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Sunday, March 31, 2019

Resolution to require study of response to hepatitis A outbreak, and recommendations to avoid a repeat, failed in the legislature

Hepatitis A vaccine (USA Today photo by Nikki Boliaux)
The state Cabinet for Health and Family Services won't have to conduct a study of its response to the hepatitis A outbreak that has killed at least 52 in the state and is the nation's worst outbreak of the liver disease. It also won't have to make recommendations to the General Assembly "to ensure that future responses to outbreaks are more effective," as a legislative resolution would have directed.

The Senate-passed resolution directing the study and recommendations wasn't brought up for a vote in the House on the last day of the session, "despite broad bipartisan support," reports Deborah Yetter of the Louisville Courier Journal.

The sponsor of the resolution, Senate Democratic Leader Morgan McGarvey of Louisville, told Yetter that he didn't think it failed because of any opposition to the measure. "Rather, he said, he thinks it got caught in the crush of last-minute legislation that kept members of the House wrangling over other, more controversial bills almost till midnight," he said.

McGarvey said he will "demand answers" about how state officials responded to the outbreak, and Rep. Joni Jenkins, D-Shively, "said she expects lawmakers will pursue the matter with the cabinet," Yetter reports. Jenkins said, "It is a national embarrassment that we've handled it so poorly."

"The Courier Journal reported in February that a slow response over the past year by state public health officials to an outbreak of the contagious liver disease appeared to contribute to what became the the nation's largest and deadliest outbreak," Yetter notes.

Medical News Today: The 'burden of disease' in those who recover from addiction

A recent investigation into health conditions that develop in people recovering from addiction reveals that more than one-third have a chronic disease.

Medical News Today: Could reused cooking oil trigger breast cancer spread?

A new study in mice finds that reused cooking oil may encourage breast cancer metastases. These preliminary results are sure to spark more research.

Saturday, March 30, 2019

Medical News Today: What causes bloody urine in men?

Seeing blood in the urine is a symptom of many underlying problems in males, including infections, an enlarged prostate, and kidney stones. Learn about the causes and their treatments here.

Medical News Today: How to stop getting sick

Some people find that they keep getting sick. Potential causes of frequent sickness include stress and lack of sleep. Lifestyle changes can help reduce the likelihood of a person becoming ill. Learn more about why some people keep getting sick and what to do about it here.

Medical News Today: What are the most healthful oils?

Healthful oils are an essential part of all diets. In this article, we compare some of the most popular oils, looking at their health benefits, nutrition, and uses in cooking. We include olive oil, coconut oil, canola oil, and vegetable oil.

Medical News Today: Wishing others well may boost your own well-being

New research has found a simple psychological technique that could reduce stress and anxiety and make people happier in just 12 minutes.

Medical News Today: Music may enhance the effect of pain relievers

Can music soothe pain? A new study in mice finds that listening to Mozart alongside taking standard pain medication works better than drugs alone.

Medical News Today: What does herpes look like?

Herpes is a condition caused by the herpes simplex virus. People may notice herpes symptoms across the body, including in the mouth, on the genitals, or in the eyes. This article discusses what herpes looks like, describes the symptoms, and provides pictures to help identify herpes.

Friday, March 29, 2019

Medical News Today: Causes and treatment of foot cramp

There are several possible causes of foot cramps, including overexercising, nutrient deficiencies, and dehydration. In this article, we explore the causes of foot cramps and their treatments.

Medical News Today: Ulcerative colitis medications and other options

Ulcerative colitis medications include corticosteroids and immunomodulators. Other medical and natural treatments, such as surgery or nutrition, may also help. Learn more here.

20 test positive for E.coli, six hospitalized, mostly in Central Ky.; state health department searching for source

E. coli symptoms (Graphic by JR Bee, Verywell Health)
Twenty Kentuckians have tested positive for an infection caused by a strain of E. coli bacteria, and public health officials say they have not yet identified the source of the outbreak, the state Department for Public Health said.

Investigators said some element of food distribution is the likely cause of the outbreak, which has struck both children and adults, mostly in Central Kentucky.

The health department reports that no deaths have been linked to the outbreak, but six people have been hospitalized.

Health-care providers across the state have been alerted to watch for patients with quick-onset diarrhea, which can be associated with E. coli. The release says this is a particular strain of E. coli that produces a type of toxin, called Shiga toxin, that can be dangerous for those infected.

“Exposure to E. coli bacteria can be debilitating and potentially life-threatening, especially for small children and individuals with weakened immune systems," said Public Health Commissioner Dr. Jeff Howard. "With this in mind, the Department for Public Health has taken swift action to identify patients, ensure appropriate testing, and follow-up care as we work to determine the source."

Howard encouraged everyone to be aware of the signs and symptoms of E.coli infections and to seek care if they exhibit any of them.

Symptoms typically include stomach cramps and diarrhea, including bloody diarrhea. Symptoms usually start two to five days after consuming contaminated food. The state news release notes that the infection can sometimes lead to hemolytic-uremic syndrome, a serious complication that can cause kidney failure a week or more after the onset of diarrhea.

"State health officials are working with staff at local health departments in the counties with suspected or confirmed cases to determine the source of the infections," says the release.

To prevent E. coli infections:
  • Wash hands frequently for at least 20 seconds with soap and warm water, especially before eating,after going to the bathroom, when handling raw meat and eggs, and after handling or petting animals 
  • Thoroughly wash produce before eating
  • Thoroughly cook meat
  • Clean and sanitize food preparation areas
  • Avoid swallowing lake or pool water
  • Drink only pasteurized milk
  • Frequently clean and sanitize restrooms, including door knobs and faucet
If you believe you have an E.coli infection, call your health-care provider, write down what you ate in the week before you got sick, report your illness to the health department, and be prepared to answer questions about your illness, the health department advises.

Medical News Today: Possible reasons weight loss is not working

Efforts to lose weight may not work for a range of reasons. A person may be following an ineffective fad diet, or consuming sugary drinks, or exercising more but making no dietary changes, for example. Learn more here.

Bill to require 'reasonable accommodations' to pregnant women at work passes on last day of legislative session

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill that allows pregnant women "reasonable accommodations" while at work, and supports breastfeeding, passed on the last day of the legislative session. It awaits action by Gov. Matt Bevin, whose decision will be final because it passed on the last day

Sen. Alice Forgy Kerr
Senate Bill 18, sponsored by Republican Sen. Alice Forgy Kerr of Lexington, gained final passage in the House on an 87-5 vote.

In presenting the bill to the House, Rep. Nancy Tate, R-Brandenburg, said it had the support of many business and pro-life groups, adding that 24 other states have passed similar laws. She stressed that the bill does not require mandatory paid parental leave.

The bill passed the Senate on 25-7 on Feb. 22, with an amendment that allows employers to choose from a list of accommodations rather than a mandatory list. It also removed a 10-day notice period for employers to alert pregnant employees of their rights, according to a state news release.

The "reasonable accommodations," which include things like more frequent breaks or being moved to a less strenuous or less hazardous position, are limited to employers with 15 or more employees. Normal anti-discrimination law applies to those with eight or more employees. The bill also requires applicable employers to provide a private space that is not a bathroom for expressing breast milk.

“Providing clarity on this issue is badly needed in Kentucky,” Kerr said in presenting the bill to the Senate. “As things stand right now, the employer and employees are forced to navigate a complex web of federal law and case law which leads to confusion and frustration. It discourages workforce participation among our women.”

The American Civil Liberties Union called the bill's passage a great victory for Kentucky families. "Senate Bill 18 provides much-needed clarity for employers and reasonable protections for pregnant workers to prevent problems before they start," ACLU-KY Advocacy Director Kate Miller said in a news release. "After working with a broad array of partners for a number of years to pass these critical protections, we are thrilled the General Assembly brought this law to final passage.”

