Kids' back-to-school stress: Talk it out, take it slow, get back into a routine, use available resources, Children's Hospital doctor says

By Dr. Amy Lynn Meadows
University of Kentucky 

Children have coped with a lot of change over the past several years. It’s important to recognize that change, even good change, can sometimes be challenging for kids. As we work on establishing post-pandemic equilibrium, we must be sensitive to those who may be having a harder time with the transitions.

Mental health experts are still seeing higher rates of anxiety and mood issues in children and adolescents compared with pre-pandemic rates. Depression and anxiety in children may not look exactly like it does in adults — they may be more likely to isolate themselves or act out.

Here are few tips to help your child during this time of transition:

Talk it out. The most important thing is to be open and communicate about emotions with kids. Talk with kids regularly, like at dinner or at bedtime, and ask specific and deeper questions. Don’t be afraid to ask kids questions. We all have a role to play in normalizing mental health, but we can start by having open discussions about mental health, stress and self-care with our kids.

Take it slow. Parents sometimes jump into problem-solving mode when we really should just slow down and acknowledge that it can be normal to be stressed or anxious. Grown-ups can validate the emotion, be open about talking about it, and help kids to come up with their own solutions instead of us trying to solve it for them.

Get back into a routine. One of the biggest challenges is getting kids back in a good routine. Mental and physical health are closely related, so we talk about a few cornerstones. Make sure that kids have had their checkups and are physically healthy, pay attention to regular sleep (including a set bedtime and wake-up time each day), limit screen time (including putting phones away), and encourage kids to have some gentle movement each day — walking, playing, stretching.

Take advantage of available resources. Pediatricians and primary care providers can be a great resource for screening and information. Online, I always encourage families to seek reputable resources, including the Resource Centers through the American Academy of Child and Adolescent Psychiatry.

If your child’s stress or anxiety is interfering with his or her life (for example, school, ability to enjoy friends or family or their activities), reach out to your child’s doctor, school counselor or find a mental health professional for an evaluation.

If you, your child, or someone you know are thinking about suicide or self-harm, call or text 988, the national Suicide and Crisis Lifeline, or go to the nearest hospital emergency room.

Amy Lynn Meadows, M.D., is director of the Division of Child and Adolescent Psychiatry at Kentucky Children’s Hospital.

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Broad symposium on rural-health issues to be held at UK Aug. 26

Health-care practitioners and people interested in rural health policy are invited to attend a wide-ranging symposium on rural health issues Friday, Aug. 26, at the University of Kentucky.

UK's Rural and Underserved Health Research Center is hosting the symposium, which will be held from 10 a.m. to noon ET in Room 411 of the Charles T. Wethington Building, near the UK hospital and adjacent to Kentucky Clinic. Admission is free; parking will be available in the connected hospital garage on Limestone Street.

Researchers affiliated with the center will discuss some of their recent findings, including screening in primary care for colorectal cancer, in which Kentucky ranks first in the nation; dispensing of naloxone, the drug that blocks drug overdoses in progress; prevalence and monitoring of diabetes, which is more common in Kentucky than most states; and "Addressing Social Determinants of Health in Family Medicine Practices," from Dr. Lars E. Peterson, a UK professor and vice president of the American Board of Family Medicine.

Following the presentations, national and regional experts will have an open discussion of rural-health issues. The panelists will be Dr. Andrew Bazemore, ABFM senior vice president for research and policy; Veronica Judy Cecil, deputy commissioner of Kentucky's Medicaid program; Mary Charlton, associate professor and director of the Iowa Cancer Registry at the University of Iowa; Dr. Gilbert Liu, medical director of The Ohio Colleges of Medicine Government Resource Center; Alan Morgan, CEO of the National Rural Health Association; and Tim Putnam, former president and CEO of Margaret Mary Health in Batesville, Ind.

Possible topics for the panel discussion include the impact of Inflation Reduction Act, the impact of flooding in Eastern Kentucky, possible changes in federal definitions of rural, metropolitan and micropolitan; and the future work of the federally funded center.

