'Understanding autism: A KET Forum' premieres June 27

Autism, which is a complicated and often misunderstood neurological and developmental disorder, will be the subject of a forum on KET at 8 p.m. ET Tuesday, June 27 and on KET2 at 9 p.m. ET Thursday, June 29. The program will be available on demand at KET.org and the PBS app.

Kelsey Starks will host "Understanding Autism: A KET Forum" with experts including doctors, therapists and those affected by what some call "a neuro-difference" to help viewers understand how individuals with autism learn and interact with the world around them. They will also discuss education opportunities and the need for early intervention, and suggest ways to navigate the resources available. The guests will be:

• Dr. Gregory Barnes, director of the Norton Children’s Autism Center in Louisville and chair of the Kentucky Advisory Council on Autism

• Dr. Marisa Toomey, developmental pediatrics specialist at UK Children’s Hospital in Lexington

• Melanie West, executive director of Families for Effective Autism Treatment of Louisville

• State Rep. Tina Bojanowski, a special-education teacher in Jefferson County Public Schools and parent of a child with autism

• Scott Brinkman of Louisville, attorney and parent of a child with autism, and former state representative and state Cabinet secretary

• Susan Mills of Lexington, founder and executive director of the nonprofit My Autism Tribe and parent of child with autism

• Tanya Sturgill, autism resource specialist with the Fayette County Public Schools.

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Kentucky ranks 40th in child well-being 3 slots lower than 2021; child obesity and underweight births up child death rate way up

By Melissa Patrick
Kentucky Health News

Kentucky, where nearly one in four people are children, ranked 40th among states for the overall well-being of its children, dropping three slots from the last report, according to the 2023 Kids Count Data Book.

“As we look ahead to a contentious gubernatorial race this fall and a state-budget year for the General Assembly, now is the time to look more deeply at the needs of the child care sector and what it will cost the commonwealth – what it will cost our kids – if there’s no action,” Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. "The Data Book shows concerning trends in education, health, and family economics as we enter a post-pandemic world. Our elected officials must use this as a place of common ground and as a springboard for action in 2024."

The Data Book, released June 14 by KYA and the Annie E. Casey Foundation, rates children's overall well-being through 16 indicators in four major domains: health, economic security, education and family and community.

Overall, Kentucky saw improvements in four of the 16 indicators, all of them in the family and community category, did worse in nine of them and and stayed the same in three. Here is a look at each domain. 

Health: Kentucky's ranking dropped for the third year in a row, with three indicators used to measure health worsening. This year's report ranks the state 40th, down from 35th last year. 

This year's report shows 41% of Kentucky's children are either overweight or obese in 2020-21, up from 37% in 2018-19.  The national rate is 33%. 

The state also saw a big increase in the rate of deaths of children. It rose to 37 deaths per 100,000 in 2021, up from 29 per 100,000 in 2019. 

It also saw an increase in the rate of babies born weighing less than 5.5 pounds, which is considered underweight. That rate increased to 9.1% in 2021 from 8.7% in 2019. 

The only good news in this section is that the share of Kentucky's children with health insurance stayed the same between 2019 and 2021, 4%.

Education: Kentucky ranked 29th in the report's Education domain, down from 26th last year.  The good news was  that 91% of the state's high school students graduate on time, well above the national rate of 86%. And, this rate has held steady between 2018-19 and 2019-20. 

The other three indicators of education worsened. By far, the biggest change was seen in the percentage of eighth-graders not proficient in math, increasing to 79% in 2022 from 71% in 2019.  The percentage of fourth-graders not proficient in reading also increased, to 69% in 2022, up from 65% in 2019. And the share of preschool-age children not in nursery school, preschool or kindergarten increased to 60% in 2017-21, up from 58% in 2012-16. 

Economic well-being: Kentucky ranks 41st in economic well-being, down from 38th in last year's report, with three indicators worsening since 2019. 

The percentage of children whose parents lacked secure employment increased to 33% in 2021 from 31% and teens not in school or working increased to 9% from 8%. Also, the percentage of Kentucky children living in households with a high housing cost burden increased to 24% in 2021 from 23% in 2019. A high housing-cost household is defined as one where more than 30% of monthly household pre-tax income is spent on housing-related expenses, including rent, mortgage payments, taxes and insurance.

