Hal Dempsey wanted to “escape Missouri.” Arlo Dennis is “fleeing Florida.” The Tillison family “can’t stay in Texas.”

They are part of a new migration of Americans who are uprooting their lives in response to a raft of legislation across the country restricting health care for transgender people.

Missouri, Florida, and Texas are among at least 20 states that have limited components of gender-affirming health care for trans youth. Those three states are also among the states that prevent Medicaid — the public health insurance for people with low incomes — from paying for key aspects of such care for patients of all ages.

More than a quarter of trans adults surveyed by KFF and The Washington Post late last year said they had moved to a different neighborhood, city, or state to find more acceptance. Now, new restrictions on health care and the possibility of more in the future provide additional motivation.

Many are heading to places that are passing laws to support care for trans people, making those states appealing sanctuaries. California, for example, passed a law last fall to protect those receiving or providing gender-affirming care from prosecution. And now, California providers are getting more calls from people seeking to relocate there to prevent disruptions to their care, said Scott Nass, a family physician and expert on transgender care based in the state.

But the influx of patients presents a challenge, Nass said, “because the system that exists, it can’t handle all the refugees that potentially are out there.”

In Florida, the legislative targeting of trans people and their health care has persuaded Arlo Dennis, 35, that it is time to uproot their family of five from the Orlando area, where they’ve lived for more than a decade. They plan to move to Maryland.

Dennis, who uses they/them pronouns, no longer has access to hormone replacement therapy after Florida’s Medicaid program stopped covering transition-related care in late August under the claim that the treatments are experimental and lack evidence of being effective. Dennis said they ran out of their medication in January.

“It’s definitely led to my mental health having struggles and my physical health having struggles,” Dennis said.

Moving to Maryland will take resources Dennis said their family does not have. They launched a GoFundMe campaign in April and have raised more than $5,600, most of it from strangers, Dennis said. Now the family, which includes three adults and two children, plans to leave Florida in July. The decision wasn’t easy, Dennis said, but they felt like they had no choice.

“I’m OK if my neighbor doesn’t agree with how I’m living my life,” Dennis said. “But this was literally outlawing my existence and making my access to health care impossible.”

Mitch and Tiffany Tillison decided they needed to leave Texas after the state’s Republicans made anti-trans policies for youth central to their legislative agenda. Their 12-year-old came out as trans about two years ago. They asked for only her middle name, Rebecca, to be published because they fear for her safety due to threats of violence against trans people.

This year, the Texas Legislature passed a law limiting gender-affirming health care for youth under 18. It specifically bans physical care, but local LGBTQ+ advocates say recent crackdowns also have had a chilling effect on the availability of mental health therapy for trans people.

While the Tillisons declined to specify what treatment, if any, their daughter is getting, they said they reserve the right, as her parents, to provide the care their daughter needs — and that Texas has taken away that right. That, plus increasing threats of violence in their community, particularly in the wake of the May 6 mass shooting by a professed neo-Nazi at Allen Premium Outlets, about 20 miles from their home in the Dallas suburbs, caused the family to decide to move to Washington state.

“I’ve kept her safe,” said Tiffany Tillison, adding that she often thinks back to the moment her daughter came out to her during a long, late drive home from a daylong soccer tournament. “It’s my job to continue to keep her safe. My love is unending, unconditional.”

For her part, Rebecca is pragmatic about the move planned for July: “It’s sad, but it is what we have to do,” she said.

A close call on losing key medical care in Missouri also pushed some trans people to rethink living there. In April, Missouri Attorney General Andrew Bailey issued an emergency rule seeking to limit access to transition-related surgery and cross-sex hormones for all ages, and restrict puberty-blocking drugs, which pause puberty but don’t alter gender characteristics. The next day, Dempsey, 24, who uses they/them pronouns, launched a GoFundMe fundraiser for themself and their two partners to leave Springfield, Missouri.

“We are three trans individuals who all depend on the Hormone Replacement Therapy and gender affirming care that is soon to be prohibitively limited,” Dempsey wrote in the fundraising appeal, adding they wanted to “escape Missouri when our lease is up at the end of May.”

Dempsey said they also got a prescription for a three-month supply of hormone therapy from their doctor in Springfield to tide them over until the move.

