Wednesday, April 26, 2017

Community health workers aren't medically trained but help rural people manage their health care and their health

By Melissa Patrick
Kentucky Health News

As health advocates at the April 24 Kentucky Voices for Health annual meeting discussed how to reduce health disparities and assure health equity in the state, a model of integrated care that includes community health workers resonated as a possible solution.

MCHD Community Health Worker helping a patient
"I really believe in the community health worker model," said Keisha Cornett, health education coordinator for the Montgomery County Health Department in Mount Sterling. She added later, "Everything that we've talked about, about health equity, community health workers can play a very important role in. The goal is to empower individuals to take an active role in their health care, their health and also in their environment."

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy and deliver education on prevention and disease self-management.

Cornett noted that patients will often tell their CHW things they would never tell their doctor, such as not having adequate transportation to get to the pharmacy or not having enough money to buy their medications. CHWs work to understand what their clients need on an individual level and then meet them where they are, she said.

The federal Bureau of Labor Statistics says Kentucky had 710 CHWs in May 2016 with an annual average wage of $38,290.

Cornett said some providers have voiced concerns about CHWs providing health education. But she said it's important to allow CHWs to work at the top of their skill set, adding, "We are just encouragers" who "never go out of the scope of what we can do."

Montgomery County's CHW program, called "The Bridge" ("El Puente" for Latino clients) is funded by a federal Health Resources & Services Administration grant and focuses on chronic disease self-management and education. It largely serves clients whose incomes are less than 150 percent of the federal poverty level.

Cornett explained that CHWs connect people to services that help improve their health, like the Kentucky Diabetes Prevention and Control Program, which teaches diabetes self-management, or the Kentucky CARE Collaborative, a heart-disease and stroke-prevention program with a focus on high blood pressure.

Cornett pointed to an ongoing survey that shows clients have reduced emergency room visits; are more likely to have a medical home; have better medication adherence and have shown a drop in their A1C levels, a test for blood sugar.

She said the local diabetes self-management education class recently increased from four participants to 12, and 11 of the participants were from the CHW program. The CHWs have also created a diabetes support group, which they will lead for a month before turning it over to the members.

CHWs recently formed the Community Health Worker Association, which is working with the CHW Workgroup of the state Department for Public Health to standardize training across the state. Cornett said they are getting close to having the certification and curriculum approved.

"CHWs are an evidence-based model to address the health care concerns that we have . . . and really [gets] people involved in their own health care," she said.

Tuesday, April 25, 2017

Rep. Yarmuth tells health advocates how to fix ACA: restore and maintain subsidies, offer public option to help small, rural counties

Dustin Pugel and Rep. Yarmuth at the meeting (AARP Ky. photo)
By Melissa Patrick
Kentucky Health News

Congress needs to maintain subsidies for buyers of Obama insurance policies, reestablish subsidies for insurance companies that cover more than their share of sick people, and create a public insurance option that would help small, rural counties, U.S. Rep. John Yarmuth said at the Kentucky Voices For Health annual meeting in Frankfort April 24.

"The primary problem that we've had and the most obvious fix would be to re-establish the risk corridors," the law's name for the subsidies to insurance companies, the Louisville Democrat said. "The fundamental problem with the markets now is they [Republicans in Congress] eliminated the risk corridors."

That happened in the 2014 omnibus spending bill, which barred the Obama administration from using federal funds to make up risk-corridor shortfalls. The move led directly to the failure of the Kentucky Health Cooperative, which was expecting $77 million in risk-corridor subsidies but only got $9.7 million.

Yarmuth said a public option is necessary because a third of U.S. counties (and almost half in Kentucky) have only one insurance company offering Obamacare policies, partly because many of those counties have so few people.

"No insurance company is going to find it worth their while to go into a market, negotiate with providers, do the marketing, find prospects for 1,000 or so customers," he said. "So that is why we will need to have a national option for those population groups. It is really essential."

The Patient Protection and Affordable Care Act also authorizes subsidies that help low- to mid-income people afford insurance. Congress hasn't appropriated money for the subsidies, but the Obama administration paid them anyway, and now the Trump administration and Congress are talking about ending them.

"They have set out to sabotage the law in as many ways as possible," he said. "The uncertainty is causing a great deal of problems right now because if the cost-sharing reductions go away, more insurance companies will either abandon the individual market or they will raise premiums." He noted that insurance companies have said an end to the subsidies would mean 20 to 30 percent increases in premiums.

Kentucky has extended its deadline for filing 2018 Obamacare plans to June 7, from May 17, "to allow insurers more time to obtain relevant data, including enrollment and claims data for the beginning of 2017, for use in developing assumptions utilized by actuaries to determine necessary plan pricing," Ronda Sloan, spokeswoman for the state Department of Insurance, said in an e-mail.

The U.S. House of Representatives sued the Obama administration to stop the cost-sharing subsidies, and won, but the administration's appeal is still pending. "The worst case scenario is that the Trump administration drops the appeal if they are allowed to . . . then the lower-court ruling stands [and] the money stops," Yarmuth said.

He said later, "I'm relatively optimistic that those payments will continue because if Republicans act in any way that the money goes away, there will be a causal line between their actions and the insurance companies bailing or raising rates and that line would be like in a matter of days. So there would be no confusing the fact that Republicans acted and people got hurt."

Flexibility and cost concerns

The other big part of Obamacare in Kentucky and most other states is the expansion of Medicaid to those who earn up to 138 percent of the federal poverty line.

Kentucky has applied for changes to its Medicaid program through a waiver that would charge small, income-based premiums and would require "able-bodied" recipients to either work, volunteer or take job training, gradually increasing in hours to a maximum of 20 hours a week after one year, among other things. State officials say they expect the Trump administration to approve the waiver in June, and that it will go into effect Jan. 1.

Gov. Matt Bevin, a Republican, says the state can't afford to pay its part of the expansion unless the program is made more restrictive. Yarmuth, Kentucky's only Democrat in Congress, said he understood the concern about cost, but the real question is affordability "in terms of the overall health and well-being of the citizens of a particular state, and . . . job creation [and] reduction in uncompensated care" at health facilities.

Dustin Pugel, a research and policy associate for the Kentucky Center for Economic Policy, said at the start of the discussion that uncompensated care has dropped 67 percent and the state has added 13,000 jobs in the health sector since Medicaid was expanded in 2014.

Pugel also said people are using more primary care, having more preventive screenings and are getting routine care for their chronic conditions. Dr. Gil Liu, the Kentucky Department of Medicaid Services medical director, said at the meeting that about 1.4 million Kentuckians are on Medicaid.

Looking forward

Yarmuth spoke before conservative and moderate Republicans reached a tentative agreement Wednesday to revive the party's proposed American Health Care Act. He predicted the failure of the bill "or any iteration of it because they don't have the votes. Republicans are finding that there is no alternative to the Affordable Care Act, except single payer and they are not willing to go there."

He said the benefit of the current debate is that it shows how hard it is to come up with an alternative to the ACA, and creating a free-market health care system is "like searching for a unicorn" because it doesn't exist anywhere in the world.

"So, I don't really worry about Congress passing anything that is going to undermine the Affordable Care Act," Yarmuth said. "I do worry about the administration potentially doing more to sabotage the ACT, but again there will be a causal effect and then some repercussions."

