Thursday, April 23, 2015

Anthem gives $140,000 for 3-county program to cut smoking by pregnant women, still at 21.9% in Ky., among highest in U.S.

Health departments in Christian, Hopkins and Madison counties will start a program called Giving Infants and Families Tobacco Free Starts, with a $140,000 grant to the state health department from the Anthem Foundation.

The GIFTS program was created to help decrease the number of women who smoke during pregnancy and reduce exposure to secondhand smoke for the pregnant woman and her infant, a state news release said. Smoking before and during pregnancy is the single most preventable cause of illness and death among mothers and infants, according to the federal Centers for Disease Control and Prevention.

“Tobacco use is a serious problem in Kentucky, but it is an even more serious issue for women who smoke during pregnancy,” said Dr. Ruth Shepherd, director of the state health department's Division of Maternal and Child Health. “Smoking during pregnancy and infant exposure to secondhand smoke create numerous risks for babies, including pre-maturity and low birth weight, and risks for developing certain conditions like asthma.”

Smoking rates among pregnant Kentucky women dropped from 26.3 percent in 2004 to 21.9 percent in 2013, but that is still among the highest rates in the U.S. In 2013, 13.3 percent of Kentucky births to smoking mothers were premature, compared to 10.2 percent of births to mothers who did not smoke. Even more striking were these numbers: 13.6 percent of babies born to smokers had low birth weight, compared to only 7.5 percent of those born to non-smokers.

The GIFTS program includes a screening tool for assessing tobacco dependence; screening for depression, social support and domestic violence; individualized counseling and support; referral to a service that helps smokers quit; and educational materials, including relapse prevention and the risks of secondhand smoke exposure in the home.

“Reducing the amount of tobacco use and secondhand smoke exposure is not only crucial for improving the health of our state,” state Health Commissioner Stephanie Mayfield said in the news release. “We are thrilled to receive this grant from the Anthem Foundation and look forward to building on the success of GIFTS and working toward reaching our state’s health goals.”

Wednesday, April 22, 2015

Smokers using electronic cigarettes are less likely to quit smoking than those who don't use the devices, California study finds

The sudden increase in use of electronic cigarettes has prompted questions about whether they actually help people quit smoking. A study published online in the American Journal of Public Health found that individuals who use e-cigarettes are actually less likely to quit smoking than those who do not. In Kentucky, 24 percent of adults and 41 percent of those aged 18 to 29 reported using e-cigarettes, according to a Kentucky Health Issues Poll.

The study, conducted by researchers from the University of California San Diego School of Medicine, discovered that smokers who use e-cigs are 59 percent less likely reduce cigarette use and 59 percent less likely to stop smoking altogether, compared to smokers who have not used e-cigs.

"Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting," said Wael Al-Delaimy, professor and chief of the Division of Global Public Health in UC-San Diego's Department of Family Medicine and Public Health. He said the research showed the hypothesis was false, and more studies are required to find out why these people can't stop smoking. "One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes," he said.

E-cigs don't contain tobacco, but smoking them releases ultra-fine particles and volatile organic compounds such as heavy metals. The study also found that women and those who smoke daily are more likely to have tried e-cigarettes.

Tuesday, April 21, 2015

New treatment for symptoms of advanced Parkinson's disease approved by FDA and unveiled at UK

Portable infusion pump used
to deliver Parkinson's drug
The University of Kentucky unveiled a new treatment for people with advanced symptoms of Parkinson's disease at a news conference April 21 and invited one of the first patients to participate in the clinical trial to share how this treatment has improved his function and productivity.

The new, trademarked, treatment, Duopa, provides a continuous 16 hour dose of levodopa, which is the "gold standard" drug to treat Parkinson's disease ,using a special gel preparation, is put directly into the small intestine by a portable infusion pump. It was developed by AbbVie Inc. and approved by the U.S. Food and Drug Administration in January.

"This treatment extends our ability to manage the signs and symptoms" of Parkinson's, said Dr. John Slevin, professor of neurology and vice chair of research at UK's Kentucky Neuroscience Institute. Slevin also worked with international investigators to test this treatment and is the lead author of the study, which is published in the Journal of Parkinson's Disease.

Parkinson's is a chronic and progressive disease of the nervous system that is characterized by motor symptoms such as tremors,slowness, stiffness and impaired balance and coordination. It can also cause non-motor symptoms such as sensory deficits, cognitive difficulties and sleep problems.

The cause of Parkinson's is unknown and there is no cure, but it is known that the disease process involves the death of nerve cells in the brain that produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination.

