Friday, February 28, 2014

Medical-marijuana bill clears House committee; cannabis-oil bill, more likely to pass into law, goes to full Senate

A bill to legalize medical marijuana in Kentucky passed the Kentucky Health House and Welfare Committee Thursday, but whether the issue will come up for a vote in front of the full House was unclear. Meanwhile, the Senate is moving a bill that would allow experimental use of cannabis oil, which is produces from marijuana but has no psychoactive effects.

Rep. Mary Lou Marzian, D-Louisville, the sponsor of House Bill 350, known as the Cannabis Compassion Act, said that the historic passage was "a miracle," Rae Hodge reported for The Associated Press. "It was so rewarding to be able to offer the folks who are suffering from so many different medical conditions a little bit of hope," Marzian said.

Rep. Robert Benvenuti, R-Lexington, opposed the bill. He was concerned about marijuana being a Schedule 1 drug and that "not enough is known about the drug to support Kentucky research on it." The committee approved the bill by a vote of 9 to 5. It went to the Rules Committee, which can send it to the full House or to another committee.

Marzian said she plans to amend the bill to decrease the amount of marijuana available to patients from three ounces to a half an ounce, and to add more stringent guidelines specifying who can access it in order to get more support for the bill, Hodge reports.

Senate Bill 124, which is sponsored by Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, and Sen. Whitney Westerfield, R-Hopkinsville, chairman of that chamber's Judiciary Committee, would allow trial use of cannabis oil to treat severe childhood seizures.

That bill cleared a Senate committee on Wednesday. If passed into law, it will allow the use of cannabis oil, which has none of the primary psychoactive ingredient in marijuana, in research at the hospitals at the University of Kentucky and University of Louisville.

Sen. Perry Clark, D-Louisville, is sponsoring the Senate version of the medical-marijuana bill. He told Hodge that he doubts that either his bill or Marzian's will pass the Republican-led Senate, but does think the cannabis-oil bill will pass.

Marzian told Hodge, "Any kind of crack we can make in this wall that has forbidden access to medical marijuana or oil — or anything we can do — is opening the door. I don't know if it'll move forward, but if it doesn't, that gives us the whole interim [between legislative sessions] to fashion it in a bill that can be agreeable to folks that may have some concerns but also the people who are in desperate need of alternatives."

Nearly 80 percent of Kentucky adults think people with serious illnesses should be allowed to access and use marijuana for medical purposes if their doctors recommend it, according to a Kentucky Health Issues Poll released in May 2013

Twenty states and the District of Columbia have adopted medical marijuana laws, Hodge reports, and at least 15 are considering such bills this year.

Study shows a decline in obesity rates in preschool children; Kentucky ranks 6th in obesity among pre-kindergartners

The rate of obesity in preschool-age children dropped about two-fifths over the past decade, according to a federal health survey published in the Journal of the American Medical Association, Betsy McKay reports for the Wall Street Journal.

The rate of obesity in children aged 2 to 5 dropped to 8.4 percent between 2011-2012, from 13.9 percent in 2003-2004, according to the federal Centers for Disease Control and Prevention. The rate also dropped for children ages 6 to 11, but less so, to 17.7 percent from 18.8 percent over the previous period.

The decrease among preschoolers could be a result of child-care centers offering more healthy food and increased exercise and a decline in the consumption of sugar-sweetened drinks, the CDC said. It could also be the result of an increase in breast-feeding rates.

Last August, the CDC reported that the obesity rate for low-income preschoolers declined between 2008 and 2011 in 19 of 43 states and territories measured, with Kentucky showing a decline. F is for Fat reports that 15.5 percent of 2-to-4-year-olds in Kentucky low-income families were obese in 2011, a decrease from 17.2 percent in 2003. Kentucky ranks sixth highest for pre-kindergarten obesity, with one in three children either overweight or obese before entering kindergarten. The latest figures for Kentucky are expected in late summer.
Source: Pediatric Nutrition Surveillance System 2008-2011
"We continue to see signs that, for some children in this country, the scales are tipping," CDC Director Tom Frieden told McKay. "This confirms that at least for kids, we can turn the tide and begin to reverse the obesity epidemic."

The Kentucky Department of Public Health is working toward decreasing early childhood obesity in the state with a $275,000 CDC grant, which will help some early care and education centers improve nutrition and exercise standards through training the providers about  healthy eating, physical activity, breast-feeding support and how much screen time is appropriate for young children.

The project is designed to help 4,000 children at 75 child-care centers in Jefferson, Fayette, Boone, Kenton and Campbell counties.

This is good news, because overweight children often become overweight teenagers. A study published in the New England Journal of Medicine found that overweight kindergartners have four times the risk of becoming obese by age 14 as those of normal weight.

The CDC cautioned that obesity rates rose among teens  remain high among both adults and children, having changed little over the past decade, McKay notes. In 2011-2012, 16.9 percent of 2-to-19-year-olds and 34.9 percent of adults were obese. In 2003-2004 the respecti ve rates were 17.1% and 32.2%. 

State House panel approves bills to require HPV vaccinations of boys and girls and ban use of tanning beds by children

The state House Health and Welfare Committee approved two bills Thursday to require that boys and girls to be vaccinated for the human papilloma virus before sixth grade and to generally ban use of tanning beds for those under 18. HPV causes cervical and oral cancer, and tanning is a cause of skin cancer.

House Bill 311 would allow parents to withhold consent for the HPV vaccination for any reason. House Bill 310 would bar anyone under 18 from using a tanning bed without a prescription. Under current law, use of a tanning bed by 14- to 17-year-olds requires consent of a parent or guardian.

Gov. Steve Beshear issued a press release praising the bills and the prime sponsor, Democratic Rep. David Watkins, a retired physician from Henderson. "Every year, more than 9,000 Kentuckians succumb to various forms of cancer, making the commonwealth the worst state in the nation for cancer-related deaths," Beshear said. "Last week, I outlined seven major goals to reduce our rate of cancer deaths, as well as improve Kentucky’s other dismal health statistics, by 2019. . . . I am optimistic that House members will look favorably upon these common sense measures to improve the health of Kentuckians and vote for their passage."

Thursday, February 27, 2014

Dr. Gene Paxton Lewis dies; he was a leader in public health dentistry in Kentucky and the nation

Dr. Gene Paxton Lewis, a dentist who did the first survey of Kentucky's oral health and helped create the state's oral health coalition and its first mobile dental office, died Feb. 12 in Ft. Lauderdale, Fla. He was 78.

"Lewis spent more than 20 years with the U.S. Public Health Service, and much of that time was spent helping develop community health centers, colleges focusing on health professions and other initiatives in Kentucky and other southeastern states," Karla Ward reports for the Lexington Herald-Leader. Lewis served as president of the American Board of Dental Public Health and the American Association of Public Health Dentists.

At the University of Kentucky, Lewis was chairman of the Department of Community Dentistry and interim dean of the College of Dentistry. After serving as executive assistant to the state health commissioner, he oversaw the college's public and professional services. The college is known for its outreach, and Lewis was "in large part responsible for that," Dr. Raynor Mullins of the UK Center for Oral Health Research told Ward.

Report links smoking with rheumatoid arthritis, other diseases

By Melissa Landon
Kentucky Health News

Smoking is even more harmful than previously thought. It not only can cause lung cancer but also rheumatoid arthritis and a long list of other diseases, according to The Health Consequences of Smoking—50 Years of Progress, a report of the surgeon general. Kentucky leads the nation in the habit, with 28.3 percent of adults smoking.

Since 1964, more than 20 million Americans have perished from smoking-related illnesses. Although most of the deaths were deliberate smokers, 2.5 million were nonsmokers who are believed to have died from exposure to secondhand smoke. "The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products; rapid elimination of their use will dramatically reduce this burden," the report says.

The report provides supporting evidence that smoking often causes people to die early. Besides respiratory disease, cardiovascular diseases, and diabetes, new information gathered for this study reveals that smoking can also cause reproductive effects, such as ectopic pregnancy; eye disease, such as age-related macular degeneration; and immune and autoimmune disorders such a rheumatoid arthritis.