Bailey withdrew his rule after the state legislature in May restricted new access to such treatments for minors, but not adults like Dempsey and their partners. Still, Dempsey said their futures in Missouri didn’t look promising.

Neighboring Illinois was an obvious place to move; the legislature there passed a law in January that requires state-regulated insurance plans to cover gender-affirming health care at no extra cost. Where exactly was a bigger question. Chicago and its suburbs seemed too expensive. The partners wanted a progressive community similar in size and cost of living to the city they were leaving. They were looking for a Springfield in Illinois.

“But not Springfield, Illinois,” Dempsey quipped.

Gwendolyn Schwarz, 23, had also hoped to stay in Springfield, Missouri, her hometown, where she had recently graduated from Missouri State University with a degree in film and media studies. She had planned to continue her education in a graduate program at the university and, within the next year, get transition-related surgery, which can take a few months of recovery.

But her plans changed as Bailey’s rule stirred fear and confusion.

“I don’t want to be stuck and temporarily disabled in a state that doesn’t see my humanity,” Schwarz said.

She and a group of friends are planning to move west to Nevada, where state lawmakers have approved a measure that requires Medicaid to cover gender-affirming treatment for trans patients.

Schwarz said she hopes moving from Missouri to Nevada’s capital, Carson City, will allow her to continue living her life without fear and eventually get the surgery she wants.

Dempsey and their partners settled on Moline, Illinois, as the place to move. All three had to quit their jobs to relocate, but they have raised $3,000 on GoFundMe, more than enough to put a deposit down on an apartment.

On May 31, the partners packed the belongings they hadn’t sold and made the 400-mile drive to their new home.

Since then, Dempsey has already been able to see a medical provider at a clinic in Moline that caters to the LGBTQ+ community — and has gotten a new prescription for hormone therapy.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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armacyclics, Janssen) and obinutuzumab (Gazyva, Genentech) in older patients with CLL.“This was one example where we learned that when we balance all factors, safety and efficacy, it turns out

The Dominican Medical Association (CMD) revealed that it is investigating a person with an apparent false registration operating as a doctor in a health center in the province of Puerto Plata.

The president of the association, Senén Caba, did not give details of the person being followed so as not to hinder the investigation process.

He added that a false doctor had been brought to justice in the same province, but the authorities “did nothing” about it.

The doctor said that he has collaborated with journalist Nuria Piera, who has denounced dozens of doctors working in the country’s health centers with false qualifications in several of her investigative programs.

The investigation of the alleged neuroscientist
Recently Nuria Piera investigated Elizabeth Silverio Sillien, an alleged neuroscientist, educator, and pastor, who was the director of the closed Kogland Neurocognitive and Psychopedagogical Therapy Centre, a space located in Gascue and created in December 2021, which she ran with her husband and partner David Báez Zorrilla under the object of pedagogical therapies.

According to what the journalist found out after her investigation, the woman claimed to have a doctorate in Neurosciences in the modality of cognitive-brain intervention in clinical and pedagogical areas, claiming to be a graduate of Cambridge University in England.

She claimed to have a master’s degree in Academic Management Administration and Educational Corporate Modeling from the West Indies University Campus.

Silverio Sillien also claimed to have a Ph.D. in child and general neuroscience, specializing in the intervention of developmental disorders, syndromes, and comorbidities. She also specializes in neurobiological, neurocognitive, and neuropathological areas from the University of Florida.

The fraudulent doctor claimed to have a Master’s degree in ESD model of inclusion, special education at the West Indies, Barbados campus, a specialization in the therapeutic structure of intervention treatment creation at the University of Valencia, Spain, and a postgraduate degree in updating millennial psychological modality.

Following the investigation, the Ministry of Public Health reported that the center was closed, and Elizabeth was ordered to submit an exequatur.

Tips to prevent mosquito-borne diseases this hurricane season

IT wouldn't be the hurricane season without rain, and that comes with a threat — dengue fever.

And as the island experiences increased rainfall, the Ministry of Health and Wellness is reminding Jamaicans to expect an increase in the breeding of mosquitoes, especially disease-carrying types such as the Aedes aegypti that transmits dengue.