Slevin said that there are many challenges in treating the symptoms of Parkinson's as it progresses. In addition to the continued loss of nerves in the brain, he said levodopa looses its effectiveness over time and the dose level begins to fluctuate. He also noted that over time patients will get a side-effect from the drug called dyskinesia, or involuntary muscle movement.

Another challenge, which he said prompted the development of this treatment, is that the muscles that control digestion are also affected by the disease, which creates an inconsistency in the blood level of levadopa that can be turned into dopamine in the brain.

This new treatment alleviates this challenge by placing the drug directly where it is absorbed in the intestine, allowing "The blood level, and thereby brain level (to remain) constant and that reduces the probability of having intermittent dyskinesia," Slevin said.

Marion Cox
"We are extremely pleased with the results," Slevin said in a press release. "Patients with advanced Parkinson's disease treated via this new method demonstrated marked improvement in symptom fluxuations and reduced dyskinesia."

Marion Cox, a 70-year-old Georgetown farmer and former real estate developer, who has had Parkinson's for 16 years, participated in the clinical trial for three years and said that this treatment has given him a "new lease on life."

"It was the best thing that ever happened to me. The improvements have been that great," Cox said. Later saying, "I can do anything I want to do. I can horseback ride. I've got a team of horses that I drive. I've got lots of farm equipment, excavating equipment that I drive. Before I went on the trial I was still doing those things, but unbelievably slow."

Dr. Michael Karpf, Becky Cox, Marion Cox, Dr. John Slevin
Dr. Michael Karpf, UK's vice president for health, said he was proud to be part of a major health center committed to doing clinical trials: "What UK HealthCare has to do is to not (just) practice the standards of care, we have to move the standards of care forward." Cox will be the first patient in Kentucky to receive Duopa after FDA approval.

Becky Cox, Marion's wife of 25 years, said the treatment "saved him from an early retirement." She noted that before Duopa, he had been taking an "unmanageable" number of pills to treat his symptoms, but now, after he hooks up to the pump in the morning, "It is a set it and forget it kind of thing. ... He is off and running like he always used to be, so that has been a great blessing."

Because this treatment involves an invasive procedure and because most people with Parkinson's disease respond well to oral medication initially, Slevin said this treatment is meant for those with advanced Parkinson's symptoms. He also said the cost for this treatment is still being determined, but it was already approved by Medicare. He noted that the next step will be to train other medical centers in how to deliver this treatment.

The National Parkinson Foundation website says 1 million people in the U.S. have the disease, with 50,000 and 60,000 new cases diagnosed each year. Kentucky has 14,000 people with it, Tony Bucalo, Parkinson's neuroscience account executive at AbbVie, said after the news conference.

Sunday, April 19, 2015

Kentucky re-bidding Medicaid managed care contracts to address complaints of patients, advocates and health-care providers

By Melissa Patrick
Kentucky Health News

State officials are re-bidding Medicaid managed-care contracts that cover more than 1.1 million Kentuckians. The news came as a delight and surprise to many health-care providers and patient advocates.

“I was both stunned and thrilled by the announcement. I did not know it was coming,” Sheila Schuster, a Louisville mental-health advocate, told Tom Loftus of The Courier-Journal. “A number of the changes that they say will be part of the new contracts are things those of us in the behavioral health community have brought up time and time again.”

Kentucky changed to Medicaid managed care from a traditional fee-for-service model in 2011 to fill a projected budget overrun of $166 million. Health Secretary Audrey Haynes said in a news release that doing so has "saved Kentucky taxpayers more than $1.3 billion in state and federal funds" and had also improved the delivery of health care to the Medicaid population.

"However, after several years of experience, we determined it was time to retool, rebid and strengthen the contracts to appropriately address concerns expressed by advocates and healthcare providers," Haynes said.

The transition to managed care has been met with consistent complaints from both patients and providers, despite efforts of the cabinet to work through the issues and keep the channels of communication open between providers, the cabinet and the managed-care organizations.

Two passionately debated bills in the recent legislative session challenged some practices of the current MCOs: one seeking an appeals process for denial of payments and the other removing a cap of "triage fees" for emergency-room services that MCOs later deem not to be emergencies.

Both issues have been challenging to the financial health of rural hospitals. State Auditor Adam Edelen addressed many such issues in a recent report on the financial health of rural hospitals.

“We are pleased to see the cabinet taking steps to improve and strengthen managed care contracts, many of which we recommended in our recent report on the financial strength of rural hospitals,”Edelen told Insider Louisville.

Some requirements for the new contracts include: required statewide coverage; standardized rules among the MCOs; improved administrative processes; increased oversight of claim denials; continued expansion of behavioral health services; incentives for MCOs to work with Medicaid patients to decrease emergency-room use and improve their health; and increased penalties to assure contract compliance. Click here for the Cabinet for Health and Family Services' complete Request for Proposal.

