not more impact than the genes you get,” said Keith, who is an advanced practice registered nurse with UofL Health. Environmental interactions account for most chronic illnesses, she said.

People with asthma or chronic obstructive pulmonary disease are more likely to suffer immediately, she said, but air pollution can have long term effects on health as well.

Air pollution can trigger heart attacks, Keith said. Exposure over time can increase the risk of heart disease, some cancers and diabetes.

If people with asthma or COPD feel they need to use inhalers but it’s not helping, “and you still feel like you are having that air hunger or still having an asthma attack,” it’s time to see a doctor, Keith said.

Also keep an eye out for signs of a heart attack: pain and chest pressure, nausea, lightheadedness.

“We should still limit our outside time at these times” when air quality is really bad, Keith said. “We should limit our exposure.”

Even people not predisposed to things like heart disease can experience throat irritation, Keith said, and burning eyes.

If you must be out in poor air quality, an N95 mask can help protect your body, she said. But: “Limiting your exposure is the best prevention.”

The Washington Post reports, "From landscapers to farm laborers, many workers whose jobs require time in the outdoors have plowed on this week, even as smoke from wildfires raging in Canada has created abysmal air quality up and down the East Coast. Their predicament reveals how outdoor laborers, more than any other segment of the workforce, remain vulnerable when it comes to climate change."

Panagis Galiatsatos, a pulmonary medicine physician at Johns Hopkins School of Medicine and a spokesman for the American Lung Association, told the Post, “If it is feasible, I would encourage not working outside.” But he acknowledged that many people in the path of wildfire smoke don't have that option: “If people have to work outdoors, by all means take the proper precautions to stay safe,” he said.

Pike County to be part of pilot project to improve lung-cancer screening rates in Central Appalachia, big hotspot for the disease

National Cancer Institute map shows Eastern Kentucky has a very high rate of death from lung cancer; other maps show its rate of lung-cancer cases is also very high. For larger version, click on it.

By Melissa Patrick
Kentucky Health News

The Appalachian Community Cancer Alliance has launched a pilot project to improve lung-cancer screenings in rural Appalachia, and Pike County is part of it. 

Dr. Michael Gieske, director of lung cancer screening at St. Elizabeth Healthcare in Northern Kentucky, told Kentucky Health News that he had been working with the regional alliance off and on for about four and a half years, most recently on projects that involve diversity, equity and inclusion. 

Dr. Michael Gieske

Gieske said the alliance is recognized by President Biden's Cancer Moonshot Initiative and has been charged with improving cervical, colon and lung cancer screenings in the 13-state Appalachian region. 

"They felt after some of their initial work that lung cancer screening was by far the greatest need and demonstrated the greatest disparities when you were looking at health care inequities," he said. 

This realization prompted the alliance to form the Rural Appalachian Lung Cancer Screening Initiative, a multidisciplinary group of which Gieske is the subject-matter expert. 

Gieske said St. Elizabeth, which has one of the most robust lung-cancer screening programs in the country, has done 33,000 screenings since 2013 and has found 525 cancers – 70 percent of which were in either Stage I or Stage II, which are considered the early stages of lung cancer, ans most treatable.

"We're finding it when the chance of cure can be greater than 90 percent," he said. 

And, he said, because of recent improvements in treatment in lung cancer, it's really important to emphasize that even people with late-stage lung cancers are surviving the disease.  

Pilot project

To decide the location of the pilot project, leaders of the initiative used geospatial mapping to find the intersection of the highest mortality rates and lowest access to care in Appalachia, Meg Barbor writes for the ASCO Post, published by the American Society of Clinical Oncology.

Pike County (Wikipedia map, adapted)

"It was very apparent that there was a glaring area where Kentucky, West Virginia and Virginia came together," Gieske said. "They had the highest incidence of lung cancer, the highest mortality from lung cancer, the worst five-year survival rates, the highest smoking rates, the worst access, the highest poverty rates, the lowest education rates, and all these came together in this region. So we thought, well, this is probably going to be a very difficult challenging area to work in, but at the same time, it would give us an opportunity for the greatest impact." 

The pilot will include 10 counties that Gieske said "really lit up the brightest" on that map. He said Pike County, Kentucky's largest in land area, is the only county in the state in the project. Five of the counties are in Virginia and four are in West Virginia.

Gieske said they would be working with Dr. Aasems Jacob, a pulmonologist at Pikeville Medical Center, on the project. 

Dr. Leigh Boehmer

Dr. Leigh Boehmer, chief medical officer and deputy executive director of the regional cancer alliance, told Barbor that the initiative aims to increase lung-cancer screening rates by identifying and addressing informational, literacy, and cultural barriers that inhibit rural Appalachians from seeking recommended preventive care.

“The alliance was designed to provide a platform to share promising, evidence-based, translatable practices and solutions to improve access and quality of care for patients in this part of the country," Boehmer said. 

Gieske said "education and communication" are key when it comes to reaching out to primary-care providers who are on the front line of care. 

Most electronic medical-record systems "will flag a patient if they meet the criteria, and then it's it's up to the provider to order the test," he said. "Lung cancer is just as important if not more important than breast cancer and colon cancer and cervical cancer screening. Lung cancer kills more patients or more individuals in our state, in our country than prostate, breast and colon cancer combined. Lung cancer kills three times more women than breast cancer, and a lot of women don't realize that." 

The only recommended screening for lung cancer is low-dose computed tomography, also called a low-dose CT scan, according to the Centers for Disease Control and Prevention. Annual CT scans are recommended for adults between 50 and 80 who have smoked at least 20 "pack-years" (a pack-year amounting to one pack of cigarettes a day for a year, or an equivalent amount, such as half a pack a day for two years) and either still smokes or has quit within the last 15 years. Medicare rules are a bit different. 

