Saturday, September 24, 2016

U.S. attorney general hears from Central Ky. families of overdose victims, who offer suggestions on what needs to be done

U.S. Attorney General Loretta Lynch attended events in Lexington and Richmond this week as part of the first national Prescription Opioid and Heroin Epidemic Awareness Week, Bill Estep reports for the Lexington Herald-Leader.

In Lexingon, families who have lost loved ones to drug overdoses shared their stories with Lynch: stories about lying awake at night wondering if their addicted son would make it home, stories of desperation in the search for treatment, stories about the difficulties in paying for treatment and stories about the death of their loved ones.

“We cry every day,” said David Greene of Lexington, whose son Domonique, 23, died of a heroin overdose last October, leaving behind a baby daughter.

Drug overdose deaths in Kentucky rose to a record 1,248 in 2015, compared with 1,088 in 2014, according to the latest annual report from the Kentucky Office of Drug Control Policy.

Members of the group USA HEAT, which stands for U.S. Attorney's Heroin Education Action Team, met Lynch in Lexington at the office of U.S. Attorney Kerry Harvey, whose office helped to set up the group.

The group was created to help members share their stories to increase understanding of heroin and painkiller abuse, and have since presented "to more than 2,500 people at schools, churches and other locations, including the federal prison in Manchester," Estep reports.

In addition to their personal stories, members of the group told Lynch what they thought was needed to fix the problem, including more efforts to educate parents about the issue; "more effective prevention education for young people; better ways for families to find treatment resources; treatment that lasts long enough; quick access to treatment in the moments of clarity when addicts reach for help; and more affordable treatment options," Estep writes.

Harvey told Estep that he was not aware of a similar program in any other U.S. attorney’s office, and his office told Estep that Lynch mentioned trying to replicate it.

“Their stories were devastating, but their resolve to spare other parents the same fate is inspiring,” Lynch said at the University of Kentucky.

Before meeting with the USA HEAT members, Lynch was part of a discussion about heroin and opioid abuse at Madison Central High School, where about 500 students from Madison Central, Madison Southern and Richmond Model Laboratory high schools attended.

"Dozens raised their hands when Lynch asked how many knew someone who had overdosed. Far fewer raised their hands when she asked how many people had survived," Estep writes.

Alex Elswick, who is in long-term recovery from addiction to heroin and pain pills, told the students he got hooked after he had his wisdom teeth removed and received pain pills, Estep reports. “You don’t know what you’re in for” when using drugs, he warned them.

Kayla Greene told students to not use any drugs, even marijuana, saying that her son used marijuana but eventually moved to pills and heroin.

Lynch told one student who asked what to do if they had a friend with a drug problem to tell a trusted adult about it. “You’ve gotta get in between your friend and that problem,” she said.

At UK, Lynch announced $8.8 million to improve state prescription monitoring systems, including Kentucky's system.

President Barack Obama has called for $1.1 billion in new federal spending to fight opioid abuse, with a large part of it going to make medication-assisted treatment more widely available. "The administration estimated in June that Kentucky would get up to $18 million over two years to boost access to treatment for opioid abuse if Congress approves Obama’s budget request."

Friday, September 23, 2016

Lung transplant recipient who battled bureaucracy to get coverage, dies five days after being widowed; funeral is Sunday

"Katie Prager, the Kentucky lung transplant recipient whose story with her late husband, Dalton, touched millions, has died," reports Cheryl Truman of The Lexington Herald-Leader. Katie and Dalton met online and married in 2011. "Both had cystic fibrosis, and both had lung transplants that failed."
(Lexington Herald-Leader photo.)

Katie, 26, died in her Flemingsburg home early Thursday, a family member said.

Debra Donovan, Katie's mother, said it was Katie's wish to be surrounded by loved ones in her final moments. “Early this morning she gained her wish of being at home, in her bed, surrounded by her mom, dad, brother and her dogs, dying peacefully away from the hospital, tubes, IVs,” Donovan, wrote Thursday morning on Facebook.

