Acrocyanosis, venous pooling of blood in the legs that causes them to turn blue, may be yet another symptom of long COVID, according to a case report published in The Lancet.

The case report features a 33-year-old man who for 6 months experienced blue legs after 10 minutes of standing, accompanied by a heavy, itching sensation. The legs returned to a normal color after 2 minutes of lying down.

The man had never experienced blue legs until his long-COVID diagnosis and subsequent diagnosis of postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing. When lying down, the man's pulse was 68 beats per minute, but upon standing for 8 minutes, his pulse increased to a maximum of 127 beats per minute.

The authors of the report said there have been documented cases of acrocyanosis among children experiencing post-viral illness, but few cases have yet to be connected to long COVID.

"Patients experiencing this may not be aware that it can be a symptom of Long Covid and dysautonomia and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid," senior author Manoj Sivan, MD, said in a University of Leeds press release.

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Researchers said the increase in maternity deserts and poor access to care is in part due to obstetric  wards.  A whopping 5.6 million birthing people are finding themselves without access to maternity care as the prevalence of maternity deserts continues to grow, according to reports from the March of Dimes. 

These care access issues are compounded by the social determinants of health that also impact maternal health outcomes, the report authors said.

Illinois Report - download here.

Summary of the USA  Report- click here.

Report Shows 4% Drop in Birthing Hospitals with Nearly 6 Million Women Living in Areas with No or Limited Access to Care

The March of Dimes report comes as the healthcare industry grapples with a fraught maternal health problem.

Separate studies have found that the US has the worst maternal health outcomes and worst maternal health equity out of the developed world. On top of that, the Supreme Court’s reversal of Roe v. Wade has called into question overall access to all kinds of reproductive healthcare, not just abortion.

Now, March of Dimes is outlining the state of birthing and maternity care access, particularly by shining a light on maternity care deserts.

“A person’s ability to have a healthy pregnancy and healthy birth should not be dictated by where they live and their ability to access consistent, quality care but these reports shows that, today, these factors make it dangerous to be pregnant and give birth for millions of women in the United States,” Dr. Elizabeth Cherot, March of Dimes president and chief executive officer, stated publicly.

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Structural inequities and higher burden of social determinants of health are more than home-based care nurses can mitigate, researchers said.

Even with home-based care interventions, social determinants of health and structural barriers get in the way of good maternal health outcomes, a new Health Affairs study has found.  [Patient Engagement HIT]

The report, received under embargo, showed that a home-based nursing care program had a negligible impact on the health outcomes of pregnant, Medicaid-eligible people. That’s likely because structural barriers and other social determinants of health are likely more than nurses can mitigate.

These findings call into question the efficacy of home-based nursing care among pregnant populations and how such programs can be reshaped in the future.

The researchers zeroed in on the Nurse-Family Partnership (NFP) program, which offers home visits from a registered nurse to Medicaid-eligible pregnant people throughout their pregnancy and up to 24 months after delivery. NFP operates in 40 states and, as of 2020, has served more than 50,000 families. It also received additional funding as part of the American Rescue Plan Act of 2021.

As part of their home visits, NFP nurses use different patient-provider communication strategies to uncover targeted needs and to tailor healthcare and social services solutions. In addition, NFP nurses conduct mental health screenings, monitor pregnancy, and provide guidance on healthy behaviors related to exercise and nutrition.

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Medicaid Administrator Kelly Cunningham said last week they expect to have conversations in the coming months with federal partners regardingIllinois’ recently-submitted1115 waiver for behavioral health services.

The five-year extension application to the Centers for Medicare and Medicaid Services proposes 10 programs, including efforts to address food and nutrition services, employment assistance, non-medical transportation and community reintegration for previously incarcerated individuals.

While they await those negotiations with the federal agency, Cunningham told the Medicaid Advisory Board Friday that the next big step for the agency will be creating an implementation design for the initiatives. She said the agency will be working with stakeholders to help plan how to roll out the programs.

“It's really how do we design an implementation strategy so that these services and that this planning actually has the desired outcome in terms of improving health and addressing the needs of the Medicaid population," Cunningham said.

CMS said earlier this summer that they have extended the state’s demonstration through next June as the two sides negotiate over the current extension application.

The agency also said it is preparing to schedule a public hearing on changes to the Medicaid-like program for undocumented individuals ages 42 and older. The changes include a pause on new enrollees between the age of 42 and 64 and copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits.