The report says that in 2021, 22% of Kentucky's children lived in families with incomes below the poverty threshold, defined then as a family of two adults and two children with an income below $27,479. This rate was the same in 2019. 

Family and Community: Kentucky ranked 42nd in this domain, the same as last year. It showed improvement in all indicators, including children living in high-poverty areas (12%), children living in families where the household head lacks a high school diploma (10%), children living in a single-parent household (33%), and teen births. In 2021, there were 22 teen births per 1,000 females aged 15-19. In 2019, that number was 25 per 1,000. In 2021, the national rate was 14 per 1,000. 

The Kids Count Data Center provides current and trend data for child well-being indicators related to each of the four domains in the report, at both a state and county level. It also offers a feature to create customized tables, maps, bar charts and graphs.

Focus on child care

This year's report also explores how the lack of affordable and accessible child care shortchanges children and causes parents to frequently miss work or even quit their jobs, and those who can find child care pay dearly for it. 

Brooks said, “Without safe child care they can afford and get to, parents face impossible choices, affecting not only their families, but their employers as well. These consistent challenges facing the child care infrastructure – accessibility, cost, and low wages for the workforce – impact the commonwealth’s economy, parents’ ability to advance in careers, and the early learning of our youngest Kentuckians.”

KYA called on the state to invest in child care in the same way it does other core infrastructure, like roads and emergency-response systems. 

It also called on public and private leaders to work together to improve the infrastructure for family child-care homes by increasing access to startup and expansion capital. 

And it called on Congress to reauthorize and strengthen the Child Care and Development Block Grant Act, to increase funding for public pre-kindergarten and Head Start and to expand the federal Child Care Access Means Parents in School program, which serves student parents. 

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FDA panel recommends updating Covid-19 vaccines; here's why

The Food and Drug Administration's external scientific committee unanimously recommended Thursday that Covid-19 vaccines be updated to thwart new versions of the virus, which is mutating about twice as fast as the flu, vaccines for which are updated annually, Katelyn Jetelina reports in Your Local Epidemiologist.

Also, "The current Omicron variant (XBB) circulating is meaningfully different than other Omicron variants," Jetelina writes. "Covid-19 vaccines are waning in protection against hospitalization (62% effectiveness has dropped to 24%) and ICU admission, albeit with a smaller decline (69% to 52%). This is happening faster when exposed to XBB virus compared to other Omicron variants."

Hospitals aren't filling up with Covid patients "because vaccine effectiveness now represents the incremental benefit above and beyond the baseline protection in the general population. This is different than when we first introduced vaccines and the general population had a very low immunity wall." In other words, natural immuiity (not just antibodies but other features of the immune system) combined with vaccines provide a relatively high immunity wall.

What's next? "Pfizer, Moderna, and Novavax will start manufacturing millions of vaccines. Once they’re ready, the FDA will approve the updated vaccine," Jeteline writes. Then the committee "will determine who should get the vaccines. Expect this to happen in late summer or early fall."

"Everyone’s curious to see how this year plays out," Jetelina says of her community of interest. "The rest of the year will be very telling as to whether Covid-19 has settled into a seasonal, predictable pattern. Comparing Covid-19 to the flu is helpful, but the viruses, and thus processes, are different. This needs to be communicated better."

She adds, "Don’t let anyone tell you there are no human data on these vaccines. All vaccine manufacturers presented preliminary data on humans and animals. What we do not have yet is the safety of these vaccines when combined with RSV and flu vaccines." RSV is respiratory syncytial virus, which targets mainly the young and the elderly. 

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Opioid panel to hold hearings on funding ibogaine drug research including a promoter; member sees a conflict chair quashes talk

By Melissa Patrick
Kentucky Health News

The commission that manages the state's opioid-settlement money voted June 13 to hold two public hearings to discuss the idea of funding development of an opioid-use disorder treatment using the psychedelic drug ibogaine.

Two members of the Opioid Abatement Advisory Commission questioned the idea, one saying it seems to benefit a company developing a treatment, but the head of the commission, who proposed the idea, said discussion about his proposal would have to happen at those hearings, not at that meeting.

Bryan Hubbard at the June 13 commission meeting
(Kentucky Health News photos by Melissa Patrick)

"The first order of business is to determine whether this is a pathway that should be pursued with an explanation of what ibogaine is, and make sure we educate ourselves on whether or not what we see here has legitimacy," said Bryan Hubbard, the panel's executive director and chairman.