"By the time Katie's close-knit Fleming County family gave her a Christmas-in-September party on Saturday, she was underweight, her once-abundant blonde hair sparse, her color waxen." Truman writes. "She had made a decision to discontinue all life-extending measures except for dialysis and had entered hospice care. She was sleeping a great deal, using an oxygen tank and getting weaker by the day."

Hours before the start of the family gathering, Dalton died in his hometown of St. Louis. "He had been trying to get to Kentucky to see his wife, who was in Hospice care after her own failed lung transplant, one last time," Truman writes.

Read more here:

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Katie and Dalton received national attention because they both had "the Burkholderia cepacia infection, which limited the number of surgery centers specializing in their conditions," Truman writes. "Dalton received his lung transplant in November 2014. Katie, after a lengthy bureaucratic snafu over insurance coverage, received her new lungs at the University of Pittsburgh medical center in July 2015." Both transplants were unsuccessful.

"During the Saturday Christmas party, Katie said that she believed in an afterlife and would see her husband again," Truman writes. "At the family gathering in Ewing after Dalton’s death, Katie said, 'I’ll see him soon.'”

Read more here:

Visitation for Katie will be 4 to 9 p.m. Sunday at Elizaville Christian Church in Flemingsburg. Funeral services will be at 10 a.m. Monday at the church.

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Thursday, September 22, 2016

Annual health forum looked at connections between health and the economy

The relationship between health and the economy in creating healthy communities was the focus of the 14th annual Howard L. Bost Memorial Health Policy Forum in Lexington Sept. 19. The theme of the Foundation for a Healthy Kentucky conference was "Health as an Economic Driver."

Through a series of TED-style talks, breakout sessions and a keynote address, the forum explored the relationship between health and the economy, offering insights on how anchor institutions can contribute to local economies; the high cost of health care and the lack of price transparency for consumers; and how racial inequities affect the cost of health care.

Health systems as employer and purchaser

Health systems can work as economic drivers in communities through buying local, hiring local and helping employees to live local.

Robert Eckardt
That's what three anchor institutions in Cleveland, Ohio, have done with the help of The Cleveland Foundation, Robert Eckardt, executive vice president of the foundation, said during his TED-style talk. The institutions are Case Western Reserve University and its School of Medicine, University Hospitals of Cleveland and the Cleveland Clinic.

The neighborhoods around the highly profitable anchor institutions are among the poorest in the state, Eckardt noted. His foundation asked the institutions to become stronger partners with the communites through a three part strategy: "Buy local, hire local and live local." The institutions have changed their hiring protocols to hire locally, adding a six-month training program to make it possible, and have agreed to work with three worker owned co-operatives.

Eckardt said foundations can be a "safe space" to help institutions think about their role in the community, noting that many of them have never even considered this an option or a responsibility. "I encourage you to think about how anchor institutions can change their perspective from an internal one to an external one," he said. 

Health care costs

High-deductible, consumer-driven health plans are designed to encourage patients to become more active consumers of their health care by seeking out best price and value, but often this information isn't readily available, said AJcScheitler, manager of stakeholder relations at the UCLA Center for Health Policy Research.

AJ Scheitler
Scheitler said an analysis of health-care costs in Los Angeles found the cost of a circumcision varied between $175 at a reputable clinic that does 20 to 30 circumcisions a day and $3,000 at a local hospital.

She said the cost of care in the U.S. is much higher than in other countries, citing an article by David Lazarus of the Los Angeles Times that told the story of a woman's experience getting a four-shot treatment for rabies in four different facilities that costs less than $20 overseas, and ran more than $5,000 in the U.S.

She mentioned a Reuters analysis of drug prices that found Americans pay seven and a half times more for their insulin than people in Great Britain, and a study published in the Journal of the American Medical Association that found the average cost of insulin in the U.S. more than tripled between 2002 and 2013, jumping to $736.09 from $231.48.

"We have no idea what we are paying for," she said, and though there is beginning to be some price transparency, it is not enough to be effective yet. 