“I’d like to say that they heard the voice of the people,” Schuster told Insider Louisville.“If you look at the Medicaid Advisory Council, those meeting are every two months and it’s the same litany of complaints and concerns every darned time with no response. The only thing I can think of is it’s a gesture by this outgoing administration to get things right so that regardless of who comes in next year, there are strong contracts in place. I applaud them for it, and I’m stunned.”

The current contracts with Anthem, Aetna's Coventry Cares, Humana's CareSource , Passport and Wellcare expire on June 30, 2015 and proposals for the new contracts are due by May 5. The statewide contracts will be awarded to multiple MCOs for a one-year period with four, one-year renewal option, according to the news release.

Kentucky's suicide rate is above the national average; experts say we need to ignore the stigma and become educated about it

Kentucky's suicide rate is higher than the national average, and an expert says we must create an open dialogue about it and provide more education if we want this rate to decrease, Kat Russell reports for The Paducah Sun.

"People commit suicide when they see no way out from whatever the situation is," Dr. Laurie Ballew, medical director at Paducah's Lourdes Behavioral Health Institute, told Russell. "Usually people feel hopeless, they see no light at the end of the tunnel, and that hopelessness is a key factor in someone following through with the act of killing themselves."

Russell did an in-depth look at suicide in McCracken County, where the newspaper and its owner, Paxton Media Group, are based. "McCracken County is ranked 13th in the state as far as suicide, so if you take into consideration all of the (120) counties in Kentucky, we're pretty high," Ballew said. Click here to find out where your county ranks.

Kentucky has 15.5 suicides per 100,000 people, compared to 12.5 nationwide. It is the 10th leading cause of death in Kentucky and the second leading cause of death in people 15 to 34, according to the according to the federal Centers for Disease Control and Prevention, Russell reports.

McCracken County Sheriff Jon Hayden told Russell that his department investigated 31 suicides in each of the last two years and five so far this year. The Paducah Police Department reported 31 suicides in 2013 and 35 in 2014, and six suicides this year. The local 911 dispatch center told Russell that it had fielded more than 540 calls threatening suicide and more than 130 attempted suicides since Jan. 1, 2013.

"We get calls multiple times per week, threatening suicide either with medication or a weapon of some sort," Hayden said, noting that most of the calls do not result in suicide and the individual usually gets the help they need.

WebMD lists these warning signs of suicide, which are especially concerning if a person has attempted suicide in the past:
  • Always talking or thinking about death
  • Clinical depression that gets worse
  • Having a "death wish," tempting fate by taking risks that could lead to death.
  • Losing interest in things one used to care about
  • Making comments about being hopeless, helpless, or worthless
  • Putting affairs in order, tying up loose ends, changing a will
  • Saying things like "it would be better if I wasn't here" or "I want out"
  • Sudden, unexpected switch from being very sad to being very calm or appearing to be happy
  • Talking about suicide or killing one's self
  • Visiting or calling people to say goodbye
Drug and alcohol abuse also can be factors, Ballew told Russell. "What do those things do? They decrease our inhibition, they decrease our filter that tells us 'Oh no, you don't want to do that.'"

Ballew told Russell if a person's behavior changes are milder, "sometimes showing that person support and compassion can alleviate some of his or her suffering and encourage them to get help," but it is important to seek medical attention for "severe cases."

"If you have an individual who just gets more and more depressed, who won't get out of bed or gets to the point where they can't get out of bed, then you (should) call an ambulance or get them to a hospital and have them admitted," Ballew said, stressing the importance of education and open discussion.

"Emotional illness can hit anybody," she told Russell. "We're all humans. ... Anybody can feel hopeless or helpless at any time. If we could reduce the stigma that is attached to depression and mental illness and suicide, then I think people who are suffering might see that maybe there is some hope. But the only way to prevent something is to be educated about it."

Pilot salad bar will determine whether other Jefferson Co. schools follow suit in bid to increase students' veggie and fruit intake

The Jefferson County Public School system is pilot-testing a salad bar at Atherton High School to entice students to eat more vegetables and fruits, a goal of the new federal nutrition standards, Allison Ross reports for The Courier-Journal.

Photo from
"We're always looking for new ideas to increase participation or attract students to come through the serving line," Terina Edington, assistant director for nutrition services, told Ross.