The Atlantic hurricane season started on June 1 and will continue until November 30, 2023.

Dr Jacquiline Bisasor-McKenzie, Jamaica's chief medical officer (CMO), noted that members of the public have a role to play in preventing a possible increase in the transmission of dengue.

Bisasor-McKenzie urged individuals to be active in "searching for and destroying all potential mosquito breeding sites in and around their surroundings".

She said Jamaica's high dengue transmission period coincides with the hurricane season annually, as is the case with the rest of the Caribbean.

"In anticipation of that the ministry will activate an enhanced public education programme, home inspections, and the destruction of breeding sites by vector control workers, and [will implement] islandwide fogging by the parish health departments."

The US National Oceanic and Atmospheric Administration has predicted a "near normal" hurricane season, with 12 to 17 named storms packing winds of at least 39 mph (63 kph). Of those, five to nine could become hurricanes, with one to four developing into major hurricanes.

Additionally, according to the Centers for Disease Control and Prevention (CDC), each year, up to 400 million people are infected by the dengue virus and approximately 100 million people get sick from infection — with 40,000 dying from severe dengue.

In a release on April 17, 2023 the CDC cautioned travellers to protect themselves from contracting the dengue disease as cases trend upwards in four Caribbean countries.

The CDC listed Cuba, the Dominica Republic, as well as French Caribbean territories Guadeloupe and Martinique.

The Aedes aegypti mosquito breeds in any containerised environment — that is, anything that can hold water.

Some of the common breeding sites for the Aedes aegypti mosquito are drums, tyres, buckets, and animal feeding containers.

Last month, health promotion and education officer Gerald Miller said the Westmoreland Public Health Department would be increasing its efforts to educate citizens about how to avoid contracting the virus.

During last Thursday's monthly sitting of the St Ann Municipal Corporation, the St Ann Health Department served notice that it has no problem throwing the book at people who allow mosquitoes to breed on their premises despite repeated warnings to address the health threat.

Meanwhile, the health ministry said members of the public are encouraged to search their surroundings at home and work at least once per week to ensure there are no Aedes aegypti breeding sites. This, the ministry added, is the best strategy to mitigate against a possible outbreak of dengue later in the year.

The public is also being encouraged to take protective action to reduce their contact with mosquitoes.

There are no confirmed cases of dengue in Jamaica thus far for 2023.

Dengue-prevention tips:

*Stop Aedes aegypti mosquito breeding by looking for anything water can settle in and cover it/ keep it dry/ clean it regularly/ fill it with soil or sand/ punch holes in it/ recycle it/dispose of it.

*Avoid being bitten by mosquitoes.

*Use insect repellent containing DEET, IR3535 or Picaridin.

*Use mosquito nets.

*Use mosquito destroyer.

*Put screens on windows and doors.

*Take community action regarding prevention.

The World Health Organization (WHO) has published a new report on access to morphine for medical use, which describes how the global distribution of morphine, as a vital pain medicine, is unequal and does not fulfil the medical need. The report, titled 'Left behind in pain', highlights the problems with accessing this essential medicine and offers actions to improve safe access through balanced policy.

Despite morphine being an effective and relatively low-cost medicine for relieving strong pain, listed since 1977 in the first edition of the WHO Model List of Essential Medicines, the disparity in access across countries is stark. There is a five- to 63-fold difference in the estimated median consumption of morphine between high-income countries and lower income countries.

Consumption pattern varies significantly across countries of similar wealth, it does not correspond to medical need as indicated by the estimated number of days people are in pain or suffer with severe shortness of breath for people with a terminal illness.

This data echoes that of the 2018 Lancet Commission, which described the lack of access to pain relief medication as "one of the most heinous, hidden inequities in global health" with the richest 10 per cent of countries possessing 90 per cent of distributed morphine-equivalent opioids.

"Leaving people in pain when effective medicines are available for pain management, especially in the context of end-of-life care, should be a cause of serious concern for policymakers," says Dr Yukiko Nakatani, WHO assistant director general for medicines and health products. "We must urgently advocate for safe and timely access to morphine for those in medical need through balanced policy, everywhere."