Bad news and good news

Gieske noted that Kentucky has a long history with lung cancer, largely because of its association with tobacco.

"We're by far the worst state in the country for the incidence of lung cancer, we're 55% above the national average, we have the highest mortality rate, we're fourth from the bottom for five years in lung-cancer survival," he said, "But the good news is . . . we're now number two in the country, if you go by the American Cancer Society data for lung cancer screening, and we are really starting to make a difference." 

Gieske said several state-based initiatives have helped increase screening rates, including the Kentucky Health Collaborative and the Kentucky LEADS Collaborative, for "Lung cancer education, awareness, detection and survivorship," and data from the University of Kentucky's Markey Cancer Center shows a decrease in late-stage lung cancer. 

"We have now seen a 19% reduction in late stage lung cancer – that's Stage 3 and Stage 4 lung cancer  –over the last six years," he said. "And that's strictly a result of screening. And that's two times faster than the national average, that decline." 

Gieske encouraged anyone who qualifies for lung-cancer screening to get tested, noting that it is a simple test that takes about three minutes and does not require any "needles, tubes or dye." 

He added, "It's a very simple screening test with incredible results."

Beshear increases Medicaid reimbursement rates for home and community-based services and long-term care facilities

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear has raised Medicaid reimbursement rates for home and community-based services and long-term-care facilities to help them deal with inflation, workforce shortages and the effects of Covid-19.

"We have a duty to make sure those who need in-home care, community-based care and long-term care get the services they need and the services they deserve," Beshear said at his weekly news conference Thursday. "This increase will provide some interim financial relief for organizations that take care of our parents and our grandparents. And right now they need our help, and we need to be there for them."

Most of the money for the increase will come from the federal government, which funds about 70 percent of traditional Medicaid spending. The state share "is able to fit within our current appropriated budget without the need for additional state funds," said Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services. "The current Medicaid spending trends allow the cabinet access to funds to increase the Medicaid rate."

Dunlap noted that the cabinet "is required to adjust price-based nursing facility rates for inflation every July 1. During the budget process, the cabinet accounts for an inflationary increase in our projections for the inflationary adjustment."

The nursing-home adjustments are retroactive, to make up for underestimated inflationary increases that were provided in the last three years, Beshear said. This will result in $99.6 million more for nursing homes in the next fiscal year, which ends June 30, 2024. The state's share will be $18.9 million. 

The adjustment for home and community-based services will be for services that were delivered from Jan. 1, 2022, to May 1, 2023, at an additional cost of $13 million, according to a news release.  

The main lobbying group for nursing homes and assisted-living facilities told Kentucky Health News that it is expecting an overall adjustment of about 8 percent, and that it will vary from facility to facility. 

Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living, praised the governor's action, calling it "welcome relief" for struggling long-term care facilities that have been sounding the alarm about the skyrocketing costs required to keep their residents and patients safe and healthy. 

Betsy Johnson

“We are grateful for Gov. Beshear and his administration," Johnson said. "The pandemic had devastating effects and worsened the staffing crisis we were already facing. This funding will be paramount to providing quality care to residents and patients as well as building the foundation for a brighter future.”  

John Muller, chief operating officer for Carespring Healthcare Management in Northern Kentucky, thanked Beshear and his team at the news conference. Muller is also a KAHCF board member. 

“Nursing facilities were on the front lines of the Covid pandemic. The last number of years have been very, very difficult," Muller said. "And as we are coming out of the pandemic, the aftershock is the workforce challenges that we're facing. Nursing facilities are lagging far behind on catching up in the workforce. These much-needed funds will go a long way for the residents we serve . . . as well as the team members we need to retain and the new ones we need to recruit.”

David McKenzie, administrator and owner of The Jordan Center in Louisa, conveyed an urgent need for these increased funds in a letter to Health and Family Services Secretary Eric Friedlander on March 28. He painted a picture of his facility's dire financial situation and asked for a "funding bridge" to allow nursing homes to survive until July 1, 2024, when their rates are scheduled to be recalculated. 

"Our facility will not make it if we don't receive a funding bridge July 1, 2023," McKenzie wrote. "We have never seen price increases like this in our 49 years of business! In February 2022, we had to close half of our facility because we only had enough staff to operate 60 beds and maintain our 5-star staffing rating." 

Beshear has also committed to rebasing the Medicaid rate effective July 1, 2024, but that would require appropriations from the General Assembly next year, and Beshear's term will end late this year unless the voters given him a second four-year term in the Nov. 7 election.

"We're dealing with an election. We're dealing with a budget session. So there are lots of things for us to address," Johnson said. "But as you just stated, right now, where it stands, we understand that the current administration and the Kentucky legislature are very sympathetic to our challenges and we believe that we can all work together so that this money will be appropriated." 

Johnson said nursing homes have received inflation-based increases every July 1, but in many years the raise was only 0.1%, and since 2008 the state has not "rebased" their rates by looking at their cost reports to determine the true cost of running a nursing home. Those costs, she said, have gone up significantly. 

The $29 pandemic boost, which the legislature adopted, was an add-on to the basic rate. It "continues to be a lifesaver for our skilled nursing facilities and the residents that they serve," Johnson said. But she also says it's not enough, and it's time to rebase their rates.

"This funding is a good first step toward getting us back on our feet," she said, adding later, "If you ask any one of our member providers, when we say, 'Oh, post-pandemic world or post-Covid,' they will look you in the eye and say, 'Betsy, we're still in it' because the struggles are real. It has forever changed the way they operate and the staff that they need. It's very, very important that we should all, as Kentuckians, be invested in this taking care of our elderly, and our most vulnerable citizens."