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CJ visits Illinois abortion clinic; Bristol clinic closer to much of Ky.

With almost all abortions illegal in Kentucky, at least for the time being, and largely unavailable in most other bordering states, Sarah Ladd of The Courier Journal went to the abortion clinic in Granite City, Ill., to describe how it has become a medical magnet for women from 19 states.

"On the day Roe v. Wade fell, hundreds of people called the Hope Clinic," Ladd reports. "Front-desk employees of the Granite City abortion clinic usually field no more than 200 calls a day. But when the U.S. Supreme Court overturned the federal right to abortion on that day in June, more than 600 people called the office seeking help. For many in the surrounding region, the Land of Lincoln suddenly became the only place to legally access abortion, following a series of state "trigger" laws banning or severely limiting the procedure."

Supporters post signs at the Tennessee Clinic, above, and the
new Virginia clinic. (Photo by Sam Whitehead, Kaiser Health News)

But Granite City isn't the only abortion magnet within a few hours' drive of most Kentuckians. Sam Whitehead of Kaiser Health News reports that a doctor at Bristol Regional Women's Center in Bristol, Tenn., got an out-of-state abortion provider to open Bristol Women's Health a mile away in Bristol, Va., because of the change in the law. Tennessee's ban on abortions after six weeks of pregnancy takes effect Aug. 25.

Bristol, Va., is closer than Granite City to the geographic center of Kentucky, Lebanon; and to the state's center of population, which is near Willisburg, 20 miles north-northeast of Lebanon. According to Google Maps, they're 4 hours and 40 minutes and 4:45 from Bristol, respectively.

A Memphis-based abortion provider is planning to open a clinic this month in Carbondale, Ill., which is three and a half hours from Louisville, about 20 minutes less drive time than Granite City. When the clinic opens, Lebanon will be about the same distance from it as from the Bristol clinic. 

Bristol is two hours from Middlesboro, on Kentucky's southeastern corner; 2:10 from Pikeville; three hours from Corbin; and 3:40 from Somerset.

The owner of the Bristol clinic is Diane Dervis, who owned the Mississippi clinic that lost the Supreme Court case, Dobbs vs. Jackson Women's Health Organization. "Derzis said a doctor at the Bristol Regional Women’s Center reached out to her with the idea for the Virginia clinic," Whitehead reports.

"Derzis said the Tennessee and Virginia clinics are separate, distinct operations. . . . She said she’s working to offer abortions to people across the Southeast who have lost access as states restrict the procedure. She opened Las Cruces Women’s Health Organization in southern New Mexico in late July after closing her clinic more than 1,000 miles away in Jackson."

Like almost any abortion clinic, the one in Bristol has already drawn protesters. "On a recent weekday morning, a handful stood on the sidewalks around the clinic holding large anti-abortion signs," Whitehead reports. "On the clinic property, a group of volunteers who call themselves the Pink Defenders had put up pro-abortion rights signs and hung large sheets in various shades of pink and purple around the clinic parking lot."

In Granite City, longtime anti-abortion protesters Daniel and Angela Michael drive from 40 minutes away "several times a week in a purple RV that advertises 'Mobile Medical Unit' and 'Real Hope … Real Help'," Ladd reports. "They run an organization called Small Victories, which provides things such as ultrasounds, formula and diapers to people. 

The Michaels "criticized protesters who name-call and berate patients headed into the clinic as hypocritical," Ladd writes: “They always scream and yell at people and talk them out of abortion, but they won't help them after that,” Daniel said, his voice breaking as he spoke.

"Both he and Angela feel like a lot of crisis pregnancy organizations make it too difficult for people to get assistance, such as requiring classes in exchange for supplies." The Michaels "estimate they’ve turned more than 6,000 potential patients away from the clinic. Two of the couple’s 13 children were adopted from people who had initially come to the clinic for abortions, Daniel said. . . . The couple raises about $100,000 annually and uses the money to drive to the clinic, as well as provide supplies for mothers through the first year after birth, Daniel said."

