Monday, July 28, 2014

CDC director to attend a series of events Aug. 4-6 to talk about health issues in Appalachian Ky.; public is invited to attend

The director of the federal Centers for Disease Control and Prevention will participate in four events in Eastern Kentucky next week to discuss and look for solutions to the many health issues that plague the region.

Dr. Thomas Frieden
Dr. Thomas Frieden and his team will take part in the first-ever Health Impact Series, which is part of the Shaping Our Appalachian Region initiative launched by Republican U.S. Rep. Hal Rogers of the 5th District and Democratic Gov. Steve Beshear.

Topics of discussion will include the high rates of cancer, diabetes, heart disease and obesity in Appalachian Kentucky.

"While the diagnosis of illnesses like cancer and diabetes are heartbreaking, we know that hope is abundant. We've made great strides in awareness and prevention, but I am eager to hear Dr. Frieden's prescription for Eastern Kentucky and what we can do to help save lives and improve healthy living," Rogers said in a press release. "Dr. Frieden not only plans to share information with us, but wants to hear what medical professionals and health coalition leaders are already doing to change lives. This is our chance to speak directly to an international leader in healthcare about the long-time health disparities in our small corner of the world."

Compared to the national averages, the prevalence of heart disease is 84 percent higher in the Appalachian Kentucky. Diabetes is 47 percent higher, and obesity is 26 percent higher. from 2006 to 2010, the region had the highest number of people in the nation die from lung cancer, 67 percent higher than the national average. Kentucky as a whole has the nation's third highest rate of deaths from drug overdoses.

Frieden said in the release, “In working to improve health, we are all in this together. The more effectively we are connected, the more effectively we can address these opportunities. This visit to Kentucky is an important step.”

Accompanying Frieden will be Dr. Judith Monroe, deputy director of the CDC, who was raised in Lawrenceburg, earned her undergraduate degree from Eastern Kentucky University and first practiced medicine in the Appalachian region.

Here is the schedule of events:
Monday, Aug. 4: 6:30 p.m. reception & 7 p.m. dinner, Center for Rural Development, Somerset.
Tuesday, Aug. 5: 10 a.m. to 2 p.m., Hazard Community and Technical College; 5:30-7:30 p.m., Ramada Paintsville Hotel and Conference Center.
Wednesday, Aug. 6: 10 a.m. to 2 p.m., Morehead Convention Center.

All the events are free and open to the public, but registration is recommended to ensure meal service. To register, contact Cheryl Keaton at ckeaton@centertech.com or 606-657-3218.

Teens sensitive to light or noise after a concussion are more likely to suffer anxiety or depression, UK study finds

Teens who are sensitive to light or noise after a concussion may also have increased emotional symptoms, such as anxiety or depression, according to a study at the University of Kentucky.

“While most people recover from a concussion within a week, a number of factors affect their recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes,” co-author Lisa M. Koehl said in a news release. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school.”

The study followed 37 athletes, ages 12 to 17, who had persisting symptoms for an average of 37 days following a concussion. They were checked for post-concussion changes in physical, emotional and cognitive symptoms. The study determined that there were no differences in the severity of concussions in the group, and that a family history of psychiatric problems did not affect post-concussion emotional symptoms.

But it did find that teens who are sensitive to light or noise after a concussion may also be more likely to have emotional symptoms, including irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions.

Of the 37 athletes studied, 22 had emotional symptoms, and of this group, five (23 percent) were sensitive to light while three (14 percent) were sensitive to noise. Of the 15 athletes with no emotional symptoms, only two (13 percent) were sensitive to light and no teens were sensitive to noise, according to the release.

"Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability," said co-author Dan Han. "While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion."

The researchers presented their findings at the American Academy of Neurology's Sports Concussion Conference in Chicago in July. Click here for more information about concussions.

Saturday, July 26, 2014

Mass. study finds home-packed school lunches lack whole grains, fruits and vegetables, and have too much sugary stuff

Packing a healthy lunch that kids will eat is an ongoing challenge for families, and a challenge that is often not met, according to a study by researchers at Tufts University in Medford, Mass.

“When deciding what to pack, parents are juggling time, cost, convenience, and what is acceptable to their children. Unfortunately, these factors are not always in harmony with good nutrition,” the senior author of the study, Jeanne Goldberg, said in a press release.

The researchers used digital photography to document the lunches and snacks of more than 600 Massachusetts third- and fourth-graders in 12 schools in six public school districts. Only 27 percent of the lunches met at least three of the five National School Lunch Program standards, and only 4 percent of the snacks met at least two of the four Child and Adult Food Care Program standards. Both emphasize fruits, vegetables, whole grains and low- or non-fat dairy products.