OPINION: Criminologists say baseless anti-transgender claims fuel adoption of harmful laws in Kentucky and other states

By Henry Fradell and Alexis Rowland
Republished from The Conversation

It has been seven years since North Carolina made headlines for enacting a “bathroom bill” — legislation intended to prevent transgender people from using restrooms that align with their gender identity. After boycotts threatened to cost the state more than $3.7 billion, legislators repealed the law in 2017. Since then, however, religious and political conservatives have successfully spread an anti-trans moral panic, or irrational fear, across the United States.

As far back as 2001, Republican lawmakers proposed the first of what are now nearly 900 anti-LGBTQ+ bills. More than 500 of these were introduced in 49 state legislatures and the U.S. Congress during the first five months of 2023. To date, at least 79 have passed.

Many of these laws have been  written and financed by a group of far-right interest groups, including the Alliance Defending Freedom, the Family Research Council, the American Principles Project and Liberty Counsel.

These groups claim the laws protect cisgender women and girls – whose gender identity matches the sex they were assigned at birth – from violent trans people who are often depicted in movies and other media.

But as criminologists, we know these claims are without merit. No reliable data supports the argument that transgender people commit violent crimes at higher rates than cisgender men and women. In fact, transgender people are more than four times as likely to be the victim of a crime as cisgender people.

In the last year, at least 18 states including Kentucky have enacted laws that limit medically age-appropriate gender-affirming health care for trans minors, with similar bills pending in 14 more states. And Florida’s barrage of anti-LGBTQ+ regulations even prohibits the mere discussion of sexuality and gender identity in schools through the 12th grade. Journalist Adam Rhodes called these efforts a “centrally coordinated attack on transgender existence.”

We believe these laws and bills illustrate the increasingly hostile legislative landscape for LGBTQ+ people despite polls showing that most people in the United States want trans people to be protected from discrimination in public spaces on the basis of their gender.

What the data show

A variety of myths, false narratives, bad science, misconceptions and outright misrepresentations undergird anti-trans laws. The reality, however, is that trans-exclusionary laws do not protect cisgender women and girls from harassment or violence. Rather, they result in dramatic increases in violent victimization for transgender and gender-nonconforming adults and children.

When laws permit transgender people to access sex-segregated spaces in accordance with their gender identities, crime rates do not increase. There is no association between trans-inclusive policies and more crime. As one of us wrote in a recent paper, this is likely because, just like cisgender folks, “transgender people use locker rooms and restrooms to change clothes and go to the bathroom,” not for sexual gratification or predatory reasons.

Conversely, when trans people are forced by law to use sex-segregated spaces that align with the sex assigned to them at birth instead of their gender identity, two important facts should be noted.

First, no studies show that violent crime rates against cisgender women and girls in such spaces decrease. In other words, cisgender women and girls are no safer than they would be in the absence of anti-trans laws. Certainly, the possibility exists that a cisgender man might pose as a woman to go into certain spaces under false pretenses. But that same possibility remains regardless of whether transgender people are lawfully permitted in those spaces.

Second, trans people are significantly more likely to be victimized in sex-segregated spaces than are cisgender people. For instance, while incarcerated in facilities designated for men, trans women are nine to 13 times as likely to be sexually assaulted as the men with whom they are boarded.

In women’s prisons, correctional staff are responsible for 41% of women’s sexual victimization, with cisgender women committing the balance of nearly all prisoner-on-prisoner violence. Similarly, trans boys and girls who are barred from using the washrooms and locker rooms that align with their gender identity are respectively between 26% to 149% more likely to be sexually victimized in the locations they are forced to use than cisgender youths.

In society at large, between 84% and 90% of all crimes of sexual violence are perpetrated by someone the victim knows, not a stranger lurking in the shadows – or the showers or restroom stalls. But trans and nonbinary people feel very unsafe in bathrooms and locker rooms, though others experience relative safety there. In fact, the largest study of its kind found that upward of 75% of trans men and 64% of trans women reported that they routinely avoid public restrooms to minimize their chances of being harassed or assaulted.

Lies drive harm

Because criminological data does not support trans-exclusionary laws or policies, advocates of anti-trans laws often resort to lies, flawed anecdotal evidence, or what fact-checkers have called “extreme cherry-picking” to support their position.

For instance, one of us documented how isolated news stories, often from notoriously transphobic tabloids, conflate the actions of sexual predators with the “dangerousness” of trans women. Although there are undeniably examples of actual transgender people committing crimes, even deeply troubling ones, they are not evidence of any behavioral trends among the broader class of trans people. No such data exist.

We believe the spate of anti-trans proposals represents a textbook example of crime-control theater – an unnecessary, ineffective and harmful legislative response to unfounded fearmongering.

Anti-trans laws are not just baseless. They’re hurtful and damaging, especially to LGBTQ+ teenagers. Recent polls indicate that more than 60% of these people experience deteriorating mental health — including depression, anxiety and suicidal thoughts – as a result of laws and policies aimed at restricting their personhood.

The criminological research is clear that anti-trans laws do not help the people they are claimed to protect. In fact, these laws inflict harm on people who are even more vulnerable.

Henry Fradella is a professor in the School of Criminology and Criminal Justice at Arizona State University, where he also holds a law-school appointment . He is the author, co-author, or editor of 13 books, including LGBTQ+ Issues in Criminology and Criminal Justice. Alexis Rowland is a Ph.D. student in criminology, law and society at the University of California, Irvine.

