Monday, October 27, 2014

End of Daylight Saving Time, which can disrupt sleep pattern, is a good time to review your sleep habits, experts say

Sunday, Nov. 2, is the end of Daylight Saving Time this year and for those who already sleep poorly, it might mean further disruption to their sleep patterns.

Turning our clocks back one hour in the fall can be disruptive to our sleep patterns, says Sabrina Brem, an instructor at Columbia University School of Nursing, making a few suggestions to help with the transition:

Going to bed and getting up at the same time every day is the "single most important thing" to getting a good night's sleep, she says.

"Plus or minus two hours can be OK, but you’ll have the best sleep if you can stick to a very similar routine seven days a week," Brem said.

It is also important to avoid stimulating activity before bedtime, which means no exercise, television, iPad, iPhone, tablet, or bright screen of any kind. If you like to read before bed, Brem suggests an actual book or a device with e-ink.

Brem also suggest no caffeine six hours before bedtime and no alcohol three hours before bed.

“Lots of people will say a cocktail helps them fall asleep, and it does,” says Brem. “The trouble is usually that cocktail will also cause you to have fitful sleep, wake up frequently, and feel unrested in the morning.”

The National Sleep Foundation adds these tips to Brem's suggestions to get a good nights sleep:
  • Create a bedtime ritual.
  • Avoid naps, especially in the afternoon.
  • Exercise daily.
  • Create a soothing sleep environment, which includes cool temperatures and no light.
  • Make sure your mattress has not exceeded its life expectancy - usually 9-10 years.
  • Avoid cigarettes and heavy meals at bedtime.
  • If you can't sleep, get up and do something relaxing until you are tired.
  • Speak to your health care provider if you are still having trouble sleeping.

Sunday, October 26, 2014

KET will look at how Kentucky communities are fighting back against the heroin epidemic

Heroin use is sky-rocketing in certain areas of Kentucky and many communities are fighting back with local solutions.

Host Renee Shaw and guest will share how communities are coming together to save lives, expand treatment options and prevent others from becoming addicted on the next episode of KET's "HealthThree60" program Monday, Oct. 27 at 9 p.m. ET; and Wednesday, Oct. 29 at 3 p.m ET.

KETKY will air the show on Wednesday, Oct. 29, at 3 p.m.; Thursday, Oct. 30, at 11 p.m.; and Friday, Oct. 31, at 9 a.m. All times are Eastern.

Saturday, October 25, 2014

Students at elementary school in Bowling Green create walking trail to promote health and education

Ribbon cutting ceremony for walking trail
Wednesday, Oct. 22 at T.C. Cherry Elementary School.
Photo: Miranda Pederson/Daily News
Students at T.C. Cherry Elementary School in Bowling Green came up with the idea of creating a walking path around their school in April and when they showed up for school in August, it had become a reality, Laurel Wilson reports for The Daily News in Bowling Green.

The Leadership Bowling Green class "took it to the next level," T.C. Cherry Principal Kory Twyman told Wilson.

The Leadership Bowling Green program is a nine- month leadership-development program coordinated by the Bowling Green Area Chamber of Commerce. Over the summer, the 2014 leadership class constructed a 1/3-mile gravel path around the school for its class project - bringing to fruition a project chosen because it "would have the largest impact on the community by promoting health and education," class president Jason Marshall told Wilson.

Seven signs along the path reinforce the seven habits students learn as part of "The Leader in Me" curriculum: Be proactive; begin with the end in mind; put first things first; think win-win; seek first to understand, then to be understood; synergize; and sharpen the saw.

Students can take pride in the fact that they helped make the walking trail happen, Twyman.told Wilson. “It made them aware that even as 9-, 10-, 11-year-old children, they have a voice and people are listening,” he said.

Study finds that signs that connect calories to activity are more effective than nutrition labels to change behavior

Most Americans don't adjust their bad eating habits after reading nutrition labels, but when they are provided information that is easy to understand, like connecting the amount of exercise needed to burn a certain number of calories, many do make healthier choices, according to a recent study from Johns Hopkins University's Bloomberg School of Public Health.

“People don’t really understand what it means to say a typical soda has 250 calories,” Sara N. Bleich, lead author of the study, said in a release.  “If you’re going to give people calorie information, there’s probably a better way to do it."