Sunday, April 23, 2017

Southern Ky. doctor charged with illegal prescriptions that feds say caused 3 deaths; another will serve a year on similar charges

One Southern Kentucky physician was sentenced this month to a year and a day in prison for illegally prescribing painkillers to five people, three of whom died; and another was indicted on charges of doing likewise to six people, three of whom died.

Clella Louise Hayes of Glasgow, who practiced medicine in Tompkinsville, pleaded guilty in September and was sentenced April 20. Dr. Michael Cummings of Albany was indicted April 13 and faces penalties of up to life in prison and fines of up to $3.25 million.

Hayes, 41, wrote prescriptions for six painkillers "outside the course of professional medical practice" from 2008 to 2014, the U.S. attorney's office for the Western District of Kentucky said in a press release.

In the three fatal cases, she did so without a legitimate diagnosis of the patient's pain complaints, "failed to establish an individualized treatment plan, failed to take into account significant risk factors for abuse, and failed to take into account multiple inconsistent urine drug screens which reflected drug abuse and diversion."

The release identified the three patients only by their initials. "On September 19, 2011, Dr. Hayes prescribed fentanyl to A.R.," it said. "On September 23, 2011, at age 55, A.R. died as a result of a fentanyl overdose, with post-mortem toxicology reports reflecting fentanyl at five times the therapeutic range in A.R.’s blood."

Another patient, A.H., received prescriptions from Hayes over a year then "died at age 48 as a result of a poly-pharmacy overdose, with post-mortem toxicology reports reflecting high blood concentrations of medications Dr. Hayes prescribed to A.H."

In the third case connected with a death, "On January 1, 2014, K.S. died at age 53 as a result of a poly-pharmacy overdose, with post-mortem toxicology results reflecting oxycodone, and hydrocodone at 10 times the therapeutic dose, both of which Dr. Hayes prescribed to K.S. in December 2013."

The other doctor, Cummings, was charged with 18 counts of dispensing pain killers "without a medical purpose and outside the course of professional medical practice, and resulting in the deaths of three patients" in 2014, said a release from U.S. Attorney John Kuhn, which also used initials to identify the decedents.

The indictment says Cummings, 61, dispensed 120 Oxycodone pills and 60 Oxycontin pills that caused the death of a patient identified as S.F. on April 7, 2014; and combined hydrocodone-acetaminophen pills that caused the deaths of patients identified as S.C. and P.G. on April 2 and June 3, 2014.

"The investigation has been ongoing for at least two years," reports the Clinton County News of Albany. "In May 2015, authorities executed a search warrant at the location of Cummings’ practice located in the Twin Lakes Medical Arts facility."

10-year study: Having one or more diet sodas a day nearly triples the risk of having a stroke or Alzheimer's; overall risk is still low

A study suggests a connection between diet soda and both stroke and dementia, "with people drinking diet soda daily being almost three times as likely to develop stroke and dementia as those who consumed it weekly or less," Fred Barbash reports for The Washington Post.

The lead researcher, Matthew Pase of Boston University, said the findings “included a higher risk of ischemic stroke, where blood vessels in the brain become obstructed, and Alzheimer’s disease dementia, the most common form of dementia.”

Pase stressed that the study, published in the journal Stroke, showed only correlation, not causation, and a low overall risk of stroke and dementia, but said diet drinks “might not be a healthy alternative” to sugary ones. And he cautioned that diet-soda drinkers shouldn't go back to sugared drinks.

"They have been associated not only with obesity and its consequences, such as diabetes, but with poorer memory and smaller overall brain volumes," Barbash notes. "A parallel study of sugary drinks did not find an association with stroke or dementia."

The 10-year study looked at 2,888 people 45 and over for the development of a stroke, and 1,484 older than 59. It “found that those who reported consuming at least one artificially sweetened drink a day, compared to less than one a week, were 2.96 times as likely to have an ischemic stroke, caused by blood vessel blockage, and 2.89 times as likely to be diagnosed with dementia due to Alzheimer’s disease,” the American Heart Association said.

“So, the bottom line is, ‘Have more water and have less diet soda,” Christopher Gardner, director of Nutrition Studies at the Stanford Prevention Research Center, said in the AHA news release.

Barbash writes, "The artificial sweeteners consumed by those in the study included saccharin, acesulfame-K, and aspartame. Other sweeteners, including sucralose, neotame and stevia have been approved by the FDA since, the study said."

The American Beverage Association replied:  “Low-calorie sweeteners have been proven safe by worldwide government safety authorities as well as hundreds of scientific studies and there is nothing in this research that counters this well-established fact. . . . While we respect the mission of these organizations to help prevent conditions like stroke and dementia, the authors of this study acknowledge that their conclusions do not — and cannot — prove cause and effect.”

Proposed changes in Medicaid, especially making beneficiaries earn dental and vision benefits, alarm them and health advocates

Family Health Centers in Louisville built a dental clinic after Medicaid
expanded; under proposed changes people in the expansion would
have to engage in self-improvement activities to get dental or vision
benefits. (Angela Shoemaker photo, special to The Courier-Journal)
Gov. Matt Bevin's plans to change Kentucky Medicaid alarm people who are on the federal-state program, reports Deborah Yetter of The Courier-Journal.

The first example is Louisville construction worker David Thompson, who was able to get his first heath coverage in years through then-Gov. Steve Beshear's expansion of Medicaid under the Patient Protection and Affordable Care Act in 2014. "Thompson is hurrying to schedule dental and eye exams — care he said he urgently needs but realizes could be eliminated," Yetter reports.

Bevin's changes would initially eliminate basic dental and vision benefits for "able-bodied" adults in the expansion, which covers people with household incomes up to 138 percent of the federal poverty level. That makes a family of four with annual income of as much as $33,400 eligible for Medicaid.

For the first three years of the expansion, the federal government paid the full cost. Now states are paying 5 percent, and by 2020 that share will rise in annual steps to 10 percent, the ACA's limit — unless the ACA is changed, which also seems likely.

Bevin says the state can't afford the cost and expects the Trump administration to let him make changes that his aides say will leave Kentucky Medicaid with 85,000 fewer people on its rolls in five years than it would have without the changes. About 1.3 million Kentuckians are on Medicaid.

The governor and other state officials say the changes aren't just about saving money. Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, said the plan will "better engage members in their own health, wellness, education and employability," as well as improving Kentuckians' health outcomes.

The plan would charge small, income-based premiums and co-payments for Medicaid coverage of people with incomes above the poverty line, and would require able-bodied people on the program to work, look for work or take job training unless they are a primary caregiver. They could earn rewards points to get dental or vision benefits by "passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes.," Yetter notes.

"Advocates and public-health officials are increasingly concerned about what they believe will be an adverse effect on Kentuckians," Yetter reports. "Advocates worry consumers won't understand the complex changes to the program and, as a result, will lose coverage."

They especially worry about the "loss of dental benefits in a state with poor overall dental health," Yetter writes. She quotes Muriel Harris, associate professor of public health at the University of Louisville and board chair of Family Health Centers: "We're all very, very concerned. Those who have made the decisions are not considering the population we serve. It's just undermining any gains we have made in the past."

As for vision benefits, Yetter reports, "Kentucky optometrists have argued routine eye exams often uncover other serious health problems including diabetes, high blood pressure and eye disease that can result in blindness."