Kentucky is one of the most sleep-deprived states; Appalachian Ky. is even more so, and that affects people's health and safety

Screenshot of interactive map; for the interactive version, with county-by-county figures, click here.

Kentucky is one of the leading sleep-deprived states, ranking fourth in the percentage of adults reporting that they get less than seven hours of sleep per day, 40.5 percent. So says the 2020 Behavioral Risk Factor Surveillance System survey, a continuing national poll by the Census Bureau. The U.S. rate was 34.8%.

Even fewer adults in Kentucky's Appalachian counties are getting enough sleep. CDC data from 2018 shows that between 40.6% to 49.1% of people living in the region reporting they get less than seven hours of sleep per day. McCreary County's 49.1% was the highest in the nation.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults sleep at least seven hours a night. 

The CDC reports that the percentage of adults who had trouble falling asleep most days or every day in the past 30 days was highest outside metropolitan areas (17.1%). Adults in nonmetro areas also had the highest rate for having trouble staying asleep (22.4%). 

Dr. Kay Miller Temple took a look at the impact of sleep on rural America's health and safety for The Rural Monitor, published by the Rural Health Information Hub. Rural doctors told her that while sleep problems presented as a primary concern for many of their patients, their trouble sleeping was often related to other conditions, both physical and mental. 

“Sleep also shows up as ‘incident to’ other presenting complaints,” Dr. Jennifer Brull, a recently retired family medicine physician from Plainville, Kansas, told Temple. “For example, when you’re working with a patient on addressing blood pressure that’s too high, or diabetes that’s poorly controlled, or mental health conditions like depression and anxiety, a sudden change in the stability of chronic conditions is often linked to sleep patterns.”

Talking about sleep is a great way to open the discussion about other sensitive topics, like substance use disorder and mental health, board-certified clinical psychologist Tess M. Kilwein, who operates a teletherapy practice with 75% of her patients located in rural areas of four states, told Temple. 

Dr. Lois Krahn, a psychiatrist, sleep medicine specialist and medical educator, told Temple that sleep deprivation can result in people being "really unhappy, irritable, reactive, and just overall miserable." She said people in rural areas might only get three hours of sleep during harvest time or if they do shift work.

One challenge for rural people who are sleep-deprived is that they have to drive longer distances in an unchanging landscape to do anything, and that often includes commuting long distances to do shift work, Brull told Temple.

“We know from the National Highway Traffic Administration that drowsy-driving crashes and fatalities are more common in rural areas,” Anne Wheaton, deputy associate director for Science in the Division of Population Health at the CDC, told Temple. 

One reason seniors in rural areas fall asleep so often is because they are bored or because they don't have any social interaction, Dr. Evin Jerkins told Temple. 

"If they live an hour out on a country road, there are no local activities to attend, so I find out when they’re most likely to fall asleep, and together we figure out a practical activity to slot into that time, like calling friends and family," said Jerkins. 

And an unexpected reason that is contributing to people getting less sleep is climate change, Kasha Patel reports for The Washington Post. 

Researcher Nick Obradovich, principal investigator at the Max Planck Institute for Human Development in Germany, and his colleagues found that "humans are already losing shut-eye in warm environments, especially at the beginning of the night. Models predict a solid sleep will further decrease as temperatures rise, especially in lower-income and elderly communities," Patel reports..

The study looked at 47,000 adults in 68 countries and found there were "notable change in sleep duration when nighttime temperatures rose above 50 degrees (10 degrees Celsius). On nights above 86 degrees, people slept about 14 minutes less on average," Patel writes.

This story has been fixed to reflect the correct publisher of The Rural Monitor.

Ky. is getting older; sees more deaths than births for several years

Kentucky State Data Center maps

Kentucky's population is getting older, and that is expected to put a strain on the state's health-care system, which already lacks enough primary-care providers, Sarah Ladd reports for the Kentucky Lantern. 

An analysis of new census data by the Kentucky State Data Center found that Appalachian Kentucky is aging faster than the rest of the state, possibly due to young people moving away, but the oldest counties are in West Kentucky, while counties with colleges and military clusters are home to the younger populations Ladd reports.

The data show that from 2010 to 2020, the median age of Kentuckians increased from 38.1 to 39.4 and the share of people 65 and older increased from 13.3% (just over one in eight) to 17% (just over one in six).

 “It’s not unexpected that the population is aging like this,” said KSDC director Matthew H. Ruther, a University of Louisville professor, told Ladd. 

Ruther said that the increase from 13% to 17% in people 65 and older is “a really big jump.”

“And it’s not done yet. We’re going to still be seeing this going into the future," estimating that the 65 and older population will eventually hit 20%, he told Ladd. 

“The peak of the baby boom was in 1957,” he explained. “Those people are now 66. And so you’re … still going to be seeing this older population get larger, both in absolute terms and as a percent of the population.”

Effects on health care and health

With Kentucky's aging population comes an influx of medical needs that the state and its health-care systems will have to consider, writes Ladd. 

The National Council on Aging said in March that about 95% of older adults have at least one chronic condition, such as diabetes or heart disease. And almost 80% have two or more chronic conditions, according to the Center on Aging.

"Yet large areas of Kentucky suffer from a lack of primary-care providers," Ladd notes. "The Kentucky Primary Care Association said in 2022 that 94% of the state’s 120 counties don’t have enough."

“People are already having trouble getting to doctors or hospitals because of supply issues,” Ruther told Ladd. “If nothing changed, then this is going to become more problematic in the future.”