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UK HealthCare and St. Elizabeth Edgewood-Covington Hospitals tie for best Ky. hospitals in U.S. News & World Report rankings

By Melissa Patrick
Kentucky Health News

Six Kentucky hospitals have been named among the nation's "Best Regional Hospitals" in the annual ranking by U.S. News & World Report magazine. 

The No. 1 hospitals in Kentucky are the University of Kentucky hospital and St. Elizabeth Edgewood-Covington Hospitals, followed by Baptist Health Lexington, Baptist Health Louisville, Louisville's Norton Hospitals , and U of L Health-Jewish Hospital.

To make the list, a hospital must:

• Offer a full range of services;
• Rank nationally in one of 11 measured specialties, or have seven or more high-performance rankings for procedures and conditions; and
• Have at least three more "high performing" than "below average" rankings for procedures and conditions.

The report offers an overview of 123 Kentucky hospitals with a breakdown of each of the measured categories, according to the services a hospital provides. 

UK HealthCare, for the seventh straight year, is No. 1 with its Albert B. Chandler Hospital. It ranked in the top 50 hospitals nationally for cancer care for the sixth straight year, ranking 33rd. Its Markey Cancer Center is Kentucky's only National Cancer Institute-designated cancer center, and one of 71 in the nation.

“In Kentucky, we have the highest rates of cancer in the country, and this issue is especially pronounced in Eastern Kentucky and Appalachia,” Dr. Mark Evers, director of UK's Markey Cancer Center, said in a news release. “Nowhere in the country is it more important for people to have access to complex and compassionate cancer care. This ranking is a testament to the hard work of Markey’s health care providers and staff, who are committed to ensuring that no patient has to travel outside the state for the care they need.”

The evaluation of the UK hospital includes data from Kentucky Children's Hospital and Good Samaritan Hospital. The hospital system was also nationally ranked as high performing in two adult specialties: gastroenterology and gastrointestinal surgery and geriatrics and two children's specialties: pediatric cardiology and heart surgery and pediatric orthopedics. 

Ten common adult procedures and treatments for conditions at UK HealthCare also received a high-performing designation: chronic obstructive pulmonary disease, colon cancer surgery, heart attack, heart bypass surgery, heart failure, kidney failure, lung cancer surgery, ovarian cancer surgery, pneumonia, and stroke.

St. Elizabeth Edgewood-Covington Hospitals, which tied for No. 1 with UK, ranked high performing in 14 procedures and conditions, including: COPD, colon cancer surgery, lung cancer surgery, abdominal aortic aneurysm repair, heart attack, heart failure, diabetes, kidney failure, back surgery (spinal fusion), stroke, hip fracture, hip replacement, knee replacement, and pneumonia.

Baptist Health Lexington, which tied for No. 3 with Baptist Health Louisville, ranked high performing in 11 procedures and conditions: COPD, colon cancer surgery, uterine cancer surgery, abdominal aortic aneurysm repair, heart attack, heart failure, kidney failure, back surgery (spinal fusion), stroke, hip fracture and hip replacement. This hospital received one below-average mark, for transcatheter aortic valve replacement. 

Baptist Health Louisville ranked high performing in 10 procedures and conditions: COPD, colon cancer surgery, abdominal aortic aneurysm repair, heart attack, aortic valve surgery, heart bypass surgery, diabetes, stroke, hip replacement and knee replacement.

Norton Hospitals (Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Healthcare Pavilion and Norton Women's and Children's Hospital) ranked No. 5 in Kentucky and No. 2 in Louisville. It ranked high performing in nine procedures and conditions: COPD, heart attack, heart failure, diabetes, kidney failure, stroke, maternity care for uncomplicated pregnancies, hip replacement and knee replacement. It ranked below average for uterine cancer surgery. 