State health department funds mobile syringe exchange for Laurel, Whitley, Knox, Clay and Jackson counties

A mobile syringe exchange will go to five Eastern Kentucky
 counties: Knox, Laurel, Whitley, Clay and Jackson. (WYMT) 
Five Eastern Kentucky counties will soon have a mobile syringe exchange to minimize the spread of infectious diseases and to help get people who are addicted to drugs into treatment, Justin Kase reports for WYMT. It is expected to be operational in two months.

The Mobile Harm Reduction Unit for the exchange, a van, is funded by a grant from the state Department for Public Health and will serve adjoining Knox, Laurel, Whitley, Clay and Jackson counties. All but Jackson are among the top 54 counties in the nation with an increased risk of outbreaks of hepatitis C and HIV due to intravenous drug use.

Mark Hensley, the executive director of the Laurel County Health Department, told Kase that the mobile exchange will offer many of the same services as stationary ones, including HIV and hepatitis C testing, hepatitis A vaccines, information about addiction treatment, and a peer counselor aboard.

Each of the counties in the program has an established syringe exchange in place. Hensley said Laurel County opened its syringe exchange about two months ago, and participation has been a bit slow. He told Kase that he expected better participation with the mobile van because it might help to break down some of the barriers associated with syringe exchange programs, such as "reliable transportation or just fear of the program itself."

The plan is for the unit to spend one day in each county before moving on to the next. Locations have not been determined. "We might establish four different locations within the county, you know, maybe try to hit the four corners of those rural areas," Hensley told Kase.

Medical News Today: Hematoma: Everything you need to know

A hematoma occurs when blood leaks from a large blood vessel. In this article, learn about the causes and symptoms of hematomas as well as the different types and when to see a doctor.

Medical News Today: Dark spots on the skin: Causes and how to treat them

Dark spots on the skin are usually the result of hyperpigmentation. They are usually harmless. In this article, we look at the symptoms, causes, and treatments for dark spots on the skin.

Medical News Today: Can you get pregnant on your period?

A person can get pregnant at any point in their menstrual cycle, but it is much less likely during their period. In this article, we look at the factors affecting whether someone can get pregnant before, during, and after their period.

Medical News Today: How can you make your period come faster?

People have tried many methods to induce periods using traditional and modern medicine. In this article, we look at the evidence behind various ways to make a period come faster, risks, and methods that have no scientific backing.

Medical News Today: What does science say about the effects of meditation?

In this Spotlight feature, we look at the benefits of practicing meditation or mindfulness, and we weigh up some of the potential unwanted effects.

Medical News Today: Vitamin C can cut time spent in intensive care units

An analysis of published trials calls for research into vitamin C's effects on critically ill patients after finding it can cut time in ICU by 8 percent.

Medical News Today: Could probiotics evolve in the gut and cause harm?

New research shows how bacteria adapt inside the gastrointestinal tract of mice and suggests that the effectiveness of probiotics might change over time.

Medical News Today: What can cause stomach pain when breathing?

Stomach pain when breathing is often due to a problem with the diaphragm or the tissues in the chest cavity. Possible causes include injuries, hiatal hernia, pregnancy, pleurisy, and gastroesophageal reflux disease (GERD). Learn more here.

Medical News Today: 15 healthful gluten-free meals to try

Making healthful, filling gluten-free meals is easier than many people think. In this article, we provide 15 gluten-free recipes that people can use to make breakfasts, lunches, and dinners.

Medical News Today: Using artificial intelligence to predict mortality

Newly published research compares the accuracy of machine learning algorithms in predicting mortality with that of conventional mathematical models.

Why the wheelchair? Could it be gout?

When Paul Manafort appeared in court for sentencing recently, he was in a wheelchair and pleaded for leniency, in part because “his confinement had taken a toll on his physical and mental health.” He reportedly had symptoms of depression and anxiety — but what was the health problem that put him in a wheelchair? According to multiple news reports, the answer is gout. Yes, that ancient disease you may have thought didn’t exist anymore has stricken Mr. Manafort. He joins the rising number of people in the country diagnosed with this common disease.

What is gout?

Gout is a cause of severe joint pain and inflammation. This form of arthritis develops when crystals of uric acid (a normal byproduct of our body’s metabolism) deposit near joints and other parts of the body. Gout develops because the body makes too much uric acid, the kidneys don’t get rid of enough of it, or a combination of both.

For some, dietary factors — consuming foods and beverages that produce a lot of uric acid — seem to play an important role. For others, the problem may be one or more medications that cause the level of uric acid to rise. Genetic factors are also important; the way the body handles uric acid may vary based on the genes you inherit. The observation that gout sometimes runs in families supports a genetic contribution.

Some facts about gout

Gout is on the rise. According to the most recent estimates, nearly 4% of the adult population in US now has gout, while less than 3% had it 25 years ago. The increase is thought to be due to rising rates of obesity, use of certain medications, and the rising popularity of high-fructose corn syrup (as found in carbonated beverages and many other foods and drinks).

Men are more likely to get gout and can develop gout at any age, but women rarely get it before menopause.

Gout used to be called “The disease of kings.” This was supposedly because in ancient times, only those who were wealthy enough to consume a lot of alcohol, red meat, and organ meats (such as liver) tended to get gout. While Henry VIII reportedly had gout, it can no longer be considered the disease of kings. People of any socioeconomic status can have gout.

Diet may matter less than we thought. A new study analyzed dietary surveys, genetic analyses, and uric acid levels among more than 16,000 people in the US. They found that dietary choices accounted for less than 0.5% of the variation in uric acid, while genetic factors accounted for about 24%. Since gout is caused by high uric acid, this study suggests that genetics matter much more than diet when it comes to the risk of gout.

The good news

Among all forms of arthritis, gout is among the most preventable and treatable. Some of the best ways to avoid gout include maintaining a healthy weight, moderating alcohol consumption, and maintaining a healthy blood pressure.

And there are highly effective treatments. These include several medications (including corticosteroids, anti-inflammatory medications, and colchicine) to treat a sudden gout attack, and others (including allopurinol and febuxostat) that can prevent future attacks by lowering uric acid. In fact, treatments for gout are so good, it’s quite unusual that a person would be confined to a wheelchair despite proper treatment.

There may be more to gout than arthritis

While the sudden and severe arthritis of gout gets most of the attention, high blood uric acid may cause other problems. A kidney stone is another common (and terribly painful) complication. In addition, there is mounting evidence that high uric acid may contribute to high blood pressure, kidney disease, and cardiovascular disease, and that medications to lower uric acid may reduce the risk of these problems (although more research is needed to prove this).

The bottom line

Although gout can be temporarily debilitating, excellent treatments are available. So, while most of the news hasn’t been good for Paul Manafort lately, his gout should be just a temporary setback.

The post Why the wheelchair? Could it be gout? appeared first on Harvard Health Blog.

Medical News Today: This drug failed to treat cancer, but it could improve dementia

Scientists have found that an experimental drug that failed against cancer may treat dementia instead. However, can they test it in clinical trials?

Thursday, March 28, 2019

Medical News Today: What to know about cupping therapy

Cupping therapy involves placing cups on the body and creating suction. Benefits include pain relief and sports recovery. There are also some potential side effects, such as nausea and headaches. Learn more here.

Statewide tobacco-free-schools bill finally passes, and is the governor is expected to sign it into law, effective in 2020

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to ban the use of tobacco products in all Kentucky public schools and events finally passed on the last day of the legislative session and is on the way to Gov. Matt Bevin's desk for his signature or veto.

Sen. Ralph Alvarado
Because it was the last legislative day, Bevin's decision will be final. Sen. Ralph Alvarado, Bevin's running mate for lieutenant governor, reiterated that Bevin had told him he would sign the bill if it comes to his desk, and said he would be shocked if he didn't.