Ladd also reports that deaths exceeded births in 2020, the first year of the pandemic, when there were nearly 4,000 more deaths than births in Kentucky. In 2021, deaths exceeded births by 8,089, according to the Centers for Disease Control and Prevention (CDC). 

That trend is slowing, but is continuing. Preliminary data released June 1 show that in 2022, Kentucky deaths (57,269) exceeded births (52, 219) by 5,050.

However, Kentucky was one of only 13 states that showed an increase in births in 2022, barely: five more births than in 2021, according to the preliminary data for 2022 and final numbers for 2021.  

Nationally, the number of births has plateaued after a modest increase in 2021, reports Tim Henderson of States Newsroom, Kentucky Lantern's parent organization, citing CDC data available May 30. 

Parkinson's disease: What to know about it, what to do about it

By Dr. Julia Stasich, Ochnser Health

Parkinson’s disease is named after James Parkinson, the English physician who described this degenerative disease of later life. Here are the history, symptoms, causes and treatment options for Parkinson's.

What characterizes Parkinson’s disease?

• Slowness of movement with slow, shuffling gait, short steps
• Rigidity or stiffness of the limbs and trunk
• Impaired balance and coordination
• Head held forward, and body stooped forwards
• Drooping eyelids, open mouth, drooling

What are some of the biggest misunderstandings seen in Parkinson’s disease? Not all Parkinson’s patients have tremor, and Parkinson’s disease does not shorten lifespan, but the symptoms can affect quality of life.

Who first identified Parkinson’s disease? The disease we call Parkinson’s was known to ancient eastern Indians as “Kampavata.” A man by the name of Charaka is known to have described this disease as “kampa” meaning shaking and “vata” meaning decreased muscle movement or weakness. About 500 years later in Greece, Galen, a student of Hippocrates, also described a “shaking palsy.” But it wasn’t until the 1800s when Dr. Parkinson described the criteria of patients with the “shaking palsy” and separated out other diseases that may shake or have weakness. We actually still call the syndromes that look like Parkinson’s disease by the name “Parkinsonism.”

What are the brain changes we see in Parkinson’s disease? Parkinson’s patients experience a slow, progressive loss of cells that make dopamine in the brain. Dopamine, in the right amount and right places, plays a vital role by making our bodies move faster, including arms, legs, mind and even bowels. It also makes us feel good when it is released, like during social events, eating or sex. It is also released as a reward during events such as fishing, hunting, shopping or gambling.

What are the early signs of Parkinson’s? Early Parkinson’s disease is easy to miss by doctors because the symptoms can mimic common ailments:

• Feeling “dizzy” or easily off balance
• Loss of sense of smell
• Loss of arm swing on one side of the body
• Daytime sleepiness
• Depression
• Constipation

What are some of the symptoms of Parkinson’s disease? As the disease progresses and more dopamine-producing cells are lost, more symptoms arise and may include muscle stiffness, tremor, choking and excess saliva.

What causes a loss of dopamine? We don’t know. Certainly, there are familial forms of Parkinson’s, but these are much less common than the sporadic type.

How do we treat Parkinson’s disease?

• Promote the release of dopamine
• Replace dopamine with medication
• Alternatives/additions to dopamine treatment
• Deep brain stimulation surgery

What you can be doing to increase your own dopamine levels? You can do this through regular exercise such as dancing, walking or activities such as Tai Chi. You will also feel better if you sleep better and are well-rested. Massage makes everyone feel good, but there is research that suggests that massage may reduce the symptoms of Parkinson’s disease. A loving, supportive relationship improves both lives, but the Parkinson patient may even notice improved physical effects.

What your doctor can do for you to help increase dopamine? We can directly replace that dopamine with a dopamine precursor, Levodopa. Levodopa was found to be effective in the 1950s by a Swedish scientist, Arvid Carlsson, who later won a Nobel Prize for that work. It is now available in several formulations and is always paired with carbidopa to help absorption.

We can mimic dopamine with drugs called “dopamine agonists.” Pramipexole, ropinerole and rotigatine patch are all in this category.

We can limit the breakdown of your own dopamine using drugs belonging to a family called the MAO-B inhibitors. Two examples are selegiline and rasagiline.

As with some medications, there can be side effects, so be sure to talk to your doctor about a treatment plan that is going to be right for you.

University of Louisville gets $6.1 million in federal grants to study possible cause of serious illness and death from Covid-19

University of Louisville diagrams show levels of neutrophil immune cells in various types of patients. Data analysis by Corey T. Watson, Ph.D., David Tieri, Ph.D., and M.D./Ph.D. student Anne Geller.

By Sarah Ladd
Kentucky Lantern

University of Louisville researchers announced Friday that three federal grants totalling $6.1 million will allow them to further study immune-system dysregulation, which they say causes serious illness and death in some patients who have Covid-19.

The funding from the National Institutes of Health comes after UofL researchers “discovered that a specific type of immune cells, low-density inflammatory neutrophils, became highly elevated in some Covid-19 patients whose condition became very severe,” a university news release said. (Neutrophils are white blood cells in the immune system that play a role in fighting infections). The researchers published those findings in 2021.

“At one time we had over 100 patients with Covid in the hospital. Once they were on a ventilator, mortality was about 50%,” Dr. Jiapeng Huang, an anesthesiologist with UofL Health, professor and vice chair of the Department of Anesthesiology and Perioperative Medicine in the UofL School of Medicine, said in a statement. “We were looking at this issue to see why some people would do well while some developed bad lung disease and did not do well or died.”

Immunologist and lead researcher for the 2021 study, Dr. Jun Yan, said the new federal funding could help with development of a therapy. “That’s why we do this research,” Yan said. “Eventually we want to benefit the patients.”