Bleich, associate professor in the Department of Health Policy and Management at the Bloomberg School, explained that the research findings, printed online in the American Journal of Public Health, found that when you explain calories in an easily understandable way, you can encourage behavior change.

The study found that teens who saw printed signs explaining the number of miles they would need to walk to burn off the calories in a sugary drink were more likely to leave the store with a lower calorie beverage, a healthier beverage or a smaller size beverage. And these healthier choices persisted after the signs came down.

These findings could be important to chain restaurants next year when they will be required to display calorie counts on their menus, a requirement of the Patient Protection and Affordable Care Act. Researchers say in the release that "policymakers may need to rethink  how that information is communicated."

The research involved posting one of four signs with easy to understand nutritional information at six different corner stores in African-American neighborhoods in Baltimore.

The signs focused on sodas, a commonly purchased item among teens. The signs pointed out that a 20 oz. bottle of soda, sports drink or fruit juice contained 250 calories, or had 16 teaspoons of sugar, or would take 50 minutes of running to work off those calories or would take five miles to walk the calories off.

The research found that when teens saw any of the four signs, they were more likely to choose a drink with fewer calories. The most effective sign was the one that told shoppers they would have to walk five miles to burn off the drink calories, Bleich said in the release.

“This is a very low-cost way to get children old enough to make their own purchases to drink fewer sugar-sweetened beverages and they appear to be effective even after they are removed,” Bleich says. “Black adolescents are one of the groups at highest risk for obesity and one of the largest consumers of sugary beverages. And there is a strong scientific link between consumption of sugary beverages and obesity. Using these easy-to-understand and easy-to-install signs may help promote obesity prevention or weight loss.”

This simple solution could also be applied in Kentucky where 18 percent of Kentucky's high school students are obese, according to the 2013 Kentucky Youth Risk Behavior Survey, in which15 percent of them reported drinking a can, bottle, or glass of soda three or more times per day during the seven days before the survey.

Friday, October 24, 2014

In a report for PBS, KET's Renee Shaw looks at the influence of health-care reform on the U.S. Senate race

Kentucky is a state "where both the economy and health care poll as high issues and where the state’s exchange under the health care law ... has a very different reputation than the law does when it’s called Obamacare," KET's Renee Shaw reports in a segment for PBS "NewsHour."

Courier-Journal Political Writer Joe Gerth explained the disconnect for the national audience: "Five letters, O-B-A-M-A. You have to look at the polling on Obama. His favorability rating in Kentucky is somewhere around 29 percent. He’s not liked. People don’t like his policies. They don’t like him personally. And that’s played a huge role in why Obamacare is viewed so negatively."

Shaw interviews small-business owner Charles Howard of Chaplin, who doesn't like the law, and Kendell Nash of Louisville, who does. Shaw concludes, "Kentucky is full of strong feelings on the health care law, but it’s not clear how much those will affect the election. Like much of the nation, the state is getting ready for the next round of open enrollment on its health care exchange. That will be the next test of the health care law here. Enrollment starts two weeks after the midterm election."

Thursday, October 23, 2014

Anyone returning from an Ebola-stricken country will be monitored by health authorities for three weeks

All travelers who arrive in the U.S. from the Ebola-stricken countries -- Sierra Leone, Guinea and Liberia -- will be closely monitored for 21 days by public health officials, Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, announced Wednesday, Oct. 22.

These measures took effect immediately in the six states that receive approximately 70 percent of travelers from Est Africa: New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia. All other states that receive travelers from the region, including Kentucky, will implement these policies "over the following days," a CDC release said..

Kit for travelers entering U.S. from West Africa
Travelers who have been in these countries will get a kit at the airport with an explanation of what Ebola symptoms are, a thermometer and instructions on how to use it, and specific contact information to report symptoms. These people will also be required to maintain daily contact with state and local officials for the entire 21 days following the last possible date of exposure to the Ebola virus.

"These new measures I'm announcing today will give additional levels of safety so that people who develop symptoms of Ebola are isolated quickly," Frieden told reporters.

These measures are in place only for travelers without symptoms. Those showing symptoms will be isolated and, if need be, transported by trained medical personnel. If a traveler is considered "high risk," but not yet showing symptoms, Frieden said he or she would be quarantined and not permitted to travel via public transportation.