When presenting the bill to the Senate, Alvarado, a Winchester physician, said that 8,900 Kentuckians die every year from smoking; and that tobacco-related illnesses cost Kentucky nearly $2 each year, including nearly $600 million in Medicaid expenses.

"It's time for Kentucky to step up to the plate and protect its children," said Alvarado. "Let's get our children healthier. Let's save taxpayer money. Let's save Kentucky lives." The bill would take effect Jan. 1, 2020.

Rep. Kim Moser
The Senate passed House Bill 11, sponsored by Rep. Kim Moser, R-Taylor Mill, by a 28-10 vote. It had passed the House 85-11, but not until two amendments were added to appease concerns about state-government overreach. One would give school boards three years to opt out of the ban; the other would allow adults to smoke on field trips or events off school property events if students are not present. 

Even with the amendments, Sen. John Schickel, R-Union, called the bill "the very definition of government overreach" and said it was "what some people would call a nanny state." He argued that the bill wasn't necessary because school boards already have the authority to pass such policies.

"We as conservative Republicans have no business dictating to local communities on matters such as this," he said.

Only 42 percent of Kentucky school districts have 100 percent tobacco-free policies, covering 57 percent of the state's students, and many of them have not updated their policy to meet new standards for electronic cigarettes, which have become a real problem in Kentucky schools.

Federal research showed a 78 percent increase in "vaping" among high school students and a 48 percent among middle schoolers in the last year alone. And though state-level data hasn't been released, focus groups led by Kentucky Youth Advocates showed a similar uptick in the state.

Alvarado also pointed to the rose in e-cigarette use among teens as a reason to pass the bill. He said that teens have no idea that one Juul pod has the same amount of nicotine as a pack of cigarettes, and that some kids are going through eight pods a day. The Juul products are the most popular among teens because they look like oversized flash drives, come in flavors and are easy to hide. 

"We're creating an entire new generation of addicts when it comes to nicotine," Alvarado said.

Speaking in favor of the bill, Sen. Reginald Thomas, D-Lexington, called it a "good start" toward improving youth smoking rates in the state, which he said were among the worst in the nation.

In Kentucky, 14.3 percent of high-school students smoke, compared to 8.8 percent nationally.  Almost as many, 14.1 percent,  use e-cigarettes, a bit above the 13.2 percent nationally, according to the 2017 Youth Risk Behavior Survey. That said, health experts have warned that e-cigarette figures are probably higher now because Juul sales have surged since the survey.

Thomas also pushed back against the government overreach argument, pointing to two school-related bills that passed this session, one to mandate the last Wednesday in September of each year as a day of prayer for Kentucky's students and another to require schools to display "In God We Trust." He said to applause from the gallery, "We are always for local control until we are against it."

Speaking in favor of the bill, Sen. Danny Carroll, R-Paducah, said that even though it had some flaws, "Anything that we can do to decrease smoking in our state to save lives is a vote worth taking."

Sen. Paul Hornback, R-Shelbyville, who voted no, said he thought passing a bill to raise the age to purchase tobacco to 21, like the one that had failed to get out of his committee this session, would have been a better way to deal with this issue.

Moser, who was in the Senate chamber when the bill passed, said, "This is just a great step in the right direction for Kentucky students."

Bonnie Hackbarth, vice-president for external affairs with the Foundation for a Healthy Kentucky, said that the bill's passage means that about 275,000 more Kentucky students will be covered by tobacco-free school policies.

"That's a huge win for the health of Kentucky and the health of Kentucky kids," she said. "It is going to reduce youth initiation and ultimately smoking rates in Kentucky"

"Tobacco conversations in Kentucky are complex and bring lots of pressures on our elected leaders, and that is why House Bill 11 is such a profound win for Kentucky's kids," Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release.

He added, "Prohibiting tobacco use on school campuses creates an environment where smoking cigarettes and e-cigs is not the norm, provides positive adult role modeling, and protects students, staff, and visitors from the harms of secondhand exposure."

Alvarado called the passage of the bill "the beginning of a gradual culture change that needs to happen."

Medical News Today: Hypothyroidism: Foods to eat and avoid

Certain diets can improve hypothyroidism, or an underactive thyroid, while others can make the symptoms worse. In this article, we look at which foods and nutrients to eat and avoid to improve the symptoms of hypothyroidism.

Health departments, regional mental-health centers, other entities get a pension fix, but at a cost to some employees' pensions

Teachers filled the Senate gallery. (Herald-Leader photo by Matt Goins)
As it closed up shop, the legislature gave local health departments, regional mental-health centers and other government-related agencies another reprieve from pension costs that threaten their future, but at a cost to some employees' pensions.

"Under the plan, the organizations can remain in the Kentucky Retirement Systems and begin paying a staggering 84 percent of their payroll as their share of pension contributions, which is what the rest of state government paid this year," John Cheves reports for the Lexington Herald-Leader. "Or they can leave KRS by July 2020 and pay off their pension liabilities, either with one lump sum or starting at their current rate of 49 percent of payroll and gradually increasing by 1.5 percent a year" until the liability is funded.

In organizations quitting KRS, employees hired since 2014, and all new hires, "will be enrolled in defined-contribution plans" like 401(k)s, Cheves writes. "Longer-term employees can choose whether to remain in KRS with their defined-benefits pensions or switch to a defined-contribution plan. But if they remain in KRS, their employer’s liabilities will increase.

The revised House Bill 358 "would allow most employees of the affected groups to continue accruing future retirement benefits in the current pension plan," unlike the Senate's earlier version of the bill, which would have moved most employees to "a new 401(k)-like plan," Tom Loftus reports for the Louisville Courier Journal. "Any group that leaves the pension plan or is more than 30 days late in making payments" would be moved into a 401(k)-like plan, "and pension checks to retirees from such groups could be suspended until the group gets current on its payments."

Gov. Matt Bevin had told lawmakers that he would sign the Senate's earlier version into law, but would reject any approach he thought would unnecessarily harm the badly underfunded pension plan. "Sen. Chris McDaniel, the Taylor Mill Republican who co-chaired the committee that worked out the compromise, said he hoped that Bevin would sign the bill into law, but did not know whether he would," Loftus reports. Because Thursday night was the last one of the session, "Bevin could veto it and the legislature would have no ability to override the veto."

The bill passed largely along party lines, 26-11 in the Senate shortly before 8:30 p.m. and 58-39 in the House at 11:11 p.m.

Health departments, regional mental health agencies, domestic violence shelters, rape crisis centers and other groups warmed that an increase in their pension contributions to 84 percent of payroll, from the current 49 percent, "would force dramatic cuts in services," Lofts writes. "Health departments serving 64 counties would become insolvent and likely close their doors within two years."

But the Senate did not want to merely grant relief because that would have robbed the pension plan "of money it anticipates and desperately needs. The plan is considered the worst-funded public pension plan in America with only 13 percent of the assets on hand needed to cover future benefits," Loftus notes. "The compromise bill is projected to cost that plan $799 million — forcing what is sure to be a big hike in future contributions from the remaining employer in that plan: state government."

"There's nothing but bad choices involved in this," McDaniel told reporters Thursday night. "And this (the compromise bill) is the best of all of those."

Cheves writes, "Critics of the bill complained that it was a complex measure being foisted on them in the final hours of the legislature, and that given the huge costs involved, some quasi-public agencies might not be able to afford either option available. “This doesn’t help the quasis,” said Sen. Robin Webb, D-Grayson. “It doesn’t help them. It’s a path to insolvency. It’s a path to bankruptcy.”