Social justice, health and the economy

Adewale Troutman
Dr. Adewale Troutman, who identifies himself as a social justice and human rights activist, pointed out during his TED-style talk that poor communities with no employment or educational opportunities have poor health outcomes.

"It has been proven quite clearly that the most important number in your (health) profile is not your blood pressure, not your blood sugar or any of that," he said. "The most important number is your zip code. Where you live is the most important factor in your health outcomes."

Among other things, Troutman is the former president of the American Public Health Association with ties to Kentucky as a former associate professor in the University of Louisville School of Public Health and Information Sciences and former director of the Metro Louisville Department of Public Health and Wellness.

Troutman also noted how health inequities increase the cost of care, citing a study by Thomas A. LaVeist of John Hopkins University that examined the direct and indirect costs of providing health care to a sicker and more disadvantaged population.

The report says, "More than 30 percent of direct medical costs faced by African Americans, Hispanics and Asian Americans were excess costs due to health inequities, more than $230 billion over a four year period. And when you add the indirect costs of these inequities,the tab comes to almost $1.3 trillion."

"When you look at the issue of economics and health, it is quite clear that the relationship is very, very strong," he said.

Gail Carpenter
Dr. Gail Carpenter, a national expert in holistic health and diversity, also emphasized the importance of improving racial inequities as a way to improve health outcomes and to create savings in health care.

"The lions share of the cost savings that this country would experience if we were to achieve racial equity . . . are health care cost," she said in her keynote speech.

Carpenter, vice president for program strategy at the W.K. Kellogg Foundation, said that the unifying factor that connects racial inequity to poor health outcomes is exposure to adversity and to stress.

"People who have access to education, people who have access to income, people who are not subjected to discrimination and adversity have better health outcomes," she said. "And when they have better health outcomes, they have fewer interactions with the health care system and therefore they spend less."

The forum is held in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.
Co-sponsoring partners with the Foundation for a Healthy Kentucky were Kentucky Educational Television, Health Enterprises Network, Kentuckiana Health Collaborative, Kentucky Center for Economic Policy, Kentucky Chamber of Commerce, Kentucky Hospital Association and the Federal Reserve Bank of Cleveland.

Wednesday, September 21, 2016

Nov. 11 Health Coverage Workshop offers something for all journalists, even their bosses

Kentucky faces many unique health challenges, but they don't get enough news coverage, which hamstrings the state and its communities from fully addressing their health problems. These challenges and how to tackle them from a news perspective will be addressed at the Health Coverage Workshop on Nov. 11 at Natural Bridge State Resort Park in Slade.

The workshop is open to any Kentucky journalist, from those who are just starting to cover health issues to those with years of experience in the subject matter, and it offers something for everyone: reporters, editors, news directors, publishers, photojournalists and everyone in between. The workshop is free, thanks to the Foundation for a Healthy Kentucky.

Specific health topics will include oral health, smoking, obesity and cancer, where to find information on these issues and how to localize it for your audience. Revenue building through special health sections will also be addressed.

Several guest speakers will discuss their areas of specialization. Van Ingram, of the Kentucky Office of Drug Control Policy, and Kentucky Health News Senior Reporter Melissa Patrick will talk about how to cover one of Kentucky’s biggest, most complicated problems: opioid dependency and the consequences that follow.

Al Cross, director of the Institute for Rural Journalism and Community Issues, will discuss several topics, including proposed Medicaid changes and their implications for your readers, as well as the basics of managed care organizations that handle Medicaid for the state.

Jennifer P. Brown of the Kentucky New Era in Hopkinsville and Sharon Burton of the Adair County Community Voice in Columbia will discuss, respectively, how a small newspaper can cover health and how newspapers can use health sections to gain revenue and serve readers who need more health information. Finally, Cynthia Lamberth of the Kentucky Population Health Institute will talk about how to look for health policy in all stories.

Natural Bridge has made available a small block of rooms for those participants who would like to arrive the night before. Call the park at 800-325-1710 to make a reservation.

To register for the workshop, complete this registration form as soon as possible.