The funding comes from three grants:

• A four-year $2.9 million grant to UofL. Researchers will use this to better understand acute respiratory distress and work to prevent those complications, UofL said.
• A five-year $2.9 million grant to UofL. Researchers will use this to “characterize different subsets of neutrophils and measure their changes over the course of Covid-19 disease progression.”
• A one-year, $306,000 grant to Degranin Therapeutics and UofL. Researchers will use this to study the effectiveness of a compound to reduce immune dysregulation.

“The knowledge gained through these studies may benefit not only Covid-19 patients, but those with other conditions in which immune dysregulation can occur,” UofL said. Those include “other types of viral and bacterial pneumonia and autoimmune diseases, and patients undergoing cancer immunotherapy and organ transplantation.”

61 larger Ky. hospitals get mostly Cs in national patient-safety ratings, and one gets an F; raters warn infection rates remain high

This story has been updated to include Kentucky's healthcare-associated infection rate increases during the Covid-19 pandemic. 

By Melissa Patrick
Kentucky Health News

Most of the Kentucky hospitals graded on a nonprofit group's twice-a-year report card for patient safety again got a C.

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small, so they are not rated by Leapfrog; it rates 61 Kentucky hospitals.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave A ratings to four Kentucky hospitals; Kentucky's percentage of A grades, 6.6%, ranked it 46th among states. That was down 10 slots from the last report, when it ranked 36th. Leapfrog gave Bs to 15 Kentucky hospitals, Cs to 31, Ds to 10 and an F to one, in Hazard.

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections, and whether hospitals have systems in place to prevent them.

A Leapfrog press release draws attention to a significant national increase in healthcare-associated infections, reporting that the average risk of three HAIs – Methicillin-resistant Staphylococcus aureus (MRSA), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) – remain high after spiking to a five-year high in hospitals during the Covid-19 pandemic.

Comparing infection data from late 2021 and 2022 to the safety grades reported in 2021, which covered the period immediately before the pandemic, Leapfrog's analysis found that CLABSI increased 60%, MRSA infections increased 37%, and CAUTI rose 19%. 

During that same timeframe, in Kentucky, the CAUTI rate increased 33.7% and its MRSA infections increased by 65.06%, according to data provided by Leapfrog. The state's CLABSI increase was not statistically significant.  

“The dramatic spike in HAIs reported in this Safety Grade cycle should stop hospitals in their track. Infections like these can be life or death for some patients,” Leah Binder, president and CEO of The Leapfrog Group, said in the release. “We recognize the tremendous strain the pandemic put on hospitals and their workforce, but alarming findings like these indicate hospitals must recommit to patient safety and build more resilience.”

The Leapfrog site offers details on the measures for each hospital under the heading Infections. It also provides detailed information under headings titled Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. The information is provided in an easy-to-read, color-coded scale that indicates how the hospital is performing.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation.

Top Scores

Hospitals getting As were Baptist Health Lexington, Clark Regional Medical Center in Winchester, The Medical Center at Bowling Green, and St. Elizabeth Healthcare-Ft. Thomas.

The Bowling Green hospital moved up to an A after getting Cs on the last 14 reports.

Screenshot of page for The Medical Center at Bowling Green (click to enlarge)

Baptist Health Lexington has received an A grade for 11 consecutive grading periods. Clark Regional maintained its A for two consecutive grading periods and St. Elizabeth Healthcare-Ft. Thomas has maintained its grade for three reporting periods. 

Shifts up and down

Seven Kentucky hospitals moved down to a B after getting an A on the last report, including Advent Health Manchester, Deaconess Henderson Hospital and Spring View Hospital in Lebanon.  

In addition, Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children's Hospital all moved down to a B, after getting As for seven straight periods. 

Three hospitals moved up from a C to a to a B: King's Daughters Medical Center in Ashland, St. Elizabeth Healthcare-Florence and Three Rivers Medical Center in Louisa. 

Other hospitals with B grades are Baptist Health Louisville, Meadowview Regional Medical Center in Maysville, Owensboro Health Muhlenberg Community Hospital in Greenville, St.Elizabeth Healthcare-Edgewood and U of L Health Shelbyville Hospital. 

Three hospitals moved up from a D to a C: Flaget Memorial Hospital in Bardstown, Jackson Purchase Medical Center in Mayfield and Taylor Regional Hospital in Campbellsville. 

Baptist Health Richmond moved down to a C after receiving five straight As. 

Eleven hospitals moved down from a B to a C:Bap tist Health Corbin, Baptist Health Deaconess Madisonville, Ephraim McDowell Regional Medical Center in Danville, Middlesboro ARH Hospital, Leitchfield's Owensboro Health Twin Lakes Medical Center, Lexington's Saint Joseph East and Saint Joseph Hospital, Bowling Green's TriStar Greenview Regional Hospital, University of Kentucky Albert B. Chandler Hospital, UK HealthCare Good Samaritan Hospital, and University of Louisville Hospital.

The remaining 15 hospitals with a C list all got Cs on the last report card too. 

Two Kentucky hospitals moved down from C to a D. Kentucky River Medical Center in Jackson got a D after receiving Cs on the last three reports, and Tug Valley ARH Regional Medical Center in South Williamson got a D after receiving four Cs and one B in the last five reports. 

Other hospitals with D grades are Murray-Calloway County Hospital, Pikeville Medical Center, Saint Joseph Mount Sterling, St. Claire Regional Medical Center and UofL Health-Mary & Elizabeth Hospital. 

The only hospital that got an F was Hazard ARH Regional Medical Center, down from a D on the last report. The last time a Kentucky hospital got an F on the Leapfrog report was in the fall of 2019, when Jewish Hospital received one. It got a C on this report card. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded.

