This is National Nurses Month, and North Carolina lawmakers continue to debate lifting restrictions for advanced-practice registered nurses so they can provide care without physician oversight.

More than two dozen states have passed laws similar to the SAVE Act, which stalled in the General Assembly last year.

Vincent Guilamo-Ramos, dean of the school of nursing and vice chancellor for nursing affairs at Duke University, said many of the state's health-care access problems existed before the pandemic and now have reached a breaking point.

"Ninety-seven of North Carolina's 100 counties are actually classified as primary health-care-professional shortage areas," he said. "In those particular counties, there's either no access to care or there's suboptimal or limited access to care."

Guilamo-Ramos said expanding Medicaid would make health-care affordable for an estimated half-million more residents, although North Carolina is one of a handful of states that has chosen not to do so. He said he believes independent APRNs could step in to fill gaps and reduce costly emergency-room visits.

But groups such as the American Medical Association, maintain that physician oversight is needed for patient safety and quality of care.

Winifred Quinn, director of advocacy and consumer affairs at the AARP Public Policy Institute's Center to Champion Nursing in America, countered that physician oversight, which is often done remotely, has little to no impact on APRNs' ability to deliver top-notch primary care.

"Decades of research shows that that kind of chart review has no impact on quality of care," she said.

Guilamo-Ramos said independent-practice nurses could ease the burden on the state's health-care system and create better outcomes for patients, who consistently have ranked nursing as the most trustworthy and ethical profession.

"And that comes from longstanding, 30-years-plus of data that has shown that clinical outcomes associated with NP practice are good," she said.

Research from the University of North Carolina Chapel Hill showed that the state could potentially lose around 21,000 nurses to retirement by 2033.

By Marlowe Starling and Andrew Wasley for Sentient.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the Sentient-Public News Service Collaboration

As global leaders at the UN in New York pledged to tackle human suffering caused by antimicrobial resistance, the U.S. food giant Cargill was found to be slaughtering cattle containing residues of powerful antibiotics.

Data obtained by the Bureau of Investigative Journalism (TBIJ) covering the past two years showed that farms supplying Cargill are still using antibiotics that the World Health Organization (WHO) deems vital for human health.

Two years ago, TBIJ revealed that Cargill, which sold beef to McDonalds, sourced meat from farms that used at least five critically important antibiotics. At the time, Cargill said it was "committed not to use antibiotics that are critically important for human medicines," although it defended using other human antibiotics in farming.

This time, there were 12 different antibiotics found to be in use, including two of the most important types.

These drugs, known as "highest priority critically important" antibiotics or HP-CIAs, are so important for human health that the WHO warned livestock farmers to stop using them entirely. Use on farms can make the drugs - which are often the last treatments available for treating serious bacterial infections - less effective.

Leaders attending the high-level meeting at UN headquarters yesterday made an international declaration to cut the number of deaths caused by antibiotic resistance. The draft specifically mentions cuts in drug use on livestock farms.

Megan Brown, a sixth-generation hog and cattle farmer based in California, said that enforcement of existing rules on antibiotic use in farming in the U.S.: "Historically, we've shown we really can't be trusted unless we're made to."

Cargill said there was no evidence that beef with excessive antibiotic residues had entered the food chain as any cattle testing at these levels would be segregated, and that the company complied with relevant food safety standards.

New Rules in Farmers' Hands

In 2023, the US Department of Agriculture introduced a rule requiring a vet's prescription before farmers could get antibiotics for their animals. However, the new rule still leaves farmers in control of how to give antibiotics and relies on them to make sure there's enough time between treatment and slaughter, according to Crystal Heath, a vet.

Heath is also the founder and executive director of Our Honor, a nonprofit that advocates for animal welfare. She says that intensive livestock farming has created a vicious cycle that relies on confining animals in smaller and smaller spaces. This in turn increases the risk of sickness, leading to more antibiotics being used. "This is going to be a problem for as long as we raise animals this way," she told Sentient and TBIJ.

Daniel Czyz, a microbiologist at the University of Florida who studies antimicrobial resistance, said: "It all boils down to lowering the price of the production and increasing the profits for producers that are already struggling."

The FDA rule was meant to minimize people's exposure to antibiotic-resistant bacteria, which can increase the risk of superbugs spreading to people.

Antibiotic residues can linger in meat products if an animal is slaughtered too soon after being treated, before the drug has cleared its system. The U.S. government routinely investigates livestock farms that send animals for slaughter that contain drug residues, including antibiotics.

Brown, the cattle farmer, said that while some farmers still felt under pressure to send their animals on for slaughter soon after treatment, the FDA rule had changed how she used antibiotics. "I'm not going to send it to the yard until I know the withdrawal is gone," she said.

These days Brown uses vaccinations more often than antibiotics, which she says boosts the value of her cattle while reducing the risk of disease. The drugs, she added, are expensive.

Antibiotic Wild West

While Brown has taken steps to reduce antibiotic residues, the US Department of Agriculture's food safety agency recently questioned certain meat industry claims that some beef products have been raised without antibiotics.

The agency collected samples from nearly 200 cattle slaughtered at U.S. meat-packing plants and analyzed them for 180 veterinary drugs. One in five of the samples from the "raised without antibiotic" market contained antibiotic residues.

A prominent industry association continues to defend some controversial uses of antibiotics. Social media posts by the Animal Agriculture Alliance (AAA), a lobby group with links to Cargill through one of its board members, appear to endorse "preventative" antibiotics for farm animals - using the drugs on animals who are not unwell - despite concerns that this increases the risk of drug resistance. Preventative antibiotic treatment was recently restricted in the EU in 2022.

Another AAA post claims that there is "little overlap between antibiotics used in animal agriculture and antibiotics used in human medicine." This is at odds with the views of many public health experts, including the WHO, who agree that farms' use of antibiotics is directly contributing to drug-resistant disease in humans.

The AAA did not respond to requests for comment.

Cargill said: "Our position has been and continues to be a commitment to finding ways to reduce the use of human antibiotics across our operations and supply chains, while protecting the health and well-being of animals in our supply chains."

"We don't want to use antibiotics in agriculture that are clinically used for humans," said Czyz. He warned that once a disease develops resistance to a drug, it's difficult or impossible to reverse.

For real progress to happen, according to Czyz, there needs to be a coordinated global approach to the problem of antimicrobial resistance, as shown at the UN this week. "We cannot target [antimicrobial resistance] at one place if another place neglects the issue," he said.


Marlowe Starling and Andrew Wasley wrote this article for Sentient.


get more stories like this via email

A New York group has a new program to help veterans.

The Center for Independence of the Disabled New York's Veteran Direct Care program helps veterans choose a home care provider. Initially, the program began with a few veterans on Staten Island but has grown to include people from other New York City boroughs.

Sharon McLennon-Wier, executive director of the center, said the program has been a year in the making with some challenges along the way.

"There was a lot of paperwork to become a provider through the federal government, the Veterans Administration," McLennon-Wier explained. "It required a lot of background checks, it required developing a manual, a lot of training with getting connected to the VA portal system, their referral system, their payment structure."

Since the program's launch, she reported feedback has been positive since New York City did not have such a program before. McLennon-Wier noted it also provides benefits for veterans' caregivers, who can earn income from this program.

An AARP report showed caregivers for veterans spend an average of $11,500 of their own money, since they often require more advanced care.

Though the program is still relatively new, McLennon-Wier hopes to grow it into a new department at CIDNY to help veterans access necessary services but it comes as the state and nation face a shortage of mental health providers for veterans. She pointed out along with extra training, the roles involve an understanding of veteran culture.

"Post-traumatic stress disorder in a veteran is something that a clinician who hasn't worked with veterans needs to understand the nuances of it," McLennon-Wier emphasized. "It's a different military lifestyle. It's a different culture. It's a different mentality."

She added mental health providers would also need training to help veterans with traumatic brain injuries. A Department of Veterans Affairs Inspector General report found psychologists are the fourth top shortage position, while psychiatrists are the top shortage among specialty physicians.

November is National Diabetes Month and experts said with healthier habits, more Tennesseans can reverse prediabetes and prevent Type 2 diabetes and all its complications.

The prevalence of diabetes is quite high in Tennessee, at 14.6%, which is three points higher than the national average.

Dr. Griffin Rogers, director of the National Institute of Diabetes, Digestive and Kidney Diseases in Bethesda, Maryland, said it is possible to prevent the wide range of health problems caused by high blood sugar, from heart attack and stroke, to kidney disease and vision problems. Rodgers said a helpful acronym is "ABCs."

"The A stands for hemoglobin A1C. The A1C is a measure of what the average blood sugar is in the preceding three months. The 'B' stands for blood pressure, and the 'C' stands for cholesterol," Rogers outlined. "High blood pressure and high cholesterol, in addition to high blood sugars, can contribute to the nerve and blood vessel damage."

The "s" in ABCs stands for "stop smoking." He pointed out smoking can also damage your blood vessels and can cause or increase your risk of these complications.

Rodgers recommended a diet based on fresh fruits and vegetables, whole grains and lean proteins like fish. He also suggested replacing sugary drinks with water to improve overall health, plus regular exercise and getting seven to eight hours of sleep can help.

"On the physical activity side, 30 minutes a day, five days a week for most adults is what's generally recommended," Rodgers explained. "Just walking. And if you can't do the 30 minutes all at one time, breaking it into either two 15, or three 10-minute intervals is sufficient."

Rodgers stressed diabetes is preventable and manageable. He added it is important for people to have their blood pressure and blood glucose levels checked as part of their routine wellness visits.


get more stories like this via email