New York and New Jersey have taken this new policy a step further and now require all medical workers returning from West Africa who had contact with Ebola patients to be quarantined for 21 days. Illinois will require people who have traveled to West Africa and have come into direct contact with someone infected with the Ebola virus to "undergo a mandatory 21-day home quarantine," Ray Sanchez and Elizabeth Cohen report for CNN.

New York Mayor Bill de Blasio said the policy could backfire. "These individuals who are going there to serve are the people who will end this crisis," de Blasio said. "We can't have the illusion that we can turn away from it and some day it may end. If we took that attitude, this would be a truly devastating global crisis."

Wednesday, October 22, 2014

In Senate race, McConnell and Grimes differ on health care

By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications
               The U.S. Senate race between Republican Sen. Mitch McConnell and Democrat Alison Lundergan Grimes has seen the candidates focus on several key issues, including the coal industry, the minimum wage and health care.
               The health-care issue has been almost unique among Senate races in that Kentucky is generally seen as a success story for the Patient Protection and Affordable Care Act. In August, Gov. Steve Beshear said 521,000 of Kentucky’s 4.3 million citizens had signed up for health coverage through Kynect, the state’s health insurance marketplace created under the law.
               According to a Gallup-Healthways poll, published in August, Kentucky reduced its percentage of uninsured more than any other state besides Arkansas, and lowered the percentage of uninsured in the state from 20.4 percent to 11.9 percent, thus covering two of every five uninsured Kentuckians.              
In addition to funding the expansion of Medicaid, the law requires Americans to either purchase private health insurance or enroll in some form of government assisted health care like Medicaid; requires insurance companies to cover people with pre-existing conditions and provide 10 elements of coverage in each policy; allows parents to keep their children on their health insurance until they are 26; and requires businesses employing 50 or more full time employees to provide health insurance, a provision that President Obama has suspended for a year.
McConnell says he wants to repeal the law “root and branch,” but has been more lenient toward the idea of keeping Kynect. In the Senate race debate on KET, McConnell suggested that Kynect was merely a website. However, repealing the law could pose issues for the newly insured in Kentucky because private insurance under Kynect uses federal tax credits, and provides free Medicaid coverage to citizens who earn up to 138 percent of the federal poverty level.
According to Douglas McSwain, a Lexington-based litigation attorney who specializes in constitutional and health-care law, the uprooting of the law would result in drastic changes to Kynect.
               McSwain said repealing the ACA “root and branch” would mean cutting the federal tax subsidies that are essential to Kynect’s survival.
“You take the exchange tax credit away, do you think for a minute that the website is going to stand?” McSwain asked.  “Nobody is going to buy policies.”
At a Kentucky Farm Bureau forum in August McConnell said Congress should have passed laws allowing health insurance to be sold across state lines, limiting malpractice lawsuits and making it easier for businesses to form health-insurance groups.
               McSwain said the law allows formation of such groups, and interstate regulation “is conceivable” but “The problem is we don’t have the infrastructure, regulatory-wise, to do that without having reached a compact or an agreement” among the states.
               A study on the effects of malpractice reform, published by the New England Journal of Medicine, found that Texas, Georgia and South Carolina did not see a significant reduction in the amount of doctor-ordered tests and scans after enacting reforms.  A five-person team of doctors performed the study, collecting data from 1997 through 2011.
               Grimes has only publicly discussed health reform on select occasions, taking a similar strategy to many Democrats in the 2014 midterm election because of the unpopularity of “Obamacare” and its namesake.  When she does mention health care, she talks about fixing and streamlining the law, as she did during the KET debate.
“I will not be a senator that rips that insurance from their hand,” Grimes said in reference to the half a million Kentuckians who’ve gained coverage under Kynect.  She said McConnell was in a “fictional fantasyland.”
Grimes has also talked about supporting an extension of Obama’s “grandfathering” of insurance policies that don’t comply with the law after he was criticized for not keeping his campaign promise that Americans could keep their doctor and health plan if they liked them.
               That controversy and other aspects of the law have led to negative feelings among Kentuckians about Obamacare.  A poll by Marist College for NBC News showed Obamacare had a 33 percent approval and 57 percent disapproval rating among Kentuckians, while Kynect had 29 percent approval and a 22 percent disapproval., while 29 percent of those polled said that they had never heard of Kynect and 21 percent were unsure of how to rate it. 
               At last report, about 80,000 Kentuckians had bought private insurance through Kynect and about 440,000 had used it to get on Medicaid – 320,000 of whom were eligible under the new rules and 120,000 under the what state officials call “old Medicaid.” The federal government pays about 71 percent of “old Medicaid” costs and, until the end of 2016, 100 percent of the newly eligibles’ coverage. In 2017, it will pay 95 percent of the new costs, and fall to the reform law's floor of 90 percent in 2020.