Direct questions to Danielle Ray at

Tuesday, September 20, 2016

Genetic testing is an option if you have a family history of breast cancer; regardless, if over 40 get an annual mammogram

October is Breast Cancer Awareness month, making it a good time to consider talking to your primary-care provider about genetic testing if you have a family history of breast cancer.

“Genetic testing is not recommended for all women, but can be helpful for those with a family history of breast cancer to determine if they are at risk,” said Dr. Mridula Vinjamuri of the James Graham Brown Cancer Center at KentuckyOne Health in a news release. “There is only a small chance that your family carries gene mutations that cause breast cancer. However, gene mutations account for about five to 10 percent of all breast cancers, so it is beneficial for women with a family history to be tested for these genes.”

Genetic testing helps determine if you carry certain genes that are known to cause breast cancer, such as BRCA1, BRCA2 and PALB2. Testing involves your physicians sending either a blood or saliva sample to the lab.

KentuckyOne Health notes that about 12 percent of women get breast cancer, but about 55 to 60 percent of women with the BRCA1 gene mutation will get breast cancer by age 70 and an estimated 45 percent of those with the BRCA2 gene mutation will by age 70. says that those with the PALB2 gene mutation have a 14 percent risk of developing breast cancer by age 50 and a 35 percent increased chance by age 70.

These gene mutations are inherited from a person’s mother or father. The release recommends that the first family member who has breast cancer get the gene test first, because if they don't have the gene mutations, then other family members won't either. Men with these mutations also have an increased risk of breast cancer.

KentuckyHealth One also notes the importance of seeing a genetic counselor before having any genetic testing to discuss the potential risks, limitations and benefits of the testing.

While there is no medical risks associated with genetic testing other than the slight risks associated with having your blood drawn, there are some psychological risks. The release notes that some who are tested become anxious, angry, sad or depressed because of the uncertainty related to finding out they carry the abnormal genes; others feel a sense of inevitability, though this may not be the case; and others struggle over what they should do next.

“Being aware of how to reduce your risk for a breast cancer diagnosis is very important," said Dr. Mounika Mandadi of the KentuckyOne Health cancer center, which provides breast cancer genetic counseling and testing. “Our goal at the clinic is to raise awareness of breast cancer, decrease risk of diagnosis, and provide chemoprevention.”

The release added that as you weigh the risks and rewards of testing to remember: "All women older than 40 should receive an annual mammogram, regardless of genetic testing results, as aging women are at risk for developing breast cancer." And remember, men can also get breast cancer.

Several Kentucky hospitals are now certified as 'Sexual Assault Nurse Examiner' ready facilities

Three Kentucky hospital systems have become the first in the state to obtain certification that demonstrates their ability to provide 24 hour response for sexual assault victims.

The newly certified "Sexual Assault Nurse Examiner" facilities include all of the St. Elizabeth Hospitals in Northern Kentucky, Fleming County Hospital in Flemingsburg and Meadowview Regional Medical Center in Maysville. They have a SANE nurse on call 24 hours a day, seven days a week.

"This designation demonstrates a commitment to providing a higher standard of care for sexual assault victims by ensuring they will be examined and treated by someone with skills and expertise necessary when dealing with this type of crime. This is certainly step forward for victims' rights in Kentucky," Health Secretary Vickie Yates Brown Glisson said in a news release.

SANE nurses have advanced training in the forensic examination of sexual assault victims and are credentialed by the Kentucky Board of Nursing. The certification was made possible by the "Sexual Assault Forensic Evidence Act," which passed the 2016 General Assembly with bipartisan support. The SAFE Act also addressed the backlog of untested sexual assault evidence kits in the state. Following its passage, Gov. Matt Bevin proposed an additional $4.5 million for the state crime lab to help it meet new testing deadlines set by the bill.

"Making sure sexual assault victims receive quality, compassionate care in the immediate hours following an assault can help them begin the long journey toward healing," Eileen Recktenwald, executive director of the Kentucky Association of Sexual Assault Programs, said in the release. "KASAP commends these hospitals for recognizing the importance of SANE readiness and seeking the certification, and we hope others follow suit."

