Thursday, October 8, 2015

Another rural Ky. hospital will become part of a new group to stay afloat; Glasgow's hospital is buying Columbia's bankrupt one  
Another rural Kentucky hospital is merging with a larger hospital system in order to keep its doors open.

T.J. Regional Health, the parent company of T.J. Samson Community Hospital in Glasgow, just announced its plan to buy Westlake Regional Hospital in Columbia and its clinics, according to a news release.

“Westlake has been an important part of the healthcare infrastructure of Columbia and Adair County for 35 years," T.J. Regional Health President and CEO Bud Wethington said in the release. "We see great opportunities to collaborate with the physicians and employees to grow the health care services and continue its efforts to advance the health status across the region.”

Westlake is owned and operated by Adair County Public Hospital Corp. and the Adair County Hospital District, both of which are in bankruptcy.

The Glasgow hospital has recently cut and adjusted salaries and offered early retirement to reduce costs, and was surprised when The Medical Center at Bowling Green bought Caverna Memorial Hospital in Horse Cave, which referred many patients to Glasgow. Now the Glasgow hospital looks to rebuild its network by buying the one in Columbia.

(Base map from Google maps)
Metcalfe County, between Glasgow and Columbia, has no hospital. The Columbia hospital is close to the tax-supported Russell County Hospital in Russell Springs, a critical-access hospital managed by Baptist Health Lexington.

The proposed acquisition is contingent upon multiple factors, including reaching certain agreements with creditors, confirmation of a Chapter 9 bankruptcy plan by a federal bankruptcy judge and of approvals from state and federal regulators. 

More consolidations are expected. Fleming County Hospital in Flemingsburg recently merged with a larger hospital system to stay afloat. Rural hospitals in Nicholas and Fulton counties have closed in the last year.

Residents of Bourbon County and the Central Appalachian Coalfield are some of the nation's most sleep-deprived

Bourbon County residents are some of the nation's most sleep-deprived, according to county-level data from a study by the federal Centers for Disease Control and Prevention. The study is based on a 2009 survey that asked 432,000 people how many times over the past 30 days they didn't get enough sleep or rest. Respondents were separated into two categories: people who reported poor sleep on fewer than 15 days, and those who reported it on more than 15 days, Christopher Ingraham reports for The Washington Post.

Among Bourbon County respondents, 54 percent said they don't get enough sleep, the seventh highest total in the nation. Many Central Appalachian Coalifield counties also had high rates; those in Kentucky were led by Harlan County, 49 percent; Floyd County, 44%; Breathitt County, 44%; Knox County, 43%; Knott County, 41%; Pike County, 41%; and Morgan County, 40%. 
For an interactive version of the map, click here.
"Researchers looked at a number of social and demographic factors to see whether anything correlated—obesity, income, education, drinking rates, overall physical and mental health," Ingraham writes. "They found, interestingly, that 'relatively younger individuals of lower socioeconomic status and poorer health were more likely to live in hotspot counties.' People who were generally younger, poorer and in worse health were more likely to live in places with high rates of bad sleep."

Wednesday, October 7, 2015

Cooking classes in E. Ky. help residents, researchers find ways to overcome barriers that hinder healthy eating in rural areas

Almost 180 cooks in six Eastern Kentucky counties are learning about heart-healthy cooking at their local Cooperative Extension office, while also helping with dietary research, according to a University of Kentucky news release.

Mary Stevens of Jackson County attends heart-healthy
cooking classes with her mother Betty. (UK photo)
The program, Rural Eating and Healthy Cooking, allows REACH participants to plan and prepare heart-healthy meals and then take them home to their families for sampling. Recipes for the meals are made from the American Heart Association's official heart-healthy cookbook, of which each participant gets a free copy, are budget-friendly and are made with easily obtained ingredients.

The program is a collaboration between the UK's College of Nursing and Department of Family and Consumer Sciences, which works with Extension agents. UK nursing professor Frances Hardin-Fanning, the principal investigator on the study, said she "hopes to gather valuable information about overcoming the various environmental barriers that hinder healthy eating in rural populations."

“There are a lot of things beyond your ability to change,” Hardin-Fanning said of the difficulties people in rural communities can have with eating healthy diets. “But cooking healthy food at home is not one of them.”

West Liberty resident and program participant Bonnie Burton, whose husband is a cancer survivor and pre-diabetic, said she had already begun cutting sodium from their diet and reading nutrition labels, but since participating in the program has learned how to incorporate fresh herbs to boost the flavor of heart-healthy meals and said that she was surprised that her "meat-and-potatoes" husband liked the meatless, three-bean chili that they made in class. 

 “I know how to cook, but there’s always room for improvement,” Burton, 66, said.

The study will last 12 months. Trained interventionists provide health coaching for those in the experimental group, including: trying to identify barriers to healthy eating, regularly reviewing the participants' healthy eating goals; regularly evaluating progress toward these goals; and offering motivation for improving eating habits. The participants are asked to provide their grocery receipts each month for measuring changes in their intake of fruits, vegetables and saturated fat.

Tuesday, October 6, 2015

Australian filmmaker gained 22 pounds eating foods that most parents think are healthy; visited Ky. to see 'Mountain Dew mouth'

An Australian filmmaker, while maintaining his normal caloric intake and eating standard grocery store items, ate the equivalent of 40 teaspoons of sugar a day for two months and gained 22 pounds, expanded his weight size and developed pre-diabetes, reports The Orange County Register, in a story republished in the Lexington Herald-Leader.

Damon Gameau visited rural Kentucky to observe rotten teeth caused by "Mountain Dew Mouth" for the documentary, "That Sugar Film," which is available on videostreaming services.

"I wasn't eating any junk food," Gameau told the Register in a phone interview from Melbourne, Australia. "I was eating these perceived health foods that most parents would give their kids."

The Register notes that hidden sugar, in products like high-fructose corn syrup, has been added to most products since food companies started lowering the fat content in their products.

"Even if you're taking beverages out of the equation, there's more and more sugar creeping into more and more different foods," Michael Goran, director of the University of Southern California's Childhood Obesity Research Center, told the Register.

The Food and Drug Administration has proposed changing food labels to include the amount of added sugars, separate from natural sugars, that occur in foods. "Added sugars provide no additional nutrient value, and are often referred to as 'empty calories,'" the agency said in an explanation of the proposal.

12 Ky. schools recognized for efforts to improve student health

A dozen Kentucky schools that participate in the Healthy Schools Program have been recognized for creating a culture of health and wellness in their classrooms. Ja'nel Johnson reports for WKMS, Murray State University's radio station.

This is the first time so many Kentucky schools have made the list in the same year and they are all first-time recipients, Healthy Schools Project Manager Jacy Wooley told Johnson.

The Healthy Schools Program, part of the Alliance for a Healthier Generation, presented these 12 Kentucky schools with the National Healthy Schools Award for "promoting the benefits of a healthy diet and physical activity to students and staff," Johnson writes.

This nonprofit program is the nation's most extensive effort to prevent childhood obesity in schools, with more than 30,000 schools participating in the program, according to its website.

Kentucky ranks eighth for childhood obesity, with 19.7 percent of its 10-to-17-year-olds obese, according to the Robert Wood Johnson Foundation.

Three schools in Daviess County received the award: Daviess County Middle School, Highland Elementary School and Meadow Lands Elementary School.

Matt Robbins, assistant superintendent for Daviess County Public School District, told Johnson that this program is not just about changing habits, but also about creating a different culture.

“I think it sends the message out, because that’s the direct hint, that we care enough about you that we want to talk to you about these things and how to improve your life, your family’s life and your community’s life,” he said.

Other award-winning schools in Kentucky are: Butler County Middle School; South Edmonson Elementary School; Panther Academy, Elizabethtown; Grayson County Middle School; Pride Elementary School, Hopkins County; Livingston County Middle School; Rodburn Elementary School, Rowan County; Cumberland Trace Elementary School, Warren County; and Jody Richards Elementary School, Warren County.

Sunday, October 4, 2015

Luallen makes case for staying on health-reform course, at forum that focused on relationship between health and communities

By Melissa Patrick
Kentucky Health News

Health is not just determined by access to health care, it is also determined by the communities we live in.

This was the main focus of the annual Howard L. Bost Memorial Health Policy Forum in Bowling Green Sept. 28, with the theme "Building Healthy Places."

Lt. Gov. Crit Luallen, one of the keynote speakers, ventured off this topic and used her time to "preach a bit" about how important it is for the next administration to continue health reform in Kentucky.