Yetter writes, "Collecting premiums and co-payments, tracking work or volunteer activity and managing the rewards accounts all will involve major technology systems changes and likely, hiring of outside vendors to manage such systems, advocates say. That adds to expense and potential complications, they said. . . . Kentucky is proposing monthly premiums of $1 to $37.50 per month, based on income and length of time enrolled in Medicaid. The longer people remain in Medicaid, the more it will cost, since Bevin's plan is aimed at pushing people to move to the commercial insurance market through employer coverage when available."

Most private employers in Kentucky don't offer health insurance to employees. The Kentucky Health Issues Poll has found that the percentage of Kentuckians on employer-provided insurance rose from 37 percent to 50 percent in 2014, but fell to 41 percent in 2015 and rose to 45 percent last year.

Saturday, April 22, 2017

Free webinar on impact of Patient Protection and Affordable Care Act in Kentucky scheduled for Thursday, April 27

(Image from
The Foundation for a Healthy Kentucky will offer a free webinar, "Impacts of Implementation of the Affordable Care Act in Kentucky," from 2 to 3 p.m. Thursday, April 27.

Participants will have a chance to listen in and ask questions as the team from the University of Minnesota State Health Access Data Center presents findings from their multi-year study of the impact of Kentucky's implementation of the Patient Protection and Affordable Care Act.

During the project, which was funded by the foundation, researchers monitored pre- and post-ACA trends in five domains: health insurance coverage, access, costs, quality and health outcomes. These findings are reflected in the study's final report.

The webinar is the next in the foundation's training series, "Health for a Change," meant to prepare non-profit leaders across the state for the work of advancing important health issues. The free training series combines in-person workshops with webinars, which participants can join remotely from their computers.

Register for the webinar here.

Friday, April 21, 2017

Somerset doctor convicted of Medicaid fraud; sentenced to five years for falsifying smoking-cessation counseling sessions

Dr. Ezekiel Akande
(Photo from Twitter)
A Pulaski County judge sentenced a Somerset doctor on Friday, April 21, to five years in prison for felony Medicaid fraud.

A Pulaski County jury convicted Ezekiel Akande, who ran the Somerset Regional Pain Center, in March for receiving Medicaid payments for tobacco-cessation counseling sessions that he did not perform. The jury also convicted Akande of theft and ordered that he pay $10,000 in restitution.

The state Office of Medicaid Fraud and Abuse accused Akande of billing Medicaid for counseling sessions with patients who were not smokers, and smokers who did not wish to quit.

"Holding accountable those who defraud the government and Kentuckians is a responsibility my office takes very seriously," Attorney General Andy Beshear said in a news release. "We are working every day to protect Kentucky families from those who seek to exploit our health services for personal gain."

Only 1.4 percent of Kentucky Medicaid members who smoke received smoking-cessation counseling in 2015, the state said last year; 17 percent received smoking-cessation medications.

Thursday, April 20, 2017

It's time to clean out your medicine cabinet for the National Prescription Drug Take Back Day on April 29

Do you know the expiration dates of the medicines that have been piling up in your kitchen cabinet? If not, you might want to check those dates and throw away old medicine as part of the National Prescription Drug Take Back Day Saturday, April 29. The Kentucky State Police are partnering with the U.S. Drug Enforcement Agency to not only encourage citizens to remove potentially dangerous medicines from their homes, but to also dispose of them safely.

"Prescription medications play an important role in the health of millions of Americans. However, leftover or expired drugs can be harmful in a variety of ways,” KSP Commissioner Rick Sanders said in a press release. He noted that expired medications can lose their effectiveness and pollute water supplies if disposed of improperly. He warns, “Unused medicines in homes can also be accidentally ingested by children, stolen, misused and abused."

Rates of prescription drug abuse in the U.S. are at alarming levels and are showing no signs of slowing down. According to the DEA, "the majority of prescription drug abusers report that they get their drugs from friends and family including the home medicine cabinet," the release said.

Americans disposed of 447 tons of unneeded medications during last year’s National Prescription Drug Take-Back Day. Kentucky had 50 collection sites totaling 9,752 pounds in 2016.

This year, KSP has again set up 16 locations throughout Kentucky to serve as collection points for the safe, convenient and responsible disposal of unused or expired prescription drugs. For a list of locations click here. Collection activities will take place from 10:00 a.m. through 2:00 p.m. on Saturday, April 29. For more information about the ‘Take Back’ program, contact KSP at 502-782-1780 or visit the DEA website.

Wednesday, April 19, 2017

KentuckyOne Health announces another round of layoffs at hospitals, says most will be in corporate service jobs

KentuckyOne Health is laying off 150 people at its hospitals around the state, and 100 others will be transferred to the University of Louisville or accept retirement offers.

"Challenges brought by the continuing evolution of health-care reform and reimbursement structures have proven difficult for our organization and many others across Kentucky," the subsidiary of financially stressed Catholic Health Initiatives said, adding that most of the layoffs would be in corporate service units.

Grace Schneider of The Courier-Journal reports, "Executives couldn't say how many Louisville-area workers are being let go, but all of those affected will receive severance, assistance finding new jobs and counseling, spokeswoman Barbara Mackovic said in an email." KentuckyOne is giving up control of University Hospital on July 1.

"Interim U of L president Gregory Postel estimated [in December] that 3,000 employees at U of L Hospital who now work for KentuckyOne would become employees of University Medical Center," Schneider reports. "On Tuesday, Ken Marshall, interim chief executive for University Medical Center, said that roughly 2,200 current KentuckyOne Health employees were offered jobs by University Medical Center. It's not clear how many of the 100 KentuckyOne employees may join the U of L staff, spokesman Gary Mans said."

KentuckyOne laid off 500 employees in 2014 and eliminated 200 positions that were vacant, Schneider notes, adding: "Last July, a state inspection found that nursing deficiencies had endangered three patients at University Hospital. The state later found the hospital had corrected the problems."

Tuesday, April 18, 2017

Poll: Almost half of Ky. adults know someone who is depressed, and 30 percent say they don't know where to call for treatment

By Melissa Patrick
Kentucky Health News

Nearly half of Kentucky adults know someone who has a serious problem with depression, and most say they know who to contact for treatment, according to the latest Kentucky Health Issues Poll.

"Depression is common in Kentucky, as it is elsewhere in the country, and it's important to understand that it is a serious mood disorder that can and should be treated," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Knowing where to find help is an important first step in getting treatment or counseling, but lack of health insurance and access to integrated care can be a barrier for those trying to get help."

The poll, taken Sept. 11 through Oct. 19, found that 49 percent of Kentucky adults know someone who is seriously depressed. More women than men, 53 percent to 45 percent, said they knew such a person.

Nearly 70 percent of those polled said they knew who to contact for services or treatment for depression, while 30 percent said they didn't know who to contact. Adults 30-64 were most likely to know about available treatment (74 percent), compared to younger adults (63 percent) and older adults (58 percent).

The poll's overall error margin is plus or minus 2.5 percentage points, but more for subsamples such as age groups.

Nearly one in five Kentucky adults at some time in their life have been told by a health-care provider that they are depressed, according to polling by the federal Behavioral Risk Factor Surveillance System. However, fewer than half who have a mental illness have received treatment or counseling, according to a federal report on Kentucky's behavioral health.

Sheila Schuster, the executive director of the Kentucky Mental Health Coalition, said in the news release that she was troubled by the number of Kentuckians who are feeling depressed, but don't seek treatment.