The changes also will pause enrollment in the program for those 65 and older once the total number of members reaches 16,500. Officials said last week it has yet to meet that threshold.

Laura Phelan, policy director at the department, said the details of the meeting “will be forthcoming.”

Additionally, she said work is underway to create a dashboard to track enrollment data on the program.

“Our goal is to make it consumer friendly and also easily consumable,” Phelan said.

 The committee also approved a motion for the department to respond by year’s end to a report created by the MAC’s community integration subcommittee. The report lays out short- and long-term recommendations to increase the number of seniors and persons with all types of disabilities receiving services in community settings.

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When Denver Health wanted to open an inpatient opioid detox unit specifically for teens, doctors there searched high and low for a model to copy. They didn’t find one. [KFF Health News]

Teens who land in emergency rooms with an opioid overdose generally receive naloxone to reverse the effects of dangerous drugs in their system and are sent home with a list of places they can go for follow-up care. But too often, those teens never seek additional help. They are left to suffer through the agony of withdrawal with no medications to ease their cravings. As a result, many, seeking relief, go back to opioids, often with tragic consequences.

Christian Thurstone, the director of behavioral health services at the Denver hospital, said six of his teen patients have died of fentanyl overdoses in the past two years. Denver Health has now opened what he believes to be the nation’s first adolescent inpatient detox unit.

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It’s estimated that at least 1 in 5 people with a SARS-CoV-2 infection never develop symptoms. Genetics might explain some of these asymptomatic cases, it turns out. In a new study appearing in Nature, people with a particular gene variant appeared to have preexisting T cell immunity to the virus, likely a holdover from previous bouts of the common cold. [JAMA Network]

Why This Is Important

Hollenbach and her coauthors note that many studies have looked at genetic factors in severe COVID-19 disease, but fewer have examined the underpinnings of asymptomatic or mild infection. Insight into factors that allow the immune system to quickly clear the virus could help scientists better understand the disease and improve immunotherapies and vaccines, they say.

Benjamin Solomon, MD, who was not involved with the work, is clinical director of the National Human Genome Research Institute, part of the US National Institutes of Health. “It’s interesting to see a major study focus on people on the less-affected end of the curve, as this can be clinically important and offer useful biological insights, but may be less studied than the other end of the curve,” Solomon wrote in an email.

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-the misinformation is about misinformation.

Robert Califf, MD, the head of the FDA, doesn't seem to be having fun on the job.

"I would describe this year as hand-to-hand combat. Really, every day," he said at an academic conference at Stanford in April. It's a sentiment the FDA commissioner has expressed often. [MedPage Today]

What's been getting Califf's goat? Misinformation, which gets part of the blame for Americans' stagnating life expectancy. To Califf, the country that invents many of the most advanced drugs and devices is terrible at using those technologies well. And one reason for that is Americans' misinformed choices, he has suggested. Many don't use statins, vaccines, or COVID-19 therapies. Many choose to smoke cigarettes and eat the wrong food.

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...Findings  In 2018, the estimated economic burden of racial and ethnic health inequities was $421 billion (using MEPS) or $451 billion (using BRFSS data) and the estimated burden of education-related health inequities was $940 billion (using MEPS) or $978 billion (using BRFSS). Most of the economic burden was attributable to the poor health of the Black population; however, the burden attributable to American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations was disproportionately greater than their share of the population. Most of the education-related economic burden was incurred by adults with a high school diploma or General Educational Development equivalency credential. However, adults with less than a high school diploma accounted for a disproportionate share of the burden. Although they make up only 9% of the population, they bore 26% of the costs.

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In a round of interviews before he stepped down as director of the US National Institutes of Health (NIH) in December 2021, Francis Collins, MD, PhD, frequently discussed the problem of misinformation, which, many argue, became more rampant during the COVID-19 pandemic, thanks in large part to social media. [JAMA Network]

Some have used the term “infodemic” to describe the glut of COVID-19 information—much of it false or misleading—on social media. During a disease outbreak, an infodemic “causes confusion and risk-taking behaviors that can harm health” and “leads to mistrust in health authorities and undermines the public health response,” according to the World Health Organization.

When asked about the NIH’s role in pushing back against misinformation, Collins told Nature, “I wish we had more insights from behavioral social science research into how this has come to pass, and why it could have gotten so completely widespread.”

At the end of Collins’ tenure as NIH director, the agency planted the seed of a new program to support that very kind of research.

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