UofL Health-Jewish Hospital, which also included data from UofL Health-Frazier Rehabilitation Institute, ranked No. 6 in Kentucky and No. 3 in Louisville. It ranked high performing in seven procedures and conditions: COPD, heart attack, heart failure, diabetes, kidney failure, stroke and knee replacement. This hospital ranked below average for back surgery (spinal fusion) and hip fracture.  

The 33rd annual rankings compared hospitals in 15 specialties and 20 common procedures and conditions. This year, the survey added new cancer ratings: ovarian cancer surgery, prostate cancer surgery and uterine cancer surgery.

Of the 4,500-plus hospitals evaluated, only 164 were nationally ranked in at least one specialty, compared to 175 last year, and 493 were ranked among the Best Regional Hospitals in a state or metro area, compared to 531 last year. 

While it is not included in the rankings, the U.S. News report includes an updated health equity measure  for each hospital that features measures of racial disparities in unplanned readmission, a measure of how much charity care each hospital provides, and a measure of how well low-income patients are represented among the patients each hospital serves.

Click here for a list of frequently asked questions about how the magazine ranks the hospitals. 

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot, followed by Cedars-Sinai Medical Center in Los Angeles, NYU Langone Hospitals in New York and Cleveland Clinic.

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Loved ones say actor killed himself after losing all in flood, showing need for mental-health services for region's homeless

Tony Calhoun (Showhouse Productions)

A Kentucky actor and screenwriter killed himself after losing everything he owned in last month's flash floods, his fiancée said, and "His friends and family hope the incident emphasizes the need for mental health services as part of Eastern Kentucky’s recovery," reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

Tony Calhoun, 39, "killed himself Monday morning, said Calhoun’s fiancée, Edith Heather Lisk. . . . Gov. Andy Beshear is counting Calhoun as the 39th death in the state flood toll. Calhoun’s parents, Betty and Lowell Thomas Calhoun, said that if even one person could be helped by talking about Calhoun’s death, it will be worth them telling his story."

Calhoun's mother said he lost first-edition comic books and "memorabilia that he had collected since he was 5 years old, but he was proud that he had not broken down in tears," the Herald-Leader reports. "What happened on Monday, she said, 'was his way of breaking down'."

Mental-health professionals are needed to tell hundreds of people made homeless by the flooding “that they don’t need to give up on life, that they can start over,” Betty Calhoun said. Breathitt County Coroner Hargis Epperson said Calhoun’s death is being investigated as a suicide.

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Panel to study mental-health issues in criminal-justice system

Chief Justice Minton, Justice Lambert, Gov. Beshear

The Supreme Court of Kentucky has created a commission to investigate mental-health issues in the state's criminal-justice system. Its membership has not been announced, but it will be chaired by Justice Debra Hembree Lambert.

“I’m excited to focus on mental health and substance-use cases, but this will also be the first time there will be an all-hands-on-board effort to assess and improve the way the court handles intellectual disabilities,” Lambert said in a news release. “No group this broad and with this many resources has ever come together to tackle all three of these important issues.”

The Kentucky Judicial Commission on Mental Health "will potentially have a great deal of latitude," report John Cheves and Aaron Mudd of the Lexington Herald-Leader. "According to Lambert, the body will examine where the court system touches cases involving mental health, substance use and intellectual disabilities, she said in the news release. The commission will also be empowered to make recommended changes where appropriate," including training for judges, other court personnel, law-enforcement officers, mental-health providers and community advocates, she said.

Chief Justice John Minton, who named Lambert chair, said Kentucky is the latest state to tackle "the growing mental-health crisis in the justice system."

But Cheves and Mudd write, "This is not the first time the commonwealth has tried to address severe mental illness in the people caught up in the state’s justice system. So far, its efforts haven’t been all that successful." They note that "Tim's Law," which lets district judges order seriously mentally-ill people into outpatient treatment, apparently has been used only once, in Jefferson County.