Hubbard said the first hearing would be "focused on the science" and include "consensus experts on ibogaine." He added that "the very intent of those hearings is to have a full, vigorous examination of any and all aspects of ibogaine and whether or not we should get ourselves involved in it."

Ibogaine is a powerful psychedelic that comes from a plant mainly found in Africa. It is illegal in the U.S. but has been reported to stop withdrawal symptoms of opioid dependence but also cause heart problems.

Hubbard cut off discussion after Rep. Danny Bentley, who joined the meeting virtually, asked when the panel would be able to discuss the idea. State Health and Family Services Secretary Eric Friedlander also voiced concern that there was no discussion by the panel before Hubbard announced the plan May 31.

Bentley, a pharmacist and a Republican from Russell in Greenup County, said, "I think we should discuss it today." Hubbard replied, "The motion on the floor is to adopt the public hearing schedule and that is what the discussion will be centered around." 

Friedlander and another commission member appointed by Democratic Gov. Andy Beshear learned about the ibogaine idea only when Hubbard revealed it at an event hosted by his boss, Attorney General Daniel Cameron, the Republican nominee against Beshear in the fall election, Beshear said last month.

Hubbard said May 31 that the commission would "explore the possibility" of committing "no less than $42 million" to developing the treatment of ibogaine for opioid-use disorder, with a goal of getting it approved within six years from the U.S. Food and Drug Administration. 

Hubbard took a few minutes to address what he said were misunderstandings. He said no funds have been allocated and "At this stage in the game, the only thing that we aim to do is to explore the possibilities related to ibogaine, its applicability as a therapeutic to opioid-use disorder. And then the second question is whether and to what extent this commission would commit funds to help develop Ibogaine as a therapeutic go through the FDA approval process. We're a good bit away from answering that question."

Sharon Walsh questions the idea.

Sharon Walsh of the University of Kentucky, who oversses a multi-year, interventional research project to find tools for preventing and treating opioid addiction, with federal funding of $87 million, voiced several concerns. 

Walsh asked how the settlement money could be used to explore a drug that has not been approved by the FDA because the commission's guiding law clearly says that the money must be used on evidence-based pursuits.

Hubbard said the law includes language that would support this effort "insofar as it recognizes that the commission may allocate resources for any projects it deems appropriate." Further, he said, "We are well within our legal ability to explore. . . and that's the only thing we're seeking to do here." 

Walsh also pointed out that there are mixed opinions about the use of ibogaine for opiid-use disorder. She asked if there would be "point-counterpoint" participants at the public hearing, or if it would only be people who are trying to develop it.

Hubbard said at least two subject-matter experts will be invited to the first public hearing, including Deborah Mash, founder and CEO of DemeRx, a pharmaceutical company developing ibogaine for treating addiction. He told Walsh that if she had an expert she would like to invite, they would work to include them. 

Friedlander asked if the focus could be broadened to include other psychedelics, but Hubbard said that wasn't possible, because while other psychedelic drugs are closer to FDA approval, they don't appear to be effective against opioid withdrawal syndrome, as ibogaine may be. 

Walsh pushed back: "If the focus is on opioid withdrawal, we have medications that are already approved for opioid withdrawal. It's not something that is difficult to manage clinically. And there are protocols that have been in place for 30-some years. . . . Those are very effective drugs. I'm not sure why we need other drugs to target opiate withdrawal." 

Hubbard replied, "Well, there are others who would seem to believe that this is worth exploring"  and that it has " breakthrough therapy potential. I want to know if that's true, right? And that's why we're having this exploration."  

Walsh also noted that she has known the proposed witness, Mash, for 30-some years and that Mash has been working on ibogaine since the 1990s. 

"She's the CEO of a company that's trying to develop it. So she's going to come and talk to us about the development of this with it, you know, with the hope of getting money. There's a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market," Walsh said. "That's why I'm asking for balance."

Hubbard repiled, "Insofar as there are individuals who you know, that have expert credentials now for alternative views, please share those with the commission staff and myself."  

Secretary Eric Friedlander also objected.

Friedlander said he wished commission members had been able to discuss the idea before the press conference, which he said presented it as a "a fait accompli," or accomplished fact, even if that was not Hubbard's intention. 

Friedlander said, "Part of what we've been able to do is have these discussions about proposals in subcommittees, among ourselves, and I feel like that didn't happen here -- which is to me a disappointment. I'm just being straight. And even today feels like it's not welcome. . . . If we can have a press conference, surely we can have a discussion." 

Hubbard said he hoped that there would be "uninhibited cross-examination questions and discussions" at the two public hearings and afterward. 

"If we get into this and we find that what I have had my eyes on for the past month is smoke without fire or lacks legitimacy, we will come to that conclusion and move on from this exploratory state without any aim at a predetermined conclusion," he said. 

Bentley and Friedlander were the only two commissioners to vote against the motion to hold two public hearings about ibogaine.  

Friedlander said, "It feels too narrow and it feels too specific. And I would have much rather have had the discussion here before a press conference and before we really were presented with a motion and couldn't have more discussion. So based on those two things, I vote no."

Bentley said he voted no because "Right now all the research on this drug is outside the United States because the FDA will not give an NDA, a new drug application, for it. So that's the reason I'm opposed."  

The hearings will be held July 17 and Aug. 16, from 9 a.m. to 3 p.m. in Room A125 of the Administrative Office of the Courts Building, 1001 Vandalay Dr,, Frankfort, at the northeast quadrant of the I-64/US127 interchange.

Hubbard announced reappointment of three members to two-year terms: Vic Brown, deputy director of the Appalachian High Intensity Drug Trafficking Area, representing law enforcement; and Karen Butcher of Georgetown and Simmons College of Kentucky Vice President Von Purdy of Louisville, representing citizens at large.

The commission's next business meeting will be held Aug. 8 at 1 p.m. in Suite 200 of 1024 Capital Center Dr. in Frankfort. 

Hubbard announced that the Opioid Conference will be held Oct. 8 to Oct.10 in Lexington and the sponsor will be the Kentucky Association of Health Plans.

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Kentucky had 5% fewer drug overdose deaths in 2022 than in '21

State Department for Public Health map, adapted by Kentucky Health News

By Al Cross

Kentucky Health News

Kentucky is still losing more than 2,000 citizens a year to drug overdoses, but last year's total was less than the year before, the first decline since 2018, according to the state's annual Overdose Fatality Report.

The report, issued Thursday, says 2,135 Kentuckians died from overdoses in 2022. A preliminary report had put the number at 2,127. The final figure is 5.4 percent under the final 2021 figure of 2,257.

"However, addiction remains one of the most critical public health and safety issues facing the Commonwealth of Kentucky," says the report, issued by the state Office of Drug Control Policy.

The office's director, Van Ingram, said in a news release, “Over the past year, we have heavily focused on increasing access to clinical care for those suffering from addiction while offering more harm reduction measures,” including distribution of naloxone (Narcan), which blocks the effect of overdoses.

Opioids were involved in 90 percent of overdose deathss, led by fentanyl with 72.5%, which was 6% less than in 2022. The number of overdose deaths "was also worsened by the widespread availability of potent inexpensive methamphetamine," the report says. Many victims had more than one drug in their system; 50.1% had fentanyl.

Among counties with 10 or more overdose deaths, Bath County, in east-central Kentucky, had the highest rate of overdose deaths in 2022, 18.5 per 10,000 residents. After it came Lee County, 15.1; Floyd County, 13.3; Estill County, 13; and Knott, 12.6. The state rate was 5 deaths per 10,000, down from 5.3 in 2021.

Rates for 65 of the state's 120 counties were not released because they had fewer than 10 drug overdose deaths. The actual numbers of overdose deaths in a county were not released if it had fewer than five.

The Centers for Disease Control and Prevention recently released a national overdose death report, which listed Kentucky as one of only eight states to record a significant decline (at least 100) in overdose deaths, the release from Beshear's office noted. It said "Beshear has increased the number of treatment beds in the community by 50% and secured the largest number ever of corrections-based addiction treatment beds."