Cheyene Miller of London, Ky., wrote this story for “Covering the U.S. Senate Race,” a special course in the University of Kentucky School of Journalism and Telecommunications.

Sunday, October 19, 2014

Medicaid expansion boosts preventive care

More Kentuckians than ever are using preventive care services since the state expanded Medicaid on Jan. 1, reports FamiliesUSA, a lobby for federal health reform that included the expansion.

Recent data from the state Cabinet for Health and Family Services show a 37 percent increase in the use of preventive care services since 2013, report Andrea Callow, a Medicaid policy analyst and Katie Supko, a Medicaid intern for FamiliesUSA. Of particular note is that more Kentuckians are getting screened for diseases that kill so many of us.

In 2013, Kentucky ranked first in cancer deaths and sixth in all premature deaths. It ranked 41st in annual dental visits and 45th in overall health status.

Since the expansion, which has provided coverage to more than 450,000 Kentuckians, the cabinet reports a 30 percent increase in breast cancer screenings, a 3 percent increase in cervical cancer screenings, a 16 percent increase in colorectal cancer screening and a 37 percent increase in adult dental visits.

Screenings and check-ups allow medical providers to identify health issues before they advance, and improves the chance that treatment will be successful. For example, with early detection, the five-year survival rate for breast cancer, the leading cause of cancer death in women, is 90 percent, and the rate for cervical cancer is nearly 100 percent, the writers note. Screenings for colon cancer, the second leading cause of cancer deaths in the U.S., have a five-year survival rate higher than 90 percent if detected early, but only 40 percent of colon-cancer diagnoses are made during this early stage.

At least one study, over two years in Oregon, found no preventive health benefits from expanding Medicaid, but advocates say it will work in the long term. "Medicaid expansion makes preventive care possible," the authors write. "Kentucky’s decision to expand Medicaid will undoubtedly reap the state many benefits, from a drop in the uninsured rate to an increase in economic activity" by expanding health-care jobs. "But the access to critical preventive care services may be the benefit that gives Kentucky a much-needed boost in the health status of its residents."

Saturday, October 18, 2014

Rural Ky. hospitals make sure they are ready for Ebola

Rural hospitals in Kentucky are making sure they are prepared in the event they get a patient with the Ebola virus, Bill Estep reports for the Lexington Herald-Leader.

The risk of Ebola coming to rural Kentucky is low and there have been no cases in the state, according to officials of the state Department of Public Health, but rural hospitals are getting ready just in case, Estep reports.

It's not known where a patient might enter the health care system, so every hospital must be prepared, State Health Commissioner Stephanie Mayfield, told Estep.

Hospital officials all over the state have told Estep that they are making sure they are prepared in case they get an Ebola patient, saying they are reporting up-to-date daily information on dealing with Ebola to their employees; staying apprised of what the state health department and the federal Centers for Disease Control recommend; updating patient-screening processes to help determine the risk of Ebola, reviewing isolation procedures; taking stock of protective gear; and providing staff education.

"The protocol for rural hospitals would be to put an Ebola patient in isolation, then contact the local or state health department for guidance on whether to transfer the patient," Joe Murrell, chief executive officer at the 25-bed Wayne County Hospital in Monticello, told Estep, because "most rural hospitals don't have the resources to treat an Ebola patient for a long period."

But is this level of preparation enough?

Health care workers continue to be concerned because the two nurses in Dallas who were caring for the infected man from Liberia who has since died, and now have Ebola, "reportedly got the virus despite wearing protective gear," Estep writes.

