Thursday, January 22, 2015

Big majority supports domestic-violence orders for dating-only partners, and prospects for passage appear to be much better

By Melissa Patrick
Kentucky Health News

A large majority of Kentuckians say state law should allow domestic-violence protective orders involving dating partners, and the prospects for such a law appear to have improved considerably.

The poll found that 80 percent of Kentucky think dating partners should be allowed to get a protective order against a partner who had made them a victim of violence.

Under current law, such orders are available only to family members, members of an unmarried couple with a child in common, and unmarried couples who either live together or have lived together. All other states allow such orders for partners who are merely in a relationship.

The poll, taken Oct. 8 through Nov. 6, found 83 percent of women and 76 percent of men in favor of the change. Majorities in each political party also supported it: 84 percent of Democrats, 77 percent of Republicans and 75 percent of independents. The poll's error margin is plus or minus 2.5 percentage points.

"Kentucky is the last state in the country not to offer protections to victims of dating violence," said state Rep. John Tilley, D-Hopkinsville, chairman of the House Judiciary Committee. "It is time we changed that."

Tilley has sponsored the change for the past four years, but has failed to get it through the Senate, where President Robert Stivers, R-Manchester, has said dating partners already have ways to get protection from the justice system. But Tilley said in a telephone interview Thursday that he thinks Stivers has "come around."

He said this year's bill is still being drafted, but will have some significant changes from previous bills as supporters have worked to bring all of the stakeholders to the table.

"I am hopeful that this bill will pass because we seem to have key leaders prioritizing this bill, from the Senate president to the speaker of the house to the governor, and that is one difference I can point out from previous sessions," he said. "This bill will expand the current system to include victims of dating violence to be eligible to receive a protective order and be put into a national network that will then protect them wherever they go in this country."

Gov. Steve Beshear called for passage of the bill in his State of the Commonwealth address. First Lady Jane Beshear, a longtime advocate for this bill, told Linda Blackford of the Lexington Herald-Leader, "This is not only a top priority for me, it's a top priority for this office. Steve has been working with leadership to find a bill that is palatable to everyone in hopes we can pass it and then move on to other important things."

Domestic violence affects nearly one out of four American women in their lifetime, and in Kentucky one in three, according to The Center for Women and Families in Louisville.

"Domestic violence is a public health crisis of a staggering multitude," Marcia Roth, executive director of The Mary Byron Project, a non-profit that advocates for domestic violence issues, said in a phone interview. "It leads to $4.1 billion for direct medical and mental health services per year."

Not only is domestic violence a health issue because of its health-care costs, Roth said, "It goes beyond the physical wounds. Victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits and to miss more well-child visits with their children."

The populations most vulnerable to domestic violence are females between 16 and 19, with the numbers not much better for those 25 to 27. Most of these young women aren't married, don't live with their partner or don't share a child in common and have no immediate protections from dating violence, Tilley said.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati.

Heavy use of e-cigarettes may deliver big doses of formaldehyde, which can be a cause of lung cancer, study suggests

Vapor produced by electronic cigarettes can contain a surprisingly high concentration of formaldehyde—a known carcinogen that can cause lung cancer through prolonged exposure—researchers reported Wednesday in a study published in the New England Journal of Medicine, Rob Stein reports for NPR. (Getty Images by Dan Kilwood)

Use of e-cigarettes among rural teens has risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

"E-cigarettes work by heating a liquid that contains nicotine to create a vapor that users inhale," Stein writes. David Peyton, a chemistry professor at Portland State University who helped conduct the research, told Stein, "We simulated vaping by drawing the vapor—the aerosol—into a syringe, sort of simulating the lungs. That enabled the researchers to conduct a detailed chemical analysis of the vapor. They found something unexpected when the devices were dialed up to their highest settings."

The e-cigarette industry dismissed the report, saying they found formaldehyde only when e-cigarettes were cranked up to their highest voltage levels, Stein writes. Gregory Conley of the American Vaping Association told him, "They clearly did not talk to [people who use e-cigarettes] to understand this. They think, 'Oh, well. If we hit the button for so many seconds and that produces formaldehyde, then we have a new public health crisis to report."

"If you hold the button on an e-cigarette for 100 seconds, you could potentially produce 100 times more formaldehyde than you would ever get from a cigarette," Conley said. "But no human vaper would ever vape at that condition because within one second their lungs would be incredibly uncomfortable." (Read more)

Research suggests eating only during a nine- to 12-hour time period can help maintain healthy weight

For a long time, scientists supposed that eating after midnight was unhealthy, but now a study has provided support for the notion. When scientists prevented mice from eating whenever they wanted, the animals avoided obesity and metabolic issues—even when the diet was unhealthy, Ben Wiseman reports for The New York Times.