Most of the lunches had pre-packaged snack or dessert foods, and almost 25 percent lacked what would be considered an entrée, like a sandwich. The study also found that the snacks children packed were not nutritious, with most including sugar-sweetened beverages.

“The few existing studies on packed lunches report that children who bring their lunch tend to consume fewer fruits and vegetables, less fiber and more total calories than those who participate in the National School Lunch Program,” Goldberg said.

Goldberg and her colleagues acknowledged that larger studies of more diverse groups of students over an extended period of time are needed, they say their study points to the need to help parents pack more nutritious lunches.

You can use the Choosemyplate.gov diagram as a starting point for a healthy lunch. Half the lunch should be fruits and vegetables, half of the grains should be whole grains, and dairy items should be low-fat or fat-free. It's also important to make sure portion sizes are appropriate, and the American Academy of Pediatrics recommends water, not sugary drinks.

“Given that over 40 percent of U.S. schoolchildren bring their lunches to school on a given day, it’s important to consider how nutrition experts and policymakers could help parents meet the challenges of cost, convenience, and child preference and add nutrition to the equation,” Goldberg said.

Getting ready to go back to school is also a reminder that it's time for that yearly 'well visit' with the pediatrician

As you're making that back-to-school checklist of things to do to get your kids ready, don't forget to put a yearly physical examination.

While parents of kindergartners and sixth graders are motivated to schedule these appointments to take care of required immunizations and those who have kids in athletics need sports physicals, the American Academy of Pediatrics recommends an annual well-check physical for all children after age 4.

“Back-to-school checkups are often the only visit most kids and teenagers have with their doctor every year,” Dr. Paul Stricker said on the academy's website. “The annual physical gives the pediatrician a chance to give the child a thorough physical exam. It’s also a good chance to address important questions, especially with teenagers, including adolescent issues of drinking, smoking, drugs, sexual activity, and depression.”

And while sports physicals offer important screening tools for potential athletic health problems, this type of physical does not address the child's overall health and is not as detailed or in-depth as a pediatrician's exam, Stricker said.

Here are other suggestions to help you make the most of your yearly well-visit with your pediatrician:
  • Bring any updated immunization records along if you have them
  • Bring your school's required physical forms
  • Bring a list of questions about anything that you have concerns about including sleep, allergies, medications, behavior and development.
  • Ask to see your child's growth chart and discuss your child's nutrition/caloric intake and exercise needs
  • Be mentally prepared for any vaccinations that may be due.
“Though no one likes to get shots, vaccines are an integral part of keeping kids and our community safe. They work to safeguard children from illnesses and death caused by infectious diseases and protect our kids by helping prepare their bodies to fight often serious, and potentially deadly diseases,” Heidi Renner, primary care physician at Loyola University Health System, said in a press release.
Centers for Disease Control and Prevention
Click here for a chart of Kentucky's state requirements for immunizations.

“Yearly physicals are a great time to touch base with your child’s physician to make sure everyone is on the same page," Renner said. " Don’t hesitate to ask questions. We can’t help you if we don’t know a problem exists.”

Ballard County joins schools with free meals for all students

Ballard County is the latest in Kentucky where all public schools will provide free lunch and breakfast to all students, now that more than 40 percent of its middle- and high-school students are eligible for free meals. Elementary schools has already reached the required federal threshold.

Amber Hayes, the school district's nutrition director, told the West Kentucky Star that the change would save families $430 a year, under the U.S. Department of Agriculture's Community Eligibility Provision.

"The USDA’s formula for reimbursing the meals is complicated, but the Hayes said the bottom line is this: For the program to be successful and continue at BCMS/BMHS, more students have to eat breakfast every day, and every family needs to complete the Household Income Form that will be included in each student’s Code of Behavioral Expectations this year," the Star reports.

“Our lunch numbers are okay,” Hayes told the online news outlet. “But in the middle and high schools, only about 35 percent of our students eat breakfast every day. To make this work, I’d like to see that number up to about 75 percent.” To do that, she will offer “grab and go” breakfasts. “The lines will be shorter, and menus will be simplified, but they’ll still get a hot, balanced meal,” she said.

"Students will be able to enter their building and get a breakfast similar to what they might find at any counter-service or fast-food restaurant," the Star reports. "The menu will vary, but will feature items like chicken biscuits, whole-grain breakfast pastries, mini cinnamon rolls, pancakes, breakfast burritos and cereal bars. Milk, juice and fresh fruits also will be available."

New school nutrition requirements extend to snacks, beverages and a la carte cafeteria items

By Melissa Patrick
Kentucky Health News

Schools will have to provide students with healthier snacks and beverages during the school day this year as part of the U.S. Department of Agriculture's "Smart Snacks in School" standards.

The Hunger-Free Kids Act, which gave schools three years to make their menus healthier with more whole grains, fruits and vegetables, less fat and sodium and smaller portion sizes, added similar nutritional guidelines to all snacks and beverages served during the school day, starting July 1.

"Nothing is more important than the health and well-being of our children," Agriculture Secretary Tom Vilsack said in a press release. "Parents and schools work hard to give our youngsters the opportunity to grow up healthy and strong, and providing healthy options throughout school cafeterias, vending machines, and snack bars will support their great efforts."

Changes in the nutritional guidelines for school meals were made in an effort to fight childhood obesity, a real problem in Kentucky, with 16.5 percent of children in Kentucky obese, according to the Trust for America's Health and the Robert Wood Johnson Foundation.

The new standards will apply to all snacks or "extras," including a la carte items in the cafeteria, snacks in school stores, snack bars and vending machines, until 30 minutes after the end of the official school day. The standards will not affect food sold at after-school sporting events or other activities.

Until this year, students have been allowed to purchase certain "extras" and a la carte items in the lunch line, giving students a "loophole" to continue unhealthy eating habits at school, Kacie Goode reports for the Kentucky Standard in Bardstown.

"I'm hopeful this restriction will encourage healthier choices and discourage skipping the good stuff for less healthy snack foods," April Peach, director of school nutrition for Nelson County, told the Nelson County School Board, Goode reports.

The standards have some flexibility. The USDA press release says students can continue to bring what they choose from home for lunch, treats for special occasions will still be allowed, and fundraisers and bake sales that involve food outside the standards can be permitted. Schools can also impose rules stricter than the standards, which set a minimum.

Schools will have one year to implement the changes. Sue Bartenfield, program manager for the schools branch in the state Department of Education's Division of Schools and Community Nutrition, said in a phone interview that the agency does not kept data on how many schools in Kentucky had already made these changes but "the competitive food rules in Kentucky were fairly strict already."

"We had to take the federal and state guidelines and go with the most restrictive," she said.

Another change allows schools to offer the entree item as an a la carte food on the day it is served as part of the meal, and the day after. These entrees will be exempt from the nutritional standards on those days, since they will be considered to be a healthy choice for students who don't want the whole meal. However, side items, snack foods, beverages and any entrees not served as part of the meal must comply with the set nutritional standards if they are sold a la carte.

“We can’t just sell an extra order of french fries, because it doesn't meet (nutritional) requirements to be sold a la carte,” Peach explained at the Nelson County meeting. “It’s good enough to go on a plate to make a meal, but it’s not healthy enough to sell them an extra serving."

Former pharmacist and county commissioner discusses his battle with addiction with Hopkinsville newspaper

Jeremy Bowles, a former pharmacist and county commissioner in Montgomery County, Tennessee, was convicted of drug and forgery charges, and now he's discussing his experience to help others find freedom from their addictions, Steve Breen writes for Kentucky New Era in Hopkinsville.

"I want to be a message-bearer," Bowles said. Addiction "happened to me as it happens to a lot of people, and people deserve a second chance." While Bowles worked as a pharmacist at Jennie Stuart Medical Center in Hopkinsville, his addiction got so bad that he took blank prescription pads and forged doctor's signatures and cashed them at two different pharmacies. The police caught him when he attempted to use a fake paper at a Walgreens pharmacy in Clarksville.

"He was later indicted in Tennessee on four counts of obtaining a controlled substance by forgery and one count of identity theft," Breen reports. "In Kentucky, Bowles was indicted on nine counts of theft of a prescription blank, three counts criminal possession of a forged prescription, theft of a controlled substance and first-degree promotion of contraband."

Bowles was required to pay $754 in restitution, sentenced to five years of pretrial diversion and given 60 days in jail. However, the jail time may be exchanged for community service. During the sentence, he is not allowed to practice pharmacy in Kentucky.

Bowles said his downhill slide began after he was robbed at gunpoint in 2009 while working at a Clarksville pharmacy and he had to take anti-anxiety medication following the incident. "It became a crutch down the road," he said. "You start out with something prescribed, and it helps you, and you want to keep using it, and it just snowballed from there."