REASONS FOR THE DISPARITY

Access to morphine for medical use is influenced by many interacting factors, including enablers related to good governance, reliable/efficient procurement and supply processes, resource availability, and capacity-building activities, along with barriers related to overly restrictive legislation and policies, inadequate service provision, and misinformed attitudes and perception.

Given different country contexts, enablers, barriers, and priorities for action vary, a stakeholder survey presented in this report, with respondents from 105 WHO member states, confirms this variation. For example, irregular supply of morphine and other strong opioids at health facilities due to limited financing were commonly noted as a barrier in low- and middle-income countries compared to high-income countries. More than a third of respondents across all regions also noted barriers arising from legislative and regulatory factors, while recognising the importance of a legislative and regulatory framework in achieving safe access. Unduly restrictive requirements could hamper patient access because they impede the flow of supply or make prescribing and dispensing difficult for health-care professionals.

It is important to note that concerns about the potential harmful effects of opioids are valid, such as their potential to lead to opioid use disorder. For this reason, a certain amount of caution about the potential harms of opioid use, for example, use in chronic non-cancer pain, is important for public health insofar as its use is well informed and proportionate to risks. Such concerns should not undermine the benefits of opioid use when clinically indicated and when used safely by trained professionals.

OPPORTUNITIES FOR ACTION

The report presents a complementary set of areas for action that aim to improve safe access to morphine. These include implementing small-scale regional or state-wide programmes on improving access to morphine for medical use with a package of essential services and products for palliative care that is formulated according to the WHO Model List of Essential Medicines and the WHO Essential Package of Palliative Care. They also include improving governance; streamlining procurement and supply processes to address any inefficiency; improving resourcing, such as stable funding; enhancing competent skill sets of the health workforce; and raising awareness about both the benefits and potential harms of opioid use. The success of these actions will hinge on collaboration and cooperation among all stakeholders at national, regional, and global levels.

“The launch of the Diabetes Nutritional Management Toolkit was held as part of CARPHA’s celebration of Caribbean Nutrition Awareness Month 2023”

View the full post CARPHA Diabetes Nutritional Management Toolkit on NOW Grenada.

The FDA approved Roche’s Columvi as a third-line treatment for a type of blood cancer called diffuse large B-cell lymphoma. This new Roche drug will compete against Epkinly, AbbVie’s recently approved DLBCL drug.

As hot days become more extreme and common, California education researchers are urging that school districts be required to develop heat plans to keep students safe, just as they have policies for severe storms and active shooters.

A policy brief published last month by the UCLA Luskin Center for Innovation offers a series of recommendations on how education and building codes can help schools become more heat-resilient in the face of global warming. State Sen. Caroline Menjivar, a Democrat, introduced legislation this year requiring schools to have heat plans by 2027, and another bill would make it easier for schools to create more shaded spaces.

“Obviously, the California Education Board wasn’t set up to think about climate change. But now that climate change is a reality, virtually every sector is going to have to think about it,” said V. Kelly Turner, an urban planning associate professor and the director of the Luskin Center.

The center’s recommendations include steps such as setting an indoor temperature limit, documenting the air-conditioning and shade infrastructure of each school, and investing in shade and greenery for play areas. The brief also calls out areas needing more research, such as the safest indoor temperature range.

The best way to keep kids cool is perhaps the most obvious: providing shade, which can reduce the heat stress experienced throughout the day by 25% to 35%, according to the Luskin Center.

That requires reconfiguring playgrounds to make them cooler, said Perry Sheffield, a pediatrician and an environmental medicine researcher at Mount Sinai in New York City. In addition to shade, swapping heat-absorbing materials like asphalt and rubber for grass and wood chips helps cool things down.

“The more we can encourage play as well as physical activity, the healthier our kids are going to be, so figuring out a way to do that safely is really key,” said Sheffield.

On a playground in the San Fernando Valley, Turner said, she once measured 145-degree asphalt and 162-degree rubber — hot enough to cause a third-degree burn in seconds.

California already has millions of dollars of grant funding available for greening schoolyards and increasing tree canopy, such as the Urban and Community Forestry grants through Cal Fire that set a goal to shade at least 30% of school campuses.