The commission is scheduled to have its first meeting Sept. 22. It apparently will have some members from the executive branch of state government, since the Supreme Court announcement was accompanied by a photo of Minton, Lambert and Gov. Andy Beshear.

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CDC eases some Covid-19 guidelines, says 89 Ky. counties are at high risk of Covid-19; state's infection rate is highest in U.S.

CDC map estimates ranges of risk for contracting Covid-19.

By Melissa Patrick
Kentucky Health News

As the Centers for Disease Control and Prevention loosened some of its Covid-19 recommendations, even more Kentucky counties moved into the high-risk category for coronavirus transmission on the CDC's weekly risk map.

And The New York Times reports that Kentucky has the highest infection rate among the states.

The number of Kentucky counties in the high-risk category, orange on the CDC map, increased to 89, from 80 in last Thursday's report. The number of yellow counties, indicating a medium risk of Covid-19, dropped to 20, down from 31.    

The good news is that for the second week in a row, the state still has green counties on the map, indicating a low risk of Covid-19 transmission. The number of low-risk counties increased by two, to 11: Fulton, Calloway, Simpson, Logan, Butler, Edmonson, Green, Taylor, LaRue, Fleming and Bracken. 

In the high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed. If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC's new guidance says people who are exposed to the virus no longer need to quarantine at home, regardless of vaccination status, although they should wear a high-quality mask for 10 days and get tested on day five. It also not longer recommends routine surveillance testing for people without symptoms and says contact-tracing is only necessary in health care settings or high-risk congregate settings. 

With schools starting, the CDC made several changes in its recommendations for schools, no longer mentioning its "test-to-stay" option and no longer recommending routine testing, unless it is in response to high-risk activities during high Covid-19 community transmission or in response to an outbreak. 

Masks continue to be recommended only in areas where community transmission is high, or if a person is at high risk of severe illness. The CDC publishes maps showing the level of community transmission in each county; all Kentucky counties but four (Hickman, Lyon, Todd and Metcalfe) have high levels. 

One CDC recommendation that remains the same is that people with Covid-19 should isolate for at least five days as long as they are without a fever for 24 hours without the use of fever-reducing medication and all other symptoms have improved. They should then wear a mask through day 10, or test negative twice over 48 hours before they stop wearing a mask. 

Beshear's view: At his weekly news conference, Gov. Andy Beshear said that with the state's weekly coronavirus cases going up and down, the hope is that we are heading toward a plateau. He said cases increasing for a while and then going down is what some experts see going forward. 

Beshear noted that hospitalizations continue to go up and while they are still relatively low, he said, "That's still a lot of people in the hospital, folks, so make sure you get vaccinated . . . Make sure you get boosted as well and if you are over 50, get that second booster."  

He added, "Everybody now has all the information on how Covid spreads, what you can do to stop it. Please try to make the best decisions for you knowing that at this point, we all know how this thing works and how we can protect ourselves." 

The data shows that the pandemic is clearly not over, even though 31.7% of Kentuckians think it is, and 53% of them say it is over for them, according to a Foundation for a Healthy Kentucky poll taken June 4-July 13. 

Asked what can be done to persuade Kentuckians that the pandemic is not over,  Beshear said Kentuckians are tired of it, and of wearing masks, then said the most important thing we can do is to get more people vaccinated and boosted. He also said Kentucky will keep sharing pandemic information with Kentuckians even as other states quit. 

He said that at this point in the pandemic, Kentuckians need to recognize that they will just need to change their behaviors, like wearing masks, for a few weeks at a time, instead of forever. 

Beshear spoke as the CDC was relaxing its guidance, while sharing a similar message as the governor. 

“We’re in a stronger place today as a nation, with more tools—like vaccination, boosters, and treatments—to protect ourselves and our communities, from severe illness from Covid-19,” CDC epidemiologist Greta Massetti said in a news release. “We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation. This guidance acknowledges that the pandemic is not over, but also helps us move to a point where Covid-19 no longer severely disrupts our daily lives.”

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