A recent study finds an association between sugary drinks and higher rates of mortality from cardiovascular disease, as well as higher cancer rates.
Monday, March 25, 2019
Sunday, March 24, 2019
Health departments scramble to fight hepatitis A outbreak
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| Peyton Manning had hepatitis C but didn't know about hepatitis A or the outbreak until it hit him. (Michael Clevenger, Courier Journal) |
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.
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| 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.
“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."
"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.
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| 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 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.
"These are really low rates, especially when you compare these to rates of treatment for hypertension, diabetes, cancer, etc.," he said.
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.
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) |
"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 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."
'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."
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.
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| Ty Borders |
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.
Medical News Today: Cystic fibrosis: Existing drug may improve lung function
According to a recent study, a commonly used antifungal medication could be useful for treating lung infections related to cystic fibrosis.
Medical News Today: Stroke: Rewiring eye-brain connection may restore vision
Groundbreaking research finds that some vision loss after a stroke may be reversible. The researchers hope that this finding may inform future treatments.
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:
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:
