- Rural Children Struggle to Access Hospital Services, Say Researchers
- Outlining the Intersection between Health Care and Missing and Murdered Indigenous People
- Biden-Harris Administration Announces Critical More Than $1.5 Billion State and Tribal Opioid Response Funding Opportunities
- RPHARM Program Fulfills Need for Rural Pharmacists
- Farmers Don't Do Mental Health
- A Pilot Program in Rural Vermont Hopes to Build a Blueprint for Substance Abuse Recovery
- Rural Telehealth Extension Reintroduced in Congress
- Students From Across the State Emphasized the Need for Mental Health Resources in Rural Alaska During a Conference
- The South Was the Center of Rural Population Growth Last Year
- How HHS SUD Confidentiality Regulations Will Impact Rural Providers
- VA Announces Expansion of "Close to Me" Cancer Program as Part of the Cancer Moonshot, Bringing Cancer Diagnosis and Treatment Closer to Thousands of Veterans
- Navajo Psychiatrist Bridges Gaps Between Native American Culture and Behavioral Health Care
- Biden-Harris Administration Releases National Strategy for Suicide Prevention and First-Ever Federal Action Plan
- Biden Administration Sets Higher Staffing Mandates. Most Nursing Homes Don't Meet Them.
- Rural Communities Face Primary Care Physician Shortage
CDC Gives a Monkeypox Update and Provides New Resources
New data show the outbreak is slowing; as of Wednesday, September 28, there were there were 25,509 confirmed cases. The Centers for Disease Control and Prevention (CDC) continues to provide updates on trends and resources, recently focusing on reducing stigma. CDC also recommends health care personnel adhere to recommended infection prevention and control measures and stay up to date on pain management for infected patients. See Funding and Opportunities below for the CDC’s Monkeypox Vaccine Equity Pilot Program.
Read the New GAO Report on Telehealth in Medicare
The federal agency charged with examining how taxpayer dollars are spent reports on the effects of temporary waivers issued by the U.S. Department of Health & Human Services (HHS) to ease the use of telehealth during the COVID-19 pandemic. For beneficiaries of Medicare – the public health insurance that allows access to care for those who are 65 years and older, and younger people with certain disabilities – use of telehealth increased from about 5 million services pre-pandemic to more than 53 million services from April to December 2020. GAO also found that, while telehealth use increased across all provider specialties, 5 percent of providers delivered over 40 percent of services. The difference in telehealth use between rural and urban Medicare beneficiaries was slight – 33 percent versus 39 percent respectively. In considering whether to make these changes permanent, GAO makes three recommendations to the Centers for Medicare & Medicaid Services: 1) clarify guidance for billing audio-only telehealth to allow tracking of these visits, 2) require providers to use available place of service codes, and 3) make a comprehensive assessment of the quality of services delivered via telehealth to insure improved outcomes for patients.
What States Should Know About the New REH Designation
The National Academy for State Health Policy (NASHP) provides another layer of insight into how a new provider type, the Rural Emergency Hospital (REH), will work when it goes into effect at the start of next year. Eligible hospitals that receive the designation may reduce their risk of closure and receive an additional payment from Medicare – regardless of facility size or volume of patients – to maintain emergency services in rural areas. As reported here a few weeks ago, the National Conference of State Legislatures is tracking the way states are tailoring REH licensing requirements. In spring 2023, NASHP will join HRSA in a day-long, in-person peer-to-peer learning opportunity for state officials to develop implementation plans for individual states. In the near term, the Federal Office of Rural Health Policy (FORHP) will host a webinar on Wednesday, October 12 at 3:00 pm ET to explain the Rural Emergency Hospital and other FORHP-funded activities to support hospitals exploring the REH option.
Asking for Final Recommendation Statements: Screening for Syphilis Infection in Nonpregnant Adolescents and Adults
The U.S. Preventive Services Task Force released a final recommendation statement on screening for syphilis infection in nonpregnant adolescents and adults. The Task Force recommends screening people at increased risk for infection. To view the recommendation, the evidence on which it is based, and a summary for clinicians, please go here.
Polio Virus Infection Detection and Prevention
The Pennsylvania Department of Health (PA DOH) is alerting healthcare providers, laboratories, infection control specialists, and local health departments about an unvaccinated adult with poliovirus infection and acute flaccid paralysis along with wastewater detection in adjacent counties reported July 2022 in Rockland County, New York. PA DOH urges healthcare providers to consider polio as a possible cause of sudden onset of limb, facial, oropharyngeal, or respiratory muscle weakness, especially in persons who are not vaccinated or who are under-vaccinated for polio and have traveled to areas with a higher risk of polio or who have had contact with such persons. If providers have a clinical suspicion of a case of polio after they have evaluated a patient, they are to contact their local or state health department to discuss the case and to determine to test. Healthcare providers should immediately identify and schedule appointments for patients in your practice who are not up to date on the poliovirus vaccine. To read the full PA DOH Advisory, click here.
Pennsylvania Health Department Recognizes Expansion of Innovative Food Program Supporting 50 Hospitals
Acting Secretary of Health and Pennsylvania Physician General Dr. Denise Johnson recognized fifty hospitals in 26 counties for creating a culture of health by offering nutritious foods and beverages to patients, employees and visitors, and promoting locally-sourced and sustainably-produced products.
Dr. Johnson joined leaders from Philadelphia and the Hospital and Healthsystem Association of Pennsylvania (HAP) to recognize the 50 hospitals participating in the Good Food, Healthy Hospitals programOpens In A New Window. Click here to access the list of hospitals, by scrolling to the “SEE what’s happening at our pledge sites” section of the page.
“The Department of Health is proud to partner with the Philadelphia Department of Public Health and the Hospital and Healthsystem Association of Pennsylvania to implement food service guidelines to help ensure better nutrition is available daily for thousands of patients, employees and visitors at hospitals throughout the state,” said Dr. Johnson. “We commend those who have committed to adopting and further innovating this program that gives access to healthy, local food to so many people. Healthy food is an important tool in both healing and preventing illness.”
Healthcare facilities participating in Good Food, Healthy Hospitals pledge to voluntarily adopt food, beverage and procurement standards in all areas where food is purchased, served or sold. These standards include, among others:
- indicating vegetarian, heart healthy, and whole grain options on patient menus
- placing healthier beverages and snacks at eye level for consumers
- prominently displaying nutrition information of foods and beverages
- replacing regular fried chips with baked varieties
- promoting water as a healthy and necessary beverage choice throughout the hospital
- purchasing locally-sourced and sustainably-raised foods where possible
- purchasing rBGH-free dairy products
The hospitals work closely with the Good Food, Healthy Hospitals team, including the Philadelphia Department of Public Health (PDPH), the Pennsylvania Department of Health and HAP, for technical assistance and collaboration with participating hospitals.
“We strive to promote healthy, livable communities,” said PDPH Health Commissioner Dr. Cheryl Bettigole. “The hospitals participating in the Good Food, Healthy Hospitals Initiative have demonstrated that you can make it easier for patients, staff and visitors to eat a nutritious diet. It’s this type of leadership and investment that is making our hospitals safer, healthier places.”
Started in 2014, the Good Food, Healthy Hospitals initiative continues to expand. WellSpan Health, Endless Mountain Health Systems, Magee Rehabilitation Hospital (Jefferson Health), Geisinger Medical Center Muncy, and St. Luke’s Carbon and Easton Campuses have signed the pledge for a total of 50 participating hospitals located in 26 counties across the commonwealth. In Philadelphia, 15 hospitals continue implementing the program’s food service guidelines.
“Hospitals do more than treat illnesses and injuries — they partner with patients and their communities for better health,” said Andy Carter, president and CEO of the Hospital and Healthsystem Association of Pennsylvania. “HAP is proud to support Pennsylvania hospitals’ efforts toward better access to nutritious food, more educated food choices, and healthier patients and communities through the Good Food, Healthy Hospitals program.”
The expansion across Pennsylvania is made possible by the State Physical Activity and Nutrition (SPAN) Program grant and Preventive Health and Health Services Block Grant. Pennsylvania was one of 16 states awarded the SPAN grant from the Centers for Disease Control and Prevention in 2018.
More information on healthy eating can be found on the Department of Health’s website at www.health.pa.gov
For more information about Good Food, Healthy Hospitals, visit www.foodfitphilly.org/gfhh/Opens In A New Window
Expanded Eligibility of Monkeypox Vaccine and Updated Clinical Considerations
The Centers for Disease Control and Prevention announced expanded eligibility for monkeypox vaccination to include pre-exposure prophylaxis (PrEP) for several high risk groups. These groups include:
- Men who have sex with men, transgender or nonbinary people who in the past 6 months have had any of the following:
- A new diagnosis of one or more sexually transmitted diseases including acute HIV, chancroid, chlamydia, or gonorrhea
- More than one sex partner
- People who in the past 6 months have had any of the following:
- Sex at a commercial sex venue (like a sex club or bathhouse)
- Sex at an event, venue, or in an area where monkeypox transmission is occurring.
- People whose sexual partner identifies with any of the above scenarios
- People who anticipate experiencing any of the above scenarios
Additionally, preliminary data has shown that those eligible who did not receive the monkeypox vaccine were about 14 times more likely to become infected than those who did receive the monkeypox vaccine. Lastly, CDC has provided additional interim clinical considerations related to intradermal administration of the monkeypox vaccine.
White House Selects a Christmas Tree from a Pennsylvania Farm as its Official Christmas Tree to Stand in the Blue Room
The White House will select its official 2022 Christmas tree to stand in the iconic Blue Room from Evergreen Acres Tree Farm.
On October 10, 2022 at 10:00am EST, Robert Downing, the White House Executive Usher, will lead a delegation to officially select the 2022 White House Christmas Tree. The tree will be chosen from the many beautiful firs and pines growing on Paul and Sharon Shealer’s Christmas tree farm, Evergreen Acres.
The Shealers earned the honor of providing the official White House Christmas tree when their Douglas Fir entry was selected as Grand Champion at the National Christmas Tree Association’s National Tree and Wreath Contest. To qualify for the national contest, Shearles first had to win the 2021 Pennsylvania Farm Show’s competition earning the opportunity to represent Pennsylvania in the national contest. Paul Shealer shared, “We were thrilled to win Grand Champion and are even more excited and privliged that our farm will provide the White House’s official Christmas tree. Evergreen Acres takes great pride in its trees every year, and it seems this year we can stand even taller!”
The tree selection event will include statements from Tim O’Connor, Executive Director of the National Christmas Tree Association, a representative from the Pennsylavania Department of Agriculture, and Randy Cypher, President of the Pennsylvania Christmas Tree Growers Association.
“Pennsylvania growers produce one million of the nation’s most impressive Christmas trees every year,” Pennsylvania Agriculture Secretary Russell Redding said. “We’re proud to showcase our finest growers at the PA Farm Show each January. We’re even prouder that the Shealer family qualified to win the National Christmas Tree competition by winning at Farm Show and will grace the White House, representing our commonwealth proudly and focusing the eyes of the nation on world-class PA-grown product.”
The event will take place at 10:00am at Evergreen Acres Tree Farm located at 135 Fort Lebanon Road, Auburn, PA 17922.
For more information about the official White House Christmas tree selection at the Shealer’s Evergreen Acres, please contact Aaron Grau at 717-229-9227 or aaron@christmastrees.org.
Preorder Pediatric Pfizer Bivalent Vaccines for Children 5-11 Years Old
Pending FDA Emergency Use Authorizations (EUAs) for the new Pediatric Bivalent COVID-19 Vaccine in the next few weeks, the Centers for Disease Control and Prevention (CDC) is planning for a pre-ordering period during which certain vaccine doses will be made available to each jurisdiction based on pro-rata allocation. During this pre-ordering phase, the PA Department of Health (PA DOH) and the Philadelphia Department of Public Health will submit vaccine preorder requests on behalf of providers. For Philadelphia County the deadline to order was Sept. 27. For all other counties in the Commonwealth, the deadline to submit preorder requests is Sept. 30 at 4:00 pm. Click here to submit a vaccine request form to preorder the vaccine through the PA DOH. Please do not order pediatric Pfizer Bivalent vaccines in PA SIIS until advised to do so, as any order put on PA SIIS for this product will be deleted. Vaccine preorder requests are not guaranteed to be fulfilled, as the supply may initially be limited. Doses that are pre-ordered will be processed for delivery following the issuance of the EUA. Additionally, the deadline for HRSA Health Center COVID-19 Vaccine Program participants to pre-order Pfizer bivalent boosters for pediatric patients ages 5-11 was Sept. 28 and was capped at 100 doses per site. The updated CDC Fall Vaccination Operational Planning Guide includes more detailed information about pediatric bivalent boosters.