As a whole, Kentucky seniors are the third most unhealthy in the nation, ranking better than only Louisiana and Mississippi

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd

Kentucky Lantern

New data shows Kentucky among the worst states for key health points among senior citizens, including tooth extractions, food insecurity, insufficient sleep and more.

The statistics, published in the America’s Health Rankings Senior Report in May, show Kentucky seniors have the most tooth extractions.

As a whole, Kentucky seniors rank second for insufficient sleep, exercise and cognitive difficulties; third for food insecurity, and sixth for obesity.

As a whole, Kentucky seniors are the third most unhealthy, healthier only than their counterparts in Louisiana and Mississippi.

Dr. Michael Stockman, a geriatric physician based in Minnesota, said there is a “bright side” of the report: Older Kentuckians, generally, don’t drink too much or have severe housing insecurities, and they consume sufficient fruits and vegetables.

For older Kentuckians not to drink excessively “is great because excessive drinking can lead to things like liver disease, diabetes,” said Stockman, who works for UnitedHealthcare. “It can also interfere with the medications that people are taking as well.”

The United Health Foundation released the report, which examines the health of older adults with 52 measures including social and economic status, physical environment, clinical care, behaviors and more. The rankings are based on data available up to March 8.

Kentucky had higher rates of physical inactivity than the national average, the report showed, which Stockman said can itself lead to poor health.

Nationally, 31% of seniors 65 and older are physically inactive, while the number jumps to 37% in Kentucky.

“It’s important to do those simple daily things like walking 30 to 45 minutes a day to really make a positive impact on overall health and well being,” Stockman explained.

Exercises like walking, stretching, yoga and tai chi can all help strengthen the body and prevent falls, which can lead to fractures, he said.

Social isolation

Kentucky seniors are at high risk of social isolation, the report says, a fact exacerbated by the Covid-19 pandemic. The report ranks Kentucky ranks fifth in social isolation among older adults.

“The pandemic did really create a social isolation amongst all of us. I think seniors were disproportionately affected and it … worsened during that pandemic,” Stockman said. “Being socially isolated puts people in a very vulnerable situation, particularly as they’re going through stressful life events common with aging, such as losing maybe a close friend or a family member, or as they move into retirement. Being socially isolated can lead to, really, a decline in a person’s cognitive functioning. It can increase the risk of depression and decrease the overall quality of life of older adults.”

The bright side to that point, though, is that there are more households now with access to high-speed internet than in 2019. The internet can help seniors gain access to telehealth appointments, stay in contact with family and friends and participate in social activities.

Kentucky seniors seem to be closing the gap in high-speed internet. From 2019 to 2021, 9 percent more of them used broadband, while the national increase was 7 percent.

Opioid commission leader suggests it use at least $42 million to get exotic psychedelic drug approved to treat opioid-use disorder

Hubbard announced his plan as his boss, Attorney General
Daniel Cameron, sat behind him. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

The head of the commission that manages the state's opioid-settlement money said Wednesday that the panel will "explore the possibility" of committing "no less than $42 million" to developing a treatment of opioid-use disorder with the psychedelic drug ibogaine, which is not legal in the United States.

Gov. Andy Beshear questioned the idea and said it was announced without consulting his two appointees on the Opioid Abatement Advisory Commission, which has yet to approve it. The commission operates under Attorney General Daniel Cameron, the Republican nominee against Beshear in the fall election. 

Bryan Hubbard, executive director and chairman of the commission, told reporters at the event, "It is our hope that we can achieve an approval within six years" from the U.S. Food and Drug Administration for ibogaine.

"This is the first time an effort like this has ever been undertaken by an individual state in history," Hubbard said. "So we are in uncharted territory by even discussing the possibility of executing this project." 

Ibogaine is a powerful psychedelic that comes from a plant mainly found in Africa. It is anecdotally reported to stop the withdrawal symptoms of opioid dependence.

"Anecdotal evidence that is a mountain high and decades wide, suggests that ibogaine, within 48 to 72 hours of administration in safe, clinically controlled conditions, resolves opioid withdrawal syndrome," Hubbard said.

"It appears to do so by clearing and resetting the brain's opioid receptors, while also restoring the brain's organic dopamine and serotonin production to pre-opioid exposure levels. If this anecdotal evidence can be clinically validated, ibogaine would represent a transformative therapeutic for the treatment of opioid-use disorder." 

The commission's news release about the idea did not mention any drugs, nor did Cameron in his opening remarks to a crowd of at least 60 who came to hear the announcement on the state Capitol lawn.

Representatives from several organizations were on hand to support the initiative, including the Veteran Mental Health Leadership Coalition, Reason for Hope, Heroic Hearts Project, Veterans Exploring Treatment Solutions and the Foundation for a Healthy Kentucky.

"I am so excited to support Kentucky in this innovative ibogaine research initiative; it's second to none," said retired Marine Corps Lt. Gen. Martin Steele, who is CEO of Reason for Hope and president of the Veteran Mental Health Leadership Coalition. "The existing clinical research and the growing body of personal anecdotes suggest that ibogaine when used with careful medical screening, treatment protocols, and oversight, has incredible promise for treating veterans and all others struggling with opioid addiction." 

With great emotion, several people shared their stories of addiction – and recovery after being treated with ibogaine in a country where it is legal. 

One was Bobby Laughlin, CEO of New Course Enterprises, a California investment firm, who told how he was able to stay off heroin and other opiates after going through inpatient and outpatient treatment with ibogaine under medical care in 2013. 