The state Cabinet for Health and Family Services is required to certify SANE-ready hospitals annually and to post the list on its website. This list is also provided to the Kentucky Board of Emergency Medical Services, which then shares it with local EMS providers.

Health advocacy group that opposes new Medicaid proposal to hold eight community forums across the state to discuss it

This story was updated on 9/23/16.

Kentucky Voices for Health will host eight community forums across the state to discuss Gov. Matt Bevin's proposed changes to the state's Medicaid program during the 30-day federal comment period, which ends Oct. 8.

Each event will feature a brief presentation about the proposed changes, allow time for questions and will provide an opportunity for attendees to discuss how the proposed changes will impact them, their families and their communities, according to the website.

KVH opposes the governor's new proposal, saying on its website blog that it is "costly, complex and greatly reduces access to care."

The governor's new Medicaid proposal was submitted to the federal government in the form of a waiver from federal rules, under a section of law allowing for demonstration programs. It mainly targets able-bodied adults who now qualify for Medicaid under the expansion of this program to those who earn up to 138 percent of the federal poverty level. It does not affect children, pregnant women, the medically frail and adults who were eligible for Medicaid before the expansion.

The proposal is designed to encourage participants to have a higher level of involvement in their health care, through premiums and "community engagement" requirements, and to save taxpayers money by reducing enrollment by about 86,000 people. All of these conditions are controversial and could be denied by the federal government. To date, no proposal with work requirements has been approved.

Bevin has said that if this new plan is not approved, "there will be no expanded Medicaid in Kentucky," a decision that would take away Medicaid coverage from 430,000 Kentuckians who now qualify under the expansion, but he has also said he is willing to negotiate with federal officials.

Six of Kentucky's congressional delegation have sent a letter to  the U.S. Department of Health and Human Services Secretary Sylvia Burwell in support of the governor's new Medicaid plan, asking that it be afforded "a fair and timely review and allow the Commonwealth the opportunity to demonstrate that the Kentucky HEALTH waiver proposal can improve health outcomes while also protecting the long-term viability of the Medicaid program."

Kentucky HEALTH is the official name of the governor's plan and stands for Helping to Engage and Achieve Long Term Health.

The letter was signed by Senate Majority Leader Mitch McConnell, Sen. Rand Paul, Rep. Brett Guthrie, Rep. Hal Rogers, Rep. Andy Barr and Rep. Thomas Massie, all Republicans.

Here's the schedule for the forums:

Sept. 26 - Morehead: Morehead Conference Center, 111 E 1st Street, 6-8 p.m.
Sept. 27 - Paducah: McCracken County Public Library, 555 Washington St., 6:30-8:30 p.m.
Sept. 27 - Lexington: Mary Queen of the Holy Rosary, 601 Hill N Dale Dr., 6:30-8:30 p.m.
Sept. 29 - Elizabethtown: Pritchard Community Center, 404 S. Mulberry St., 6-8 p.m.
Oct. 3 - Prestonsburg: Jenny Wiley State Resort Park, 75 Theatre Ct., 6-8 p.m.
Oct. 4 - London: First Baptist Church, 804 W. 5th St., 6-8 p.m.
Oct. 5 - Louisville: First Unitarian Church, 809 S. Fourth St., 6-8 p.m.
Oct. 6 - Covington: Kenton County Public Library, 502 Scott Blvd., 6:30-8:30 p.m.

Click here to submit your comments. Click here to see the full report.

Monday, September 19, 2016

KentuckyOne Health lays off several top executives

KentuckyOne Health laid off several top executives Sept. 16, the latest sign of trouble at the hospital company created by mergers four years ago.

Andrew Wolfson of The Courier-Journal called the firings "a bloodbath" and wrote: "In an internal announcement that wasn’t shared publicly, the Kentucky division of financially troubled Catholic Health Initiatives said it was axing leaders to “improve operational efficiency and ensure continued focus on patient care.”