Because smoking weakens the immune system and causes systemic inflammation, it can not only cause RA but also impede treatment of it. RA is a chronic disease that involves inflammation of the joints and sometimes other parts of the body, according to WebMD. The report also found that women who smoke are just as likely as men to die from smoking-related illnesses—including lung cancer.

Though smoking has become less common since 1964, the costs associated with it are still high. The cost every year for direct medical care needed to treat smoking-related issues is $130 billion annually, and the cost for loss of productivity resulting from premature deaths are greater than $150 billion.

Regardless of constant warnings about the harmfulness of smoking, almost 42 million adults and over 3.5 million middle- and high-school children still smoke. "Each year for every adult who dies prematurely from a smoking-related cause, more than two youth or young adults become replacement smokers," the report says. Advertisements and marketing influence young people to begin smoking at a young age—88 percent begin before age 18—then the addiction to nicotine makes them continue.

The report suggests the following five measures for fighting the smoking battle in our society: raising the price of cigarettes and tobacco products, forming media campaigns, providing access to cessation treatments and funding statewide tobacco control programs.

Wednesday, February 26, 2014

Here's a fresh strategy for reforming malpractice lawsuit rules: measure doctors by national standards, not local custom

A bill that would create three-person panels of medical experts to give non-binding opinions on malpractice lawsuits before trial doesn't appear to be getting anywhere in the Kentucky General Assembly, at least not at the moment. The medical malpractice laws do need to change—by altering the "basis for finding a doctor guilty of malpractice in the first place," Peter R. Orszag, budget director in the Clinton administration, writes for Bloomberg View.

The discrepancy exists in the fact that doctors' performances are measured against "customary practice," which is defined as what doctors usually do, which isn't always necessarily based on the best medical science, Orszag writes. If doctors followed protocols published by a professional medical association, they could be protected by law. The Center for American Progress, a moderate Democratic think tank, presented this idea and gave suggestions for how it could be implemented.

A study by Professor Michael Rakes of Cornell Law School and Anupam Jena, a professor of health-care policy at Harvard Medical School, found that shifting away from local "customary practice" standards toward national practices can improve health care. "The literature to date has largely failed to appreciate the substantive nature of liability rules," Frakes and Jena write, "and may thus be drawing limited inferences based solely on our experiences to date with damages caps and related reforms." Limiting lawsuit damages is unconstitutional in Kentucky.

If doctors knew they could be protected from lawsuits if they followed specific procedures, "the safe harbor might have an even bigger effect on their behavior than the Frakes-Jena study suggests," Orszag writes.

Though it could take a long time for this change to happen nationally—because most Democrats in Congress are against malpractice reform and Republicans are concentrating on damages caps—states can reform their individual malpractice systems, Orszag notes.

Monday, February 24, 2014

Rural children are more likely to be obese, but rural communities have several strategies to fight the problem

Children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas, studies show. Rural communities have come up with several strategies to battle childhood obesity, Sarah Lifsey and Karah Mantinan report for the Altarum Institute, a nonprofit health-systems research and consulting organization.

 Many people are surprised to hear that childhood obesity is a rural phenomenon because they assume that rural kids have more access to the outdoors and physical activity. However, studies have found that there is little open public space in rural areas, often because of a lack of a strong government to provide and maintain such public spaces, Lifsey and Mantinan write. They also cite research showing that fear of crime in public spaces is a reason rural families don't use public activity areas, even though crime is least likely to occur in rural areas.

 Rural children are also at increased risk of poverty compared to children in cities or suburbs, and face lower access to health care, lower levels of physical activity, lower-quality food, and limited options for transportation.

 Many of Kentucky's children are poor, overweight and sedentary. One in four children in Kentucky lives in poverty according to the American Public Health Association and 37.1 percent of children in Kentucky between the ages of 10 to 17 are considered overweight or obese, according to the Foundation for a Healthy Kentucky. Seventeen percent of Kentucky children reported not getting any physical activity in the seven days prior to a survey given by the federal Center for Disease Control and Prevention and 28.8 percent of children on the same survey watched television three or more hours per day on an average school day. 

Poorer food and lower levels of activity are often the result of the distance it takes to get to a physical-activity venue or a grocery store in rural areas, the authors write. The round-trip time it takes to get there and the cost of gas for these trips adds a time-and-cost burden to families that often creates a lack of commitment to transport children back and forth to after school activities or to travel to groceries with better food options, Lifsey and Mantinan write.

 Many rural families who lack access to fresh and healthy foods live in "food deserts," Generally defined as those with no grocery with fresh produce within 10 miles. Studies have found poverty and childhood obesity are more likely in rural food deserts.

 Rural communities are using several school-based strategies to fight obesity, Lifsey and Mantinan report. They include making sure school-bus schedules and family transportation schedules coordinate to encourage after-school activities; ensuring that schools provide gym class and recess; allowing recreational areas of school grounds to be available to the community after hours; providing alternative transportation options to students who need rides home in order to participate in after school activities; improving school meals to include more whole grains, fruits and vegetables; and improving the choices available in soda and vending machines.

 Engaging programs and groups that are already in existence, such as 4-H Youth Development and telemedicine programs that focus on childhood obesity intervention, are great places to start when initiating childhood obesity programs, the authors write. Having local farmers teach gardening skills can also improve access to healthy food.

 Noting that African-American children are the most likely to be obese, Lifsey and Mantinan say communities must keep minority populations in mind. They also suggest working with employers to start employee wellness programs that encourage parents to model healthy behaviors for their children.

 Also, It's important for rural communities to observe, measure and decide how each of them want to attack this issue to increase the probability of success, they say.

 Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation. Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the Nutrition Obesity Research Center's Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina's Active Living by Design.

Remote Area Medical plans to bring more local clinics to Kentucky and other areas in the 'distressed corridor' of Appalachia

More help could be coming for Appalachian Kentuckians who need health care. Remote Area Medical is launching a two-year campaign beginning in September called "Stop the Suffering in Appalachia," designed to work with community organizations, health-care professionals and volunteers in Kentucky, Tennessee, North Carolina, Virginia, West Virginia, Ohio and Mississippi to raise funds to provide free care to as many people in the "distressed corridor" as possible, according to the group's website. RAM lists 15 percent of the Appalachian population, or 180,000 people, as needing the services. The cost per patient is $22.22. A clinic is scheduled Oct. 25-26 at Rowan County Middle School in Morehead. (Los Angeles Times photo by Genaro Molina: Patients at a clinic in California)

RAM, which has more than 84,000 volunteers, has provided more than $75 million worth of free medical care in more than 700 mobile clinics to 545,000 patients, according to the organization. Despite those staggering numbers, they say they want to reach even more people in need "to establish RAM Affiliates based in Appalachian states to provide ongoing services and healthcare access beyond 2016." (Read more)

The solution is to "work with local organizations and doctors in each state organizing clinics on a local level by donating two trucks to help with health care procedures," Laura Halm reports for WATE-TV in Knoxville. That means, RAM founder Stan Brock told Halm, that when RAM holds the clinic in October in Kentucky, "those people in the middle of Kentucky don't have to drive all the way down to Knoxville or come and find us in some other part of the country." It also means RAM can hold more clinics each year, raising its average total from one or two to five or six. Brock told Halm, "We really need to have an intense focus on Appalachia in our own backyard, because the need is so great." (Read more) For the clinic schedule click here.

County analysis shows wide range in numbers of previously uninsured who now have coverage through state exchange

Since enrollment for coverage through the Patient Protection and Affordable Care Act opened Oct. 1, more than 255,000 Kentucky residents have signed up; because a goal of the law is to provide everyone with affordable insurance, the Lexington Herald-Leader
looked at county data on enrollments and previous numbers of those who didn't have coverage.

The newspaper found that Perry County has the highest percentage of previously uninsured people who signed up through the Kynect, the state's health-insurance exchange—67 percent—while Owen County has the lowest—17 percent, Mary Meehan and Linda J. Johnson report. For an interactive map and individual county data, click here.