Initially Dr. Tom Frieden, director of the CDC, said any hospital could safely take care of Ebola, Kimberly Leonard reports for U.S. News & World Report. “You need a private room with a private bathroom, and rigorous, meticulous training and materials to make sure that care is done safely so caregivers aren’t at risk,” he said, Leonard writes.

But Linda Greene, an infection prevention manager at Highland Hospital in Rochester, N.Y., and a member of the Professionals in Infection Control and Epidemiology Regulatory Review Panel, told Leonard, "Despite the best efforts, we do know in many hospitals that infection-prevention control measures are under-resourced,” and "There may be need for even more specialization than we initially thought."

But Greene goes on to say that despite these challenges,"Every hospital, however, should be able to screen and identify a patient at risk and immediately put them into isolation as necessary and do the initial triage, Leonard reports.

This is what Kentucky hospitals seem to be doing, despite concerns of some that it might not be enough.

Kevin Kavanagh, a Somerset physician and board member of Health Watch USA, told Estep that there are still "unanswered questions" about care for patients with Ebola, citing "his understanding that the CDC still doesn't know how the Dallas nurses got infected despite wearing protective gear" and "what plans hospitals have to dispose of the medical waste" and the "extent of the knowledge about how the disease spreads."

News media blamed for most of Ebola scare; experts continue to say that risk of infection is low

The reaction of many Americas regarding the Ebola virus has gone beyond what is medically necessary, but is a natural reaction to fear, Maggie Fox reports for NBC News.

Medical experts told Fox that while the federal Centers for Disease Control and state health departments are taking appropriate measures to keep an eye on people who were in direct contact with Ebola patients, some actions "may be excessive," such as Cleveland-area schools closing after a middle-school worker "traveled home from Dallas on Frontier Airlines Tuesday on a different flight, but perhaps the same aircraft" as the Ebola-infected nurse, Fox reports.

“They are taking drastic steps for a risk that is rather remote,” said George Kapalka, professor of psychological counseling at Monmouth University in New Jersey.

Blame for this fear is placed on the news media and politicians, Fox reports. Media are “undoubtedly complicit in stoking this fear, not by covering the story — that’s fine,” risk perception expert David Ropeik told Fox. “They are complicit by burying all the qualifiers about how minimal the risk is.”

So how risky is Ebola?

“The only individuals potentially at risk for Ebola in the United States right now are those who have traveled to affected areas of West Africa or who have been directly involved in treating cases of Ebola or close contacts to a symptomatic patient with Ebola," Stephanie Mayfield, Kentucky's public health commissioner, said in a press release.

Mafudia Suaray, a family physician at Rutgers Robert Wood Johnson Medical Schoolsays the risk of getting Ebola in the U.S. is "very low." She explains that "Ebola is a virus that is spread from person to person through contact with bodily fluids, including saliva, tears, sweat, urine, blood, stool and semen. It is not spread through the air. ... The virus cannot be spread through contact with intact skin and a person must have symptoms of the disease to spread it to others."

Adam Cole of NPR created a visual to show how unlikely an Ebola infection is, based on the reproduction number of the virus, which indicates how many people one person might infect. It says that for every person who has Ebola will infect two others, but direct contact with a bodily fluid is required.

And the reason that officials, including the CDC Director Thomas Frieden, think Ebola will be contained in the U.S. is because our public health system is good and Ebola isn't contagious until symptoms are present, allowing time to isolate those who have come in contact with anyone who has been infected, and thus stopping the spread of the disease, Michaeleen Doucleff reports for NPR.

Suaray reminds us in the release that "common sense prevention measures should always be the priority, whether for Ebola or for more common illnesses such as the cold and flu." Wash your hands, stay home if you have fever, see a health care provider if your fever is high, cover your face with your arm or a tissue when you cough or sneeze and talk to your doctor if you plan on traveling to an infected region.

Friday, October 17, 2014

Nine hospitals in Kentucky get maximum Medicare penalty for readmissions; they blame socioeconomic factors

Article updated 10/20/2014
Nine hospitals in Kentucky, eight of them in Appalachia, have been hit with the highest penalty possible by Medicare for high rates of patient readmission.

This is the third year the program has fined hospitals, under the federal health-reform law, for having too many patients return within 30 days for additional treatment.