The release also said "A recent article from The Associated Press noted that . . . the decrease in overdose deaths is due to Kentucky’s intentional work to address addiction and offer more treatment services," but that is an overstatement. The article paraphrased Columbia University epidemiologist Katherine Keyes as saying that since Kentucky and other states with declines had high overdose-death rates during the epidemic, their declines (emphasis added) "might be a sign that years of concentrated work to address the problem is paying off. State officials cited various factors for the decline, like social media and health education campaigns to warn the public about the dangers of drug use; expanded addiction treatment — including telehealth — and wider distribution of the overdose-reversing medication naloxone."

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Ky. nursing-home company closes 2 Louisville homes agrees to pay $1 million after inspectors find rodent infestation and filth

Exceptional Living Centers of Lexington, which operates several Kentucky nursing homes. "has agreed to close two of its Louisville facilities, displacing roughly 200 people, after state inspectors uncovered serious problems over the past six months, including a rodent infestation, filthy living conditions and a general lack of care for the elderly and ailing residents," John Cheves reports for the Lexington Herald-Leader.

The company and the federal government entered a settlement last week in U.S. District Court "to voluntarily terminate its Medicare provider agreements at Hillcreek Rehabilitation and Care and St. Matthews Care and Rehabilitation Center. Such a loss is typically a financial death blow for a nursing home," Cheves reports. "The company is working closely with state and federal officials to transfer residents of Hillcreek and St. Matthews to other nursing homes around Jefferson County by July 6, according to its closure plan, obtained by the Herald-Leader. The company also agreed to pay civil monetary penalties of $1,026,408 to the U.S. Centers for Medicare and Medicaid Services."

Inspedction reports of the state Cabinet for Health and Family Services, "which inspects nursing homes on behalf of the federal government . . . cited a persistent rodent infestation; unheated bedrooms in freezing winter months; filthy living conditions, including dirty bathrooms, the lingering stench of urine and feces, and trash cans overflowing with adult diapers; a lack of clean linens; blood-testing equipment that was not sanitized between use on different patients; and direct-care employees hired despite having disqualifying criminal records," Cheves reports.

Hillcreek Rehabilitation and Care (H-L photo by Marcus Dorsey)

At Hillcreek, "Residents complained that staff did not check on them overnight, between 7 p.m. and 7 a.m., leaving them 'humiliated' and 'feeling dirty' in soiled pajamas and sheets because nobody responded to their calls for assistance, inspectors wrote. A resident who fell in his unheated room the day after Christmas lay uncovered on the floor for more than three hours until he finally was discovered, inspectors wrote. Emergency medical workers described his skin as 'freezing cold.' He died 10 days later at the hospital of hypothermia, they wrote."

The reports say residents and staff told inspectors they were scared by mice and rats scurrying through parts of Hillcreek, "including bedrooms and on a resident’s bed, and by hearing them skitter and shuffle on the floors," and one resident required medical care after a rat bit hsi thumb, Cheves reports. Inspectors found rodent feces near a nurse's station, and one rat was so familiar that housekeeping staff gave him a nickname, “Ben,” inspectors reported. One nurse “stated the rats were ‘huge’ and as big as cats,” inspectors wrote.

"Hillcreek, which already had a history of critical state inspections, has been hit with about a dozen negligence or wrongful death lawsuits filed by residents’ families since 2021. It is rated with one star, or 'much below average,' on Medicare’s Nursing Home Compare website," Cheves reports.

"At St. Matthews, inspectors cited abuse of residents, including 'a severely cognitively impaired' female resident whom police determined to have been sexually assaulted at the facility, and a resident who said she or he was hit by an employee but whose assault allegation was not reported up the chain of command, as required. As at Hillcreek, inspectors said St. Matthews used blood-testing equipment on different patients without sanitizing it, risking the spread of infectious diseases and blood-borne pathogens, and it hired direct-care employees despite 'disqualifying events' in their past, such as a social services assistant with a conviction for physical harassment."

Exceptional Living Centers President Tom Watts declined to comment to the Herald-Leader, as did the company’s lawyers. The firm continues to operate these facilities listed on its website: Bluegrass Senior Living in Somerset, Clifton Oaks Care Center in Louisville, Green Hill Rehabilitation and Care in Greensburg, Lyndon Woods Rehabilitaiton and Care in Lyndon, Stanford Care and Rehabilitation, Frankfort Care and Rehabilitation, and Vanceburg Rehabilitation and Care. 

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

By Sarah Ladd
Kentucky Lantern

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

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

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

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

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

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

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

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

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

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

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

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

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