"Kentucky, right now, is at a defining moment in its goal to improve the health of our citizens," she said. "Today for the first time we have the tools to provide access to quality, affordable health care to all Kentuckians and to move that needle from some of our most persistent low health rankings."

Luallen noted that because Kentucky embraced health reform and Medicaid expansion, which provides health insurance to those who make up to 138 percent of the federal poverty line, its uninsured rate is now the lowest in the country, dropping to 8.5 percent from 20.4 percent in 2013, just before the Patient Protection and Affordable Care Act took full effect.

She also listed in great detail many of the positive impacts that health reform has brought to the state, including: dramatic increases in preventive screenings; $2.2 billion added to the state's economy from Medicaid expansion; 12,000 new health-related jobs; and a decrease in uncompensated care to less than $60 million at the end of 2014 from $300 million in 2013.

The last two points are of special interest to Kentucky hospitals, which have cut about 7,000 jobs in the last two years but complain more about managed-care Medicaid than the reform law.

Luallen said, "Even if you don't agree philosophically with the core fundamental principle of health reform, which is that everyone deserves access to health care, you can't argue with the numbers about positive economic impacts for local hospitals, local communities, (and) all medical service providers both in terms of direct payments and also in the slashing in the cost of uncompensated care."

Having worked for seven governors, Luallen noted that as administrations change there is often a lack of "sustained commitment over time to successfully tackle our toughest challenges," but said it is important to stay committed to the bipartisan "overarching goal" of a healthier Kentucky and remember that "lasting health improvement will take years" and that it is important to "keep this momentum moving forward."

She also noted that it is important for public policy leaders to "connect the dots" and recognize "the critical linkages between health, economic development, education, crime, drug abuse, businesses needs, and environmental needs."

"But too often in my experience we let political posturing derail our efforts or we take the easy course when we are faced with difficult decisions," she said. "But right now, right now in Kentucky, we have the opportunity to truly change the future of this state if we can cement these reforms in a way that has lasting and stable impact, and that will take everyone in this room working toward that goal."

To the critics who say we can't afford health care reform, Luallen said, "The truth is, we can't afford not to move forward with this," saying that the state-funded, independent studies by both PriceWaterhouse Coopers before the reform was implemented and by the Deloitte Consulting analyzing the first year of the reform clearly say that we can afford it.

Building Healthy Places

The forum then explored through a series of TED-style talks and breakout sessions the link between health and communities, offering insights on how transportation and housing, education, food systems and policy, and employers and workplaces affect our health.

Transportation and Housing: This session focused on how community design and land-use choices affect health, noting that because most of these decisions are made at a local level, community input is often welcomed.

Andrew Dannenburg, affiliate professor at the University of Washington Department of Urban Design and Planning and Environmental and Occupational Health Sciences, recommended communities determine what their "community treasures" are when making plans to improve their community design and then create active living spaces around these areas such as walkable town centers or activating public spaces with farmers markets and free concerts.

"You can educate and tell people to walk, but if you haven't built the physical infrastructure for a place for people to walk that education has not much value," Dannenburg said.

He said community design is important because it affects many people at one time and determines physical activity opportunities, water quantity and quality. food access, air quality, transportation safety, and opportunities to engage in social interactions.

Dannenburg suggested ways to create a healthier community, including streets that allow all walkers and cyclers; neighborhoods that provide walking paths to desired destinations like schools and shopping; walkable access to parks; shared-use agreements between schools and their communities; and rail-to-trail conversions like the Dawkins Line Trail that runs from Johnson County to Magoffin County.

He also noted that communities need to ensure safe housing for everyone because substandard housing creates many health problems like asthma, respiratory infections, poisonings, neurological disorders, depression, injury, heart disease and cancer.

Food Systems and Policy: Margo Wootan, director of nutrition policy at the Center for Science and Public Interest, said eating in America is like playing Candy Crush, an online multi-level game played by over 90 million people.

"As the game draws us into spending more time and money, the food environment draws us in to eating more calories," she said. "More calories than often we plan to eat, and oftentimes more calories than we really want to eat."

Wootan blamed much of the obesity epidemic on how companies market food and said that it matters because "This whole huge epidemic that is facing this state and the country is explained by an extra 100 calories per person per day."

" Marketers study human nature and hijack our biology to get us to buy more and more," she said. "Companies should use their marketing genius to support health rather than undermine it."

Wootan said it is possible for policy to create change, citing how a major shift in food manufacturing has reduced the amount of trans-fats in the foods we eat by 80 percent. She said that will result in "fewer deaths from heart disease, in less disability from heart disease and stroke and a lower health care cost."

She also noted that stronger national nutrition standards have led to children eating more fruits and vegetables and whole grains, and calorie labeling on menus of chain restaurants have resulted in companies reformulating what is on the menu and reducing calories for all people who eat in those restaurants.

Education: There are many social determinants to health and education is connected to most of them, Mary Gwen Wheeler, who was health secretary under then-Louisville Mayor Jerry Abramson.

"Education and health are inextricably intertwined," she said. "College-educated people smoke less, they eat more fruits and vegetables, they exercise more, and they are less obese."

Also, better-educated people have better social determinants of health, including higher incomes, higher levels of employment, better access to health insurance, living in safer neighborhoods, having better access to green space, living near groceries that offers healthy foods, and living in a communities with cleaner air, Wheeler said, adding, "Education tracks very closely with income."

Health also affects education, Wheeler said, noting that children with asthma often have poor school attendance and thus poor school performance; and that kids who come to school hungry and sleepy often have poor attendance and aren't able to pay attention even when they do come to school.

Wheeler noted that while correlation is not causality, she suggested that because so many poor health outcomes and chronic diseases are rooted in poverty, "poverty is a great place to start" looking for a way to improve these social determinants correlated to a lack of education.

She then circled around to say that education is one of the best ways to reduce poverty.

The Kentucky Center for Education and Workforce Statistics recently released a report that says the median wage for high-school graduates in Kentucky three years after graduation is $11,500, below the federal poverty line, she said.

Employers and Workplaces: Employers need to extend corporate health programs into their communities to create a healthier workforce, said Vera Oziransky, author of the report "Beyond the Four Walls: Why Community is Critical to Workforce Health."

"Workforce health promotion is insufficient without community health promotion," she said

As an example, she described a worker who has access to healthy food at work, breaks during the day and incentives to engage in activity, but at home lacks access to healthy housing or healthy and affordable food, and lacks the green space to engage in physical activity. These community factors undermine any initiatives that are taken in the workplace.

The Bost forum is sponsored by the Foundation for a Healthy Kentucky in memory of Dr. Howard L. Bost, who created the national Medicare program, developed the Appalachian Regional Hospital system, developed Kentucky's Medicaid program, improved mental-health services in Kentucky and created the vision for the foundation.

Co-sponsoring partners of the forum were the Friedell Committee, Health Enterprises Network, Kentucky Health Information Exchange, Kentucky Medical Association, Kentucky Public Health Association, Kentucky Educational Television, Leadership Kentucky and the Prichard Committee for Academic Excellence.

Saturday, October 3, 2015

Infographics offer perspective, more data on impact of health-reform law in Kentucky

New infographics are available with information about the big reduction in the number of Kentuckians without health insurance from 2013 to 2014, when the federal health reform law took full effect. It includes data based on characteristics such as age, race, citizenship status, education, work experience and income.

The graphics were prepared by the State Health Access Data Assistance Center of the University of Minnesota, under contract with the Foundation for a Healthy Kentucky. Highlights from the data:
  • Kentucky had the largest percentage point decline (5.8 percent) in its uninsured rates between 2013 and 2014.
  • Kentucky's uninsured rate fell from 14.3 percent to 8.5 percent, representing approximately 250,000 fewer uninsured Kentuckians.
  • Kentucky had approximately 234,000 fewer uninsured adults (ages 18-64) and 16,000 fewer uninsured children (ages 0-17) during this time frame.
  • Among Kentucky's largest counties (those with approximately 65,000 residents or more), Christian County had the sharpest percentage point drop in the uninsured for both adults (8.1 percentage points) and children (7.9 percentage points).

Information for the infographics comes from the recently released American Community Survey by the U.S. Census Bureau.

Friday, October 2, 2015

Kynect tries to get more eligible people to sign up for subsidized insurance, disputes report that 2/3 of eligible haven't enrolled

By Melissa Patrick
Kentucky Health News

State officials recognize that there is a shortfall in the number of people who have signed up for subsidized health-insurance plans through Kynect, the state insurance exchange, but disputes the recent report that two-thirds of eligible people have yet to take advantage of the opportunity.