After he was arrested in Tennessee, Bowles went to a rehabilitaiton center in Knoxville for 120 days before going to the Christian County Jail to deal with his Kentucky charges, Breen writes. Bowles said he is glad his family and friends have helped him throughout the difficulties: "I've really changed my life 180 degrees. What I look for now in life is: God comes first, others second and myself third."

He will probably continue working his current job as a consultant for a media company until the suspension of his Tennessee license is lifted. Also he helps out in his 12-step recovery program by serving as a sponsor for two addicts. He said he doesn't have any plans to return to politics. (Read more; subscription required)

Friday, July 25, 2014

Choose a diet specific to your health needs, and recognize that even small changes will create a healthier you

Dieting doesn't just mean cutting back on calories anymore. Now you can choose a diet based on specific outcomes such as weight loss, heart health or diabetes control, writes Travis Thomas, assistant professor in the Division of Clinical Nutrition at the University of Kentucky College of Health Sciences.

Nutrition professionals embrace having more than one choice in dieting, recognizing that a single diet plan doesn't suit all people, Thomas writes. The goal is to "tailor a diet strategy to the goals and personalities of each patient," with the understanding that a structured diet plan makes dieting easier.

But just because there are plenty of diets to choose from doesn't mean they are equally recommended.

U.S. News and World Report recently posted the Best Diets Rankings for 2014, evaluating 32 of the most popular diets. They were evaluated on ease to follow, nutrition, safety and effectiveness for weight loss and whether they were against diabetes and heart disease.

Many of the trendy diets like Atkins, which ranked No. 29; Zone, No. 22; and Paleo, No. 31, are near the bottom of the U.S. News rankings. The DASH diet, developed to fight blood pressure, and the TLC diet, or Therapeutic Lifestyle Changes diet, ranked Nos. 1 and 2.

Thomas says it is important to recognize that no one diet is right for everyone, and to remember that our dietary needs change throughout life. For example, certain medical conditions such as pregnancy have specific dietary recommendations that many popular diets don't support. He also notes that sometimes the list of restrictions in some diets is not sustainable.

And for those who find following a rigid diet plan overwhelming, Thomas recommends starting small.

Making small lifestyle changes that include the attributes found in the top-rated diets is also effective in improving overall health, Thomas writes. Incorporating a balanced diet high in fruits and vegetables, paying attention to what you eat and including structured exercise will "improve overall health without the perceived rigidity of a traditional diet plan."

"Recognize that significant diet overhauls may be difficult to maintain long-term and are not always indicated or scientifically validated," Thomas writes. "Consider starting with small, manageable changes to help you on your way to a healthier life."

For more information on diet and lifestyle go to www.choosemyplate.gov.

Anthem, Humana, Golden Rule and Time health insurers to refund $6.2 million in Ky. for not spending enough on patient care

Four insurance companies will refund $6.2 million to Kentuckians because the insurers didn't meet a requirement of federal health reform, to spend at least 80 percent of the money they get in premiums on caring for patients and improving the quality of care.

The Department for Health and Human Services announced the refunds Thursday. Individual policyholders will get a refund check in the mail, a lump-sum reimbursement to the same account that was used to pay the premium, or a reduction in future premiums.

Employers who provide health insurance must provide one of those options, "or apply the refund in another manner that benefits its employees, such as more generous benefits," said the HHS press release. The average refund will be $43.

"Four Kentucky health insurance plans will refund money," Mary Meehan reports for the Lexington Herald-Leader. "Anthem Health Plans of Kentucky had by far the largest refund at $4.4 million. Humana Health Plan was at $766,295, Golden Rule Insurance Co., $342,336, and Time Insurance Co., $333,096."

Thursday, July 24, 2014

Older rural residents are more likely to seek care at rural hospitals, national study finds

Rural hospitals are more likely to serve older patients seeking hospitalization, while younger rural residents seek medical care in urban areas, says a study by the National Center for Health Statistics at the federal Centers for Disease Control.

"Rural hospitals primarily serve an aging, poorer population admitted for low-acuity care of chronic diseases, and so they likely want to remain close to their homes and their personal physicians," John Commins reports for HealthLeaders Media. "The younger rural hospital patients, who are more likely to have greater mobility and access to commercial health insurance, likely seek care in urban settings because rural hospitals often don't have the funding or patient populations to support specialists or a particular area of specialty care, such as cardiac or oncology."