Many of Kentucky's children are falling far short of the daily recommended four and a half cups or more of fruits and vegetables, a shortcoming that one study says will contribute to early heart disease. The Centers for Disease Control and Prevention 2013 State Indicator Report on Fruits and Vegetables found that only 50 percent of Kentucky adolescents reported eating fruit and 43 percent reported eating vegetables with a median intake of one time per day for both.

Salad bars were once common in Jefferson County schools, but concerns about portion control and contamination concerns caused them to "slowly disappear," Edington told Ross. Many schools across the country continue to "remain leery" of adding salad bars because of such health concerns, Ross writes.

This trial will help the district determine whether it will put salad bars in other schools. Cafeteria modifications for the salad bar at Atherton cost $400, Ross reports.

A push for schools to add more salad bars has been led by First Lady Michelle Obama's "Let's Move" initiative, which co-sponsors a "Salad Bars 2 Schools" program that has donated more than 4,000 salad bars to schools, Ross reports. "A 2014 evaluation of that program found that 57 percent of participating schools saw an increase in student participation in school lunch, and 78 percent reported buying more fruits and vegetables."

The school's Facebook page said that the salad bar would have diced ham, turkey breast, fajita chicken strips, cucumbers, baby spinach, radishes and four types of dressings, with the lettuce and meat portions pre-measured, while the other ingredients will be self-serve.

Atherton High parent Lynn Greene told Ross that she is "thrilled my child has a healthy option," saying she hopes other schools will also get salad bars.

Friday, April 17, 2015

Proposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate

A three-year research project to determine factors that can support a culture of health in Appalachia and whether that knowledge can be translated into actions that address the region's health disparities has released its Request for Proposal to invite proposals from qualified research teams and consultants who would like to work on this project.

The project,“Creating a Culture of Health in Appalachia: Disparities and Bright Spots,” is sponsored by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky and will run through the end of 2017.

The research for this project will identify Appalachian “bright spots,” where health outcomes are better than would be expected based on unemployment and poverty rates and other community factors, and try to figure out why. Researchesr will also try to determine why health outcomes in some communities are not as good as would be expected.

The request for proposals offers detailed guidelines for submissions, which are due June 8. Applicants are encouraged to register for a webinar, detailed on the RFP, to be held May 7 at 10 a.m. EDT. Click here for more information.

Thursday, April 16, 2015

Mount Sterling follows lead of another KentuckyOne Health hospital, in Bardstown, to host monthly 'Walk With a Doc'

Saint Joseph Mount Sterling is the second KentuckyOne Health hospital to host monthly "Walk With a Doc" events as part of a nationwide program that promotes walking as a great way to improve your health, while at the same time offering a place to get to know your local physicians in an informal setting as you walk together. The program also offers a complimentary health screenings at the event, says a news release from KentuckyOne Health.

Flaget Memorial Hospital in Bardstown, also part of KentuckyOne Health, began its "Walk With a Doc" program in March.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein and even reduce risks of bone fracture. Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer," says the release.

The Mount Sterling walks begin at 9 a.m. on Saturday, April 25 at Easy Walker Park, located at 1395 Osborne Rd. For more information call 859-497-5556.

Stranger donates kidney after knowing recipient 5 minutes; could boost living kidney donations, which have better odds

Two strangers were randomly asked to take part in a five-minute demonstration of living art. It led to one of them donating a kidney to the other, Bailey Loosemore reports for The Courier-Journal.

The  idea of the demonstration, produced by Transylvania University faculty members for the 2013 IdeaFestival, was to ask two strangers to talk for five minutes, and then post a "burning question" on Twitter.

After five minutes of discussion, a University of Louisville employee, identified only as Kathy, told Loosemore that she thought about how she wanted to do something important and  decided her burning question was, "What's next?"

Jackie Thomas (C-J photo by Alton Strupp)
Jackie Thomas, a retired teacher and dialysis patient since 2011, was also wondering "What's next?" She had recently been placed on a kidney transplant list, but had already started looking into living donations, in which a healthy person volunteers to donate one of their organs, because the wait is so long to get a kidney from a deceased donor, Loosemore writes.

But Thomas said she wasn't sure how she was going to ask someone for a kidney until Kathy asked, "What's next?" She thought "Wow, that is really a powerful question," and replied with a burning question for Kathy's Twitter feed: "Would you like to donate a kidney to me?"

Kathy said yes. "I think my question about what's next was kind of in my head, and this was kind of an answer. OK, I can donate a kidney," she told Loosemore. She asked that her last name not be revealed because she did not want the focus to be on her.

The offer left Thomas speechless, Loosemore reports: "I said to her, 'I've only known you for five minutes, and you're going to give me a kidney?' She said 'Yeah,' and she looked really serious. ... So I thought, 'Here is the answer to my prayers, maybe.'"