This year, the maximum penalty is a 3 percent reduction in Medicare payments for all patient stays in the fiscal year beginning Oct. 1. Last year, the cut was 2 percent. The fines are based on readmissions from July 2010 through June 2013.

Kentucky hospitals fined the maximum amount this year are the Appalachian Regional Healthcare hospitals in Harlan, Whitesburg and Hazard; Memorial Hospital in Manchester; Methodist Hospital in Henderson; Pineville Community Hospital in Bell County; Three Rivers Medical Center in Louisa; Monroe County Medical Center in Tompkinsville; and Westlake Regional Hospital in Columbia. All except Henderson are in Appalachia, and most are in Eastern Kentucky.

“Some of the specific challenges that have faced hospitals in Eastern Kentucky is that they see a greater proportion of patients who have suffered from heart attacks, heart failure and pneumonia,” Elizabeth Cobb, vice president for health policy at the Kentucky Health Association, told Kevin Halpern of the Middlesboro Daily News.

Cobb also said the region has "higher numbers of chronically ill patients, who require a greater amount of hospitalization," and that high rates of obesity and smoking, which affect how well a patient does after discharge, as well as a lack of oupatient services in rural areas, also contribute to readmissions. The formula for calculating readmission penalties does not take such problems into account.

Nationwide, 2,610 hospitals received a readmissions penalty, but only 39 were hit with the full 3 percent. In Kentucky, 63 hospitals, about two-thirds of the state's total, were penalized, with the average penalty being a 1.21 percent reduction in payment, according to an analysis of federal records from Kaiser Health News.

Halpern, citing KHA, reported that Kentucky represented a "disproportionate share of (the) hospitals receiving the maximum penalty, with nine hospitals, representing 23 percent of the total."

KHA supports pending legislation that will require the Centers for Medicare and Medicaid Services to adjust its program to account for socioeconomic conditions that "are beyond a hospital's control," Halpern reports. Opponents say "hospitals that have many readmissions are providing substandard care and should not be let off the hook," Kaiser's Jordan Rau reports.

The penalties have forced hospitals to provide better follow-up care for their patients after discharge in efforts to avoid readmission. The days of handing a patient a written discharge plan and expecting the patient to follow them without follow-up are quickly becoming a thing of the past, Rau reports.

Instead, hospitals are finding ways to ensure patients are not readmitted like ensuring outside doctors monitor discharged patient's recoveries; providing free medication for those who can't afford them; or sending a nurse to a patients home to make sure they are taking care of themselves.

But some hospitals are still struggling with these new guidelines, resisting many such efforts because they aren't paid for these services, Rau reports, and some continue to readmit patients because it has been financially beneficial to the hospital in the past.

Medicare officials estimate that $17 billion of the $26 billion Medicare pays for readmissions is a result of "potentially avoidable readmissions," Rau reports.

Telemedicine helps reduce waits for mental-health patients in ER and provides better health-care access in schools

Health professionals have used telemedicine to help delay Alzheimer's disease and reduce hearing loss in Appalachia, especially among children. Now the new approach is helping students access health care, and mental-health patients to get faster medical attention in emergency rooms.

AMD Global Telemedicine has been establishing telemedicine systems in schools, which allow "providers to care for students on-site with few clinicians to support it," Katie Wike writes for Health IT Outcomes. So far "the Center for Rural Health Innovation in western North Carolina used the technology to support 14 school-based programs and provide care to 4,000 students.

The health-care provider can ask the questions during the exam, and "it doesn't assume the presenter knows the questions to ask," said CRHI Executive Director Amanda Martin. This approach allows one nurse practitioner to provide care to thousands of children. Some Kentucky schools are already using the telemedicine platform, Wike reports.

Sometimes when patients seek mental-health care in emergency rooms, no psychiatric services are available. In this case, hospitals often contact and wait for a provider to arrive or send written evaluations for review, Karla Paris writes for Health IT Outcomes. Now KentuckyOne Health has a telemedicine program that gives faster response times for those requesting mental-health care. For example, patients who visit Louisville's Ss. Mary & Elizabeth Hospital for mental-health care will be able to videoconference with professionals from Our Lady of Peace Hospital. "Patients can then be referred for admission at Our Lady of Peace, another outpatient program or care center," Paris reports.