The analysis shows that southeastern Kentucky leads in signups; nine adjoining counties and neighbor Whitley have the highest enrollments. The 10 counties with the lowest percentage of previously uninsured enrollees are Boone, Todd, Anderson, Spencer, Christian, Hickman, Crittenden, Meade, Shelby and Owen. These counties are spread throughout Kentucky.

Courier-Journal map shows county uninsured rates in 2012.
"People in the counties with higher rates of signups say personal connections have helped spur friends and neighbors to sign up," Meehan and Johnson write. Hospital workers, nonprofit staffers and insurance agents have become certified kynectors—those who promote and clarify the insurance process for others. The state provided grants to three agencies—including $600,000 to the Kentucky Primary Care Association—to fund more kynectors. Some Kentuckians may still lack the necessary information about the ACA and how to sign up.

"The kynectors are really great about using their personal networks, churches and families, so there is a face-to-face, one-on-one" conversations someone familiar, said Lindsay Nelson, state coordinator for outreach and enrollment with Kentucky Primary Care Association. She said the system wouldn't have worked had they hired people from outside Eastern Kentucky. The kynectors have even visited places like jails, schools and gas stations to talk to people about health insurance. Nelson said kynectors inform people of their options but warn them about the penalty involved with not signing up.

Kynect Director Carrie Banahan said counties with many low-income people might be enrolling them more quickly because many qualify for Medicaid, which doesn't require premiums. "Of the 231,367 enrolled in health insurance, 181,705 have enrolled in Medicaid," the Herald-Leader reports, using data gleaned before last week's updated number.

Karen Ditsch, executive director of Juniper Health, a public health clinic that serves Breathitt and Lee counties, said relationships are working in her community. "This is a mountain community," she said. "It is small; everybody knows everybody. I think they trust us." (Read more)

Foes of bill to raise truck weight limits raise safety concerns

The state House is considering a Senate bill that would allow trucks hauling poultry, other livestock and agricultural products to carry 88,000 pounds instead of the current 80,000. The Kentucky Ambulance Providers Association, the state school-bus association and some law-enforcement groups are fighting the bill, which they say could be heard by the House Transportation Committee this week.

The Coalition Against Bigger Trucks said in a news release that Senate Bill 44 "will endanger Kentucky motorists, speed up deterioration of roads and bridges and impose new burdens on taxpayers. Tom Adams, president of the ambulance lobby, said emergency personnel “see the negative impact of big rigs firsthand. In the very recent past, one of my ambulances was struck by a semi-trailer truck that was unable to stop at the scene of a crash on the interstate. We don’t want emergency responders or the public contending with even heavier, 88,000-pound trucks.”

Police officers say safety is their primary concern. “There were more than 2,500 large-truck collisions in 2012, and 82 people lost their lives, so loading up to four more tons onto trucks makes them even more dangerous to motorists,” said Tim Hazlette, chief of the Campbellsville Police Department and a former state trooper. “Some business interests hope to haul their loads at reduced prices, but the expense to public safety must be considered.”

In addition to the ambulance group, CABT members in Kentucky are the Kentucky Association of Pupil Transportation; the state, Bluegrass and Louisville FOP lodgesthe Kentucky Constables Association, the Brotherhood of Locomotive Engineers and AARP, formerly the American Association of Retired Persons.

Some other states have passed such bills, some with lesser increases. The Kentucky bill passed the Senate 35-3; voting against it were Sens. Tom Buford, R-Nicholasville; Brandon Smith, R-Hazard; and Johnny Ray Turner, D-Prestonsburg.

Jamie Fepke, president and CEO of the state's main trucking lobby, the Kentucky Motor Transport Association, said it does not have a position on the bill, which is being pushed by the poultry industry. He said poultry facilities often lack scales and incorrect weight estimates can put trucks over the limit. "This doesn't mean that people are automatically going to add 8,000 pounds," he said. Trucks can handle 88,000 pounds; the questions are, is the truck maintained, are the drivers trained?"

Friday, February 21, 2014

Henderson County jumps into the fight against childhood obesity, a major problem in Kentucky

Henderson County is investing in a holistic program to battle childhood obesity, a huge problem in Kentucky, Erin Schmitt reports for the Henderson Gleaner.

Childhood obesity is at 18 percent in Kentucky—one of the highest rates in the country—and 35.7 percent of Kentucky children ages 10 to 17 are overweight or obese, according to the Kaiser Family Foundation. Nationally, rural children are more likely to be obese than those in cities and suburbs.

Local organizers hope to improve these statistics by implementing the research-based Coordinated Approach to Child Health, or CATCH, to school-aged kids, Schmitt writes.  CATCH has been proven to produce lasting results through the promotion of physical activity and healthy food choices.  This is accomplished by using a four-pronged approach that  includes involving the school cafeterias, home, the curriculum and after school activities.

“Henderson County has the potential to lead the state,” Chase Fulcher of the Community Foundation of Henderson told Schmitt. “We’ve got the potential to be the first school system and county in Kentucky to adopt this program.” Subway franchise owner Jeff Troxel, a partner of CATCH, approached Fulcher about investing in the program, Schmitt reports, and soon after the foundation agreed to donate $20,000 and lead the cause.

Fulcher has since secured a $10,000 to $20,000 commitment from Methodist Hospital, private donations of $20,000, and $5,000 from the Henderson County Board of Education, and is looking for state and federal grants, Schmitt writes. The money, along with involvement by local staffs, is expected to sustain the program.

A CATCH trainer is scheduled to begin training the local school principals about the program March 12, Schmitt reports. After this training, the program will move into the schools.

Thursday, February 20, 2014

Beshear lays out plan for improving Kentucky's health, with specific goals and largely administrative strategies

By Al Cross
Kentucky Health News

Gov. Steve Beshear set seven specific, numerical goals Thursday for improving Kentucky's "dismal" health status, which he said is hurting the state's education, productivity, attractiveness to employers, state revenues "and our very quality of life."

Beshear, whose term ends in early December 2015, set the goals to be met by Jan. 1, 2019 and said he would hold his appointees "accountable for measurable, reasonable progress." The goals of the program, dubbed "kyhealthnow," are:
  • Health insurance: Reduce the share rate of uninsured Kentuckians to less than 5 percent, through Kynect, the insurance exchange Beshear created under federal health reform.
  • Smoking: Reduce Kentucky’s smoking rate, now the highest in the nation at 28.3 percent of adults, by 10 percent. The strategies include increasing the use of smoking-cessation therapy, now covered under Medicaid, by half; and two major legislative items, a statewide smoking ban and a higher cigarette tax, for which Beshear said he would keep pushing in next year's legislative session if not passed in the current one. "Smoking is the single biggest factor negatively affecting the overall health of Kentuckians," he said.
  • Obesity: Reduce the rate by 10 percent through 13 separate strategies, including measures to encourage physical activity, using Kynect to double the number of enrollees in the state diabetes prevention program, and partnering with school districts to increase the number that collect and report students' body-mass indexes. Kentucky is the fifth worse state for physical activity among adults.
  • Cancer: Reduce cancer deaths by 10 percent, largely through more screening. Kentucky has the nation's highest cancer death rate.
  • Cardiovascular Disease: Reduce cardiovascular deaths by 10 percent, with measures such as more smoking cessation and aspirin therapy. Kentucky has the nation's third-highest death rate from diseases of the heart and circulatory system.
  • Dental Decay: Reduce the percentage of children with untreated dental decay by 25 percent, and increase adult dental visits by 10 percent. The strategies include public-private partnerships to see that three-fourths of the state's grade schoolers get fluoride varnish treatments. "the poor dental health of Kentuckians has not only subjected Kentucky to ridicule, but has detrimental impacts on children, the workforce and families," Beshear said.
  • Drug Addiction: Reduce deaths from drug overdose by 25 percent, and reduce the average number of poor mental health days of Kentuckians by 25 percent. The strategies include a "Good Samaritan Law" for people seeking drug treatment for themselves or others, and 50-percent increases in the availability of substance-abuse treatment. Kentucky ranks third in the nation in drug overdoses.
From left: Cabinet Secretary Mary Lassiter, Justice Secretary
J. Michael Brown, Beshear, Abramson, Haynes, Mayfield
Increasing drug treatment would cost money, but Beshear said the state, nonprofits and the private sector can make most efforts "with very little cost to anybody." For a complete list of the goals and strategies, click here.