Medical News Today: Normal sperm count: Everything you need to know

A sperm count is part of a larger test called semen analysis. A doctor may test a person’s sperm count if they have fertility concerns. Learn about average, low, and high sperm counts here.

Medical News Today: Rectal pressure: Causes and when to see a doctor

Rectal pressure is a common symptom of a variety of problems, from constipation to ulcerative colitis. Learn more about the causes and possible treatments here.

Medical News Today: Why do I wake up hungry?

A person may wake up hungry because they did not eat enough or exercised heavily the day before. There are several other possible reasons. Here, learn more about waking up hungry and how to prevent it.

Medical News Today: Smoking may not be related to dementia risk after all

Study of 531 cognitively healthy older adults over 11.5 years finds no link between smoking and dementia after accounting for 'competing risk' of death.

Medical News Today: Letter from the Editor: Looking to the future

This month, MNT attended the Future Healthcare 2019 Conference and Exhibition. Managing Editor Honor Whiteman discusses some exciting new technologies.

Medical News Today: Depression: Brain stimulation may be a good alternative treatment

A new review of clinical trials delves deeper into the benefits of various forms of non-invasive brain stimulation for treating severe depression.

Medical News Today: Plant compound could fight eye cancer

A toxin present in the coralberry plant can stop the division of cancer cells, a new study has found. The findings may lead to enhanced treatment.

Safer Surgery: Steps you can take

Chances are high that most of us will have a surgical procedure at some point during our lives. Estimates based on 2002 data in three states suggest Americans have a lifetime average of nine surgical procedures. In 2010 in the United States, there were an estimated 1.4 million inpatient procedures, ranging from childhood tonsillectomies, breast lumpectomies, and gallbladder removal to cataract surgeries, hernia repairs, and hip or knee replacements. And the rate of surgical procedures continues to rise. So it’s valuable to know what you can do to make safer surgery and a successful outcome more likely.

How do I choose my surgeon?

If you are having elective (non-emergency) surgery, such as a knee or hip replacement, you have a choice of surgeons. Your primary care physician, best friend, or physician acquaintance may recommend a surgeon. Even with a strong referral, though, it’s essential to ask questions. What do they like about that surgeon? Do they have any concerns you should be aware of?

When you meet with a surgeon, find out if he or she is board-certified. Board certification tells you that a doctor has gone beyond minimum licensing requirements to demonstrate expertise in their specialty. Ask how often the surgeon has done your procedure. Studies show that outcomes improve when a surgeon has more experience –– for example, in performing hip surgery.

Less obvious is whether you’ll have your procedure at a hospital that does a high or low volume of surgeries. Research suggests it’s safest to avoid having surgery at a hospital that does less than 10 per year of a given procedure. Outcomes are better for certain surgeries –– including orthopedic and cardiovascular procedures –– when performed in a hospital that does a high volume versus a low volume of surgeries. That’s because high-volume hospitals have processes, resources, and an experienced team that can lower complication rates and respond quickly if a complication does occur.

How do I choose my procedure?

Most often, your surgery will seem straightforward –– for example, you are having your gallbladder out. However, increasingly people are faced with several choices for a given surgery. For example:

  • Traditional “open” surgeries are one option.
  • Noninvasive approaches using laparoscopy are increasingly common. Laparoscopy is done using a small scope and tools that require a few small incisions, instead of the larger incision needed for open surgery.
  • Sometimes there is a choice between laparoscopic robotic surgery — that means a robotic device helps the surgeon control the tools –– and standard laparoscopic surgery.
  • Also, surgery like a hip replacement can be done with an anterior (front), lateral (side), or posterior (rear) approach. The newer anterior approach for hip replacement may not be how your surgeon was originally trained.

Ask which approach your surgeon plans to take, why, and what the risks and benefits are for this approach versus alternative options. Also ask about his or her experience with the chosen approach. Think about whether you prefer an older surgeon with deep experience using a traditional procedure or a more recently trained surgeon using new advances.

Prior to your surgery, you will be asked to sign an informed consent: one for your surgery, and another for your anesthesia. This is your time to ask questions about risks and alternatives, if you haven’t already done so.

If you feel inclined or your insurance requires this, get a second opinion. This is quite common. In fact, having a doctor discourage you from getting a second opinion is a red flag.

Are there steps I can take to help ensure safer surgery?

You can compare rates of surgical complications and infections at different hospitals on the Medicare website. You may also wish to check out your hospital’s patient satisfaction scores. These scores are also associated with higher surgical quality.

Although an infection after surgery is a common complication, you can take steps to protect yourself.

  • You will likely be asked to bathe or shower before surgery with plain or antimicrobial soap. This reduces the likelihood of skin bacteria entering the incision.
  • Not only do you want your surgical team to be clean and sterile, it’s also important that you, your visitors, and family members all wash hands rigorously. Be sure people do this when entering your room, after coughing, or before touching your skin following surgery.
  • If you are having surgery after a long hospitalization or nursing home stay, you may be tested for colonization of a certain type of bacteria known as methicillin-resistant Staphylococcus aureus, or MRSA. If present, these bacteria can be eradicated prior to surgery.

Most importantly, always speak up if something doesn’t look or feel right. Ask your family members to do the same. You and your family members are valuable members of your safety team.

The post Safer Surgery: Steps you can take appeared first on Harvard Health Blog.

Medical News Today: Is this a better way to deliver drugs to the brain?

According to a new study in mice, shorter-wave ultrasound pulses could help scientists deliver drugs straight into the brain more safely and efficiently.

Medical News Today: Musical training may improve attention

New research finds that people who have had musical training are better at controlling their attention and blocking out distractions.

Wednesday, March 27, 2019

Medical News Today: What to eat on the Indian diet

The Indian diet consists of eating vegetables, legumes, and rice. It can be healthful when people follow the diet in a balanced way. Learn more about the Indian diet here.

Man who ran drug-treatment facilities in Ironton and Portsmouth, Ohio, is indicted on drug-trafficking charges

Graffiti under the U.S. Grant Bridge in Portsmouth, Ohio
(Cincinnati Enquirer photo by Liz Dufour)
The former operator of Ohio drug-treatment facilities just across the river from northeastern Kentucky was indicted Wednesday on 34 felony counts ranging from drug trafficking to Medicaid fraud.

Paul Vernier, 56, operated Community Counseling and Treatment Services in Ironton and Portsmouth, the Cincinnati Enquirer reports. He is accused of overbilling Medicaid and illegally operating a dispensary for Suboxone, a drug used in medication-assisted treatment for addiction.

“The evidence will show that this guy abused the trust of hurting people who were looking for help and that he played the rest of us – who pay the bills – for fools,” Ohio Attorney General Dave Yost said in a press release. “Time for some accountability.”

Medical News Today: Everything you need to know about antifreeze poisoning

People who suspect that they or someone else has antifreeze poisoning should seek immediate medical care. Symptoms develop slowly, so it is important to seek help even if no symptoms are present. Early symptoms may be similar to alcohol intoxication. Learn more, including treatment and prevention, here.

Bevin signs bill setting deadlines for insurers to authorize medications prescribed by health-care providers

Gomerpedia.org
Gov. Matt Bevin has signed into law "a bill that’s expected to ease the process for getting some medications and treatments pre-approved by insurers," Darla Carter reports for Insider Louisville.

Senate Bill 54 could speed up the authorization process "to five days or less, along with other enhancements," Carter writes, and quotes Dr. Bruce Scott, a Louisville ear, nose and throat physician who is president of the Kentucky Medical Association.

“Five days is a considerable improvement for our patients,” Scott said. “It’s still five days of stress and five days of waiting, but that’s a whole lot better than what we used to have, which could often stretch on for weeks.”

KMA says the bill, sponsored by Republican Sen. Ralph Alvarado, a Winchester physician, targets "a process that has become onerous to medical providers and patients alike, with doctors’ office staffs sometimes spending hours on hold waiting to hear back from insurers," Carter writes.

Scott told her the process can lead patients “to abandon treatments that are recommended by their doctors, and it adds stress to patients who are waiting for approval of a medication, a treatment, a diagnostic study that their trusted physician has recommended to them.”

An American Medical Association survey "found that nearly 30 percent of physicians report that the prior-authorization process required by health insurers has led to serious or life-threatening events for patients," Carter reports. "The survey of 1,000 practicing physicians also found that more than a third of physicians employ staff strictly to work on pre-authorization tasks."

Insurers say they have an obligation to keep costs down. "Stephanie Stumbo, acting executive director of the Kentucky Association of Health Plans, reminded members of the House Banking and Insurance Committee that insurance companies also have to deal with headaches related to prior authorization," Carter writes.

The bill takes effect Jan. 1. It will require health plans to make decisions about urgent services within 24 hours of getting the necessary information, and on non-urgent services within five days. Scott told Carter the insurers “pushed for seven days, and the bill was originally written at 72 hours [three days], and we compromised with five days.”

Prior authorizations for maintenance drugs, usd to treat chronic conditions, will be good for a year, with some exceptions, including opioid painkillers and benzodiazepines (minor tranquilizers).

Medical News Today: Why do antidepressants fail for some?

Differences in genes and structures of nerve cell that make and use serotonin could explain why some people with major depression do not respond to SSRIs.

Medical News Today: Knee osteoarthritis: A low-carb diet may relieve symptoms

A new study compares the effects of a low-carb diet with those of a regular diet and a low-fat diet on knee osteoarthritis in older adults.

A silver lining for migraine sufferers?

Could there be any benefit associated with having migraine headaches? Most migraine patients would agree this is an odd question. Migraine is a common, inherited, lifelong, and often debilitating illness that impacts people most during their productive working and parenting years. It has been associated with a higher risk of vascular disorders such as stroke and heart attack, and psychiatric disorders like depression and anxiety. What could possibly be good about migraine?

Migraines may protect against type 2 diabetes

But maybe there is some good news. A recent study suggests that, at least in women, having a diagnosis of active migraine is somewhat protective against the development of type 2 diabetes. In this study, which followed nearly 75,000 women for 10 years, women with active migraine were 20% to 30% less likely to develop type 2 diabetes over the course of the study than women with no history of migraine. In addition, if the migraine condition improved and the headaches lessened, the chances of developing diabetes went up. This supports the notion that migraine is protective against developing diabetes, and this is not simply a chance association.

Headache specialists had long observed that their migraine patient populations did not develop diabetes as frequently as the general population, so this finding was not entirely unexpected. The reason for this relationship, though, remains unclear; after all, what could it be about having a headache that could make your blood sugar and insulin function improve? Looked at the other way around, one consideration could be that elevated blood sugar levels are somehow protective against developing a headache. Yet another explanation may have to do with CGRP, a protein molecule in the body that is active in both conditions and may be the factor that links them.

This was a large, well-conducted study. Two limitations were that it only studied women and that the population studied was a rather homogenous group of mostly white professionals. Nonetheless, experts feel that the findings can likely be generalized to other populations.

Migraines may protect against alcoholism

There is another beneficial effect of migraine: research has suggested that migraine sufferers are relatively protected against the development of alcoholism. This may be a more intuitive relationship than with diabetes, since many people with migraine report that they avoid alcohol because it can trigger headache.

Migraines may have offered an evolutionary advantage

The possible evolutionary advantages of migraine have also been studied. As a rule, conditions that impair the function of an individual should lead to poorer survival in the long run and eventual dying out of the trait. And yet, after millions of years, migraine survives and thrives.

Several evolutionary explanations have been cited. One is that migraine may have originally evolved as a protective alarm system against toxins entering the body. Avoiding the ingestion of toxic substances because they produce headache could result in improved health and evolutionary advantage, compared to individuals without headache who might overuse such substances and thus suffer undesirable consequences. The migraine that we know today may have developed as a result of overactivity or oversensitization of that evolutionarily important early warning system.

However small the practical and daily consequence to those who suffer its effects, migraine may in fact have one or more silver linings after all.

The post A silver lining for migraine sufferers? appeared first on Harvard Health Blog.

Medical News Today: Can changes in brain energy pathways cause depression?

Scientists repurposed an accessible bioinformatics tool to find DNA mutations, some of which occur at high levels in people with major depressive disorder.

Medical News Today: What really happens in the brain during a hallucination?

A new study reveals a surprising brain mechanism tied to the experience of drug-induced hallucinations. These findings may even have wider implications.

Tuesday, March 26, 2019

Medical News Today: The effects of going more than 24 hours without sleep

It is not clear how long a person can go without sleep, but in a famous 1964 experiment, a person managed to stay awake for 264 hours. Sleep deprivation can negatively affect energy levels, mood, and cognitive functioning. In the long term, it can increase a person's risk of several chronic conditions. Learn more here.

Medical News Today: Is it safe to take Humira and alcohol together?

Humira is a biologic medication that treats inflammatory conditions. In this article, we look at the safety and risks associated with taking Humira and drinking alcohol. We also discuss other Humira side effects and interactions.

African American men respond better to treatments for advanced prostate cancer in clinical trials

Racial differences have long been evident in prostate cancer statistics. In particular, African American men are diagnosed with prostate cancer more often than white men, and they’re also nearly twice as likely to die of the disease.

But new research also shows that African American men who receive the most advanced treatments for late-stage prostate cancer can live at least as long — or even longer — than their Caucasian counterparts.

Why is this the case? Scientists are searching for an explanation. “The fact that African American men have better survival is of huge research interest,” said Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center in Los Angeles. “If we can figure this out, we’ll obtain key insights into the factors driving survival in late-stage prostate cancer. And that in turn will help spur better treatments for all men — regardless of race.”

Each year, about 160 per 100,000 African American men receive a prostate cancer diagnosis. That’s three times higher than the comparable figure for white American men, and it’s also higher than the number of black men diagnosed annually with prostate cancer in Africa. It’s possible that dietary or environmental factors — perhaps in combination with genetic susceptibilities — put African American men at greater risk in the United States. But African American men also tend to have less access to health care than white Americans, and many of them are diagnosed after their tumors have already begun to metastasize, or spread.

A surprising survival advantage

What the new research shows, however, is that survival advantages can favor African Americans who undergo treatment for advanced prostate cancer in clinical trials. One study  pooled data from nine clinical trials, enrolling a combined 88,200 men with metastatic prostate cancer who were treated with a chemotherapy drug called docetaxel. The African American and white men had similar survival rates — 21 months and 21.2 months respectively. But after adjusting for factors such as age and prostate-specific antigen levels, the researchers found that African Americans were 20% less likely to have died during the course of those trials than their white counterparts.

Freedland co-authored another recent study showing that African Americans respond better to newer drugs that target testosterone, which is a hormone that drives prostate cancer to grow faster. Using data gathered by the Veterans Health Administration between 2013 and 2018, the researchers looked at how long African American and white men with metastatic prostate cancer lived after treatment with one of two drugs: abiraterone acetate or enzalutamide. They had access to records from nearly 3,000 men. The unpublished results, presented at a medical conference in February, showed that median survival among the African Americans lasted 30 months, compared to 26 months among their white counterparts. “So, the key takeaway is that if they get to advanced prostate cancer, and are treated equally in an equal access medical center, black men can have similar or even better outcomes,” Freedland said.

The data still need to be confirmed in additional research, Freedland emphasized. But in the meantime, the studies add to a growing body of evidence that’s changing how scientists look at racial differences in prostate cancer. Ideally, the research will reveal new biological insights into prostate cancer, and allow doctors to tailor treatments more effectively.