In a previous study, researchers at Salk Institute for Biological Studies in San Diego began studying mice eating patterns. The mice in the study that weren't permitted to eat whenever they wished gained weight and became unwell, while the mice who were only permitted to eat during an eight-hour window didn't gain much weight or develop metabolic problems.

The new study, which was published in the journal Cell Metabolism in December, Salk scientists provided groups of mice with one of four diets: high-fat, high-fructose, high-fat and high-sucrose and regular mouse food. "Some of the mice in each dietary group were allowed eat whenever they wanted throughout their waking hours; others were restricted to feeding periods of nine, 12 or 15 hours," Wiseman writes. The caloric intake for all the mice was the same.

Some of the mice in the time-restricted groups were allowed to eat whenever they wanted on weekends, and some of the eat-anytime mice were moved to the restricted groups halfway through the study. At the end of the study, the mice that ate whenever they pleased became obese and metabolically ill, but the time-restricted mice stayed healthy. The mice switched from the former group to the latter lost some of the weight they'd gained, Wiseman writes.

Though scientists don't know exactly why eating during a designated timeframe helps prevent weight gain, Dr. Satchidananda Panda, who oversaw the studies, and his colleagues think it has to do with the body's internal clock. "Meal times have more effect on circadian rhythm than dark and light cycles," Panda said. Circadian rhythm influences the function of many genes in the body that have to do with metabolism.

These studies have only been performed using mice, but Panda believes the results could apply to humans. He suggests that people only eat within a 12 hour—or shorter—window each day. The clock begins with the first thing a person eats in the morning. (Read more)

Study finds kids eat too much pizza, too often, and it's bad for their health

While pizza consumption is lower than it used to be, kids are still eating too much of it, and it's affecting their health, Roberto A. Ferdman reports for The Washington Post.

The health issues are a result of the extra calories, fat and sodium consumed when children eat too much pizza, too often, according to a study published by the journal Pediatrics from the University of Illinois - Chicago, Ferdman writes.

"When you eat extra calories and don't compensate for it at another point of the day or week, it can lead to weight gain and even obesity," William Dietz, one of the study's authors and the director of the Sumner Redstone Global Center for Prevention and Wellness at the George Washington University, told Ferdman.

Obesity is a real problem for many of Kentucky's children. The state is ranked first for high school obesity, eighth for obesity in children aged 10 to 17, and sixth for obesity among 2- to 4- year-olds from low income families, according to the States of Obesity report.

The researchers tracked the diets of more than 11,000 children and teenagers using data from the National Health and Nutrition Examination Survey and found that "On any given day, roughly 20 percent of all children aged 2 to 11 and adolescents aged 12 to 19 eat pizza," Ferdman reports. The younger children eat roughly 400 calories and teens upward of 600 calories on the days they eat pizza, rarely with a healthy side like salad or vegetables.

This boils down to pizza days being associated with "considerably higher" intakes of saturated and sodium, and an extra 84 calories for children and an extra 230 calories for teens.

"There are a bunch of takeaways from the study. But the biggest thing is that parents are serving their kids too much pizza," Dietz told Ferdman.

It's cheap. It's convenient. It's universally loved. And an estimated 3 billion pizzas are eaten every year in the United States. "What's to be done?" Ferdman asks.

"We're not suggesting that kids avoid pizza altogether,"Dietz told Ferdman. "But when parents serve it, it's important that they understand it's extremely caloric. They should serve smaller pizzas, or at least smaller slices. They might also want to serve it with vegetables instead of sausage on top."

Sunday, January 18, 2015

Weekly paper in Carter County runs voluntary-response survey about statewide smoking ban, finds slim majority in favor

Wikipedia map: Carter County
The Journal-Times, the weekly newspaper in Carter County, is running an online "poll" of reader opinions about the proposed statewide smoking ban and finding a slim majority in favor of it. At 4:20 p.m. Sunday, 52.3 percent of the voluntary respondents said they favored the legislation, while 45.4 percent said they opposed it and 2.3 percent said they didn't care.

Despite those numbers, reporter Leeann Akers writes that the idea "seems to be unpopular in Carter County," based on "overwhelming opinion on social media." She cites the Facebook page of the Carter County Citizens For a Better Way and this post from Brandon Boggs: “If a business wants to prohibit smoking they have that right, however, we have the right to support that business or not depending on our personal preferences.”

Some posters on the page favor the ban. Travis Horton wrote: "I as a nonsmoker think people that smoke in restaurants or in businesses are showing disrespect for people with health issues and other things."