Beshear named Lt. Gov. Jerry Abramson to head a working group that will push the goals, with Public Health Commissioner Dr. Stephanie Mayfield Gibson as vice chairman. The group will contain leaders from every state cabinet and will seek advice and partnerships from agencies and institutions outside state government.

Health and Family Services Secretary Audrey Haynes acknowledged that improving Kentucky's health status requires individuals to change their unhealthy behaviors, but said the greater availability of health insurance through Medicaid and subsidized insurance gives them more opportunity to do that. "Now we just have to lead them to the water and make them drink," she said, adding later, "We have to put peer pressure on each other," and health-care providers "have to become educators, more than ever."

Beshear discounted an Oregon study that found expanding Medicaid didn't improve the health of new beneficiaries, saying it only covered two years. "We all know this is a long-term process," he said. "We need to look 10, 15 years out. . . . This is for the next generation." For a story and six-minute video from Nick Storm of Time Warner Cable's cn|2, click here.

Kentucky Chamber of Commerce President Dave Adkisson attended the announcement and distributed a written endorsement saying, "The business community has grown increasingly troubled by the impact of our state's poor health status on workforce productivity, absenteeism, health insurance rates and tax bills."

The Foundation for a Healthy Kentucky said it sees in Beshear's plan "a mix of winnable battles – and a commitment to measuring impact – that together will help make Kentucky healthier and more competitive.  Decreasing smoking and the number of families living without health insurance, and increasing the numbers of Kentuckians with ready access to healthy foods and safe places for active living, in the near term is likely to have the payoff we all seek in reducing preventable disease and death from cancer and heart problems in years to come."

Legislature passes bill requiring schools to have trained employees to give insulin and epilepsy medication to students

A bill to require schools to have an employee on duty to administer insulin and epilepsy medication to students is on its way to Gov. Steve Beshear for final action.

House Bill 98, received final passage Thursday in the House, 96-2, after initial House passage and Senate amendments. The "no" votes were cast by Republican Reps. Ken Upchurch of Monticello and Ben Waide of Madisonville.

The bill would require that a licensed health worker, non-licensed health technician, or trained school employee be on duty at schools to administer or help with self-administration of insulin, other approved diabetes drugs, and seizure-rescue drugs approved by the federal government.

Written permission from a child’s parent or guardian, and instructions from the child’s health-care provider, would be required before any of the medications could be administered. The training requirements would go into effect July 15; the rest of the bill would take effect immediately.

The bill's sponsor, Democratic Rep. Bob Damron of Nicholasville, said it would make Kentucky the 34th state to adopt such legislation.

The bill would also allow children to perform their own blood-glucose checks and self-administer insulin at school with written request of parent or guardians and authorization by the child’s health provider.

Poll: Only 23% of Kentuckians say they eat recommended daily portions of fruits and vegetables; cost and location may be factors

Only 23 percent of Kentuckians eat the recommended daily portions of fruits and vegetables, and cost and accessibility of food may be factors, according to a recent statewide poll.

Fruit and vegetable consumption can decrease a person's chance of developing chronic diseases like cancer and high blood pressure. Kentuckians fall short of the recommended portions; 26 percent eat the recommended amount of fruit, 12 percent eat the recommended amount of vegetables, and 39 percent don't meet either recommendation, according to the latest Kentucky Health Issues Poll, taken Oct. 25 through Nov. 26.

The recommended dietary suggestion for adults is to make half their plate fruits and vegetables at every meal.  This guideline assures that  adults would get at least two servings of fruit and three servings of vegetables per day, according to U.S. Department of Agriculture guidelines.

Some Kentuckians seem to know they don't eat well; only 39 percent of those surveyed said they have an excellent or very good diet. In general, those who claimed to have better diets also had better health, which comes as no surprise. However, 38 percent of adults who claimed excellent or very good health did not meet the dietary recommendation for fruit or vegetable consumption.

Income appears to be an influencing factor, because just 30 percent of Kentuckians whose incomes are below 138 percent of the federal poverty level (the limit for Medicaid) said they have an excellent or very good diet, while 47 percent with incomes above 200 percent of the FPL said they did. Although 81 percent of those surveyed said they had easy access to healthy foods, of those in non-Appalachian counties 10 percent said they did not; the latter number was higher in Appalachian counties, where 20 percent said they did not.

Cost is also a concern. Half of the respondents said fruit and vegetable prices in their areas are fair to poor, and only 19 percent reported excellent or very good prices.

The Kentucky Health Issues Poll is funded by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed 1,551 randomly selected Kentucky adults,

Wednesday, February 19, 2014

State House panel OKs bill to regulate e-cigarettes in Ky.

Electronic cigarettes would be regulated as tobacco products in Kentucky under a bill that the House Licensing and Occupations Committee approved Wednesday.

HouseBill 309, sponsored by Rep. Joni Jenkins, D-Shively, would include the relatively new product among cigarettes, cigars, and other types of tobacco products that are regulated by the state. It would also make e-cigarettes off limits to anyone under age 18.

E-cigarettes have a battery, electric circuit or other component that allows them to produce vaporized nicotine. The nicotine is derived from tobacco grown in India and China, said National Center for Tobacco-Free Kids regional director Amy Barkley, who testified on the bill with Jenkins.

Rep. Brad Montell, R-Shelbyville, questioned whether e-cigarettes would be taxed as tobacco products if redefined under HB 309. Jenkins said that would be up to the House Appropriations and Revenue Committee, which is now working on a state budget for the next two years. Montell and Rep. David Floyd, R-Bardstown, voted against the bill.

Concerns about how broadly the legislation could be interpreted were expressed by Rep. Adam Koenig, R-Erlanger, who asked Jenkins, “Why don’t we just have a bill that says, e-cigarettes: You can’t buy them if you’re 18.”

Jenkins replied, “I guess because the industry is constantly changing, and if we just say e-cigarettes next year there’ll be a another product very similar but that’s not exactly an e-cigarette.”

HB 309 now goes to the Rules Committee, which could send it to the full House or to another committee.

Tuesday, February 18, 2014

KentuckyOne Health announces layoffs, but not how many

Major hospital operator KentuckyOne Health says it is laying off workers, but isn't saying how many.

"The many steps we have taken so far across KentuckyOne Health to reduce our expenses to match our revenue have not been enough," the company says on the employee page of its website. "We are saddened that we must now eliminate some positions across KentuckyOne. The current systemwide staff reductions will generally be complete by the end of February." The statement continues, "These reductions, in addition to becoming more operationally efficient, will help us reverse the system’s financial losses to sustain KentuckyOne into the future."

The company sent a statement to journalists saying staff reductions are needed to "reach our goal to become a fully integrated, financially stable health system within the next two years." Cheryl Truman of the Lexington Herald-Leader notes that on Feb. 7, President and CEO Ruth Brinkley said in a statement on the employee website, "The changes in health care are greater and have come faster than we expected. . . . We are now paid based on the quality and efficiency of the care we provide, not how much care we provide." She said the company would act "to improve our performance now and over the long term, balancing access, quality and cost."

KentuckyOne Health was formed in 2012 by merger of the Saint Joseph Health System, Jewish Hospital and St. Mary's HealthCare. Later that year, "The organization formed a partnership with University of Louisville Hospital," Truman notes.

Monday, February 17, 2014

Smoking ban has 'around 50' votes in House, sponsor says

UPDATE, Friday, Feb. 21: The bill has still not come to a vote. House Speaker Greg Stumbo said Thursday it had less than half of the 20 Republican votes needed to pass it, despite a floor amendment Westrom filed Tuesday that would exempt electronic cigarettes, private clubs and cigar bars.

The sponsor of the bill to ban smoking in enclosed public places says she expects to bring it to a vote in the state House on Wednesday or Thursday.

Rep. Susan Westrom, D-Lexington, declined to say exactly how many votes she has for House Bill 173, but averred, "I would say around 50." The House has 100 members; they do not have to vote, but at least 40 votes are needed to pass a bill. Jeff Harper, a lobbyist for Kentucky Farm Bureau, which opposes the bill, said he has heard from legislators that the bill has 46 votes.

The bill has gotten out of committee several times, but has not been brought to a floor vote because it lacked the support to pass. Senate President Robert Stivers opposes the legislation, but "Westrom believes there is sufficient support among rank-and-file senators," reports Stu Johnson of Kentucky Public Radio.

Four amendments have been filed to the measure. The one getting the most attention appears to be the one filed by Rep. Stan Lee, R-Lexington, which would eliminate electronic cigarettes. Westrom said House members have seen "a mass pounding of emails" for the amendment, but many of the senders seem to think her bill would ban e-cigarettes entirely, which it would not.

Philip Morris Cos., which typically spends more at the legislature than any other lobbying interest, recently said it would get into the burgeoning e-cigarette business. It reported spending $30,697.63 in January on lobbying the General Assembly, more than any January since 2006. Of that amount, $19,841.74 was for five lobbyists and the remaining $10,855.89 was for unspecified expenses.

Westrom said the other amendment getting considerable discussion is one by Rep. Jim Gooch, D-Providence, that would exempt cigar bars. Rep. Wilson Stone, D-Franklin, would exempt pari-mutuel wagering facilities, and Rep. Jim Stewart, R-Flat Lick, would put fines for violations in the state General Fund rather than the agency issuing the citation.

Westrom told Kentucky Public Radio that she's prepared for amendments, and said local communities could impose stricter rules than the bill even it becomes law. “They can make the bill stronger if that’s what they choose to do within their own communities,” she said. “So, I don’t look at that as a defeat or something bad.”

Westrom said she thinks the bill will pass because "the facts are so compelling and the fears are unfounded." She said the most common comment she hears from legislators is that they have many smokers in their districts, "especially in Eastern Kentucky."

Kentucky has the nation's highest smoking rate, 28.3 percent. Its Appalachian region had the lowest level of support for a ban in the Kentucky Health Issues Poll taken last fall for the Foundation for a Healthy Kentucky, but even in that area, 62 percent favored it while 34 percent opposed it. The poll defines Appalachian Kentucky as the 46 counties in the Big Sandy, Buffalo Trace, Cumberland Valley, Fivco, Gateway, Kentucky River and Lake Cumberland area development districts. The Appalachian results may reflect the fact that the region is where residents are most likely to be smokers.

Accreditation commission designates UK as one of 63 comprehensive stroke centers

The Joint Commission for accredting health-care organizations, the American Heart Association and the American Stroke Association have designated UK HealthCare a Comprehensive Stroke Center. The university's medical center joins 63 other institutions with the designation.

The certification is bestowed upon hospitals with not only state-of-the-art infrastructures and 24/7 availability of special treatment but also dedicated staff with the education and experience to help patients who suffered from complex strokes. "We are justifiably proud of the many people at UK HealthCare whose expertise and commitment to quality of care earned us this designation," said Dr. Michael Karpf, UK's executive vice president for health.

Traci Beasley, a 35-year-old elementary math teacher and mother of two, had a stroke in 2012 and was airlifted to UK, where she received the kind of care and treatment that earned the institution the designation. "Mrs. Beasley's condition required immediate intervention, and the particulars of her case led us to use an older but less commonly employed approach to prevent aneurysm from re-rupturing," said Dr. Justin Fraser, who led the team that treated Beasley.

A UK press release says, "In the hospital's state-of-the-art hybrid OR, the only one of its kind in the region, he used a microscope to deploy a tiny metal clip that sealed off the aneurysm." While caregivers watched for any subsequent problems, Beasley went to the angiography suite to correct her cerebral vasospasm, a condition that restricts blood supply to brain tissue as a result of narrowing arteries. Soon after, she returned home.

Fraser said the stroke center designation is a result of teamwork and collaboration: "Weakness in an arm or speech problems . . . are obvious neurological deficits caused by a stroke, but our goal is to achieve a more elegant solution. Can the patient balance their checkbook? Can they follow a list at the grocery store? Can they return to work and a normal life? That's why we're here."

Thursday, February 13, 2014

In wide-ranging interview, secretary says her state health cabinet is a national leader in guarding the privacy of electronic data

Despite concerns elsewhere about the privacy of personal health information, Kentucky's top health official says her agency is one of the best in the nation at protecting and managing such data.

Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, talked about information technology and privacy in an interview with Mark Green, editor of The Lane Report, a Lexington-based business publication. She credited her cabinet's information-technology department and its good record on privacy.

Secretary Audrey Haynes
"We have an extraordinary IT department at this cabinet," Haynes said. "They really are stellar. I’ve worked at national organizations, in the federal government, and of course at the state level, and we have as good an IT department, if not better, than any I’ve seen. That gives us in-house expertise and also, obviously, they can contract for further expertise."

She added, "This cabinet has a long history of maintaining people’s private information because of Medicaid and food stamps and many other programs that we run here. Last year millions of dollars were collected for Kentucky’s kids through court-ordered child support that runs through this cabinet. We have very strict requirements, both at the federal and state levels, and we take privacy very seriously. Our IT department and others plan for it, and we’re alert to it all the time."

Haynes said Kentucky is also a national leader in helping health-care providers share electronic health records, through the Kentucky Health Information Exchange, with more than 2,000 participating and getting more than $144 million in federal incentive payments. The information exchange "is nationally recognized as being in the forefront for the exchange of health information records," Haynes said. "We are one of the most progressive in the nation."

She noted that the cabinet also runs KASPER (the Kentucky All Schedule Prescription Electronic Reporting) system, which doctors and medical professionals check before prescribing controlled substances to prevent drug abuse. A 2012 law cracking down on prescription painkillers required prescribers to use the system, and it now has more than 24,700 users, Haynes said. "KASPER is a very complex system to maintain," she said, "but it is keeping Kentucky at the forefront nationally as far as helping to curb the prescription drug problem in our state.

Green and Haynes touched on many subjects in the interview, which as published runs almost 3,000 words. She said the state's health-insurance exchange, Kynect, has been successful also because of its executive director, Carrie Banahan, who "has a long history of experience with insurance, with Medicaid and with management. That’s critical. And we made it not just Carrie’s project but a Cabinet project. Then we were able to get a great company that was very committed to the success of this in Deloitte" Consulting, which built the system. "Finally, we kept it simple. We knew we could make improvements as the months and years went on. We didn’t try to be too fancy right out of the gate. We knew that it needed to work well when it was launched – that was more important than making it the fanciest online system right away."

Haynes concluded, "When I came back from Washington, D.C., to take this job, people who know me and know this cabinet were very surprised, but I’ve never regretted it. I believe in public service as well as in the role of the private sector, and this has been a dream job for me because I’ve had an opportunity to work making good policy. I’ve had some pretty neat dream jobs in my career, but this is certainly going to be the topper. Few of us ever have an opportunity to say that we have done something that can truly have an impact and be part of something that’s going to have an impact for many, many years. I think about that all the time. I wouldn’t want to be anywhere else." (Read more)

Wednesday, February 12, 2014

Bill to create panels to review medical-malpractice lawsuits passes Senate committee

UPDATE, Feb. 20: The Senate passed the bill 23-13, but House Speaker Greg Stumbo said he does not expect it to make any progress in the House.

By Melissa Patrick
Kentucky Health News

The state Senate Health and Welfare Committee approved an expanded bill Wednesday to put a hurdle in front of medical malpractice lawsuits in Kentucky.

Senate Bill 119, sponsored by committee chair Julie Denton, R-Louisville, would establish medical review panels to offer initial opinions on the merit of medical-malpractice lawsuits. A panel would consist of three medical experts. Each side in the lawsuit would choose one, and the chosen two would choose the third.

Chamber President Dave Adkisson
testifies for the bill. (KET image)
The bill is the fallback position for nursing homes (and earlier, doctors) who have been unable to get the General Assembly to offer the voters a constitutional amendment that would allow the legislature to limit damages in lawsuits. They want to decrease the number of cases that they consider frivolous but sometimes settle to limit legal fees. Hospitals and doctors recently joined the lobbying effort; the Kentucky Chamber of Commerce is also on board.

"This is common sense legislation to make sure there is merit, " Denton said. The bill passed on a 6-4 vote, with Sen. Julian Carroll, D-Frankfort, not voting after a two-hour debate.

Supporters of the bill told the committee that Kentucky's liability laws make it difficult to recruit physicians and health-care providers to the state, increase malpractice- and health-insurance premiums, and take money away from actual health care because providers spend so much on defensive practices. They said the bill would decrease the time it takes to resolve cases and decrease health-care costs.

Lawyer Larry Forgy, who represents 13 nursing homes, said lawyers from states like Florida and Texas that have passed limits on liability lawsuits were moving to Kentucky and suing the nursing homes. He said, "We have had a gator invasion in Kentucky."

Opponents of the bill said that nursing homes improved the quality of care, there would be no need for these panels. Another opponent said it would not allow adequate time for the panels to make sure all information submitted was factual.

Wanda Delaplane of Frankfort, who won a $20 million malpractice judgment, said it took four years to gather the facts for her father's case because the nursing home gave her and the state false information. She said the panel would only get information that the medical provider gave them and that this was "information that has a high degree of probability to be falsified."

Patrick Clinch of Scott County, who said his father did not receive adequate health care while in a nursing home and subsequently died, reminded the committee that the debate is not just about lawsuits, but about people, often the elderly. He said medical experts on the panels would be biased toward their colleagues, and suggested the answer to this problem is improving the quality of care.

Jim Kimbrough, AARP Kentucky state president, agreed that quality of care was the problem.

"We believe the solution to implementing the issues of care in facilities lies within each facility to improve the quality of care," Kimbrough said. He said the bill would delay the aggrieved their rightful access to the court system, and "Justice delayed is justice denied."

Similar legislation passed the Senate in 2013, but didn't get out of a House committee. It remains to be seen whether the additional lobbying power of hospitals and doctors, who are leading campaign contributors to legislators, will make a difference.

Advocates, including governor, rally for statewide smoking ban

The annual Smoke-Free Kentucky rally was held Wednesday in the rotunda of the Capitol to promote passage of a statewide smoking ban. Gov. Steve Beshear and Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, were among the advocates. Others included the sponsors of the legislation, Reps. Susan Westrom, D-Lexington, and Julie Raque Adams, R-Louisville, and Sen. Julie Denton, R-Louisville; and Sgt. Dakota Meyer of Columbia, Marine Corps veteran and Medal of Honor recipient.

Dakota Meyer said he got involved in the issue after his friend
Regan Judd, right, a spokeswoman for the American Heart
Association, told him the dangers of secondhand smoke.
(Photo by Charles Bertram, Lexington Herald-Leader)
“This is not a law that’s going against liberty,” said Meyer, 25, who has said he is interested in a political career. “It’s going (for) protecting others, and that’s what laws are for.” Other speakers at the event "said they’ve reached a tipping point, and the state that tops the nation for smoking may finally be close to passing a smoking ban," Laura Ungar and Sebastian Kitchen report for The Courier-Journal.

Smoking-ban legislation has never come to a vote in the full House because it lacked the votes to pass, but its chief sponsor said recently that she now has the votes. A similar bill has been introduced in the Republican-controlled Senate for the first time, but Senate leaders sent it to the Judiciary Committee rather than the Health and Welfare Committee, which is chaired by the bill's sponsor.

Senate President Robert Stivers, who opposes the bill, told The Courier-Journal that "he has not polled members to know how much support there is in the Senate," the Louisville newspaper reports. "He acknowledged there are mixed opinions on the legislation and there is a possibility it could come to the floor for a vote. Beshear said he will keep pushing the bill because “The health of our people demands that we do this.”

Child obesity persists among the poor and less educated; early-life factors also matter; Kentucky's rate is high

Although youth obesity has become slightly less prevalent, most of the improvement has been restricted to children in families with higher salaries and educations, according to a Harvard University Kennedy School of Government analysis by Robert Putnam and colleagues. They examined data pertaining to education and income from the 1988-2010 National Health and Nutrition Examination Surveys and the 2003-2011 National Survey of Children's Health, Joe Rojas-Burke writes for Covering Health, published by the Association of Health Care Journalists.

Childhood obesity is at 18 percent in Kentucky—one of the highest in the country—and 35.7 percent of children ages 10 to 17 are overweight or obese, according to the Kaiser Family Foundation. Nationally, rural children are more likely to be obese than those in cities and suburbs. 

Obesity in children whose parents have a college degree began falling about 10 years ago, but increased among children whose parents have a high-school degree or less. There were similar findings among income levels, and the trend was also found in non-Hispanic whites. Although calorie intake did not vary much by education or wealth, physical activity varied greatly. "Children of college-educated parents became more active than they were a decade ago, while children of less educated parents showed no improvement. One factor in this trend is that children from families with high education and incomes are playing increasingly more high-school sports, and children from poorer, less educated families have been playing fewer high-school sports.

Some believe that obesity is an issue in low-income neighborhoods because their lack of parks, recreational centers, outdoor trails and safety discourage physical activity. However, there isn't much evidence to support that claim, and "The effects of income and education tend to trump the influence of neighborhood characteristics," Rojas-Burke writes. Does an outdoor environment convenient for physical activity always pull children away from their video games and Internet?

People often seem to forget that factors from very early in life can influence and individual's likelihood of becoming obese. According to the Early Childhood Longitudinal Study, which followed 7,738 kindergarteners for 10 years beginning in 1998, half the children who became obese were already overweight in preschool, and that doesn't include the 12 percent who were already obese in kindergarten, researchers reported in the New England Journal of Medicine"Overweight 5-year-olds were four times as likely as normal-weight children to become obese by the end of the study," Rojas-Burke writes.

Sometimes factors before a person is born can make a difference. According to the authors of the NEJM paper, children with high birth weights were only 12 percent of the population but represented more than 36 percent of people who were obese at age 14. A pregnant mother's undernourishment or overnourishment can alter fetal metabolism and brain development, which may contribute to obesity. "Observational studies have linked bottle-feeding rather than breast-feeding to weight gain," Rojas-Burke repots. Societal changes have made it more difficult for children to stay healthy. Food companies are making more and more high-calorie, low-nutrient foods. A common concern—insufficient sleep—even affects toddlers, and it can interfere with the regulation of hormones. These factors and others likely vary depending on family income, education and cultural background. (Read more)

Tuesday, February 11, 2014

Medical identity theft increasing; survey says 43% of leaks involve medical records

Modern technology has brought about an increase in identity theft and lately in a particularly dangerous form: medical identity theft. According to a survey conducted by the Identity Theft Resource Center, 43 percent of all record breaches in personal information in 2013 involved health records . That's more than those involved with banking and finance, education, the government and the military, Michael Ollove writes for Stateline.

Medical identity theft is deceptively obtaining another person's personal information—such as name, Social Security number and health-insurance number—to get medical services, reimbursements or prescription drugs. "Medical identity theft is a growing and dangerous crime that leaves its victims with little to no recourse for recovery," said Pam Dixon, World Privacy Forum's founder and executive director. "Victims often experience financial repercussions and worse yet, they frequently discover erroneous information has been added to their personal medical files due to the thief's activities."

The Patient Protection and Affordable Care Act has caused even more concern about the privacy of medical information. Some people worry that online marketplaces could compromise confidentiality, and with the increased push for digitized medical records comes questions about the level of security of the computer networks. "Edward Snowden, the former National Security Agency contractor who has disclosed the agency's activities to the media, says the NSA has cracked the encryption used to protect the medical records of millions of Americans," Ollove writes.

According to Sam Imandoust of the Identity Theft Resource Center, thieves can obtain medical information by stealing laptops or hacking into computer networks. "With a click of a few buttons, you might have access to the records of 10,000 patients. Each bit of information can be sold for $10 to $20," he said. Over half of the security breaches result from a stolen electronic device, 20 percent result from a person's obtaining unauthorized access to information or giving it to someone who shouldn't have it and 14 percent result from hacking.

The Health Insurance Portability and Accountability Act and the Health Information Technology Act are the two federal laws that mandate the confidentiality of medical records. A business, institution or provider can be charged between $100 and $50,000 for failing to meet privacy standards, and a person who violates HIPAA could be charged a fine of $50,000 and serve up to a year in prison.

Even if the breach is discovered, that doesn't undo all the damage, Ollove writes. "It's almost impossible to clear up a medical record once medical identity theft has occurred," said James Pyles, a Washington, D.C., lawyer who has dealt with health issues for more than 40 years. "If someone is getting false information into your file, theirs gets laced with yours, and it's impossible to segregate what information is about you and what is about them." The U.S. has "a regulated industry that is saddled with laws with so many loopholes that they don't know what they are responsible for and a public that doesn't believe their health information is being protected." (Read more)

Monday, February 10, 2014

U of L researchers developing a breath test for lung cancer

Lung cancer victims often don't notice any symptoms before it's too late, and Kentucky suffers from the highest rate of the disease — 3,500 deaths per year. Smoking, the leading cause of lung cancer, is the nation's highest among Kentucky adults — 28.3 percent. Experts say approximately 85 percent of lung cancer cases or linked to smoking.

Now University of Louisville scientists are among those working on a test to detect the disease sooner, by analyzing exhaled breath.  The scientists use a specially designed microchip to test the breath of patients who have suspicious lung lesions, Laura Ungar reports for The Courier-Journal.

"Patients are very enthusiastic about it. The concept of having a painless method to tell if you've got cancer is really appealing," Dr. Michael Bousamra told Ungar. Bousamra and his colleague Xiao-An Fu said the test might be available to the public in five years or less to ascertain who should undergo possibly dangerous biopsies.

"Instead of sending patients for invasive biopsy procedures when a suspicious lung mass is identified, our study suggests that exhaled breath could identify which patients may be directed for an immediate" sugical treatment, Bousamra said. While the current method of diagnosis, the PET scan, can cost more than $2,000, the breath analysis could cost $50 or less.

Lung cancer is the deadliest form of cancer; it kills 158,000 Americans every year, and the National Cancer Institute statistics show that the five-year survival rate for people whose lung cancer has spread to different organs is less than 4 percent — but is 54 percent when the cancer is only in the lung. "Dr. Norman Edelman, a Long Island pulmonologist who is a senior medical adviser for the American Lung Association, said he's encouraged by the U of L study and a growing body of research looking at exhaled breath," Ungar writes. "We're delighted to see this type of research going on. It's important," Edelman told her. "The survival rate depends critically on early detection."

Researchers hold breath test bag and microchip (U of L photo)
Researchers tested 150 patients with possible or diagnosed lung cancer and 85 healthy patients. Each patient exhaled a liter of air into a bag. A vacuum pulled the air across a specially coated silicone microchip, which analyzed specific compounds of the breath with a mass spectrometer, which measures the mass of a molecule to identify it. "Two of the four compounds they found in lung-cancer patients were previously known to be associated with the disease, but Fu discovered that the two others were also linked to lung cancer," Ungar reports.

Bousamra said patients with high levels of all four compounds always had cancer. Three or four elevated compounds was predictive of the disease of 95 percent of patients with a mass, and two elevated compounds was predictive of the disease in two-thirds of patients. The absence of elevated compounds predicted a non-canercous mass 80 percent of the time. "High levels of the compounds among those with lung cancer returned to normal after doctors removed the mass," Ungar writes.

Similar research is happening in other places as well. Edelman said this research will help doctors "make real strides against the disease," but people need to remember that quitting tobacco is a key factor, too. "Half the people who are regular smokers will die of smoking-related disease," he said. "The cure is very simple." (Read more)

Kentucky hospitals disagree on how to battle MRSA, an antibiotic-resistant and highly contagious bacteria that plagues them

Hospitals agree that precautions must be taken to fight the potentially deadly super bug MRSA, but they differ in their approaches, Laura Ungar reports for The Courier-Journal.

Swab kits are used to screen for MRSA. (Photo: Matt Stone, C-J)
Ungar focuses on the Louisville Veterans Affairs Medical Center's screening approach to fight MRSA, the acronym for methicillin-resistant Staphylococcus aureus. Every patient is screened upon admission and when moved to another floor. The hospital also stresses hand washing, wearing gowns and gloves if a patient has MRSA, and continuing education on the issue.

The hospital began routine screening of the antibiotic-resistant and highly contagious bacteria in 2007 and says its infection rates have dropped 20 percent, falling to 0.09 infections per 1,000 days patients are in a hospital bed, compared with 1.89 infections per 1,000 in 2008, Ungar reports. A study of long-term-care facilities using this approach found a decrease in MRSA infections (36 percent over 42 months), according to an article in The American Journal of Infection Control.

“We don’t see many patients getting MRSA when they’re in the hospital anymore,”  Dr. Raul Nakamatsu, an infectious disease physician at the Louisville VA Medical Center, said.

Some say more hospitals should follow the VA's lead. Dr. Kevin Kavanagh, chairman of Health Watch USA, and Lisa McGiffert, director of the Safe Patient Project at Consumers Union support this strategy. “All hospitals should be doing this,” McGiffert told Ungar. “It’s a strategy that’s proven to work.”

Other hospitals in the Louisville area screen only for high-risk patients, based on studies that encourage reducing MRSA with antibiotics and anti-infection cleansing cloths, Ungar reports. The cost of screening, which is about $55 per screening, is a concern, especially when hospitals consider other infection-control methods equally effective.

Those methods include emphasis on hand washing, isolating patients with MRSA, and wearing gowns and gloves while caring for them.  Some hospitals only have private rooms, which they say decreases the chance of infection, and others wash high-risk patients with anti-infection cleansing or use antibiotics.

“In general, we have not done surveillance screening. It’s somewhat of a controversial topic,” Dr. Paul Schulz, an infectious disease specialist with Norton Healthcare, which promotes hand washing, isolation and wearing gowns and gloves to combat MRSA, told Ungar. “We do all we can do that makes the most sense.”

The state only requires hospitals to report MRSA outbreaks, with no clear definition of what this means making it difficult to compare the two strategies, Ungar notes. No MRSA outbreaks in hospitals were reported in the state last year. The federal Centers for Disease Control and Prevention don’t require or recommend routine MRSA screening, although CDC does provide some guidelines on prevention strategies.

While people can carry MRSA without being infected, when an infection occurs, it causes serious skin, wound or blood infections, or pneumonia, which can be deadly, Ungar reports. Those most at risk are the chronically ill or those in hospitals or nursing homes. The Journal of the American Medical Association said there were more than 80,000 infections in 2011. The cost of treatment for severe MRSA infections can range from $20,000 into the millions, McGiffert told Ungar.

Five states now require screening of high-risk patients and although Kavanagh said that he thinks the chances are slim of Kentucky passing this law (a bill failed to pass in 2008) he would like to see it done voluntarily. “If you have one facility that’s not doing a good job at controlling these infections,” he said, “it can affect the whole community.”

Hospitals recognize that they must have a strategy to combat MRSA, but many have not found the need to move toward the aggressive screening procedures used by the VA. Those include the ALbert B. Chandler Medical Center at the University of Kentucky.

Dr. Derek Forster, medical director for infection prevention and control for UK HealthCare, told Ungar that the hospital keeps current on research and is willing to change strategies if it finds good evidence that one works much better than another: "We always keep an open mind."

Poll finds 52% of Ky. adults favor legalizing medical marijuana

A slight majority of Kentuckians favor allowing the use of medical marijuana in Kentucky, according to the latest Bluegrass Poll by SurveyUSA for four Kentucky news media outlets.

The poll from Jan. 30 through Feb. 4 found that 52 percent of Kentucky adults support the legalization of marijuana for medical purposes. Thirty-seven percent were opposed and 12 percent were not sure. Most supporters were under the age of 50, white and registered Democratic. The margin of error was plus or minus 3 percentage points.

SurveyUSA polled 1,082 registered voters with home phones and cell phones for The Courier-Journal, the Lexington Herald-Leader, Lexington's WKYT-TV and Louisville's WHAS-TV.

Sen. Perry Clark, D-Louisville, has filed a bill to allow patients in Kentucky to qualify to use medical marijuana through the health department. Similar versions of this bill have not passed the Senate in recent years. On Monday Rep. Mary Lou Marzian, a nurse, introduced a similar bill in the House, the first in that chamber. Washington, D.C., and 20 states have passed medical-marijuana laws.

House Speaker Greg Stumbo says he’s open to discussing the idea, and Rep. Tom Burch, who chairs the House Health and Welfare Committee, said he strongly supports it, Laura Ungar reports for The Courier-Journal. But Senate President Robert Stivers said he wants to see studies that show medical marijuana has a definite medical value. He said he’s only heard of anecdotal evidence so far, Greg Hall reports for the Louisville newspaper.

Neither bill is expected to pass, but another bill has been introduced that would allow the use of cannabidiol, the marijuana-based oil that some parents credit with reducing seizures in their children. It was introduced by by Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee. The oil could legally be given only on the recommendation of a doctor associated with a research hospital or if the patient is in a clinical trial sponsored by the U.S. Food and Drug Administration, Janet Patton reports for the Herald-Leader.

Rep. Robert Benvenuti, R-Lexington, said at a House Health and Welfare committee meeting that he feared medical-marijuana legislation was a "Trojan horse to legalize recreational use of marijuana" in a state already bedeviled by drug addiction, but he was open to Denton's bill. "That oil has been the subject of clinical trials, and if that can benefit, I think it could have a chance of passing," he told Patton.

Read more here:
People who support medical marijuana gathered in Frankfort last week to voice their opinion. Supporters included two parents who shared their story of how the oil made from marijuana had helped their children cope with seizures and a man who said marijuana helped with the pain and muscle spasms associated with multiple sclerosis, Patton reports.

Those who support medical marijuana say that it is useful for symptoms of cancer, AIDS, multiple sclerosis, glaucoma, epilepsy, pain and other conditions.  Opponents note that it lacks FDA approval, and say effective legal drugs are available that do not injure the lungs, immune system or brain, or risk leading to harder drug use, reports.

Sunday, February 9, 2014

Poll indicates Northern Kentucky is having a heroin epidemic

A poll indicates that Northern Kentucky is the hotbed for heroin use in the state, which has increased since the state legislature cracked down on abuse of prescription painkillers.

The Kentucky Health Issues Poll, conducted Oct. 25 through Nov. 26, found that 30 percent of the respondents in Northern Kentucky said they knew of a family member or friend who had experienced problems as a result of using heroin. Responses in other regions of the state ranged from 7 to 9 percent, well within the poll's error margin of 2.5 percentage points.

The poll was conducted among Kentucky adults by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. Its findings are corroborated by repirts from police and hospitals in the region, as reported by Terry DeMio of The Kentucky Enquirer.

The foundation noted in its press release, "Cross-sector advocates in Northern Kentucky mobilized in September 2012 to look at the problem of heroin and in 2013 released a report, “Northern Kentucky’s Collective Response to the Heroin Epidemic: Our Plan for Recovery.” It also noted that Kentucky ranks third in the nation for drug-overdose deaths, behind West Virginia and New Mexico.

The poll also asked respondents if they had family members or friends who had experienced problems as a result of abusing prescription painkillers. Twenty-seven percent said they had, down from 33 percent in 2012. The question did not specify a time period.

Methamphetamine has also been a popular illegal drug in Kentucky. The poll found that 15 percent of Kentucky adults reported knowing friends or family members who had experienced problems as a result of using meth. For the foundation's release, click here.

Saturday, February 8, 2014

Less than a third of school districts in Ky., which has high child-obesity rates, are in program to increase physical activity

Fifty-four of Kentucky's 173 school districts have joined a national initiative to increase physical activity in schools, and school officials hope other school districts will soon join in.

Let's Move Active Schools is a program that encourages schools to create active environments to get all students moving; helps promote physical activity before, during and after school; and encourages parent and community involvement in helping students become healthier, says a state Department of Education press release.

Kentucky has one of the highest childhood obesity rates in the country, 18 percent, and 35.7 percent of those aged 10-17 are considered either overweight or obese, according to the Kaiser Family Foundation.

"Let's Move helps schools create active environments that get students moving every day and supports their success in school," state Education Commissioner Terry Holiday said.

Children need at least 60 minutes of daily physical activity, according to the U.S. Department of Health and Human Services. Studies show that students who get regular physical activity do better in school. Because kids spend so many hours at school, it is considered a great place to make sure they are getting the exercise they need.

The program, part of First Lady Michelle Obama's effort to fight child obesity, also offers support to teachers as they work to align their physical activity programs with program expectations.

County school districts that have joined the initiative are Anderson, Barren, Boone, Bourbon, Bullitt , Butler, Daviess, Estill, Fayette, Franklin, Fort Knox, Graves, Grayson, Greenup, Hancock, Hardin, Hart, Henderson, Henry, Hopkins, Jefferson, Jessamine, Kenton, Lee, Leslie, Letcher, Logan, Madison, Morgan, Nelson, Ohio, Oldham, Owen, Perry, Pike, Rockcastle, Rowan, Spencer, Trigg, Warren, Wayne, Whitley, Wolfe and Woodford.

Independent school districts in the program are Ashland, Bardstown, Beechwood, Berea, Caverna, Covington, Glasgow, Newport, Russell and Williamstown.

The Catholic schools in Louisville that have joined are Holy Spirit School, Notre Dame Academy and St. Gabriel the Archangel. Saint Pius X in Northern Kentucky has also joined the program.

Jamie Sparks, director of coordinated school health for the Department of Education, said in the release, "I would encourage other districts in the state to follow suit and bring Let's Move! into their schools."

Friday, February 7, 2014

Bill to ease prescription rules for advanced-practice nurse practitioners is first to pass in this legislative session

The first bill to pass the 2014 General Assembly and go to the governor is Senate Bill 7, which would allow more experienced advanced-practice registered nurses to prescribe non-narcotic drugs without having an agreement with a physician. Advocates of the bill say it is needed more than ever now that federal health reform and expansion of Medicaid are bringing more people into the regular health-care system.

"SB 7 is good for Kentucky’s health!" said Sheila Schuster, a Louisville psychologist who lobbied for the bill. "It will increase access – particularly in under-served areas (map) – to the safe, quality healthcare provided by advanced-practice registered nurses."

The bill's passage ended a five-year battle between doctors and APRNs, represented by the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. The House passed a bill last year to repeal the doctor-agreement law entirely, but it stalled in the Senate. Sen. John Schickel, R-Union, negotiated a deal with the APRNs and the doctors' lobby, the Kentucky Medical Association. The bill would allow APRNs who have practiced for four years to prescribe such medicine without any relationship with a doctor.

Patient care, hospitals' future at stake as smaller hospitals lag behind larger ones in electronic health records

Electronic health records have been hailed as a great boon to patients and health-care providers, but the next phase of their implementation poses obstacles for many small, independent hospitals, Jennifer Bresnick reports for EHR Intelligence.

Most hospitals have implemented a basic EHR system, but costs have discouraged them from purchasing the advanced capabilities called for by the federal health-reform law that allow them interact with other systems to share and analyze data and use clinical data warehousing, population health management and quality benchmarking. Not having these advanced capabilities may hurt these small hospitals in the long run, Bresnick reports.

“The larger hospitals are doing well,” Lorren Pettit, vice president of market research for HIMSS Analytics, told Bresnick. “But we have seen that where the applications are behind the curve tends to be in the smaller hospitals. There really is a correlation between hospital size and the breadth and depth of their applications—how advanced their infrastructure is.”

Pettit said he is concerned about critical access hospitals, those that limit their beds and procedures in return for slightly larger Medicare and Medicaid reimbursements. Kentucky has 29 such hospitals. He fears they are getting too far behind the larger hospitals in implementing the advanced capabilities of the electronic health records, creating a situation where there is a difference in the quality of care between urban and rural areas.

Pettit said the most successful critical area hospitals are those that are part of a larger system that helps them with their technology. He told Bresnick, "Being an independent, small hospital . . . there’s just too much at stake and too much investment, and it’s going to impede a lot of these hospitals from moving forward.”