"We do not feel the numbers related to the two-thirds are correct," Gwenda Bond, a spokeswoman for the Cabinet for Health and Family Services, said in an email. "The figures cited to arrive at that conclusion were preliminary estimates for Medicaid expansion and qualified-health-plan subsidy eligibility based on Census data, completed prior to the first open enrollment period."

Qualified health plans are bought through Kynect, with the premiums reduced by a federal subsidy, structured as a premium tax credit.

"We cannot say at this time exactly how many of the uninsured left in Kentucky are eligible for subsidies, because new county-level Census figures are not available yet," Bond said.

She noted that Kentucky more than doubled the number it expected to enroll in Medicaid through the ACA and "some people who were originally assumed to qualify for subsidies qualified for Medicaid instead."

Why does it matter?

Insurance markets depend on a mix of healthy people paying premiums to subsidize the medical cost of others. In Kentucky, those who enrolled in both private insurance and Medicaid through Kynect have had more health issues, which has caused insurance companies to pay more claims than expected and raise rates.

WellCare is the only insurance company on Kynect that will lower its premiums next year, by an average of 11 percent. CareSource is increasing them by an average of 11.8 percent, Anthem by 12.2 percent (0.4 percent for small groups); Humana by 5.2 percent (7.8 percent for small groups); and Kentucky Health Cooperative, which sold three-fourths of private policies on Kynect and lost $50 million, by 25 percent.

Kentucky has 1,264,275 people on Medicaid, with almost 400,000 of them signed up through the expansion, which includes those who make up to 138 percent of the federal poverty level. About 100,000 Kentuckians bought a qualified health plan.

Initially, the U.S. Department of Health and Human Services said about 40 percent of the policies sold on exchanges should cover people between 18 and 35, the most healthy group, to keep the exchanges financially stable. Recent HHS data states that this group accounted for only 28 percent of the policies nationally in 2014 and 2015.

Efforts to get qualified people to buy insurance

Kynect works to reach both the uninsured who are not eligible for Medicaid but are eligible for subsidies, as well as those who have bought or are planning to buy insurance in the individual market but are unaware that they may qualify for subsidies through Kynect.

"We have always anticipated that educating consumers and enrolling individuals who were eligible for subsidies would be a years-long process, as this facet of the Affordable Care Act is entirely new," Bond said.

One of the exchange's most recent efforts is a media campaign. It encourages those who have bought insurance in the individual private market, and who plan to renew their policies before open enrollment begins Oct. 19, to check rates on Kynect first -- and informing them that they can enroll now if their coverage period is ending. Open enrollment runs through Dec. 11.

Kynect is also emphasizing that some areas of the state will have up to eight insurers to choose from this year, Bond said.

The exchange added some new events for outreach this year, including a "Kynect All Access Lounge" at the Forecastle Music Festival in Louisville this summer and extending the hours that "Kynectors," employees who help people navigate the system, are available at local Cooperative Extension Service offices.

Thursday, October 1, 2015

Health Journalism Workshop offers a host of health-care story ideas from officials, health-care providers, journalists

By Melissa Patrick
Kentucky Health News

Kentucky journalists were challenged by policy makers, health experts and health journalists to write about Kentucky's health issues and were presented with many story ideas at a Health Journalism Workshop sponsored by the Foundation for a Healthy Kentucky Sept. 21 in Louisville.

"Kentucky needs health reporting," said Laura Ungar, national and regional health reporter at The Courier-Journal and USA Today, adding that health reporting "can really make a difference."

A panel of health experts opened the discussion with a look at the "temperature" of health reform in the state and told journalists what they thought needed to be written about.

Sen. Julie Raque Adams, R-Louisville, chair of the Senate Health and Welfare Committee, encouraged journalists to write about the affordability of the Patient Protection and Affordable Care Act, saying "We are going to have to come up with $250 million to pay for it." She was referring to the expected cost of 5 percent of the Medicaid expansion in 2017 and 2018, which Gov. Steve Beshear says will be covered by tax revenue from the jobs created by the expansion.

Health jobs in Kentucky are growing, but hospitals are cutting jobs. Adams said reporters need to write about the effects of the PPACA and Medicaid managed care on their local hospitals, noting, "We have lost 7,000 jobs in rural hospitals."

Adams, who co-sponsored a statewide smoking ban in the Senate last session, said a smoke-free law would save Kentucky more than $2 billion a year in health-care costs. She said this was something important to report on, and  dismissed the prevailing belief in her party that the issue should be decided locally: "When you are talking about $2 billion, you are talking about a statewide issue."