The fired executives included Dr. Damian "Pat" Alagia, senior vice president and chief physician executive; Randy Napier, president of Frazier Rehab Institute and Southern Indiana Rehab Hospital, and Michael Spine, senior vice president of strategy and business development. "Velinda Block, system chief nursing officer, who had previously shared her decision to leave the company, decided to resign and her position will not be filled," just as Napier and Spine's will not, Wolfson reports.

The company's announcement said “These decisions were made to strengthen our resources and support the physicians, clinicians and team members who are delivering on the needs of patients and families every day.”

Wolfson notes, "KentuckyOne was formed in 2012 by the merger of Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System of Lexington, but it has had financial troubles ever since, and in February 2014 announced it was laying off 500 employees in Kentucky. Its Denver-based parent lost $125.9 million in the last quarter of 2015 and has run up billions of dollars of debt." Alagia told Wolfson that the moves made sense for the company.

KentuckyOne and its partner, the University of Louisville Hospital, have "come under attack on several fronts over the past few months," Wolfson notes. "Last month a jury returned a $21.2 million verdict against the company and its St. Joseph Hospital in London for conspiring with cardiologists to perform unnecessary heart procedures. . . .

"In June, triggered by a surgeon's complaint that U of L Hospital was so understaffed that it endangered patients, a state inspection last month found that deficiencies in nursing services specifically endangered three patients. A dozen nurses and doctors also told state inspectors that nursing and other staff shortages put patients at risk, according to the state's 30-page report released by the company, which said the hospital is safe and has made numerous improvements. A state inspection team concluded after a follow-up visit in August that the issues had been addressed. U of L Hospital also received the lowest possible score from the U.S. Centers for Medicare & Medicaid Services in a new rating system for hospitals.

"And in May, the Kentucky Supreme Court upheld a $1.45 million punitive damages verdict against KentuckyOne’s St. Joseph Hospital in London for patient dumping in a case in which it twice kicked out an indigent, paraplegic patient in agonizing pain – the second time wheeling him across the street to a motel, leaving him there without a wheelchair and telling him if he came back again the hospital would have him arrested. He died instead."

Sunday, September 18, 2016

Kentucky's breastfeeding rate is one of the lowest in the U.S.

(Click link for more information)
By Melissa Patrick
Kentucky Health News

The federal Centers for Disease Control and Prevention says breastfeeding is a key strategy to improve public health, and Kentucky ranks 48th among the states in the percentage of mothers who breastfeed.

Studies show that children who have been breastfed have less risk of respiratory infections, Sudden Infant Death Syndrome, Type 1 and Type 2 diabetes, obesity and asthma. Mothers who breastfeed have a decreased risk of  breast, ovarian and endometrial cancers and heart disease, all conditions that plague Kentucky.

"I don't think we have any pill, any vitamin, any thing that we can take that can reduce the risk of all these diseases just at once. Like, take this pill once a day and you will be able to decrease all these diseases. There is nothing like that," Ana Maria Linares, an associate professor at the University of Kentucky College of Nursing, said in a telephone interview. "But we can give that to our babies with exclusive breastfeeding."

The American Academy of Pediatrics recommends that infants be only breastfed for the first six months, with continued breastfeeding alongside complementary foods for at least one year.

"Breast milk is especially adapted to be easily absorbed by the baby gut . . . and produces a specific microorganism in the gut that (will) protect the infant," Linares said.

The CDC's 2016 Breastfeeding Report Card says Kentucky's breastfeeding rates are slowly improving, but remain very low.
Healthy People 2020 goals are set by the U.S. Department of Health and Human Services in a plan to improve the nation's health.
Six months after giving birth, 35.3 percent of Kentucky mothers reported  breastfeeding their infants some of the time, with only Louisiana (31.2 percent) and Mississippi (23.9 percent) having lower rates. Only 19 percent of mothers in Kentucky breastfed exclusively after six months; that was much closer to the national figure of 22.3 percent.

Two-thirds of mothers in Kentucky said they tried breastfeeding at least once, indicating a willingness to do so and perhaps a lack of support to continue, the report said. Nationally, 81 percent of mothers tried breastfeeding at least once.