A continuing national survey by the federal Centers for Disease Control has found that between 31 and 46 percent of Carter County residents smoke, with the most likely number being 38 percent, well above the statewide figure of 29 percent in the same survey.

Akers reports that the county's two state legislators, "Sen. Robin Webb and Rep. Jill York, both say they remain undecided on how they will vote if it comes to the floor but both have a history of following their voters." She gives the legislators' email addresses and the telephone number to leave a message for them.

"This is the sort of story that most local newspapers with websites can do," said Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News. "But I suggest that they avoid calling any voluntary-response survey a poll, because that word implies that the results are from a scientific, random sample, and that they remind readers of that in giving the results."

New rule will improve reporting of antibiotic-resistant infections in health-care facilities, which are getting worse in Kentucky

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Kentucky will have a new weapon, in the form of data, to fight infections acquired in hospitals and other health-care facilities, with legislative approval of a regulation that changes the way antibiotic-resistant infections such as MRSA and C. difficile are reported.

Health Watch USA chart, Centers for Disease Control data
The new rule comes at a time when Kentucky has the third highest rate of MRSA bloodstream infections in the nation, according to the National Healthcare Safety Network. The state was ranked fourth last year.

Kentucky hospitals are 27 percent worse for MRSA (methicillin-resistant Staphylococcus aureus) and 21 percent worse for catheter-associated urinary tract infections than they were two years ago, according to the federal Centers for Disease Control's National and State Health-care Associated Infection Progress report.

The legislature's Administrative Regulation Review Subcommittee approved the regulation, which has been in the works since 2008, at its Jan. 13 meeting. In the meantime, hospitals have succeeded in changing the term "hospital-acquired infections" to "healthcare-associated infections" to indicate that not all such infections occur in hospitals.

"The emergence of these dangerous organisms is really a problem of our entire heath care system and it can't be fixed by any single facility or facility type," Kevin Kavanagh of Somerset, chairman of Health Watch USA, a non-profit organization that promotes health care transparency and patient advocacy, told the committee. For his testimony, click here.

The regulation redefines HAIs and HAI outbreaks for infections, and requires simultaneous data reporting to the CDC and the state Department for Public Health. The CDC already has the data, but has "no authority" to act on it, while the state health department has the authority but not the data, Kavanagh wrote in an opinion piece for the Lexington Herald-Leader. "It is imperative that we know what is happening and where, so effective action can take place."

He told the committee, "Data for action is critical. It is the first step to confront these dangerous organisms."

The regulation also will require electronic reporting via the Kentucky Health Information Exchange beginning 2016. It now goes to Gov. Steve Beshear for final approval, which is expected.

Rep. Tom Burch, D-Louisville, chair of the House Health and Welfare Committee, told the joint House-Senate regulations committee that he had worked on the regulation for many years and that the Kentucky Hospital Association supported it. It had lobbied against such regulations. "There is nobody against it right now," Burch said.

However, Sen. Alice Forgy Kerr, R-Lexington, said "This regulation seems to have caused a lot of indigestion for a lot of people," and asked for a "statement of confirmation" from someone representing a group that might have opposed it in the past.

The hospital association's vice president of government relations, Sarah Nicholson, was at the meeting but didn't speak. Dana Stephens, director of infection prevention and control at St. Joseph East Hospital and St. Joseph Jessamine, told the committee, "I have had the great pleasure and honor of working with this multidisciplinary team for the past many years to really develop legislation and regulatory language that will provide information that will improve the health of those citizens we serve."

Kerr commended the groups on reaching a compromise, but the elements of the compromise were unclear. Nicholson declined to comment after the meeting.

Kavanagh said afterward that the regulation is needed to reverse the apparent increase in hospital infections, based on the CDC data from 38 of the state's 93 hospitals. "We are going in the wrong direction, with Kentucky 27 percent worse than it was two years ago," he noted. "This regulation will help with that."
Centers for Disease Control graphic reports Kentucky data on health-care-associated infections
The regulation is expected to improve the accuracy of Kentucky's HAI data because it requires all health-care facilities to submit reports and more clearly defines HAIs, which Kananagh said will help with under-reporting of infections.

New regulations often raise questions about the cost of enforcing them. Kavanagh told the committee that the CDC had told him that it would be allocating "a lot of federal money" to state health departments through grants to confront infectious disease issues, a result of the lessons learned from Ebola. Better HAI data will support Kentucky's need for these grants, he said.

"So, I do believe the state health department, along with other entities, will have access to funds to implement this regulation change,” he said.