Because living donations are all voluntary, Thomas did not know for certain if the transplant was really going to happen until the day of the surgery, April 8, 2014.

Kathy, who told Loosemore that she meets Thomas for lunch at least once a month, said she has no regrets.

"It's a really personal decision," she told Loosemore. "I'm not going to go out and say everybody should donate a kidney, but I think people should know for a healthy person, it's relatively risk-free and it's not that painful. And if they're really interested in doing something that makes a big difference in someone's life, educate themselves, but definitely think about donating a kidney, because it's not that bad."

Loosemore reports that more than 100,000 Americans are on waiting lists for kidneys and that in 2014, living donations made up only 32 percent of transplanted kidneys -- and only 25 percent in Kentucky, according to data from the Organ Procurement and Transplantation Network. So far in Kentucky this year, there have been 13 kidney transplants, eight from deceased donors and five from living donors; last year, there were 109 from deceased donors and 36 from living.

"The benefits of living kidney donations far outweigh the risks, with living kidneys lasting twice as long as those from deceased donors and the surgeries causing little pain," Loosemore writes, quoting Dr. Mike Hughes, a transplant surgeon who works for University of Louisville Physicians and operates at Jewish Hospital — the only one in Louisville that does transplants.

Jewish Hospital continues to promote its donor champion program, in which family members are asked to request kidneys for recipients who may feel too uncomfortable to do so, and plans to hold an informational forum later this year, in an effort to raise awareness, Loosemore reports.

The forum and the donor-champion program "will help identify barriers that lead to fewer donations and will help encourage those who want to take the next step," Loosemore writes. Jewish Hospital's transplant director, Laurie Oliver, told her that living donations will become "the standard of care at some point in the future, if we can do that."

Click here to learn more about living kidney donation from the National Kidney Foundation. To learn how to donate a kidney through Jewish Hospital, call 502-586-4900.

Burgin, in heart of Kentucky, is state's 40th school district to go tobacco-free; ban, won by students, applies to vapor products

Burgin Independent Schools, in the heart of Kentucky, will be the latest 100 percent tobacco-free schools in the state, and the first in Mercer County, which has a strong tobacco heritage.

The Burgin Board of Education voted April 8 to ban all tobacco use, including vapor products, on school grounds and during school-related student trips, Robert Moore reports for The Harrodsburg Herald. The policy becomes effective July 1 and includes any building or vehicle owned or operated by the board and applies to any renters of school property.

Burgin will be the 40th Kentucky school district to become fully tobacco-free. Kentucky has 173 public- school districts, with 1,233 public schools, according to the state Department of Education.

The Kentucky 100 percent Tobacco-Free Schools website says, "Studies show that schools with 100 percent tobacco-free school policies for three years of more have 40 percent fewer smokers than those in non-tobacco free school districts." The 2013 Kentucky Youth Risk Behavior Survey found that 18 percent of Kentucky youth smoke, and 47 percent of them have smoked at least once.

"I’m really proud we’re going to be a tobacco free campus," board member Priscilla Harris told the Herald after the meeting. "We want to set a good example." The independently owned weekly newspaper recently did a three-part series on tobacco in the county, including Burgin students' efforts to get tobacco banned.
Kentucky 100 percent Tobacco Free Schools map, with Burgin added

School nutritionists' lobbying group, freshly funded by grocery makers, wants more funding and flexibility with school-lunch rules

School nutrition officials want more flexibility with new school lunch rules to cut down on the waste of unwanted food, Spencer Chase reports for Agri-Pulse, a Washington newsletter. Julia Bauscher, president of the School Nutrition Association, told the House Education and Workforce Committee that the organization supports the rules, but needs more funding to enforce them  and more flexbility to serve foods students will eat. (USDA graphic)
"SNA is requesting 35 cents more in federal funding for each lunch and breakfast that is served in the school lunch program, up from the additional six cents the government provided when the new standards were put in place," Chase writes. Bauscher told the committee, “That will help school food authorities afford the foods that we must serve, but unfortunately that won't make students consume it.”

Bauscher, who said SNA wants Congress "to soften the bill's target levels for more whole grains and less sodium in school meals," said that "in many cases, the new requirements have forced school lunch programs outside of budgetary constraints, forcing them to ask school districts to make up the difference. According to SNA, school districts will absorb $1.2 billion in new food and labor costs in 2010," Agri-Pulse reports. SNA has drawn major funding from some food manufacturers.

Chase writes that 51 percent of students qualify for free or reduced lunches, the first time the number has topped 50 percent in at least 50 years.

Wednesday, April 15, 2015

Fate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.