Children Living Near Pennsylvania Fracking Sites At Increased Risk of Leukemia, Study Finds
From State Impact PA
Correction: Nicole Deziel of the Yale School of Public Health says Pennsylvania’s wellhead setback from schools and homes should be 1,000 meters. That distance was incorrect in the original version of this story.
Children who live close to fracking sites in Pennsylvania have a higher risk for the most common form of childhood cancer, a new study found.
Researchers at the Yale School of Public Health used the Pennsylvania Cancer Registry, along with state data on unconventional oil and gas drill sites, to determine that children born within two kilometers, or 1.24 miles, of an active well site were two to three times more likely to be diagnosed with acute lymphoblastic leukemia between the ages of 2 and 7.
The study was published in the journal Environmental Health Perspectives. It looked at 405 children diagnosed with that type of leukemia between 2009 and 2017, and included 2,080 controls matched by birth year.
“The magnitude of the elevated risk that we observed was fairly striking,” said Dr. Cassandra Clark, a post-doctoral fellow at the Yale School of Public Health and co-author of the report. “After accounting for a variety of socioeconomic, demographic and biological factors that could potentially be underlying this association, it was consistent.”
Acute lymphoblastic leukemia is one of the most common childhood cancers, which is why the researchers chose to look at it. Additionally, a known cause is benzene, a chemical released by oil and gas drilling activities into both air and water. The five-year survival rate in children with acute lymphoblastic leukemia is high, at 90 percent.
Unconventional gas development is also referred to as fracking, which is a part of the overall process that injects water with chemicals at high pressure into shale rock formations deep underground to release oil and gas. Water that returns to the surface often includes those chemical additives, along with long-buried naturally occurring toxins and radiological material.
More than 10,000 unconventional natural gas wells were drilled and fracked in Pennsylvania between 2002 and 2017. The Department of Environmental Protection has reported more than 1,000 spills in that period, along with fielding about 4,000 residential well water complaints between 2005 and 2014. Many who live in rural areas rely on water from private wells, about one-third of which are within two kilometers of a wellhead.
The natural gas industry maintains it operates under regulations meant to protect public health. The Marcellus Shale Coalition has said the industry’s “top priority” is protecting health and safety of workers, the environment, and people who live near fracking operations.
One unique aspect of the Yale research includes tracing potential drinking water exposure.
“It really is a superb study,” said Dr. Bernard Goldstein, former dean of the University of Pittsburgh School of Public Health and an expert in environmental causes of childhood leukemia.
Goldstein is not associated with this study. He has conducted prior research into exposures due to oil and gas wastewater in Pennsylvania.
“It looks at a potential problem in ways that include new exposure metrics, which are really needed,” he said.
Goldstein says that though the factors that contribute to childhood leukemia are complex and still unclear, benzene is the one known link.
The interdisciplinary team of researchers included experts on leukemia and environmental science, as well as hydrogeologists. In addition to the location of well sites, researchers mapped individual watersheds and determined the flow of water from well heads to the children’s homes. They did not survey the families to determine individual sources of drinking water.
Still, they say the research shows that a child living within 1.2 miles of a well site, which is within their watershed, could be at a higher risk of exposure through drinking water.
Previous research has shown an association between fracking activities and health impacts, but determining the path to exposure is more difficult.
“I think we have about 50 epidemiological health studies demonstrating increased adverse health outcomes in communities that live near unconventional oil and gas sites,” said Dr. Nicole Deziel, a co-author of the study and associate professor at the Yale School of Public Health in the Department of Environmental Health Sciences. “I think it would be very important to understand which exposures or hazards might be driving these associations.”
Deziel says she wants the study to impact public policy, including regulations on residential setbacks from wellheads and density of drilling sites. Pennsylvania requires a 500-foot setback from schools and homes. Deziel says it should be 1,000 meters, especially since her findings show greater impacts for children exposed in utero.
Those results, she said, suggested “that that may be a sensitive time window, which is also consistent with some other studies of other environmental exposures.”