Friday, January 16, 2015

Low-income smokers have a harder time quitting, which helps explain why Kentucky leads the nation in smoking

Lower-income smokers have a harder time quitting than health-conscious middle- and upper-class Americans, Keith Humphreys reports for The Washington Post.

The numbers suggest one reason why Kentuckians lead the nation in smoking. Kentucky ranks 48th among the states and the District of Columbia in median household income in 2011-13, according to the Census Bureau; it ranked 45th in per-capita personal income in 2013, according to the Bureau of Economic Analysis.

The pol'ls margin of error was plus or minus 1 percentage point.
A 2008 Gallup poll of more than 75,000 Americans showed that the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more. The higher the income category, the lower the smoking rate, except those making less than $6,000 per year, which was skewed because many in this bracket are students, Rob Goszkowski writes for Gallup.

Once health warnings about cigarettes became widely known, better-off Americans were more likely to quit smoking. "High-income families decreased their smoking by 62 percent from 1965 to 1999, versus only 9 percent for low-income families," Humphreys reports. Education may also be a factor; income and education are usually closely related.

Humphreys list three reasons poorer smokers have a hard time quitting:
1. They inhale more deeply on each draw from a cigarette, creating stronger addiction and making it harder to quit.
2. They don't have the same social support from their colleagues and friends as wealthier smokers. For example, a doctor is likely to be encouraged to quit smoking or get social disapproval if he or she is the last of their peers to stop; a person who works at roadside cleanup might "face precisely the reverse social incentives from his smoking coworkers," Humphreys writes.
3. They are likely to have less access to effective smoking-cessation programs and less access to address behavioral health issues, like depression, that make quitting more difficult. Kentucky has addressed those problems recently by having Medicaid cover smoking cessation and behavioral-health care by any licensed provider.

Some suggest that because lower income smokers have a harder time quitting, using higher tobacco taxes as an incentive for them to quit should be re-evaluated. Humphreys writes, "Deeply addicted, low-income smokers may face the choice between spending much-needed income on tobacco or venturing into the black market for untaxed cigarettes, which carries significant risks of its own."

Kentucky's cigarette tax of 60 cents a pack is lower than all but 10 states. New York ranks first at $4.35 per pack, which pushes the price of cigarettes to $10-$15 a pack, according to the Campaign for Tobacco-Free Kids website.

Clark County schools engage students as taste-testers in search for newly required, healthy foods the kids will eat

New federal nutrition standards "are not universally popular with students" in Clark County — some throw away recently required fresh fruits and vegetables — but "participation in school lunch programs has not been greatly affected," Whitney Leggett reports for The Winchester Sun after reading School Nutrition Director Becky Lowery's annual Wellness Report Card.

“This is a way for us to just sort of look at where we are and evaluate what we can do better,” Lowery told Leggett. The report highlights the requirements of the 2010 Healthy Hunger-Free Kids Act, such as a switch to whole-grain products, restrictions on fat and salt, and age-based calorie limits.

The greatest resistance has been to fruits, vegetables and whole-grain bread and pasta, Lowert told Leggett. Despite the complaints, participation in the school lunch and breakfast programs has only decreased by 1 percent since the 2013-14 school year, Leggett reports, along with a localized illustration.
To improve student satisfaction, Lowery implemented a student panel to taste possible new menu items. “It is much more difficult and more expensive to find good quality products that students will accept,” she told Leggett. “We’re just always trying to find good products that will still meet regulations.”

As part of the Farm to School initiative, Clark County strives to use more Kentucky Proud products, such as corn grown in Clark County, green beans from Louisville, and Western Kentucky blueberries, Lowery told Leggett. “As I hear about more things available to us that we can use, I will look into them,” she said. “We try to use as much as we can.”

Officials of hospitals and state government to discuss future of Ky. health care at Jan. 29 'summit' In Frankfort

State government and the Kentucky Hospital Association will co-host a summit for hospital CEOs, hospital board members and other elected officials and decision makers on the future of health-care delivery in Kentucky on the afternoon of Jan. 29 at the Capital Plaza Hotel in Frankfort.

“The health-care market and delivery systems all across the nation are currently undergoing an unprecedented transformation,” Gov. Steve Beshear said in a statement. “The rapid pace of this transition poses challenges to healthcare stakeholders, both rural and urban, that are facing fundamental changes to how they deliver care to patients in our communities.”

State Health Secretary Audrey Tayse Haynes said the state "has been very successful in getting Kentuckians enrolled in quality, affordable health-care coverage," but "We must now translate that coverage into quality, efficient and effective treatment. . . . The methods of treatment delivery must adapt to accommodate this new population of patients.”