To help schools make the best use of funding for extra trees, Turner and her graduate student Morgan Rogers are modeling how increasing the tree canopy to 30% can affect heat stress. They will compare different tree configurations, like dispersed or clustered, and hope to issue recommendations this fall.

Legislators in Sacramento are also looking at amending state building codes to make it easier for schools to install shade structures. Currently, the rules require that an additional 20% of the budget be spent on any new construction or renovation to make an accessible path to the completed project. The bill would add an exception for free-standing shade structures.

Schools would still be required to meet accessibility requirements, but installing a shade structure wouldn’t trigger additional construction. “That’s what we are asking, not to be exempted from those requirements, but to not put the burden on the shade structure,” said Mark Hovatter, chief facilities executive of the Los Angeles Unified School District.

Menjivar said she was excited to see the new UCLA research. Her bill would require the state Department of Education to develop a template for schools to follow in creating their own heat plans, which would have to be completed by 2025 for implementation in 2027. The bill recently passed the state Senate and is now being considered in the Assembly.

Schools outside California are also reckoning with the heat. Researchers at Arizona State University partnered with public health experts and school leaders last spring to develop guidelines for “HeatReady Schools.” The 30 recommendations span topics like school policy (e.g., access to a health professional), the environment (shade coverage on at least half the playground), and training (workshops on identifying heat illness).

The program is working with 35 schools and community centers in Phoenix, with plans to expand to all of Maricopa County by 2026.

Preparing for the warming climate is front of mind for Principal Brad Rumble at Esperanza Elementary School in Los Angeles. The school’s heat-resilience efforts started with filling empty tree wells in front of the campus in 2014. Now, the school boasts a shaded courtyard and a native plant garden, and, courtesy of a grant from the district, more trees are on the way.

“We work together to make sure that our students’ needs are addressed on hot days,” Rumble said. “And, certainly, as more shade becomes available on this campus, we will be able to address those needs even better.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The findings, published in Open Forum Infectious Diseases, underscore the importance of utilizing alternative methods to identify this gastrointestinal illness's new surges.

Cholera, a severe diarrheal disease, often occurs in regions with weak or broken-down infrastructure, where laboratory capabilities may be limited. Dr Louise C. Ivers, the Harvard Global Health Institute director, emphasized the significance of robust laboratory-based surveillance to detect ongoing transmission, identify outbreaks early, and facilitate prompt public health responses.

● To evaluate whether cholera had been eliminated or was still circulating at lower rates in Haiti, the researchers enrolled 60 participants with acute watery diarrhoea meeting the clinical definition of cholera.

● The study participants, aged seven months to 80 years of age, were enrolled between September 2018 and March 2019.

● Stool culture demonstrated reduced reliability in identifying cholera cases, with a sensitivity of 33.3% and specificity of 97.4% compared to PCR, considered the gold standard.

● The addition of PCR testing allowed for a more comprehensive assessment of cholera cases that may have been missed during the period of low incidence in Haiti.

Although the study's results are based on a small sample size and do not drastically alter our understanding of cholera, they highlight the potential benefits of incorporating novel techniques into cholera surveillance. Molecular tools like PCR can enhance the ability to accurately identify and differentiate cholera from other pathogens causing diarrheal diseases.

Dr. Ivers emphasized the importance of understanding when and how to utilize molecular tools for cholera research, screening, and surveillance. These tools can play a vital role in improving our understanding of the disease's transmission patterns and facilitating timely interventions.

Cholera, which plagued Haiti for almost a decade after a devastating earthquake in 2010, was declared eradicated in the country in early 2022. However, a recent resurgence of the disease since last fall has raised concerns. Between October and December alone, over 13,600 suspected cholera cases and 283 deaths were reported in Haiti.

While the study highlights the limitations of stool culture during periods of low cholera transmission, further research and larger-scale studies are needed to validate the findings. Implementing traditional and molecular diagnostic methods could enhance cholera surveillance and response strategies, particularly in resource-limited settings.

Efforts to control cholera outbreaks and prevent the spread of this waterborne disease require ongoing vigilance, improved laboratory infrastructure, and innovative approaches for timely detection and response to emerging cases.

Reference:

Guillaume Y, et al. Open Forum Infect Dis 2023;doi:10.1093/ofid/ofad301.