Laughlin said ibogaine was key to his survival. He said the drug minimized the physiological feeling of opiate withdrawal, removed his compulsion to use opiates, and induced a spiritual experience, which reinstated compassion and love for himself – and was not a habit-forming medicine, and only needed to be used once. 

Next steps

Hubbard said he envisions the project to legalize ibogaine as a public-private partnership. Asked the basis of his $42 million estimate, he said it seemed to be a "reasonable sum" for a "breakthrough opportunity" that, if successful, would not only have a "profound" impact on Kentucky but the rest of the nation.

He said he will discuss the project with the commission at its June 12 meeting and ask it to set a schedule for how to proceed, including one or two public hearings. Then, he said the commission will work toward taking a vote, "perhaps in the fall," to commit the funds.

"Work would begin to develop the necessary criteria for the announcement of a grant opportunity . . . for any clinical research team that would seek to come in here to develop ibogaine therapy as well as the best practices model for its application to opioid-use disorder," he said.

The money would come from the $842 million the state is getting from settlements with drug manufacturers and distributors, half of which has been allocated to the state and the other half to cities and counties. 

Hubbard said, "I want to emphasize that this is preliminary and we are going to explore that possibility. Given the expense – and it is a significant expense of developing any therapeutic to go through the FDA process – we want to make sure that the money we put up to be matched by clinical research teams will be an adequate sum to get us across the finish line."  

Current treatments have 'modest' success

There is no question that Kentucky, and the nation, need to find more effective ways to treat opioid addiction. 

"Existing addiction treatment models have modest success rates," the news release noted. "Some existing treatments are also subject to misuse. Prevailing opioid-use-disorder treatment models carry an average cost of $139,200 per person per recovery attempt." The release said that from 2017 to May 26, drug companies billed Kentucky Medicaid $1.02 billion for almost 102 million doses of suboxone, "one of the most common and presently effective medications for treating opioid-use disorder." 

Cameron said that while overdose deaths dropped 5% in Kentucky in 2022, the bad news is that 2,127 Kentuckians overdosed last year and the number of overdose deaths in the state has risen 60% since 2019 – with 7,665 Kentuckians dying from overdoses in that time, and about 90% of them caused by opioids.

"We've got more work to do . . . and something has to change," Cameron said. "Obviously, we need to continue to fund the work that has been ongoing in Kentucky. We also need to explore a new approach. We have to imagine new possibilities. We have to invest in programs and potential solutions for tomorrow."

Among those attending the event was Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky and a former Democratic attorney general and congressman. He applauded the effort, saying the foundation is hopeful for the health benefits this new initiative could bring to Kentucky.

“We support innovative and data-driven methods to solve health problems,” Chandler said in a news release. “This move to explore new treatments to reverse the chemical effects of opioid addiction, including opioid withdrawal, could be the key to unlocking successful recovery and better long-term health for many Kentuckians.”

Hubbard responds to Beshear

Beshear, asked about the endeavor at his weekly news conference, held shortly after the announcement, said he had only learned about the commission's "psychedelic research" idea that day. 

He sais members of the commission from his administration, Health Secretary Eric Friedlander and Van Ingram, executive director of the state Office of Drug Control Policy, said they had not heard about the project.

"They're supposed to be the ones that decide what projects to fund," Beshear said of the commission. He also noted that $42 million is more than twice as much as the commission has appropriated in its first round of grants. "This is a huge amount of money," he said.

Hubbard said in an interview Thursday, that the commission will allocate a total of $30 million by the end of this year. He stressed that it was his idea to explore the use of ibogaine for opioid-use disorder and said he had not formally discussed the initiative with any of the commission members.

"I will take responsibility as chairman for the commission for having conducted individual research in my capacity as chairman for anything and everything that we could possibly discover that could potentially be a breakthrough therapeutic for treatment of opioid disorder," he said. " I undertook that effort because the results we are getting with our existing infrastructure are unacceptably mediocre." 

He added, "The entire point of the announcement yesterday was to present the concept to the commission members, as well as to the state as a whole. Every commission member was invited. . . . And we did not disclose details in advance because this was sensitive information that was developmental. And insofar as we presented it, we wanted to present it on a wide scale, simply because it's innovative, it's new, and we think that it should receive spotlight, celebratory attention." 

Friedlander and Ingram did not attend. 

Hubbard said he would be "ultra, ultra hesitant" to have any advanced consultations with Beshear's appointees because he thinks Beshear misrepresented the commission's work back in January. Beshear said the commission did not have enough guidance or scoring criteria for the grant applications, despite regulations that outlined factors for consideration.

Hubbard said, "I would not be able to have any confidence in the degree to which he, in a context of a press conference, would address it honestly and with good faith." 

Cameron spokeswoman Shellie May, who was on the call with Hubbard, emphasized that no money has been allocated or decided for the project because that is the responsibility of the commission, which includes two Beshear subordinates.

To Beshear's comment about "a huge amount of money," Hubbard noted that $42 million would be 10% of the state's portion of the settlement funds and 5% of the whole amount.

"And if we are successful, then we will have developed a therapeutic which will revolutionize how we treat opioid-use disorder – and reduce over the long term the unbelievable consumption of resources being devoted to the treatment of the acute phase of opioid-use disorder, which is the withdrawal symptoms," he said. "Those are the straight, cold hard facts. When he gets out and he talks about how this is a tremendous amount of money or somehow depriving other potential projects and resources, he's not even bothered to do the basic math."

Asian tiger mosquitoes, which are aggressive biters, breed in small vessels of water, not ditches or marshes like other skeeters

https://www.kentucky.com/news/state/kentucky/article275915186.html