Under federal health reform, hospitals are moving from volume-based to value-based reimbursements, and getting a larger share of Medicare and Medicaid patients, and for some that has meant empty beds, lower revenues and in some cases bankruptcy. Many Kentuckians have chronic illnesses, "which result in very low margins for some providers," a state news release said.

Letters of invitation have been sent to all members of the General Assembly and hospital CEOs. Space is limited, so invited guests are encouraged to register soon.

Thursday, January 15, 2015

1/4 of Ky. adults say they have tried e-cigs; just over half of adults (but not the e-cig users) want them taxed and regulated

More than four in 10 Kentucky adults under age 30 have tried electronic cigarettes, and the older and better off economically Kentuckians are, the less likely they are to have tried them. Overall, one-fourth of Kentucky adults and 60 percent of current smokers have tried the devices.

Those are major findings of the latest Kentucky Health Issues Poll, which also found that 61 percent Kentucky adults want the U.S. Food and Drug Administration to regulate e-cigarettes and 53 percent want them to be taxed in the same way as traditional cigarettes.

The poll, taken Oct. 8-Nov. 6, has an error margin of plus or minus 2.5 percentage points. It was conducted by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,597 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones.

The poll was conducted for the Foundation for a Healthy Kentucky and the Cincinnati-based Interact for Health nonprofit. “Last year, Kentucky became one of dozens of states to prohibit the sale of electronic cigarettes to minors,” Susan Zepeda, president and CEO of the foundation, noted in a news release.

The poll didn't ask respondents if they were currently using e-cigarettes, but the data offer some interesting details: Men (29%) were more likely than women (20%) to have used an e-cigarette, and college graduates (14%) and were less likely than others (27%) to have done so. So were residents of the Lexington area, at 16%. Among those who said they previously smoked cigarettes, 19 percent said they had tried the electronic version.

As might be expected, current smokers those who had used an e-cigarette were much less likely to say the devices should be taxed like tobacco cigarettes.

Elizabethtown doctors who paid millions to settle claims of bill-padding are sued by chemotherapy patients

"Eight former patients or their estates have sued the Elizabethtown cancer doctors who paid the government $3.7 million last June to settle claims they extended chemotherapy treatments to pad their bills," Andrew Wolfson reports for The Courier-Journal. "The ex-patients or their families say in a suit filed in Hardin Circuit Court that the clinic negligently treated them by diluting treatment drugs and extending treatment periods, which allowed them to bill more to Medicaid and other programs." As a result, the plaintiffs say, they suffered unnecessary pain and anguish, and those who died did so prematurely.

The physicians whom the suit identifies as owners of the clinic, Yusuf Deshmukh and Rafiq Rahman, are under investigation by the Kentucky Board of Medical Licensure. "The clinic's owners agreed to pay $3,739,325 last June to resolve allegations that they submitted false claims for payment to the Medicare, Medicaid and the military's medical provider for extending the duration of chemotherapy infusion treatment to patients, and for inappropriately billing office visits for infusion therapy," Wolfson reports.

Wednesday, January 14, 2015

Foundation for a Healthy Kentucky lists 2014 grants

The Foundation for a Healthy Kentucky has provided more than $1.3 million in 2014 for community programs, polling and policy initiatives to not only advise policymakers but also advocate for better health and health care across the state.

"Our strategies to address the unmet health care needs of Kentuckians are built on investment at the local and state levels," Susan Zepeda, president and CEO of the foundation, said in a news release.

The foundation said it donated $125,000 to Kentucky Voices for Health, a coalition of lobbying groups that support health reform; $50,000 to Kentucky Youth Advocates, an organization dedicated to the improvement of public policies that influence the lives of children and families and $60,000 to the University of Cincinnati for the 2013 Kentucky Health Issues Poll.

As part of a 2012-17 strategic plan to help school-aged children grow up to be healthier than their parents, the foundation provided three grantees money to set in motion the business plans they developed. Recipients included: Clinton County School District ($158,361), Fitness for Life Around Grant County ($182,033) and Louisville Metro Department of Public Health and Wellness ($161,850). The foundation also funds a multi-year study of Kentucky's transition to managed-vcare Medicaid.

The foundation matched a $3 million federal investment to begin nurse-managed clinics, telemedicine, mobile health services, care navigation and and an activities center. These projects "have improved the quality of life for more than 20,000 Kentuckians and provided training for more than 250 providers," according to the release.

To support the improvement of health literacy in Kentucky, the foundation invested $100,000 in health programming on KET, and $25,000 with the Institute for Rural Journalism and Community Issues at the University of Kentucky , mainly for the publication of Kentucky Health News.