"We are getting there," said Linares, the UK professor whose research focuses on breastfeeding. "I am really positive about that  because more and more mothers are willing to breastfeed now, at least give it a try. And that is a lot to say because before they wouldn't even consider it."

Rates for Kentucky mothers who have breastfed their infant for six months has improved by almost 34 percent since the CDC started publishing these report cards in 2007, up from 26.4 percent. And improved 153 percent for Kentucky mothers who breastfed exclusively for six months, from 7.5 percent. Data from the 2007 report came from 2004.

Linares said Kentucky is working to teach health-care providers about the importance of breastfeeding and has increased its pre-natal education about breastfeeding. The state offers a peer-counseling program that puts mothers who have had a good breastfeeding experience in touch with new breastfeeding mothers.

"The peer counselor program is one of the most important programs in the state," because it provides support for mothers not only to start breastfeeding, but to also maintain it, Linares said.

The state is also working to get hospitals certified as "Baby Friendly," which, among other requirements, allows the mother and baby to have "skin-to-skin" contact for at least two hours, with has been proven to prompt breastfeeding.

Kentucky has three such hospitals: Norton Women's and Kosair Children's Hospital in Louisville, St. Elizabeth Medical Center in Northern Kentucky, and University of Kentucky Hospital in Lexington.

Linaes said that Kentucky has work to do on its societal views of breastfeeding, because some mothers still feel that they don't have enough support to do it, especially in public places. Kentucky has had a law since 2006 that allows mothers to breastfeed anywhere.

"We need to have a law that protects mothers so that they can have maternity leave, to stay home for at least one month so that they can establish breastfeeding," Linares said, adding that six months would be preferable.

Linares said the U.S. is one of only three developed countries that doesn't offer paid maternity leave, which she said creates a situation which poses a question for mothers: "Should I work or should I breastfeed my baby?" She cited a study indicating if 90 percent of U.S. mothers were able to breastfeed exclusively for the first six months, it would save the country "billions of dollars" and "many lives."

Super-powerful narcotics threaten even more fatal drug overdoses in region; six in Danville area spur community action

“If you’re putting a needle in your arm, you’re playing Russian roulette,” because so many super-powerful narcotics such as fentanyl are in the illegal drug trade, Dr. Eric Guerrant, emergency department medical director at Ephraim McDowell Regional Medical Center in Danville, told Laura Ungar of The Courier-Journal for a story on the threat and his community's reaction to it.

The elephant tranquilizer carfentanil, 100 times as strong as fentanyl, may be the biggest threat. While it "hasn’t been definitively identified in Kentucky or Southern Indiana, the powerful synthetic drug has been confirmed in eight overdose deaths in nearby Hamilton County, Ohio, which includes Cincinnati," he drug is suspected in dozens of overdoses, a few of them fatal, in the Louisville area and Mount Sterling, Ungar notes.

"Carfentanil is cheaper for drug dealers to use as an additive because a tiny amount is so powerful. Addicts typically have no idea what they’re taking, and it can be difficult to discern even if they die. Tests to confirm the drugs can take months," Ungar writes. "While routine toxicology tests can detect fentanyl, they don’t usually pick up carfentanil, said Mike Wynn, a spokesman for the Kentucky Justice and Public Safety Cabinet and the state medical examiner's office. So conceivably, carfentanil could already be here in Kentucky."

Ungar reports, "Officials say carfentanil may be just the closest of several drug threats on the horizon. Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said he’s also worried about related synthetic opioids W-15 and W-18, which are also many times more potent than heroin and have been found in Canada and Pennsylvania. Officials say Kentucky is particularly vulnerable to this new wave of powerful narcotics because addiction is so entrenched. Statistics from the U.S. Centers for Disease Control and Prevention ranked the state’s drug overdose death rate fourth-highest nationally in 2014 – 24.7 per 100,000, reflecting 1,077 deaths. State records show that even more Kentuckians – 1,200 – lost their lives to drug overdoses last year."