The post African American men respond better to treatments for advanced prostate cancer in clinical trials appeared first on Harvard Health Blog.

Medical News Today: Home remedies for getting rid of hickeys

Hickeys, or love bites, are bruises that can appear when someone sucks on another person's skin. Hickeys tend to disappear on their own after several days, but some home remedies may help get rid of them faster. Learn more here.

Beshear says he's investigating pharmacy benefit managers for possible overcharging and discrimination against independents

Republican Gov. Matt Bevin and Attorney General Andy Beshear
Attorney General Andy Beshear announced March 21 that he is investigating pharmacy benefit managers, the "middlemen" between drug companies and health insurers, including Kentucky's Medicaid program and state-employee health plan.

Beshear is investigating whether PBMs have overcharged the state "and discriminated against independent pharmacies," his office said in a press release, which noted that a state report "indicated two PBMs took in $123.5 million last year from the state Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drugs."
The release said, "It is estimated that more than 1.5 million Kentuckians receive pharmacy benefits through Medicaid and the state employee health plan’s PBMs. Thousands of other Kentuckians receive pharmacy benefits through PBMs retained by their private insurance plans. . . . Beshear said PBMs were originally established to help companies and government programs better manage pharmacy costs, but have grown into powerful industry middlemen that go to great lengths to hide and complicate drug pricing information."

The international news agency Reuters reports, "The investigation comes against the backdrop of widespread criticism of rising costs of prescription medicines in the United States, with PBMs, middlemen who negotiate prices for employers and health insurers, coming under intense scrutiny."

The state report, titled "Medicaid Pharmacy Pricing: Opening the Black Box," was done by the state Department of Medicaid Services on orders from the General Assembly, Medicaid Commissioner Carol Steckel said upon its release, "We have additional steps that we will need to take in order to make this program fully transparent."

Beshear is seeking the Democratic nomination for governor. Gov. Matt Bevin is seeking re-election and is heavily favored in the May 21 Republican primary.

Medical News Today: What causes Achilles tendon pain?

Achilles tendon pain can result from tendonitis or a tear or rupture of the tendon. Problems with the Achilles tendon are more common in people who play sports. They typically occur from excessive use of the calf muscles but can also result from acute injuries. Learn more about Achilles tendon pain here.

Medical News Today: Atherosclerosis: Scans spot inflammation in arteries before they harden

Using advanced imaging to scan people with some atherosclerotic plaques, scientists detected inflammation in arteries that had not yet developed plaques.

Medical News Today: Time-restricted eating may prevent tumor growth

New research in mice suggests that eating all daily meals within a restricted window of time may be a good preventive strategy against cancer tumor growth.

Medical News Today: Relieving sciatica pain during pregnancy

During pregnancy, the uterus can put extra pressure on the sciatic nerve, causing sciatica pain in the low back and legs. In this article, we look at how to relieve sciatica using stretches, exercise, massage, and other methods.

Preventing depression in pregnancy: New guidelines

While pregnancy and a child’s birth are often depicted in pastel tones, many women struggle with depression during this time. Up to 14% of women are diagnosed with depression during pregnancy. Far more report having symptoms of depression during pregnancy and the first year after birth. Now new guidelines published by the US Preventive Services Task Force in the Journal of the American Medical Association provide the first-ever recommendations for preventing perinatal depression.

How can the new guidelines help?

Depression can be difficult during any period of life. Its main symptoms — a depressed or hopeless mood, a loss of interest and joy — can be accompanied by trouble sleeping, eating, and managing daily life. When depression occurs during pregnancy (perinatal) or up to 12 months after childbirth (postpartum), it can have a negative impact on the health of both the mother and the infant. For example, women with postpartum depression engage in fewer positive maternal behaviors, such as playing or praising, and more negative maternal behaviors, such as hurtful comments or harsh discipline. Children whose mothers had perinatal or postpartum depression are more likely to develop behavior problems and other psychiatric disorders.

The new guidelines recommend that health care providers discuss mental health with women during pregnancy and after birth, and screen women for depression. They can then refer women who report such symptoms, or have risk factors, to an appropriate mental health clinician. Simply raising the topic with a woman might help her feel more comfortable asking questions about depression and sharing her concerns.

Are there ways to prevent depression during pregnancy?

The Task Force reviewed a number of studies aimed at preventing depression in pregnant women. It identified two counseling interventions as recommended practices: cognitive behavioral therapy and interpersonal therapy. Both can effectively prevent perinatal depression.

Cognitive behavioral therapy, or CBT, helps people identify and change negative and incorrect thoughts. It helps people develop alternate, and more accurate, ways of viewing themselves and life events. For example, you might have broad, global, negative views of your ability to parent (“I am a terrible parent.”). Therapy focuses on identifying these thoughts, challenging the errors in them, and developing more balanced thoughts. The behavioral component of CBT includes increasing positive activities, such as social interactions and pleasant events.

Interpersonal therapy focuses on helping people resolve interpersonal conflicts and navigate role transitions, such as becoming a mother for the first time. It also teaches people how to increase effective communication with others.

The Task Force found limited or mixed evidence for other approaches to preventing depression in pregnant women, including taking dietary supplements and engaging in physical activity.

What else is important for preventing depression during pregnancy?

Further, the Task Force identified a number of risk factors that make women more vulnerable to perinatal depression. These factors include having a history of depression, experiencing abuse, having an unplanned or unwanted pregnancy, or complications during pregnancy. Other possible risk factors are stressful life events, diabetes, low socioeconomic status, lack of financial or social support, and teen parenthood. Women who have these risk factors may wish to consider counseling during pregnancy and after childbirth. Counseling can be a source of support and a way to prevent, or cope with, depression.

The Task Force recommended further efforts to develop new ways to screen women for depression and prevent depression.

What if you’re experiencing depression?

If you are experiencing symptoms of depression, it is important to talk to your health care provider about treatment options. Your provider can refer you to mental health professionals who have experience working with women during pregnancy or after a birth. Encourage friends and family who are experiencing depression to seek help.

In addition to seeking help for symptoms of depression, if you or a friend of yours is thinking about harming themselves, please call the Suicide Prevention Hotline at 800-273-8255 (TALK), or go to the closest emergency room for help.

Editor’s note

In March 2019, the FDA approved the first treatment for moderate to severe postpartum depression. Brexanolone (Zulresso) is given intravenously over a 60-hour period. During this time, women must be monitored at a certified health care facility. While the medicine can work quickly to ease depression (within 48 hours), it is not effective for everyone.

The post Preventing depression in pregnancy: New guidelines appeared first on Harvard Health Blog.

Medical News Today: Keto diet: New study unearths sex differences

A recent study investigates how the keto diet affects male and female mice. The researchers find that in females, the diet's benefits are absent.

Medical News Today: Why your household dust could fuel the growth of fat cells

Is there a link between the dust in our homes and the accelerated growth of fat cells in our bodies? New research suggests that the answer may be 'yes.'

Medical News Today: Colloidal silver: Does it work and is it safe?

Colloidal silver is a popular home remedy, and people use it to treat or prevent a range of health issues. However, the solution may not be safe to ingest, and it can have serious side effects. Learn more here.

Monday, March 25, 2019

Medical News Today: What causes a constant urge to pee?

Infections and other bladder issues can affect the way a person urinates. Some conditions can cause a constant urge to pee, even when doing so produces little urine. In this article, we look at causes, treatments, and when to see a doctor.

Medical News Today: When to consume protein: The facts

Consuming protein is necessary for muscle growth and repair. There is no single best time for this, but rather it depends on individual goals. Learn more about when to have protein here.

Medical News Today: What are the symptoms of ADHD in adults?