The study found that 60 percent of the 6.1 million rural residents who were hospitalized in 2010 sought care in rural hospitals, while 40 percent went to urban ones. For patients over 65 years old, 51 percent were hospitalized in rural areas, with 53 percent using Medicaid as their principal source of payment, compared to 37 percent of patients over 65 going to urban hospitals, with 44 percent relying on Medicaid. Rural residents ages 45-64 made up 24 percent of those hospitalized in rural areas and 32 percent in urban areas. The study found no significant difference among patients under 45. (The disparity of where difference age groups seek hospitalization)
Rural residents hospitalized in an urban hospital were three times more likely to have three or more procedures than patients in rural hospitals, the study found. Only 38 percent of patients in rural hospitals received a non-surgical procedure, compared to 74 percent of rural patients at urban hospitals.

Rural residents at rural hospitals were less likely to be discharged home, with 63 percent of rural patients sent home from rural hospitals, compared to 81 percent at urban ones, the study found. Rural hospitals were more likely to discharge patients to another facility, with 14 percent of rural residents at rural hospitals discharged to a long-term care institution, compared to 8 percent at urban ones, and 7 percent of rural hospitals discharged patients to a short-stay hospital, compared to 3 percent of urban ones. (Read more)

Wednesday, July 23, 2014

Beshear says that even if Republicans take over, they won't be willing or able to reverse his Medicaid expansion

By Al Cross
Kentucky Health News

Democratic Gov. Steve Beshear may be succeeded by a Republican next year, and the state legislature may even sooner be controlled by Republicans who have objected to his expansion of Medicaid, but he says they won't be willing or able to reduce or eliminate the coverage or the subsidies for private insurance under the federal health-reform law.

"We now have 421,000 Kentuckians who are also voters signed up for the law and liking what they are getting," Beshear told BBC reporter Claire Bolderson. He said Republicans "want to be critical of the president and his administration, but at the same time they want those 421,000 votes, so they're not going to take away that coverage from those folks."

State Senate President Robert Stivers, R-Manchester, "unlike many of his Republican colleagues in Kentucky and Washington . . . is not calling for outright repeal of Obamacare," the BBC reports, quoting him: "What we are looking for is a reasonable alternative.".

"That includes rolling back the expanded Medicaid coverage and subsidies, and eliminating all the mandates," Bolderson reports.

Stivers claimed that "They've caused more people to lose their insurance than they helped gain," but that is not true, even if those who had to get more expensive policies are counted as losing their insurance.

Agriculture Commissioner James Comer, who is expected to enter the Republican primary for governor soon, indicated at a Kentucky Chamber of Commerce forum Tuesday that he expects to pay for Beshear's expansion of Medicaid if elected.

"We're going to have to not point the finger. If it's not repealed in the next year, we're going to have to pay for it," he said. If so, he said, eligibility criteria should be tightened and "We need to privatize every service we can possibly privatize" and reduce the state workforce to get the money.

Former Louisville Metro Councilman Hal Heiner, who is already in the primary, didn't address Medicaid in detail but said the state should seek federal waivers to create incentives for healthier behavior by Medicaid recipients. He and Comer both said they did not accept studies cited by Beshear which predicted that expansion of the program would create so many jobs in health care and so much more tax revenue that the expansion would pay for itself.

Attorney General Jack Conway, the only announced Democratic candidate, pulled out of the forum a few days before it. Democrat Adam Edelen, who passed up the governor's race to run for re-election as auditor, indicated more faith in the studies, saying that in the long term it is better to have people insured than not, to improve the state's health.

Tuesday, July 22, 2014

As Virginia governor fights to follow Kentucky's lead on Medicaid, free-clinic user says she doesn't want government handout

Kentucky's success with federal health reform hasn't been mirrored in adjoining states. It is a complex topic that was made more complex by the Supreme Court ruling that made it easy for states to reject the law's main device for helping the poor, expansion of the federal-state Medicaid program. That added political complexity to a subject that has philosophical complexity, which showed up at the end of an recent article in The Washington Post about Virginia Gov. Terry McAuliffe's campaign to expand Medicaid against the wishes of his Republican-led legislature.

To illustrate the need, McAuliffe attended a free medical and dental clinic in Wise, in Virginia's southwestern coalfield, just across Cumberland Mountain from Kentucky's Letcher County. The Post's Laura Vozzella ended the story with her interview of Gilda Mountcastle, who had been waiting in line since 5:30 a.m. Mountcastle said she would not have access to a dentist or eye doctor without the free clinic, but said "she did not support Medicaid expansion, which she saw as a government handout." She told told reporters, “We’re hardworking, hillbilly mountain people. We’re too proud to beg and bum.” From the government, at least. (Read more)