"We know that depression is treatable; we also know that it should be treated and not ignored, nor handled with self-medication through alcohol or other substances," she said. "It is very important for Kentuckians to know the mental health resources and to encourage family members and friends who are struggling with depression to seek help."

The American Psychiatric Association says depression symptoms can vary from mild to severe, and must last at least two weeks to be diagnosed. It notes that depression affects an estimated one in 15 adults in any given year, and one in six people will experience depression at some time in their life.

The APA says symptoms of depression include: feeling sad or having a depressed mood; loss of interest or pleasure in activities one enjoyed; changes in appetite, with weight loss or gain unrelated to dieting; trouble sleeping or sleeping too much; loss of energy or increased fatigue; increase in purposeless physical activity, like pacing, or slowed movements and speech; feeling worthless or guilty; difficulty thinking, concentrating or making decisions; or thoughts of death or suicide.

Click here for the state Cabinet for Health and Family Services directory of behavioral health-care providers, sorted by county and health plan. Click here for a list of community mental health centers and psychiatric hospitals, including phone numbers for 24-hour crisis intervention.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the foundation and Interact for Health. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones.

Anti-smoking expert: Cigarettes kill 8,900 Kentuckians a year, so it's time to raise cigarette tax and pass statewide smoking ban

By Melissa Patrick
Kentucky Health News

"Smoking is the single most preventable cause of death that we know of," Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, said Sunday on KET's "Kentucky Health."

Hahn told Dr. Wayne Tuckson, host of the "Smoking & Health" series, that 480,000 Americans die each year from smoking; that one in five deaths are caused by cigarette smoking; that one-third of cancer deaths are caused by it; and that smoking is the leading cause of heart disease, which kills more people than any other disease.

"We talk about heroin and opioid addiction; they are awful, but cigarette smoking is the drug of choice," Hahn said. "When you talk about Kentucky, we are talking about 8,900 a year who are dying from cigarette smoking." (In 2015, 1,297 Kentuckians died from an overdose.)

Hahn, a University of Kentucky nursing professor and the director of the Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE) initiative, said there are many reasons Kentucky has the nation's highest smoking rate, 26 percent.

Those include the influence of peers and family members who smoke, as well as "insidious" advertisements that encourage smoking.

Hahn called the tobacco industry the "vector" of smoking, referring to the way they advertise their products such as placing them at the "point of purchase," placing them at the eye level of children, targeting specific populations and strategically placing them in movies.

"There is no product that we know is going to kill you that people can just sell pretty freely with very little regulation," she said.

Hahn explained that first-hand smoke is what the smoker is exposed to; second-hand smoke is what a bystander is exposed to, both from the product and the exhalation; and third-hand smoke is what is left behind on all of the surfaces.

And while she said most people worry about the 69 chemicals in smoke that are known to cause cancer, it is the tiny, toxic particles that we breathe in from the smoke that put us at risk of heart and lung disease, such as chronic obstructive pulmonary disease (COPD).

"But I think that now that we know so much about first- and second-hand and third-hand smoke, there is really no reason that anybody should be smoking inside a vehicle or inside their home for that matter, or inside a public place," Hahn said. "There is really no reason to do that because we know how much harm it causes."

Hahn said the "most effective, high impact policy" to decrease smoking rates would be to increase the state's cigarette tax, now one of the nation's lowest at 60 cents per pack. Hahn recommended that it should be raised by $1, which would still be below the national average of $1.69 per pack.

"The more expensive something is, the less people will buy, and particularly people who don't have a lot of money," she said.

Hahn also called for a statewide law that would ban smoking in public spaces and the workplace. The latest Kentucky Health Issues Poll found that 71 percent of Kentuckians support such a measure and 25 percent oppose it.  Right now only one-third of Kentucky is covered by comprehensive smoke-free policies.

"We are not saying people can't smoke," Hahn said. "those laws are only saying that you can't smoke and harm others with your smoke."

However, a statewide ban isn't likely any time soon, since Republican Gov. Matt Bevin has said this is an issue for local governments.

Hahn said smoking is a powerful addiction. She encouraged people who want to quit to call 1-800-QUIT-NOW, to visit or to contact their health-care provider, because both medications and behavioral support are often needed to quit.

A new state law will make it easier for Kentuckians to gain access to smoking cessation medications by removing the barriers that insurance companies often place on them, like co-payments and prior authorizations.

As for electronic cigarettes as a means to quit smoking, Hahn said that studies have found that smokers who use e-cigarettes to help them quit smoking are less likely to do so, and that they often become "dual users."

She added: "Electronic smoking devices are considered by the FDA as a tobacco product. They are not considered as a quit-aid and we do not recommend them as a quit-aid."

Click here for the schedule of future airings of this program.

UK gets $11.2 million, five-year grant to study links between cancer and obesity, two of Kentucky's biggest health problems

Kentucky leads the nation in some forms of cancer, and is among the leaders in obesity. Is there a connection? The federal government is giving the University of Kentucky $11.2 million to explore the connection over the next five years, through a new Center for Cancer and Metabolism.

"The center will focus on the underlying mechanisms that link dysfunctional metabolism to cancer. Recent studies have shown that the mitochondria of cells can influence how aggressive a cancer becomes," Linda Blackford reports for the Lexington Herald-Leader. "According to the U.S. Centers for Disease Control and Prevention, Kentucky ranks first in the nation in incidences of colorectal cancer in men and women, and seventh in deaths. People who are obese are about 30 percent more likely to develop that kind of cancer."

Lisa Cassis, UK's vice president for research, said the grant from the National Institutes of Health will also “enable the university to foster the development of the next generation of scientists who will lead our efforts in translating basic research findings into promising new therapies.”

Cassis said, “Research is at the heart of any progress we hope to make in bridging health gaps in the commonwealth.” She recently crticized the proposed cut of 20 percent to NIH funding in President Trump’s federal budget, saying the move would reduce UK’s federal funding from $92.4 million in 2016 to $75 million, meaning a loss of 219 jobs.

“It is not just reductions in NIH funding that are important; it is the types of research that would be reduced if these reductions were realized,” she wrote. “This is especially important, as health conditions that devastate our citizens exist at higher rates in Kentucky than the rest of the U.S. More Kentuckians die of cancer, and Kentucky ranks in the top 10 in heart attacks, drug deaths, strokes, diabetes, cardiovascular deaths and obesity.”

"UK officials said U.S. Senate Majority Leader Mitch McConnell contacted the NIH in support of the grant," Blackford reports. "In March, the Kentucky Republican said he didn’t support Trump’s proposed cuts to medical research funding."

Americans eat way too much salt, mostly from 25 commonly consumed foods; cutting back reduces risk of high blood pressure

Americans eat too much salt, and a new study found that most of it comes from 25 commonly consumed foods. The top five culprits are bread, pizza, sandwiches, cold cuts and other cured meats, and soup. Salty snacks came in seventh, behind burritos and tacos, says the study.

Salt helps the body maintain its fluid balance, but too much of it increases the risk for high blood pressure, which then increases the risk for heart attack and stroke. Thirty-nine percent of Kentucky adults have high blood pressure and the state ranks 47th for heart disease, according to America's Health Rankings.
Hypertension in Kentucky adults, 2013-2015 (Map and chart from
The study found that in 2013-14, Americans ate about 3,400 mg of salt daily, far exceeding the Healthy People 2020 goal of 2.300 mg and the "ideal limit" of 1,500 mg recommended by the American Heart Association.