The symptoms of ADHD in adults vary depending on the type of ADHD, but they may include disorganization and restlessness. Learn more about adult ADHD symptoms here.

Medical News Today: What are the health benefits of jackfruit?

Jackfruit is a healthful source of essential nutrients, including vitamin C, potassium, and dietary fiber. Research suggests that substances in the fruit and plant may have a variety of health benefits. Cooked, unripe jackfruit is a popular meat substitute among vegetarians and vegans. Learn more here.

Medical News Today: What to know about smoking and ulcerative colitis

Smoking has links to major health issues, but nicotine replacement products may help with ulcerative colitis. Some studies suggest that nicotine can ease symptoms in some people. Learn more here.

Medical News Today: The best ways to get rid of acne scars

Acne scars can form as a result of moderate-to-severe acne. Many home remedies and medical treatments can help smooth the skin and reduce scarring. Learn about how to get rid of acne scars here.

Medical News Today: What to know about tooth cavities

Tooth cavities can occur when there is a buildup of plaque on the teeth. People can prevent cavities by practicing good oral hygiene. Learn more about tooth cavities, including their possible symptoms, here.

Medical News Today: Osteoporosis: New tools help pinpoint potential risk genes

Genome analysis and 3D DNA studies helped scientists to identify two new genes that impact bone-producing cells to potentially alter osteoporosis risk.

Medical News Today: More evidence links weight gain to meal times

A recent study on obesity and weight gain finds that it is not just what we eat but when we eat it that is important. Evidence for this theory is mounting.

Medical News Today: The key to brain health: Light but frequent exercise

New research shows that light and moderate exercise benefits the brain both immediately and in the long run, providing a person is active frequently.

Cleaner living: Plant-friendly is planet-friendly

Climate change is in the news more and more, and the projections from virtually all of the world’s climate scientists are becoming increasingly dire. Almost daily, we are confronted with images of extreme weather patterns, disease outbreaks, and the loss of certain species. It is almost biblical in proportion. Most poignant, to me, are the distressing images of starving, displaced polar bears whose icy habitats are melting away.

Many of the things that we can do to prevent or slow climate change are intuitive, difficult as they may be to put into practice: conserve energy, drive less, elect politicians that are dedicated to working on this problem, and recycle, to name the basics. However, many people may be unaware that some simple changes to our daily diet can have a tremendous impact on the emission of greenhouse gasses.

How does food production affect the climate?

About 30% of global greenhouse gas emissions come from food production. About half of this is from the livestock sector alone. And it’s not just the greenhouse gasses that are the problem. Food production occupies about 40% of the global land, uses about 70% of our fresh water (which is increasingly in short supply in many places in the world, leading to strife), causes many species to become extinct, and is responsible for large areas of deforestation (cutting down the rain forest so cattle can graze) and desertification (the process by which fertile land becomes desert, typically as a result of inappropriate agriculture).

Make a difference with a planet-friendly diet

The good news is that simply by making some changes to your diet, by adopting what is known as a “planet-friendly” diet, it is possible to contribute to the solution to climate change. It’s merely a question of knowing which foods are the worst climate offenders, and then either transitioning away from these foods or replacing them altogether with climate-friendlier alternatives.

According to the World Resources Institute, far and away the most destructive food is beef. In terms of all three markers — greenhouse gas emissions, freshwater consumption, and land use — beef is an environmental disaster. Just behind beef is dairy, followed by poultry, pork, eggs, and fish.

The United Nations Intergovernmental Panel on Climate Change (IPCC) proposes that people reduce their consumption of animal products by 30% as an urgent component of their recommendations to combat climate change.

About a year ago, I gave up red meat for exactly this reason, with less than perfect success. Old habits are hard to break, and change comes slowly and requires patience.

Healthier for you and the environment

Fortunately, the foods that are healthy for the climate almost completely overlap with the foods that are healthy for your physical well-being. Cutting down on beef in favor of plant-based protein, even once a week, can lower the risk factors for diabetes, heart attack, and stroke. So, the next time you start reaching for that burger, or think about ordering that prime rib, consider choosing the veggie option instead. You’ll be doing your part to take better care of the planet and yourself in the process.

The post Cleaner living: Plant-friendly is planet-friendly appeared first on Harvard Health Blog.

Medical News Today: Why too much vitamin D can be a bad thing

Vitamin D is essential for good health. However, a new study has found that too much can have a negative effect on some members of the population.

Medical News Today: Sugary drinks can be a factor in cardiovascular disease

A recent study finds an association between sugary drinks and higher rates of mortality from cardiovascular disease, as well as higher cancer rates.

Sunday, March 24, 2019

Health departments scramble to fight hepatitis A outbreak

Peyton Manning had hepatitis C but didn't know about hepatitis
A or the outbreak until it hit him. (Michael Clevenger, Courier Journal)
The nation's largest outbreak of hepatitis A has slack off somewhat in Kentucky, but remains a threat and local health departments are dipping into their reserves and taking unusual steps to get people vaccinated for the liver disease, which has killed 44 Kentuckians during the outbreak.

The medical director of the Lake Cumberland District Health Department doesn't usually give vaccinations, but each of her counties only had one or two nurses to do that, so Dr. Christine Weyman started giving shots, too, Laura Ungar and Chris Kenning report for the Louisville Courier Journal.

"She has gone out to vaccinate drug users who largely were spreading the virus," they report. "She once went so far as to chase two men down a street to persuade them to get the shot. (They weren't interested.) She also went to the crowded Pulaski County Detention Center, realizing the 213-bed jail with more than 400 inmates could be an excellent incubator for the virus. Right outside the jailer's office door, her health department placed a refrigerator for the sole purpose of storing vaccines."

"In many ways," Ungar and Kenning wrote, the Somerset-based department "is a microcosm of rural Kentucky's continuing struggle with hepatitis A. What's happening there reflects how Kentucky's communities with limited resources are quietly battling the nation’s largest and deadliest outbreak — learning as they go and altering their strategies to meet the many challenges they face."

The state has averaged 76 hepatitis A cases per week this year, "sometimes reaching more than 90 a week, compared with 151 a week at its peak in early November," the CJ reports, but "Kathleen Winter, an epidemiologist at the University of Kentucky, said a recent downward curve in the outbreak doesn't necessarily mean it's waning."

"We still need robust intervention," Winter told the newspaper. "It's still too early to say whether it’s really winding down. We still have individuals getting sick, being hospitalized and dying."

The story's first example was Peyton Manning, 27, "who was sleeping behind a Walmart in Lexington and spending his days shooting meth and heroin. Late last year, he admitted himself to The Healing Place in Campbellsville. Then a virus hit him. He couldn’t sleep. He couldn't keep any food down." He went to the UK hospital and recovered at his mother's home.

Manning already had hepatitis C, but said he didn't know about hepatitis A or the outbreak. "didn’t even know it was a thing," he told the CJ. "I started to watch the news. It was like, damn, I didn’t know it was that bad."

Health departments are responding "with a mix of resources," the paper reports. "In addition to using state funding, local health departments can also order federally funded vaccine through the state or buy shots using money from $233 million in county health department reserves," which "vary greatly across counties and area development districts. They're in the negative numbers in some places and reach into the millions of dollars in others."

The Lake Cumberland agency had unrestricted reserves of about $5 million when the outbreak hit in 2017, but was "trying to avoid using this as much as possible to help with the pension crisis," said Ron Cimala, its administrative director. Many health departments have said they will have to close unless the legislature keeps giving them relief from the state's new requirement for funding their employees' pensions.
Ranges of health department reserves that could be used to pay Kentucky Employees Retirement System obligations. About half of the counties are in district departments; others are independent.

Montgomery County reports uptick in cases of syphilis

Health officials in Montgomery County say they're seeing more syphilis cases.