Rep. Tom Burch, D-Louisville, the longest-serving member of the legislature and chair of the House Health and Welfare Committee, said journalists should report the "bigotry" involved in political discourse about "Obamacare;" the importance of preventive care to improve the health of Kentuckians; the need for more primary-care physicians; and a higher cigarette tax to discourage smoking as well as a statewide smoking ban.

"This is one of the biggest health problems we have in Kentucky," he said, "but we just kind of wink at it."

Sheila Schuster, a mental-health advocate, said the PPACA's inclusion of behavioral health as an essential health benefit, and its requirement of parity for behavioral health, are "huge" because no substance-abuse disorder treatment was regularly covered except for pregnant women and youth. But she added that getting mental health services often takes a fight, because insurance companies often question "medical necessity to get around it."

Schuster encouraged journalists to follow the data and tell the personal stories of individuals who have benefited from these behavioral health services, as well as roadblocks they have faced.

Bill Wagner, director of Louisville's Family Health Centers, a group of community clinics that serve low-income residents, said we must never forget that the reform law includes the words "patient protection" and reminded journalists that it is important to remember the "very important protections" it offers.

He noted that with only one-third of eligible Kentuckians enrolled in the subsidized private insurance plans, "the jury is still out" on the reform's affordability and suggested this would be a good story.

The financial sustainability of the reform depends on about 40 percent of the exchange policies to be purchased by those between 18 and 35, the most healthy segment of the population, according to the U.S. Department of Health and Human Services. In 2014 and 2015, this group accounted for only 28 percent of the subsidized policies sold, according to HHS data.

Wagner also said it is important for journalists to cover the race for governor and he was "very concerned" that Republican candidate Matt Bevin says he will replace the Medicaid expansion and seek a federal waiver to implement a different program, possibly like Indiana's, which requires beneficiaries to pay varying premiums and co-payments for non-preventive services and can discontinue services to those above 100 percent of the poverty level if they don't pay their premiums for six months.

Wagner suggested that reporters do a side-by-side comparison of the plans operating under waivers and Kentucky's current expansion plan.

Lack of access to care came up several times in the discussion, especially related to specialty services like psychiatrists and dentists.

Moderator Larry Tye, director of the Boston-based Health Coverage Fellowship, suggested that journalists regularly call all of the health care providers in their coverage area and ask who takes Medicaid and who does not and then print this information in their papers, noting that the calls are necessary because the licensure boards don't always have accurate or up-to-date information.

Al Cross, director of the Institute for Rural Journalism and Community Issues and associate professor at the University of Kentucky, who describes himself as the "extension agent for rural journalists," gave an overview of the PPACA in Kentucky. (Click here for the presentation.)

Cross called for journalists to use the Medicaid Dashboard, which offers county-by-county data about the ACA, to tell community specific stories about who is benefiting from it; the effects of the ACA on employment in their communities; to tell the stories about the infection rates and readmission rates at their local hospitals; to write about their community's plans, or lack there-of, for a needle exchange which must be approved by the local board of health and public officials to be implemented; and also reiterated the importance of keeping their audience informed about the gubernatorial race and each candidates views on health.

"Every news outlet should be writing about needle exchanges, especially in Appalachia, which is number one in Hepatitis C cases," Cross said.

Cross and Tye wrapped up the session with three other prominent health journalists: Ungar, Abby Goodnough, national health reporter at The New York Times, and Mary Meehan, health reporter at the Lexington Herald-Leader and current Nieman Fellow at Harvard.

They added that journalists should write about: prescription drug abuse; the unintended consequences of the reform law, like the lack of access to providers; why emergency rooms are still being over-utilized; denial of treatments by managed-care organizations; penalties that come with not signing up for health insurance; stories to help the newly insured know how to use their health insurance; and reproductive health issues.

Wednesday, September 30, 2015

Are your children's school foods canned or in plastic? That could cause health problems, study in California suggests

Researchers have found that elementary-school children, especially low-income students who are more likely to eat federally funded foods rather than pack a lunch, are being exposed to "school meals that may contain unsafe levels of bisphenol A (BPA), a chemical often found in canned goods and plastic packaging," Paige Miller reports for Stanford University, home to some of the researchers. "BPA can disrupt human hormones and has been linked to health effects ranging from cancer to reproductive issues."

The study was done in urban, suburban and rural schools in the San Francisco Bay area by Stanford's Prevention Research Center and the Johns Hopkins Bloomberg School of Public Health, and was published in the Journal of Exposure Science and Environmental Epidemiology.

Researcher Jennifer Hartle told Miller, "During school site visits, I was shocked to see that virtually everything in school meals came from a can or plastic packaging. Meat came frozen, pre-packaged, pre-cooked and pre-seasoned. Salads were pre-cut and pre-bagged. Corn, peaches and green beans came in cans. The only items not packaged in plastic were oranges, apples and bananas."

Researchers track BPA intake in terms of micrograms per kilogram of body weight per day. Rodents experience toxicity at 2 mcg/kg, but the toxic level for humans is unknown because it's also unknown how humans metabolize BPA, Miller writes. In 1988, the Environmental Protection Agency "defined safe BPA consumption levels as 50 micrograms or less per kilogram of body weight per day," Miller writes. "Since then, hundreds of scientific papers have found detrimental biological effects of BPA at levels lower than the EPA standard. The European Food Safety Authority recently updated its standards for safe BPA intake to 4 micrograms per kilogram of body weight per day."

The study found that a student consuming pizza and milk with canned fruits and vegetables could take in anywhere from minimal levels of BPA up to 1.19 mcg/kg each school day. "While most students would not consume the maximum amount, those who do would take in more than half of the dose shown to be toxic in animal studies in just one meal," Miller writes.

Study co-author Robert Lawrence of Johns Hopkins told Miller, "With endocrine-disrupting chemicals particularly, there is so much uncertainty. We can't tie a specific dose to a specific response like we can with lead. But we know BPA is impacting human health. Animal models are showing there can be a whole range of health effects. This research shows we should take a precautionary approach." (Read more)

Sunday, September 27, 2015

National Institute on Drug Abuse director, in Ky., offers solutions to stop over-prescription of painkillers, opposes pot legalization

By Melissa Patrick
Kentucky Health News

The director of the National Institute on Drug Abuse, Dr. Nora Volkow, told a group of Kentucky journalists and others at the Foundation for a Healthy Kentucky Health Journalism Workshop Sept. 21 that it is possible to decrease the over-prescription of opioids, which she says is driving the heroin epidemic, but the solutions aren't "sexy."

Prescriptions in the U.S. for opioids have increased from 76 million in 1991 to nearly 207 million in 2013.

The increase began in 2000 when The Joint Commission (on Accreditation of Health Care Organizations, then part of its name) began to require health-care providers to assess pain as a fifth vital sign and treat it as necessary, noting that addiction training is often not part of the medical curriculum, Volkow said.

Chronic pain is rampant in the U.S., with more than 100 million Americans suffering from moderate to severe pain, she said. And because there are few alternative treatments, it has led to the over-reliance on, and over-prescription of, opioids.

Kentucky saw a surge in heroin overdoses after the legislature cracked down on so-called pill mills, but the over-prescribing of opioids is what is driving heroin addiction, not the laws that have made legal opioids harder to access, said Volkow, a neurocscientist.

Volkow said there was a "horrific escalation" of babies born physically dependent on drugs and suffering withdrawal. She said she could not predict if these children would grow up to be addicts, she did know that addiction hurts babies' ability to bond with mothers, which puts them at a higher risk for increased anxiety later on.

Volkow said education and implementing solutions that we know will work is the way to combat this problem, and "It is solvable." She offered these suggestions:
  • creating a shift in America's cultural attitude that says there is a pill for everything;
  • educating patients about the abusive potential of opioids when they are prescribed;
  • decreasing obesity rates, because obesity is a major cause of joint pain;
  • exploring non-medication avenues for managing pain, such as real-time brain imaging that shows how cognitive processes influences brain activity;
  • better educating health-care providers on how to recognize and treat addiction;
  • making sure providers are following recommended guidelines when prescribing opioids; and
  • creating new pain relievers with reduced abuse, tolerance and dependence risk.
Kentucky tied for fourth in prescription of opioids in the nation in 2012, at 128 prescriptions per 100 people, according to the IMS National Prescription Audit. Kentucky has the third highest overdose death rate in the nation, with more than 1,000 people dying each year. In 2014, 233 people died from a heroin overdose in Kentucky.

Nationwide in 2013, there were 16,000 plus deaths from opioid-prescription overdoses and 8,000 from heroin, says the Centers for Disease Control and Prevention.

The number of deaths from prescription drugs and heroin have become so dramatic that no one could ignore them, Volkow said.

She also noted that the increase in opioid use among young people was "alarming," citing that 10.5 percent of 12th graders said that they had abused Vicodin in the previous year and 5 percent of them had abused Oxycontin.

Dr. Nora Volkow
Volkow spoke at length on the importance of utilizing medications in treating opioid addicts, saying that it is proven that when drugs containing methadone and buprenorphine are part of an ongoing addiction treatment program, addicts have the most success of recovery. She noted that only 30 percent of providers prescribe such medications, and fewer than half of addicts get them.

Removing a person from the drug "is not treatment," she said, noting that this mode of "treatment" creates an almost 100 percent chance of relapse, and the best chance of success is with the use of medications like suboxone.

Volkow doesn't like the idea of legalizing marijuana. She said her view isn't driven by whether it is more or less harmful than alcohol or nicotine, but by the societal cost of legalizing another drug. She said that once a drug becomes legal, that increases exposure and addiction to it, increases the likelihood that it will be used regularly and increases the adverse effects from the drug; and marijuana is proven to have negative effects on adolescents.

She said the medical and mortality cost related to drugs comes mostly from legal drugs, noting that 400,000 people die a year from tobacco and 24,000 die from opioids, and asked, "Why do we want to expose ourselves to a third legal drug?"

Saturday, September 26, 2015

Beshear: Bevin plan to repeal Medicaid expansion is 'shortsighted'

Gov. Steve Beshear, in a statement released Tuesday, said Republican gubernatorial candidate Matt Bevin's plan to repeal the expansion of Medicaid in Kentucky and his plan to find an alternative solution through federal waivers is "short-sighted" and would cost the state more than the plan Kentucky currently has in place.

“One constant in Mr. Bevin’s ever-changing position on Kentucky’s Medicaid expansion is his consistent lack of understanding of health care. Several of his most recent statements are misleading. Regardless of the model a state chooses to cover its Medicaid expansion population, the state share remains the same – no more than 10 percent in 2020.”

Beshear challenged Bevin to “identify who among our newly insured Kentuckians he believe should lose health care coverage. Which hospitals, physicians and other providers does he think should bear the brunt of a return to increased uncompensated care?”

The governor said the Congressional Budget Office has found that waivers used to expand Medicaid in different ways “will likely cost more than the expansion as we have implemented it in Kentucky. This is a short-sighted view for the future of our Commonwealth, which is the 47th sickest state in the country. Kentucky has a plan in place that is working. Last week’s Census report showed Kentucky with the biggest drop in the uninsured rate in the country from 2013 to 2014. During this time frame, 16,000 children gained health insurance.”

Bsehear said that's good for Kentucky's economic future because “better health, especially for our workforce, has tangible positive impacts – fewer sick days, more production and a higher quality of life for our citizens. Mr. Bevin doesn't seem to understand this connection.”

Kentucky's expansion of Medicaid to people in households earning up to 138 percent of the poverty level has added about 400,000 Kentuckians to the federal-state program. The federal government pays the entire cost of the expansion through next year. In 2017, the state begins to pay 5 percent, rising to the federal health-reform law's cap of 10 percent in 2020.

Bevin insist that Kentucky cannot afford to pay for this expansion, despite a state-funded report by Deloitte Consulting that says the expansion pays for itself through 2020 by creating health-care jobs and generating tax revenue.

At a health forum sponsored by the Kentucky Rural Health Association Sept. 18, Bevin said," "We will not, and I can't be more clear about this,we will not continue to enroll or re-enroll people at 138 percent of the federal poverty level."

He said that his plan is to apply to the Centers for Medicare and Medicaid Services for waivers under Section 1115 of the Social Security Act "to customize something that allows us to provide for these same folks." In July, he said he would use examples from other states, like Indiana, which requires Medicaid expansion patients to make co-payments.

Bevin spokeswoman Jessica Ditto did not offer a response to the governor's statement.

Sannie Overly, Attorney General Jack Conway's running mate for lieutenant governor, said at the forum, "Jack and I are going to monitor our Medicaid expansion to make sure that we can continue to afford [it] moving forward, but what we won't do, and what our opponents have said they would do, on video and in writing, is to kick nearly 500,000 Kentuckians off their health care."