"If everyone reduced the amount of sodium in their diet by 1,200 mg per day, up to 99,000 heart attacks and 66,000 strokes could be prevented in the United States every year," according to the CDC.

Data for the Centers for Disease Control and Prevention study comes from the 2013-14 National Health and Nutrition Examination Survey. It only measured salt consumed in foods and did not take into account any salt added at the table. One teaspoon of table salt has 2,300 mg of sodium.

The study found that most dietary salt (61 percent) comes from packaged, processed and restaurant foods, the report said.

While most foods have a moderate amount of salt, the problem is that they are eaten all day long, Zerleen Quader, lead researcher, told Steven Reinberg of HealthDay.

"When cooking at home, use fresh herbs and other substitutes for salt. When eating out, you can ask for meals with lower salt," she said, adding that it's important to read food labels, and to choose the lowest salt option available. She also said the food industry needs to lower the amount of salt it adds to its products.

The study found that 44 percent of the salt people eat comes from just 10 foods and 70 percent of salt in the diet comes from 25 foods. Some other foods in the top 25 include bacon, casserole type dishes, salad dressing, French fries and cereal

Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City, said that processed foods not only raise blood pressure, but may also increase the risk for cancer, noting that the World Health Organization classifies processed meats, like bologna, ham, bacon, sausages and hot dogs, as carcinogens.

"Parents need to understand that feeding hot dogs, fries, and ham and cheese sandwiches to their kids (and themselves) is significantly increasing their risk for certain cancers, hypertension and heart disease," Heller told Reinberg.

The CDC offers tips for reducing salt intake:
  • Choose a heart-healthy diet like the "Dietary Approaches to Stop Hypertension," diet (DASH). Click here for more details.
  • Buy fresh, frozen or no salt canned vegetables
  • Use fresh meats, rather than canned or processed meats
  • Read labels, choose product with lowest sodium content
  • If you eat two servings, then account for two servings of salt
  • Limit sauces, mixes and "instant" product"
  • Choose spices and seasonings that do not list sodium on their label
When eating out:
  • Choose restaurants that offer low-sodium options
  • Ask server if sodium information is available
  • Request that no salt be added to your food
  • Ask for salad dressings and sauces on the side

Monday, April 17, 2017

Water remains the best way to keep kids hydrated while playing sports; sports and energy drinks not necessary

Sports drinks start flying off the shelf as the heat of summer and outdoor sporting activities begin, but health experts say water, not sugar-filled sports drinks, is the best choice for hydration -- especially for children.

“Sports drinks can replenish some of what you lost during exercise, but you really need to be exercising for more than 45 minutes to an hour before you would consider that,” Dr. Matthew Silvis, director of primary-care sports medicine at Penn State Health Milton S. Hershey Medical Center, said in a "Medical Minute" news release. “Many of our kids are not doing enough to warrant it.”

And with most 20 ounce sports drinks having about 9 teaspoons or 3 tablespoons of added sugar in them, the release notes that this only adds to the nation's childhood obesity epidemic. The American Heart Association recommends that children and teens should consume less than 6 teaspoons of added sugars a day (4 grams of sugar equals 1 teaspoon).

Thirty-six percent of Kentucky's children are either overweight or obese, and studies show that overweight children are likely to become overweight adults.

“Kids and adolescents really should not be using these drinks,” Dr. Katie Gloyer, a primary care sports medicine physician at Penn State Medical Group in State College, said in the release. “Water is the best method of hydration.”

Another concern is the emergence of energy drinks, which are loaded with caffeine and other stimulants.

The release notes that energy drinks are not regulated, contain harmful products and easily exceed safe levels of caffeine and other stimulants, adding that they "can elevate blood pressure and cause cardiac problems such as palpitations and arrhythmias, not to mention giving the user headaches, an upset stomach and a general jittery or nervous feeling."

"For children and adolescents, energy drinks can be downright dangerous," it says.

“If they are playing 30- or 45-minute halves, they should have a water break and maybe add fresh orange slices or a granola bar to add a bit of sugar and/or protein at an appropriate level,” Silvis suggested.

And for post-workout recovery, he said either low-fat or whole chocolate milk works just as well – if not better – than the fancy recovery drinks now on the market.

However, he added that if weight loss is the goal, water is always the best choice: “Otherwise you can end up drinking more calories than you burned while exercising.”

Sunday, April 16, 2017

Beware of stirring up dust where deer mice may have been; could contain a rare but deadly virus; spray interiors with bleach solution

Spring is time for cleaning, and for outdoor activities such as camping and hiking. But it's also time to "beware of a rare but deadly virus" that "kills up to 40 percent of people who become infected," Lena H. Sun reports for The Washington Post.

Deer mice spread hantavirus through dust. (CDC photo)
Hantavirus pulmonary syndrome, or HPS, is spread mostly by deer mice, which live in woodland areas and deserts and are found throughout Kentucky and adjoining states, and most of North America. "People get the disease by breathing in hantavirus when dust from rodents’ dried urine, saliva and droppings is stirred up in the air, which can happen in houses, garages and cabins, especially while cleaning," Sun reports. "People can also get it by touching mouse urine, droppings or nesting materials that contain the virus, and then touching their eyes, nose or mouth."

HPS has "no specific treatment, cure or vaccine," Sun writes, "but if infected individuals are recognized early and receive medical attention in an intensive care unit, where they can be given oxygen therapy, they may have a better chance of recovery."

Annabelle de St. Maurice, an epidemiologist at the federal Centers for Disease Control and Prevention, urges people to avoid sweeping or vacuuming mouse droppings, which "makes it more likely that someone will inhale or ingest the dust that brings virus particles into the air," Sun notes. "Instead, the CDC recommends spraying the area with a solution of one part bleach to nine parts water and letting it soak for five minutes before cleaning with gloves and paper towels."

Certain jobs have more risk of HPS: farmers, "electricians, carpenters, roofers, pest-control personnel and others who work in construction; forestry and outdoor recreation jobs; oil drilling; and the cleaning industry, especially people who go into areas where there are abandoned buildings or cars that have been left outside, or open buildings that had been previously closed, such as summer cabins.," Sun reports.

Saturday, April 15, 2017

Elizabethtown newspaper reminds readers that community health begins with individual health

The annual County Health Rankings provide a good opportunity for news stories that focus attention on the health of communities. But they also can be the basis of reminders that community health is collectively based on individual health.

The News-Enterprise of Elizabethtown recognized that and published an editorial that recapped the rankings of Hardin and some adjoining counties, all of which are in the top 25 in Kentucky, but also noted some of the major negative health factors in the area, such as a smoking rate that's above the national average.

"Ultimately, health rankings are difficult to change. Improvement trends must begin one person at a time, the editorial said. "If you smoke, try to quit. If you abuse drugs or misuse alcohol, professional resources are available to help you stop. If you aren’t getting exercise, start with a walk at lunch time or take the stairs instead of an elevator. If the number staring back at you from the bathroom scale is embarrassing, change your eating habits with the next meal. If you have multiple sex partners, use protection. If you haven’t seen a doctor in a long time, make an appointment today for a physical."

The editorial concluded, "The statistics received a headline and grabbed some attention. But the true measure of this study’s impact is not about where each county stands but about what each person should consider doing about their own health. You alone can make a difference in your life. Commit to a change for the better — even if it’s a small change."

Friday, April 14, 2017

After their child died from a drug overdose, a Kentucky family joined those who are choosing to tell the truth about addiction

By Traci Thomas
Kentucky Health News

The obituary for Katherine Bryant Reynolds, published in the April 5 Lexington Herald-Leader, was engagingly frank: "To honor Katie's life as her forever supportive family, we will strive to reduce the stigma and further the understanding that addiction is not a severe character flaw to be punished and shamed, rather a tragic chronic relapsing brain disease deserving of respect and compassionate treatment."

The Bryants are among many bereaved families across the country choosing to publicly expose addiction as a cause of their loss. Their choice to replace "died suddenly at home" with "died after a long struggle with addiction" challenges the shame often associated with substance abuse.

Katherine Bryant Reynolds
Katie, originally from Richmond, was 37. She lost her battle to drug addiction in her Lexington home on March 28. According to the Fayette County coroner, her death "was a result of poly drug abuse including levels of opiates above the therapeutic range and methamphetamine," her mother, Luanne Bryant, told Kentucky Health News in an email.

"Our being open was right for us. Right for Katie," Bryant said. "If we name something and bring it into the light, we can begin to rob it of its power to destroy. I hope others will, too."

Kentucky is one of five states in the nation with the highest rates of death linked to overdose: 29.9 per 100,000. West Virginia has the highest rate at 41.5 per 100,000, and neighboring Ohio has the same overdose death rate as Kentucky.

State officials have taken several steps to deal with the issue, but Bryant said society is offering no real solutions to the opioid epidemic, "often undermining recovery and endangering those with addiction."

She explained, "Effective and affordable resources have not been made available to our family. From drug court to multiple touches with social services and treatment facilities, to repeated incarceration with abundant access to drugs while incarcerated, the current system is broken and the toll it is taking on individuals and their families and the cost to society is devastating."

Katie Bryant with mother Luanne and sister Kennedy Konshak
Though frustrated by the lack of resources and grappling with the loss of her daughter, Bryant said Katie will be remembered as a young woman full of spirit, spunk, courage and ideas of intellect.

"By sharing Katie’s cause of death, we were refusing to play into stigmatizing opiate addicts by behaving as if this particular disease is shameful and addicts are only statistics," Bryant said. "If the families of the victims of fatal opiate addiction included that in obituaries, maybe people in general would better grasp how opiates are ravaging generations of young people and their families."

Business interests weigh in on behalf of Medicaid expansion

By Al Cross
Kentucky Health News

Medicaid, a 52-year-old program that seems to be in line for big changes from elected officials who question its cost, is getting some help from a seemingly unlikely source: business interests.

"Medicaid works" is the message of the Modern Medicaid Alliance, a national group that comprises mainly health advocacy organizations but also includes the Kentucky Association of Manufacturers. That may sound like Big Business, but many Kentucky manufacturers are small and don't provide health insurance for their employees, many of whom are eligible for the expanded form of Medicaid that took effect in 2014.

“Medicaid plays an important role in providing for the health of the local workforce and their families,” KAM President Greg Higdon said in a press release. “Programs like Medicaid are essential to ensuring that Kentucky residents are well and able to pursue employment and contribute to our state’s growth and productivity.”

The alliance is starting a Kentucky campaign that includes "organizing of Medicaid supporters, beneficiaries, and Modern Medicaid Alliance partners who will make the case to elected officials at all levels that Medicaid works," the release says. It also includes a digital advertising campaign and stories "of beneficiaries whose lives have been improved by Medicaid."

“Medicaid is essential to ensuring access to health care for Kentuckians who are economically vulnerable,” Jason D. Hall, Executive Director of the Catholic Conference of Kentucky, said in the release. “Pregnant women, children, the elderly, and the economically displaced receive essential health care services because of Medicaid. When people have health coverage, they utilize preventive services more and the emergency room less. Morally and fiscally, Medicaid is an essential program."

Under federal health reform in 2014, Kentucky expanded Medicaid to people with incomes up to 138 percent of the federal poverty line, adding about 440,000 to the program's rolls and bringing the total number of beneficiaries to 1.3 million. The federal government paid for the expansion through 2016; now the state pays 5 percent, rising in annual steps to the current law's limit of 10 percent in 2020.

Gov. Matt Bevin says the state can't afford that, and has asked the federal government to let the state impose rules such as work requirements and small, income-based premiums on beneficiaries. The Trump administration is expected to approve the changes and use them as an example for other states. The state estimates that the changes will leave the program in five years with 85,000 fewer people than it would have without the changes.

In Congress, much of the debate about health care has focused on Medicaid. "While political debates and policy discussions about health reform continue in Kentucky, the Modern Medicaid Alliance will educate policymakers and the public about the high-value care Medicaid delivers, Medicaid’s innovative solutions that are saving taxpayer dollars and increasing coverage, and the need for Medicaid to remain a strong safety net for the people of Kentucky," the release says.

Thursday, April 13, 2017

Study concludes that diabetes may kill four times as many people as reported; 13.4% of Kentucky adults have diabetes

                             Medical News Today photo
By Melissa Patrick
Kentucky Health News

Diabetes may be responsible for nearly four times as many American deaths as reported on death certificates, which would move diabetes from the seventh-leading cause of death to the third, according to a recent study. Kentucky has the 12th highest diabetes death rate in the nation.

“We argue diabetes is responsible for 12 percent of deaths in the U.S., rather than [the] 3.3 percent that death certificates indicate,” lead study author Andrew Stokes of the Boston University School of Public Health, told Arlene Karidis of The Washington Post.

Researchers say this discrepancy occurs because diabetes is often the main underlying cause of death, but is not mentioned on the death certificate. For example, the death certificate may list heart disease as the cause of death, but doesn't note that the heart disease was caused by diabetes.

The study, published in the online journal PLOS One, analyzed findings from two large national surveys, one that provided levels of A1C, a test that shows average blood sugar over two to three months, and another that provided self-reported diabetes information. Researchers compared the death rates of the diabetics in the surveys to information on their death certificates.

While the study concluded that 12 percent of deaths were caused by diabetes, "by far the highest proportion of deaths attributable to diabetes, 19.4 percent, occurred among obese people, compared to only 8.8 percent among the non-obese." It also found that diabetics had a 90 percent higher death rate over a five-year period than non-diabetics, accounting for other factors.

Adult diabetes rates in Kentucky, 2013-15, ranging from 8 to 22 percent
About 13.4 percent of Kentucky adults have diabetes, compared to the national rate of 9.9 percent, according to the 2015 Kentucky Behavioral Risk Factor Surveillance Survey. And the federal Centers for Disease Control and Prevention estimates that as many as one in three Kentucky adults have pre-diabetes, and many of them don't know. Almost 35 percent of Kentucky adults are considered obese, which places them at a higher risk of diabetes and death from it.

“These findings point to an urgent need for strategies to prevent diabetes in the general population. For those already affected, they highlight the importance of timely diagnosis and aggressive management to prevent complications, such as coronary heart disease, stroke and lower-extremity amputations,” Stokes told Karidis. He added that a better understanding of the actual number of deaths caused by diabetes would improve "messaging, funding and policy decisions, such as taxation of sugar-sweetened beverages and sue of subsidies to make healthy foods more accessible."

                           Harvard Health Publications
Diabetes symptoms and tips to get moving

Diabetics either have Type 1 diabetes, in which the body doesn't make any insulin, or Type 2, in which the body has difficulty producing and using insulin. Insulin allows a person's body to use sugar that is found in food for energy, or to store it for later. It helps keep blood sugar levels from getting too high or too low.

Type I cannot be prevented, but Type II, which is more common, can be prevented or delayed with a healthy lifestyle, including maintaining a healthy weight and exercising regularly.

Early symptoms of Type II diabetes include increased thirst, frequent urination, feelings of unusual hunger, dry mouth and weight gain or loss, Medicine Net reports in a slideshow article. WebMD reports the same symptoms for Type I diabetes.

Other symptoms include headaches, fatigue and blurred vision, frequent yeast infections or urinary tract infections, itchy skin, or an infection or sore that takes a long time to heal. Vaginal dryness in women and impotence in men are also complications that can arise from Type II diabetes.

Medicine Net notes that smoking, being overweight or obese, lack of exercise, consuming a diet that is high in processed meat, fat, sweets and red meats and high cholesterol increases a person's risk of Type II diabetes, as does women who had gestational diabetes in pregnancy and people with a family history of the disease.

In addition to working with a health care provider to create a healthy eating plan, it's also important for diabetics to exercise because this helps to lower blood glucose levels, and lowers the risk of heart disease and nerve damage, both common risks of diabetes.

The federal Centers for Disease Control and Prevention offers some tips for diabetics to "get moving and keep going," including:
  • First, check with you doctor before starting a new or more difficult activity.
  • Start slow and build up gradually; start with 10 minutes of walking and build up to 30.
  • Results are often immediate. Check your blood sugar before and after the walk.
  • Find an activity you enjoy.
  • Walking and dancing cost nothing.
  • Squeeze activity into the day; take the stairs, play with the kids, move during commercials.
  • Make a plan; prepare for exercise the night before, put it on the calendar.
  • Make a specific goal. For example, I am going to walk a mile every day for a month.
  • Work out with a partner.
  • Don't go more than two days in a row without being active.
  • Do it for the T-shirt: Sign up for a 5K run/walk and train for it.

Study says only way to protect children from smoke exposure is to quit or not smoke in house; nicotine residue is everywhere

Children carry significant levels of nicotine on their hands even if their parents don't smoke around them, according to a recent study by Cincinnati Children's Hospital Medical Center and San Diego State University.

“Parents may think that not smoking around their child is enough, but this is not the case. These findings emphasize that the only safe way to protect children from smoke exposure is to quit smoking and ban smoking in the home," Dr. Melinda Mahabee-Gittens, co-investigator of the study, said in a Cincinnati Children's Hospital news release.

Kentucky has the highest smoking rate in the nation, 26 percent. And the federal Centers for Disease Control and Prevention says that between 2011-2012, two of every five children aged 3 to 11 in the United States were regularly exposed to secondhand smoke.

The pilot study, published in the journal Tobacco Control, involved 25 children who had visited an emergency room between April and September 2016 for illnesses that could be related to secondhand smoke exposure, like a runny nose or difficulty breathing. The average age of the children in the study was 5, and all their parents were smokers.

Researchers used specially designed hand wipes to extract nicotine from the children's hands and took saliva samples to check for cotinine, which is the product formed after nicotine enters the body.

"Researchers found that the presence of significant nicotine on the hands of children was associated with equally significant levels of the harmful tobacco metabolite cotinine in their saliva," the release says. Such exposure can cause respiratory and ear infections, and more frequent and more severe asthma attacks, and other ailments in children, the CDC says.

The release says previous studies have shown that secondhand smoke accumulates in dust, on home surfaces, on clothes and household objects, like toys. It also notes that young children touch everything and have a tendency to put their hands in their mouths.

This study will be followed up by a larger analysis of more than 700 additional children, with a further look at how much secondhand and thirdhand smoke contribute to tobacco exposure in children and how it affects their health. It will also explore ways to prevent such exposure.

Wednesday, April 12, 2017

Nonprofit grades hospitals on patient safety; Ky. improves slightly in national rank, but Louisville hospitals still get near-failing scores

University of Louisville Hospital reminds visitors
and workers to wash their hands to stop infections.
By Traci Thomas
Kentucky Health News

A nonprofit group that rates hospitals has released its latest patient-safety grades, giving most Kentucky hospitals a B or C. The scores are similar to grades released in October, but the overall score for Kentucky hospitals rose from 35th to 32nd among the states.

The Leapfrog Group, a nonprofit based in Washington, D.C., evaluated 2,639 hospitals nationwide, including 51 in Kentucky. Most of Kentucky's 129 hospitals were not rated because critical-access hospitals in rural areas don’t have to report their quality measures.

The grades are calculated using 30 publicly available safety-performance measures from the Centers for Medicare & Medicaid Services, the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association’s annual survey.

The calculations gave an A to 12 of Kentucky's hospitals, or 23.5 percent, lower than the national average of 31 percent. The majority of Kentucky hospitals got average scores, with 16, or 31.4 percent, earning a B, and 20, or 39.2 percent, earning a C. The remaining three hospitals got a D, one fewer than in the fall.

The three that got a D are in Louisville and owned or operated by KentuckyOne Health: Jewish Hospital, Sts. Mary and Elizabeth Hospital and University of Louisville Hospital. A state inspection of University Hospital last year found that shortcomings in nursing had endangered three patients, and nurses and doctors told inspectors that staff shortages put patients at risk. The hospital has since corrected those problems.

Despite the low grades, KentuckyOne Health told The Courier-Journal that it's "committed to delivering high quality, safe care for the people of Kentucky," Darla Carter reports for the Louisville newspaper. "After financial squabbling between the university and KentuckyOne, an executive committee of the U of L Board of Trustees approved an agreement in December to clear the way for KentuckyOne to no longer run the day-to-day operations of the hospital and the James Graham Brown Cancer Center as of July 1."

St. Joseph Hospital and St. Joseph East in Lexington, also owned by KentuckyOne, received Cs again after getting the same grade in October.

Pikeville Medical Center has received A grades from the start.
Among Leapfrog's top safety picks is Pikeville Medical Center, the only Kentucky hospital to get straight As since the rankings began in 2013. The two University of Kentucky hospitals once again earned Bs.

The grades include separate ratings for errors, injuries, accidents and infections. Click here for Kentucky's hospital safety scores.The Leapfrog Group says its analysis was developed under the guidance of the nation's leading patient-safety experts. The report is peer-reviewed and published in the Journal of Patient Safety.

“When we launched the Leapfrog Hospital Safety Grade in 2012, our goal was to alert consumers to the hazards involved in a hospital stay and help them choose the safest option. We also hoped to galvanize hospitals to make safety the first priority day in and day out,” Leah Binder, president and CEO of Leapfrog, said in a report. "So far, we’ve been pleased with the increase in public awareness and hospitals’ commitment to solving this terrible problem. But we need to accelerate the pace of change, because too many people are still getting harmed or killed.”

State health department offers services to fight opioid epidemic, including free antidote for overdoses and education about it

The state Department for Public Health is reminding communities of the services it offers to address the impact of opioid abuse, and to educate the public about an antidote to overdoses.

"We have an enormous challenge across Kentucky right now," Dr. Ardis Hoven, the department's consultant for infectious diseases, says in a video. "Drug abuse, particularly among those who inject heroin or other forms pf opioids has reached epidemic proportions. It has become clear to use that responding to this crisis means more than drug rehabilitation. We have to address all the outlying health issues attached to injection drug use and that means treating all the forms of harm associated with it."
The agency acted after "a recent report of a death in Louisville linked to the highly potent painkiller carfentanyl, which is a large animal tranquillizer never intended for human use," it said in a press release. "It can be hidden in heroin, cocaine and methamphetamine."

“This is a very serious public health issue tied to a number of overdoses, hospitalizations and deaths across the country,” said Dr. Hiram Polk Jr., commissioner of the department. “Heroin, particularly contaminated heroin mixed with carfentanyl, fentanyl and other toxic substances, is highly toxic and can lead to respiratory failure and death. As healthcare professionals and community leaders, we must be aware of the threat and take steps to address it.”

Polk said hospitals should stock up on naloxone, often known by its brand name Narcan), an antidote to heroin and other drug overdoses.

He also noted that his agency employs a mobile pharmacy unit and on-site testing for hepatitis C and HIV, which can spread through intravenous drug use. The mobile unit is staffed with pharmacists who visit at the request of local health departments to test for the diseases, provide communities with training in the use of naloxone, and distribute free naloxone to community members who request it.

“It can take as much as three times the amount of naloxone to reverse an overdose with these mixed drugs as it would normally,” Polk said. “Communities must be educated about the risks associated with these dangerous drugs.”

Friends and loved ones of those at risk from opioid abuse can get more information about naloxone at Kentucky Stop Overdoses, which also has a registry of pharmacies where the drug is available. The mobile harm reduction program, sponsored by the health department and the Kentucky Pharmacists Association, provides education and a free supply of naloxone to those who visit the mobile pharmacy when it’s in a community. It is visiting Garrard and Nelson counties in April.

Tuesday, April 11, 2017

About half of Kentucky adults support syringe exchanges, meant to decrease the risk of outbreaks of HIV and hepatitis C

By Melissa Patrick
Kentucky Health News

More Kentucky adults favor syringe exchanges than oppose them, and the more they know about them, the more likely they are to support them, according to the latest Kentucky Health Issues Poll.

Kentucky's legislature approved syringe exchanges in 2015 to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require local approval and funding and are often called needle exchanges; a needle is part of the syringe.

In the Sept. 11-Oct. 19 survey, 56 percent of Kentucky adults polled said they were familiar with needle-exchange programs, while 44 percent weren't familiar with them; and 49 percent favored the programs, 43 percent opposed them and 8 percent said they weren't sure.

Those who were familiar with syringe exchanges were more likely to favor them. Of the 56 percent who said they were familiar, 59 percent said they favored the programs, while 37 percent opposed them. Among the 44 percent who were not familiar, 37 percent said they favored the programs, 50 percent opposed them and 13 percent were not sure.

Last year, the Centers for Disease Control and Prevention said 54 of Kentucky's 120 counties were  among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among those who inject drugs. Sixteen of the state's counties ranked in the nation's top 25.

But the decision to support syringe exchanges hasn't come easy for many counties, often because of beliefs that they condone drug use, concerns about safety and concerns about the costs to taxpayers, not to mention a general lack of knowledge about what they do.

"Research tells us that needle-exchange programs can help cut down on the spread of HIV and hepatitis C," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Research also indicates that these programs do not increase drug use."

A great example of how local news coverage can play a role in educating its readers about needle exchanges is found in Brad Bowman's in-depth article about Franklin County's exchange in The State Journal. This story not only explains why needle exchanges are important and describes how they work, but also paints a picture of who uses them: "The clients come from all walks of life, from suit-and-tie professionals to people who are unemployed," Bowman writes.

As of March 29, according to the state Cabinet for Health and Family Services, 31 counties had approved syringe-exchange programs, with 21 of them operational. Eleven are in counties the CDC has deemed most vulnerable to HIV and hepatitis C outbreaks. Click here for more information on specific locations and hours.

Income levels didn't affect opinions about needle exchanges, but age and education did: only 42 percent of adults 65 and older approved of them, while around 50 percent of those 18 to 64 did. Support also increased as education levels increased.

Randy Gooch, director of the Jessamine County Health Department, said in a foundation news release that while the ultimate goal of the program is to reduce HIV and hepatitis C infections, they also measure success in the number of clients who get counseling and treatment services because of the interactions they have with them.

"Our greatest success to date has been realized with our first participant, a 34-year-old female who came seven weeks straight to our program and returned on the eighth week to turn in her syringes and inform us she was checking into rehab. After four weeks of rehab, she was placed on medication-assisted treatment and often comes by to visit and say she is doing well," Gooch said.

Gooch said Jessamine County's exchange, which opened in April 2016, has served 114 clients in 347 encounters, has tested 20 percent of the clients and found that 30 percent of those tested are positive for hepatitis C. They have given out 11,361 syringes and have had 8,083 returned.

"The drug epidemic will only be controlled through a multi-prong approach of education, legislation, prevention, intervention, treatment, faith and other community components," Gooch said. "I'm extremely proud of our community for being proactive in these areas as a 'Safe Community'."

The poll was conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the foundation and Interact for Health. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones and has an error margin of plus or minus 2.5 percentage points.

Monday, April 10, 2017

Studies: 21% of people with serious conditions are misdiagnosed; most in U.S. will get an incorrect or late diagnosis at some time

More than one in five patients who sought a second opinion at the Mayo Clinic had been misdiagnosed by their primary-care doctors, a study concluded.

The results, published in the Journal of Evaluation in Clinical Practice"are generally similar to other research on diagnostic error, but provide additional evidence for advocates who say such findings show that the health-care system still has room for improvement," Lenny Bernstein reports for The Washington Post.

Researchers at Mayo, in Rochester, Minn., looked back at 286 patients their primary-care doctors and nurse practitioners saw in 2009 and 2010. Nearly two-thirds were under 65, and most were female. The researchers reported that in 62 cases (21 percent), the second diagnosis was "distinctly different" from the first. In 188 cases, the diagnoses were at least partly correct but were “better defined” by the second opinion, the study said. In 36 cases, the diagnoses were the same.

Mark Graber, a senior fellow at the research institute RTI International and founder of the Society to Improve Diagnosis in Medicine, told Bernstein, “Diagnosis is extremely hard. There are 10,000 diseases and only 200 to 300 symptoms.”

Graber, who was not involved in the Mayo research, "estimates that the rate of misdiagnosis, although difficult to determine, occurs in 10 percent to 20 percent of cases," Bernstein reports. The new study cites previous research that found diagnostic errors "contribute to approximately 10 percent of patient deaths" and "account for 6 to 17 percent of adverse events in hospitals."

"In 2015, the National Academy of Medicine reported that most people will receive an incorrect or late diagnosis at least once in their lives, sometimes with serious consequences," Bernstein writes. "It cited one estimate that 12 million people — about 5 percent of adults who seek outpatient care — are misdiagnosed annually. The report also noted that diagnostic error is a relatively under-measured and understudied aspect of patient safety."

James Naessens, a policy researcher at Mayo, said in a press release: "Effective and efficient treatment depends on the right diagnosis. Knowing that more than one out of every five referral patients may be completely [and] incorrectly diagnosed is troubling — not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all."