Six people in Boyle County overdosed on heroin in two weeks in July. “They were in cardio-pulmonary arrest,” Guerrant told Ungar. “Only one survived the initial resuscitation. They were all young adults. They were from all walks of life, too.” The deaths shook the Danville area into action. The Boyle County Agency for Substance Abuse Policy held a community meeting that drew more than 100 people, including church leaders, substance abuse treatment professionals, emergency workers and local politicians. "Local groups and organizations held a candlelight vigil on Overdose Awareness Day Aug. 31 and a 5K 'Run Against Addiction' a few days later. Danville resident Toni Ward launched a new group with a heavy Facebook presence called Families Into Getting Help Together, hoping to reach more young adults."

To raise awareness of the issue, President Obama has proclaimed Sept. 18-24 Prescription Opioid and Heroin Epidemic Awareness Week.

Saturday, September 17, 2016

Louisville man, 73, first this year to die from West Nile virus; officials remind Kentuckians to wear bug repellent when outside

State health officials have confirmed that a 73-year-old Louisville man died from the West Nile Virus during the week ended Sept. 17.

Beth Fisher, spokeswoman for the Cabinet for Health and Family Servicestold The Courier- Journal that this is the first death from West Nile reported in the state this year.

Symptoms of the virus may include fever, headache, body aches, skin rash and swollen lymph glands, according to the federal Centers for Disease Control and Prevention. There is no vaccine or specific antiviral treatment for the virus.

The CDC says people over 60 are at the greatest risk for a severe infection. In a separate article, The Courier-Journal notes that people with certain medical conditions, such as cancer, diabetes, hypertension and kidney disease, and anyone who's had an organ transplant also are at greater risk.

Health officials advise people to wear bug repellent and protective clothing outdoors and to stay indoors at dawn, dusk and early evening when mosquitoes are most active.

As coal declines in Central Appalachia, what is its legacy in health, including mental health?

As the coal industry declines, rapidly in Central Appalachia, there are "clues suggesting that health and mental-health issues will pose enormous challenges to the affected coal communities, and will linger for decades," Georgia State University biology professor Roberta Attanasio writes for The Conversation US.

Appalachia's death rates are higher than in the nation as a whole, Attanasio notes: "A study that examined the elevated mortality rates in Appalachian coal mining areas for 1979-2005 linked coal mining to 'socioeconomic disadvantages' and concluded that the human cost of the Appalachian coal mining economy outweighed its economic benefits."

A retired coal miner looks at Kayford Mountain in West
Virginia in 2007. (Photo by Andrea Hopkins for Reuters)
Attanasio notes research showing correlations between mountaintop-removal mining and poor health: "They show that when mountaintop removal increases, well-being decreases. However, they do not show that mountaintop removal directly causes a decline in well-being because of the nature of the pollutants and the nature of the exposure to them. Despite the intricacy of studying this area, links to adverse outcomes such as birth defects, cancer, and lung, respiratory and kidney disease, are undeniable."

Mountaintop mining may also affect some people's mental health, Attanasio writes: "People who gain a strong sense of identity from the land are most likely to experience negative outcomes. Environmental philosopher Glenn Albrecht coined the term solastalgia as 'a feeling of chronic distress caused by negatively perceived changes to a home and its landscape,' which he observed in his native Australia due to the effects of coal mining. People who experience solastalgia lack the solace or comfort provided by their home; they long for the home environment to be the way it was before. In a study of Australia published in 2007, Albrecht and collaborators documented the dominant components of solastalgia linked to open-cut coal mining in the Upper Hunter region of New South Wales – the loss of sense of place, the feeling of threats to personal health and well-being, and a sense of injustice and/or powerlessness."

Attanasio notes a survey-based study in Central Appalachian areas with and without coal "indicated that individuals who experience environmental degradation caused by mountaintop-removal mining are at increased risk for depression. The study showed that the odds of a score indicative of risk for major depression are 40 percent higher in areas subjected to mountaintop-removal mining when compared to non-mining areas. Furthermore, the risk of major depression is statistically elevated only in mountaintop-removal areas, and not in areas subjected to other forms of mining, even after statistical control for income, education and other risks."