"What had become a relatively rare disease is now seeing a resurgence nationwide," the Montgomery County Health Department said on its Facebook page Friday. The agency "said it has seen an increase in syphilis cases in recent months," the Lexington Herald-Leader reports.

Montgomery County (Wikipedia map)
The department said on Facebook, "The increase has initially been identified among those in the drug community, with injection drug use being a risk factor. However, health officials warn that this disease can be passed along to others outside of this group."

“This disease does not discriminate against anyone or any group,” said Kelly Allen, the department's nurse supervisor. “We want the public to be aware of symptoms in case treatment is needed and to take steps to protect themselves.”

Syphilis, a curable disease, is transmitted by sexual and other forms of contact with a syphilis sore, which is also the most common symptom. That is followed by a rash. "These symptoms may not be painful, but they shouldn’t be ignored," the department said. "Syphilis can cause severe health problems if not treated, including paralysis, blindness and even death. It can also be spread from a mother to her unborn baby."

Justice secretary favors treatment over incarceration; 'We have to distinguish who we are mad at and who we are actually afraid of'

By Melissa Patrick
Kentucky Health News

Nearly 90 Fulbright scholars from 49 countries attended a University of Kentucky seminar, "Combating Addiction," which included sessions on the origins of the opioid epidemic in Central Appalachia, the role of public policy, and the challenges of treatment in both rural and urban settings.

State Justice and Public Safety Secretary
John Tilley (Photos by Melissa Patrick)
State Justice and Public Safety Secretary John Tilley told the scholars Friday that treatment, instead of incarceration, is what is needed to help people who suffer from addiction -- a message that he has repeated for years.

"The best place to treat addiction is not a prison cell," he said. "And I still have policy makers in this state who think that is OK, when there is absolutely no evidence, no evidence that that approach enhances public safety."

Tilley said prosecutors tell him they are "hard-pressed" to find someone in the system who isn't there because of a drug-related offense, that 95 percent of their cases are related to addiction. He noted that since 1970, Kentucky's population rose 38 percent and its prison population rose 700 percent.

"We're beginning to realize that we can't change that behavior with punishment," he said. "We're not going to punish people into sobriety."

But some law-enforcement officials still oppose syringe exchanges that can prevent disease and accidents, and steer people into treatment, said keynote speaker Beth Macy, author of Dopesick: Dealers, Doctors and the Drug Company that Addicted America. "It all seems to collapse in that murky area between healthcare and criminal justice," she said.

Tilley said he is working on removing drug possession as a felony offense in Kentucky, as more than 15 states have done, "but there are too many who are unwilling to take that leap." He said at least 2,000 Kentuckians are in the prison system only for possession.

Tilley was instrumental in passing Kentucky's 2015 anti-heroin bill, as a state representative from Hopkinsville. Among other things, the bill created a system in which Kentucky counties and cities could authorize syringe exchanges; increased penalties for high-volume traffickers; allocated money for drug treatment; and let the Department of Corrections medicate inmates with opioid-use disorders.

Tilley, a Democrat, was appointed justice secretary in December 2015 by Republican Gov. Matt Bevin. "This is a nonpartisan piece of our government," he told the foreign visitors. "It's about justice and results, and we can all agree on those things."

He said Kentucky is working on many reforms to keep people with addictions out of prison, including, but not limited to: efforts to train police officers on how to recognize mental illness and addiction, and how to use crisis interventions and de-escalation techniques; using social workers in police departments to help find resources for people, instead of locking them up; efforts to help prisoners re-enter the workforce when they are released; pilot programs that offer medication-assisted therapies to inmates; and a program called the Angel Initiative in all 16 state police posts, which lets a person with an addiction to come in and be driven to the nearest treatment bed.

'A failed model' that varies unjustly from court to court

Tilley said the state must stop putting non-violent, low-level, non-sexual offenders in jail, and described how incarcerating worsens social problems.

He said Kentucky has the nation's second highest female incarceration rate, which in has put more children into foster care, now numbered at  more than 10,000. "It's all tied together," he said. "We have to distinguish [between] who we are mad at and who we are actually afraid of."

Tilley pointed to research that shows addiction is a disease of relapse and requires many attempts for a person to become sober, and when you add criminal entanglements, it is a "set-up for failure."

He added, "It's a failed model. Why in the world would we try to treat what I think is a public health nightmare with a criminal justice system that was never designed to do this?"

He added that people with addictions who are arrested in Kentucky are treated differently across the state, depending on judges' understanding of addiction and the availability of wrap-around services to help offenders. "It's incredibly disparate, and it's unjust," he said. "It is injustice at its best."

Most addicted people don't think they need treatment; most who need it don't get it

Ty Borders, the director of UK's Rural and Underserved Health Research Center, told the scholars Friday that most people who have been diagnosed with substance-use disorders don't think they need treatment, and most who need treatment don't get it.

He said a national study found that only 17 percent of people with a heroin-use disorder in urban areas, and 24 percent in rural areas, thought they needed treatment; and among those with disorder involving prescription drugs, only 8 percent in urban areas and 13 percent in rural areas saw a need.

"The biggest predictor of people actually trying to get treatment for drug use disorder is whether they perceive any need for it," Borders said.

Not many more with a substance-use disorder actually got treatment.

The study found that in 2014-15, about 13 percent of Americans aged 18-64 who had a drug-use disorder got any type of treatment for it. That number was higher among those with an opioid-use disorder, around 24 percent, largely because there is a medication available to treat it, Borders said.

"These are really low rates, especially when you compare these to rates of treatment for hypertension, diabetes, cancer, etc.," he said.


Ty Borders
On another point, Borders said that while more primary-care providers than ever are able to prescribe buprenorphine, a medication to treat opioid addiction, there are still concerns that their patients aren't getting appropriate counseling and therapy that is supposed to go with it, compared to what they would get from a psychiatrist.

He said Kentucky data show that the proportion of Medicaid patients who were prescribed buprenorphine and also received counseling at the same time increased between 2014 and 2016, but the proportion who actually got the drug went down in that same time frame.

"That means fewer people are getting access to this drug, if they had an opioid use disorder and they were covered by Medicaid," he said, adding that one reason for this could be that insurance firms that manage Medicaid  have put in prior-authorization requirements and other mechanisms that make it harder for providers to get approval for payment by the program.

Rep. Kim Moser, R-Taylor Mill, filed House Bill 121 to address this issue, but it got stuck in the Senate and is not far enough along in the process to pass on March 28, the last day of the legislative session. Moser told Kentucky Health News that it's important for patients to be able to get their medication-assisted treatment drugs without any delay because it keeps them from cycling in and out of jail or emergency rooms, and prevents overdose deaths.

Borders said there continues to be a great need for more buprenorphine prescribers in the central and western parts of the U.S., where some people have to drive more than 100 miles to get this medication.

Part of the problem is that the U.S. Drug Enforcement Administration requires health-care providers to either be board-certified to prescribe addiction medications or to take eight hours of training to get certified to prescribe, and then are only allowed to treat 275 patients annually.

Borders said research shows there are more buprenorphine prescriptions in states that expanded Medicaid to people who earn up to 138 percent of the federal poverty level, as Kentucky did. Borders attributed this to more people having access to a health-care provider and therefore the drug, and also being more able to pay for it because they have insurance.

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Saturday, March 23, 2019

Here's a list of health-related bills in the General Assembly

Kentucky Health News
When the General Assembly returns Thursday, March 28, for the final day of its session, it could pass any number of bills, including several related to health: to make schools tobacco-free, to set up a hotline for students to report "vaping" of electronic cigarettes; to give health departments a reprieve from increased pension payments; to require children under 12 to wear helmets when riding a bicycle; and more. Here's a list of health-related bills and their status as of Friday, March 22, with colors denoting possible action: