Hospitals say too many of the newly insured are using emergency rooms for primary care; state says it's working on the problem

By Melissa Patrick
Kentucky Health News

More people with health insurance, a shortage of primary-care physicians and a steep learning curve for the newly insured all add up to more patients than ever using emergency rooms for non-emergency purposes.

More than 413,000 Kentuckians are newly enrolled in health care coverage under the Patient Protection and Affordable Care Act, and nearly three out of four of those enrolled under the Medicaid expansion, which covers residents earning up to 138 percent of the federal poverty line.

Because many of these newly insured are using the emergency room for non-emergency reasons, emergency rooms are feeling the strain, Don Weber reports for cn|2's "Pure Politics," a service of TimeWarner Cable.

"In the past three months, we are seeing about a 12 percent increase per month in our emergency room visits," Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Weber in a broadcast.

“Many of the patients that come have multiple chronic conditions that have been undeserved," Currans said in the broadcast. "Diabetic. Obesity. Vascular disease. And so they come with chronic conditions and they don’t really have a primary-care physician. And so the ability to get them into a primary-care setting, into specialty-care settings, becomes more difficult without that primary-care person to refer and to kind of coordinate and manage that care."

Currans added, “Primary-care physicians have got to lead this transformation in health care, because  … they can take care of the whole patient. We have to reform the payment system so that the primary-care physician can spend 30 minutes with you and/or can spend 15 minutes with you, but can hand you off to a professional within their office that can help educate, continue to educate, re-mediate.”

Norton Hospital in Louisville has also seen a 12 percent spike in the number of patients, many for non-emergency reasons, Laura Ungar reported in The Courier-Journal. Weber reports that the 12 percent increase in emergency room visits is "pretty consistent with the state average."

This is not a new problem, according to Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

“Kentuckians suffer poorer health than many other Americans, and have traditionally utilized emergency rooms at a higher rate. This is not a new phenomenon," Midkiff said in an e-mail. She said Kentucky is working on the problem, focusing on so-called "super-utilizers" who use ERs at least 10 times in a year.

"Last summer, Kentucky was one of seven states chosen to participate in the National Governors Association Policy Academy on emergency-room utilization, with particular focus on managing super-utilizers," Midkiff said.

People who have never had insurance often don't know how to use their benefits, which also adds to the number of people using the emergency room instead of seeking a primary care physician, Midkiff said. "There is a steep learning curve to navigating the healthcare system and all providers and the insurance companies must help educate the newly insured," she said.

Part of that effort is being handled by the companies that manage the care of Medicaid patients under contracts with the state that reward them when expenses are less than expected.

The Kentucky Health Benefits Exchange, branded as Kynect, "is developing some very basic 'Insurance 101' materials to help educate the newly insured about how to find a primary care physician, when to seek health care services, when to visit the ER, how to use pharmacy benefits, as well as providing a glossary of commonly used insurance terms," Midkiff said. "We think this fills a real need and will help consumers more appropriately and efficiently use their health-care coverage."

Midkiff said emergency rooms have long been considered the "de facto primary care center," with some hospitals even advertising the average wait times on websites and remote-controlled billboards. "This provides a confusing message to those who are newly covered," she said. "Many hospitals across the country have revised their health-care delivery model to include both emergency services and immediate care to adapt to the increased and changing demand for services."

Many hospitals around the country have done that, and are profiting. "Hospital chains and insurers are making more money, more patients using ERs are paying for their care, and the country as a whole is enjoying slower growth in its health-care spending," Alex Wayne and Shannon Pettypiece of Bloomberg News report, on the basis of public filings by hospital chains.

Health care jobs are expected to expand as we age; newspaper in Bowling Green looks at its region

Jobs in health care are not only available for those without bachelor's degrees, such jobs are likely to become more prevalent, according to data collected in the Barren River Area Development District, Monica Spees reports for The Daily News in Bowling Green.

Ron Crouch, director of research and statistics for the Kentucky Education and Workforce Development Cabinet, compiled the data after the release of a national report of health care and health care education by the Brookings Institution.

“The demand for health care is going up,” Crouch told Spees. He said positions such as dentists, pharmacists, anesthesiologists, surgeons and other occupations will see in increase by 2020; and many of these jobs don't require more than an associate degree.

Crouch said there were 477 medical assistants in the region in 2010, with a projection of 573 by 2020. Medical assistants were paid $12.54 per hour in 2013. He also cited 634 licensed practical and licensed vocational nurses in the region in 2010, with a projection of 776 by 2020. These positions were paid $16.47 per hour in 2013. Health billing and maintenance jobs, which don't require a degree, are also available in the region.

Jobs that require a lower level of education are in high demand because they help people provide for themselves and their families without incurring college debt, Crouch told Spees. He also said that while 83.2 percent of health care positions in the region are filled by women, these jobs are suitable for both men and women.

As the population ages, the demands for health care will increase, Crouch said. In 1980, there were approximately 58,600 people older than 50 in the region. In 2010, there were almost 93,000.

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

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

Dr. Thomas Frieden

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here are other suggestions to help you make the most of your yearly well-visit with your pediatrician:

• Bring any updated immunization records along if you have them
• Bring your school's required physical forms
• Bring a list of questions about anything that you have concerns about including sleep, allergies, medications, behavior and development.
• Ask to see your child's growth chart and discuss your child's nutrition/caloric intake and exercise needs
• Be mentally prepared for any vaccinations that may be due.

“Though no one likes to get shots, vaccines are an integral part of keeping kids and our community safe. They work to safeguard children from illnesses and death caused by infectious diseases and protect our kids by helping prepare their bodies to fight often serious, and potentially deadly diseases,” Heidi Renner, primary care physician at Loyola University Health System, said in a press release.

Centers for Disease Control and Prevention

Click here for a chart of Kentucky's state requirements for immunizations.

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

Ballard County joins schools with free meals for all students

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

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

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

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

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

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The study found that 60 percent of the 6.1 million rural residents who were hospitalized in 2010 sought care in rural hospitals, while 40 percent went to urban ones. For patients over 65 years old, 51 percent were hospitalized in rural areas, with 53 percent using Medicaid as their principal source of payment, compared to 37 percent of patients over 65 going to urban hospitals, with 44 percent relying on Medicaid. Rural residents ages 45-64 made up 24 percent of those hospitalized in rural areas and 32 percent in urban areas. The study found no significant difference among patients under 45. (The disparity of where difference age groups seek hospitalization)

Rural residents hospitalized in an urban hospital were three times more likely to have three or more procedures than patients in rural hospitals, the study found. Only 38 percent of patients in rural hospitals received a non-surgical procedure, compared to 74 percent of rural patients at urban hospitals.

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

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

By Al Cross
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

Smoking-ban supporters on 'Road to a Healthier Kentucky Tour' next week to rally support for the 2015 legislative session

The Smoke-Free Kentucky Coalition is kicking off its 2015 campaign to rally support for comprehensive, statewide smoke-free laws on its "Road to a Healthier Kentucky" Tour, from Monday, July 28 to Saturday, August 2.

The tour plans to make at least 10 media appearances across the state on its way to its final stop at the annual Fancy Farm Picnic in Graves County. The coalition says its goal is to get Kentuckians active and engaged in supporting smoke-free policy as the campaign gears up for the next legislative session. The message: "It's time to take a stand for better health by making Kentucky a smoke-free state."

The coalition says 24 other states have comprehensive, statewide smoke-free laws that cover all indoor workplaces and public places, including bars and restaurants. State Rep. Susan Westrom, D-Lexington, has introduced such legislation during the last four legislative sessions but it has not gotten a floor vote in the full House. Last year's bill apparently died because legislators feared backlash in an election year.

Almost 30 percent of Kentuckians still smoke, more than any other state in the nation, but a poll last fall showed 65 percent of Kentuckians favored a smoke-free workplace law, and 90 percent of Kentucky Chamber of Commerce members support such a law.

“2015 is the year we are finally going to pass a smoke-free law and protect everyone’s right to breathe clean air in Kentucky,” said Amy Barkley, chair of the coalition. “We know Kentuckians support going smoke-free, and we’re touring the state to call attention to those supporters.”

Here's the tour schedule:
Monday, July 28: King's Daughters Medical Center, 2201 Lexington Ave, Ashland, noon.
Tuesday, July 29: Appalachian Regional Healthcare, 110 Medical Center Dr., Hazard, 11 a.m.; Manchester City Hall, 123 Town Square, 3 p.m.
Wednesday, July 30: Markey Cancer Center, 800 Rose St., Lexington, 11 a.m.; Norton Cancer Institute, 676 S. Floyd Street, Louisville, 3 p.m.
Thursday, July 31: Big Dawg Country Radio, 101 E. Main St., Campbellsville, 11 a.m.; Fountain Square Park, Bowling Green, 2 p.m.
Friday, Aug. 1: Smothers Park, 199 West Veterans Blvd., Owensboro, 10 a.m.; Baptist Health (formerly Trover Clinic), 900 Hospital Dr. Madisonville, 12:30 p.m.; Baptist Health Paducah, 2501 Kentucky Ave., 3:30 p.m.
Saturday, August 2: Fancy Farm Picnic, St. Jerome Church, Fancy Farm, 10 a.m. to 4 p.m.

Barkley says she can be reached at 502-777-8148 or abarkley@tobaccofreekids.org to inquire about additional stops. For more information visit www.smokefreekentucky.org or contact Betsy Janes, 502-797-0638 or betsyjanes@ymail.com.

The coalition includes the American Cancer Society Cancer Action Network, the American Lung Association, the American Heart Association, the Campaign for Tobacco-Free Kids and other local health, businesses and community partners.

U.S. measles cases highest in 2 decades; blamed mainly on Americans' foreign travel, but also on opting out of vaccination

By Melissa Patrick
Kentucky Health News

In the wake of the highest number of measles outbreaks in the U.S. in the last 20 years, it is important to make sure you and your children are fully immunized, especially if you are traveling abroad.

"The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the U.S. and spread (it) to others in communities where many people are not vaccinated," Ann Schuchat, director of the Center for Immunizatons and Respiratory Diseases of the federal Centers for Disease Control and Prevention, said in a press release.

Centers for Disease Control photo

Measles is a virus and is one of the most contagious diseases known. It spreads through the air when an infected person coughs or sneezes and will infect 90 percent of those who are exposed if they are not protected. It starts with a fever, followed by a cough, runny nose and red eyes. Then a rash of tiny, red spots breaks out, which starts at the head and spreads to the rest of the body. It can lead to pneumonia, swelling of the brain and death. Of every 1,000 children who get the disease, one or two will die, the CDC says.

Kentucky requires measles immunizations for children in child care and school, with exemptions made only for medical or religious purposes.

The Kentucky Annual School Immunization Survey for Kindergarten and Sixth Grade reports that for the 2013-2014 school year: 148 kindergarten students (0.3 percent) and 228 sixth graders (0.4 percent) opted out of immunization under the medical exemption, while 359 kindergartners (0.6 percent) and 249 sixth graders (0.5 percent) opted out for religious reasons.

As of May 23, measles cases have been reported in 18 states and New York City, with most reported from Ohio (138), California (60), and New York City (26). Ninety percent have been among people who have not been vaccinated or have unknown vaccination status, according to the CDC. Most of the patients report religious, philosophical or personal reasons for avoiding vaccines. Through May 23, no deaths had been reported.

Daytime mental-health programs shrink, citing problems with managed-care Medicaid; pastoral counselors to be licensed

Access to daytime mental-health care "is on a steep decline in Kentucky, leaving what some fear is a gap in care that isolates the mentally ill at home or drives them out into the streets, hospitals or jail," Mike Wynn of The Courier-Journal's Frankfort Bureau reports. The Kentucky Association of Regional Programs, the lobby for community mental-health centers, "reports that 33 of the roughly 50 programs offered across the state have closed in the past 18 months while four others have reduced their hours by half," affecting an estimated 1,000 people.

The state Department for Behavioral Health, Developmental and Intellectual Disabilities says these community mental-health centers should embrace "a shift away from using day programs," Wynn writes, but mental-health advocates "say the centers have struggled to get enough coverage authorized under Kentucky's Medicaid managed-care system to keep the services operating. That has forced programs to close before new services are available to replace them, they argue."

The advocates say that among companies that manage care in Kentucky under Medicaid, Coventry Cares and its subsidiary MHNet "are by far the worst about denying coverage or reducing hours for therapeutic day programs. Coventry and MHNet are owned by insurance provider Aetna," which "says complaints are off target and that it is committed to providing patients with high-quality care. MHNet has approved two-thirds of the requests it received for therapeutic rehabilitation since January 2013, Aetna said in a statement."

Steve Shannon, executive director of the centers' lobbying group, "said that even mild reductions — such as approving services for three days a week rather than five — can wreak havoc on a program's financial viability," Wynn writes. "He also argues that centers may have stopped requesting services once they realized that MHNet would not approve them." (Read more)

Meanwhile, Kentucky has become the sixth state to license pastoral counselors under a new law that will also allow them to be paid for their services. The sponsor of Senate Bill 61, Sen. Alice Forgy Kerr of Lexington, told Jack Brammer of the Lexington Herald-Leader that the counselors must have a master of pastoral counseling degree, in addition to the same qualifications as other licensed counselors, and must also pass a written examination. (Read more)

Some odors we emit make us more attractive to mosquitoes; various repellents, including plant oils, are available

Mosquitoes are attracted to some people more than others because of skin odors or chemicals they emit, Jill Richardson writes for Salon. Carbon dioxide, heat, moisture, scent and appearance attract mosquitoes, but it's the chemicals you emit that make them want to take a bite, she writes.

Photo from Lexington Herald-Leader

Kentucky has about 60 of the 150 species of mosquitoes found in the U.S., according to the University of Kentucky Public Health Entomology Laboratory. Not all bite, and if one does, it is always a female, which needs the protein found in blood to make her eggs, UK extension entomologist Lee Townsend writes in The Courier-Journal.

Each species differs in biting persistence, habits and ability to transmit disease and even flying ability, Richardson writes, but it is the chemicals we emit that dictate their preference of who to bite.  L-lactic acid, ammonia, carboxylic acids and octenol, especially in combination with each other, are the chemicals most likely to attract them.

Scientist have found that adding l-lactic acid to the scent of someone who is not normally bitten by mosquitoes will make them more attractive to certain kinds of mosquitoes, Richardson reports. The presence of carbon dioxide has also been found in studies to be attractive to certain mosquitoes. Ammonia, which occurs from a pH change when bacteria in sweat multiply, is also appealing to mosquitoes.

So are smelly feet. Studies with Limburger cheese, which resembles human foot odor, have confirmed this. However, malarial mosquitoes are most attracted to this odor, so the saying that "If you keep your feet clean then mosquitoes won't bite," is good advice only if you are traveling in the tropics, Richardson writes.

Human odor that attracts mosquitoes may be genetically driven, but theories vary. One says individuals who are not attractive to mosquitoes don't produce the odors that attract them; and another says some people actually emit an inherited odor that keeps mosquitoes from finding them.

For those who consider themselves "mosquito bait," Richardson makes several suggestions: bathe at dusk, when mosquitoes come out, to minimize sweat odor, rub your body with antimicrobial plants like sage, wear a full-body mosquito net suit or use a repellent, which is the most convenienct, effective protection.

The most common repellent is DEET, available over the counter in many preparations. A prescription repellent is permethrin, which Richardson says may be carcinogenic though it is approved by the Environmental Protection Agency.

A young jewelweed plant

Many people use essential plant oils, though they evaporate quickly, requiring frequent application. The one most commonly recommended is lemon eucalyptus oil, which has proven effective. Richardson's article has details about other plant oils, and recommends crushed jewelweed as a remedy for mosquito bites.

Darla Carter of The Courier-Journal also had a good roundup of mosquito information in the Louisville paper's July 18 edition: http://www.courier-journal.com/story/life/wellness/health/2014/07/17/guard-mosquitoes-summer/12786213/.

As Edelen begins hearings on rural hospitals' finances, state gives figures on Medicaid expansion and reimbursement

By Al Cross
Kentucky Health News

The expansion of the federal-state Medicaid program funneled $284 million to Kentucky health-care providers in the first quarter of the year, the state Cabinet for Health and Family Services says in a report prepared for the hearings state Auditor Adam Edelen has begun to examine the fiscal health of rural hospitals.

Under the Patient Protection and Affordable Care Act, states could expand Medicaid eligibility to people with household incomes up to 138 percent of the federal poverty level, and Gov. Steve Beshear did that. The federal government, which normally pays about 70 percent of Medicaid costs, is paying the entire cost of the newly eligibles through 2016. The state will pay 3 percent in 2017, rising to a cap of 10 percent in 2020.

Beshear says the expansion will pay for itself by creating more jobs and tax revenue in health care, but some rural hospitals are saying the combination of reduced reimbursements under Obamacare, and delayed and rejected reimbursements under managed-care Medicaid, have left them with the short end of the stick.

Auditor Adam Edelen

“Rural hospitals are teetering on the edge of survival in many Kentucky communities,” Edelen said in a press release last week announcing the schedule of 10 hearings, which began Tuesday in Prestonsburg and Hazard and continued Wednesday in Pineville. They will resume Wednesday, July 23 in Morehead.

"Aside from members, hospitals have been the primary beneficiaries of Medicaid expansion," says the report from the Cabinet for Health and Family Services. "They are beginning to see their share of uncompensated visits drop significantly as Medicaid begins to reimburse for the previously uninsured."

The report said $135 million of the $284 million in Medicaid reimbursements went to hospitals. The report covered the first half of the year, but said "due to the billing and payment cycle, these totals most likely only represent completed claims for January through March."

Rural Kentucky hospitals' reimbursements have not increased as fast as those of urban hospitals in the state. In the fiscal year that ended June 30, they received total Medicaid reimbursements of $452 million, up 3.2 percent from $438 million in the previous fiscal year. Urban hospitals' reimbursements went up 7 percent, to $836 million from $781 million.

"Some hospitals are experiencing declining Medicaid reimbursements while others are flourishing," the report said. "For example, Caldwell and Crittenden counties share a border, they have similar populations, and they both have small rural hospitals with 25 and 48 beds respectively.  Despite their geographic closeness and similarity, Crittenden County has experienced 50 percent reimbursement growth in the past three years while Caldwell County reimbursements have declined by 33 percent."

The report includes tables listing all Medicaid reimbursements to rural hospitals for the last three state fiscal years (SFY 2014 figures likely omit most of the final quarter because of billing and payment cycles):

The report lists the hospitals that had received more than $2 million in Medicaid reimbursements. An Excel spreadsheet of Medicaid payments to all hospitals can be downloaded here. Here's a list of the reimbursements to all providers for treatment of newly eligible Medicaid recipients, by county:

Edelen has scheduled other hearings at Madisonville Baptist Health July 31 at 10 a.m.; Caldwell Medical Center in Princeton July 31 at 2:30 p.m.; the Leitchfield campus of Elizabethtown Community and Technical College Aug. 6 at 10:30 a.m.; Westlake Regional Hospital in Columbia Aug. 12 at 10 a.m.; and Taylor Regional Hospital in Campbellsville Aug. 12 at 2:30 p.m.

Pediatric therapist says ADHD rising because kids don't move their bodies enough; says they need to play outside

The percentage of children diagnosed with attention-deficit and hyperactivity disorder, or ADHD, is on the rise. While many reasons are mentioned, one that is not heard often is the length of time children are forced to sit while they are in school, writes Angela Hanscom, a pediatric occupational therapist, in the TimberNook blog, which was picked up by Valerie Strauss of the Washington Post.

Kentucky leads the nation in the percentage of children with a current diagnosis of ADHD, at 14.8 percent, a jump from 10.2 percent diagnosed in 2007, according to the U.S. Centers for Disease Control and Prevention. An even higher 19 percent of Kentucky children ages 4-17, compared to 11 percent nationally, have ever been diagnosed with ADHD at some point. (CDC map)

Reasons given for this rise in diagnosis include changes in "diagnostic criteria, medication treatment and more awareness of the condition," Strauss writes. Over-diagnosis, genetic predisposition and "financial incentives" that can go along with an ADHD diagnosis are other possible reasons for this increase in diagnosis, reports Laura Ungar of The Courier-Journal.

Hanscom says the amount of time children are forced to sit while they are in school is also a contributing factor. She reflects in her article about a recent phone call from a parent of a 6-year-old whose self-esteem is being crushed because he is told every day at school that his behavior isn't good enough simply because he can's sit for long periods of time. She also writes about a local elementary teacher who told her that "at least eight of her 22 students have trouble paying attention on a good day."

The problem, Hanscom writes, is that "Children are constantly in an upright position these days" and are not moving their bodies enough.

Hanscom writes about her recent observations of a fifth-grade classroom where she found fidgeting, kids tilting chairs, kids rocking their bodies back and forth and one child hitting a water bottle against her head in a rhythmic pattern. She writes, "This was not a special-needs classroom, but a typical classroom at a popular, art-integrated charter school."

She noted that some of this behavior could have been because it was the end of the day, but she also did testing on the students' core strength and balance in several of the classrooms and found it to be poor, with "only one" out of 12 of the students having normal strength and balance when compared to children from the early 1980s.

Hanscom says children have underdeveloped balance systems today because of so much restricted movement. To develop a strong balance system, she says, children need to move their bodies in all directions for hours at a time daily.

Children often fidget in the classroom to get the movement their bodies need, which helps to "turn their brain on." But, subsequently the fidgeting gets them in trouble and so when they sit still as required, their brains "turn off," Hanscom writes. "Children are going to class with bodies that are less prepared to learn than ever before."

Hanscom suggests that the solution is to fix the underlying issues: put recess back into our schools and let kids play outside for hours when they get home from school, and "20 minutes of movement a day is not enough! In order for children to learn, they need to be able to pay attention. In order to pay attention, we need to let them move."

Smoking among Kentucky youth dropped by one-fourth from 2011 to 2013, biennial CDC survey determines

Photo from TobaccoPreventionK12

By Melissa Patrick
Kentucky Health News

Fewer Kentucky high-school students are smoking cigarettes. The state dropped to sixth place from first in high-school smoking in the 2013 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System report.

In the survey, which is done in odd-numbered years, 17.9 percent of Kentucky high-schoolers reported that they were smoking cigarettes, down one-fourth from 24.1 percent in 2011. Nationwide, the current rate is 15.7 percent.

In 1997, when the CDC first started tracking student smoking, 47 percent of Kentucky youth reported smoking.  The state has now cut that bu more than half, and gone beyond its "Healthy Kentuckians 2020" goal of reducing youth smoking to 19 percent.

The survey sampled 1,626 Kentucky high-school students and got responses from 85 percent. The final sample of 1,382 is subject to an error margin of plus or minus 2.6 percentage points, leaving no doubt that youth smoking in Kentucky declined significantly from 2011 to 2013 -- by 25.7 percent, if the figures are without sampling error.

Before state officials knew about the big drop in 2011-13, they set a goal of decreasing youth smoking by another 10 percent by 2019 as part of the "kyhealthnow" initiative.

“When I announced our ambitious goals for kyhealthnow in February of this year, smoking was one of the most obvious areas we needed to address,” Gov. Steve Beshear said in a news release. “I am pleased to see teen smoking trending downward, but I remain committed to further reducing cigarette use among our youth.”

Kyhealthnow is an aggressive plan to improve the state's collective health. One component of the plan to cut youth smoking by 10 percent includes comprehensive smoke-free policies and tobacco-free schools.

Only 33 of Kentucky's 173 public school districts are tobacco-free, according to the state Department for Public Health. Since nearly nine out of 10 smokers start by age 18, early intervention is a "key element in reducing the overall burden of tobacco use in Kentucky," the release says.

Youth who smoke can develop cardiovascular disease, smaller lungs that don’t function normally, wheezing that can lead to asthma, and eventually cellular damage that can lead to cancer, rheumatoid arthritis, type 2 diabetes and a host of other diseases, according to the release.

“While we’re pleased to see a reduction in youth smoking, it’s important to note that we still have too many youth who smoke and others who are exposed to secondhand tobacco smoke,” said state Health Commissioner Stephanie Mayfield. “The health consequences of smoking are seen throughout many of the diseases impacting Kentuckians. Smoking cessation could significantly reduce the rates of cancer, cardiovascular and respiratory diseases which are linked to tobacco use.”

Smoking cessation programs are available to people 15 and older in Kentucky, and are available in multiple languages. For more information call 1-800-784-8669 or go to www.QuitNowKentucky.org.

Paducah Baptist and Ashland hospitals 'above average' in Consumer Reports' ratings of hospitals for heart surgery

Baptist Health Paducah
(formerly Western Baptist Hospital)

By Melissa Landon
Kentucky Health News

Consumer Reports has reported ratings of hospitals for heart-valve and coronary artery bypass surgery based on hospitals' reports to the Society of Thoracic Surgeons. More than 400 hospitals in 45 states have been rated, based on "medical records showing whether patients survived the procedure and how they fared on other important measures, including complications," the magazine says.

Although more than 1,000 hospitals send data to STS, only 400 allowed it to be shared with Consumer Reports. Of those did, "20 percent (83) were above average, 75 percent (310) were average and 4 percent (18) were below average," the magazine reports. Robbin Cohen, a cardiothoracic surgery professor at the University of Southern California, said the STS has very high standards, so hospitals with average scores do a very good job.

King's Daughters Hospital, Ashland

King's Daughters Hospital in Ashland and Baptist Health Paducah (formerly Western Baptist Hospital) were the only Kentucky hospitals ranked above average for either type of procedure (and in their cases, only for bypasses). King's Daughters recently agreed to a huge settlement with the federal government for doing unnecessary heart procedures.

Four Kentucky hospitals were listed as below average for both procedures: Lourdes Hospital in Paducah and Jewish Hospital, Norton Hospital and Norton Audubon Hospital. Two were listed as below average for bypass and were not listed for valve: Baptist Health Lexington and Baptist Health Madisonville.

Several hospitals near Kentucky were on the list. Mercy Health-Anderson Hospital in Cincinnati was rated below average for bypass and was not listed for valve surgery. In Missouri, Poplar Bluff Regional Medical Center and Cape Girardeau's Saint Francis Medical Center were rated below average on both.

In Tennessee, Nashville's Tristar Centennial Medical Center and Saint Thomas Midtown Hospital were below average on both, but Saint Thomas West Hospital, was above average for bypass and below average on valves. In Knoxville, the Univerity of Tennessee Medical Center and its Fort Sanders Regional Medical Center were below average on both, and Parkwest Medical Center was above average on bypass and below average on valve. Wellmont Holston Valley Medical Center in Kingsport was below average on both, and Johnson City Medical Center was above average on bypass and below average on valves.

The top hospitals in the nation were Baystate Medical Center in Springfield, Mass., Borgess Medical Center in Kalamazoo, Mich., and Cleveland Clinic, which attracts some Kentuckians. To see the full list of ratings, click here.

Study indicates that vitamin D can help prevent early death from cardiovascular disease and cancer

Elderly people with a vitamin D deficiency are more at risk for death from cardiovascular disease and cancer, according to a large-scale study by the Mount Sinai health system of New York and a group of international collaborators, published in the June issue of BMJ, formerly British Medical Journal.

Paolo Boffetta of the Tisch Cancer Institute at Mount Sinai led a collection and analysis of data that showed a significant association between low vitamin D levels and risk of death not only from cardiovascular diseases and cancer in older people with a history of cancer, but death from all causes.

Other studies showed that vitamin D helps prevent issues like hypertension, diabetes and bone loss, but these new findings suggest it might be even more important than previously known. "Going into our study, the effect of vitamin D supplementation on risk of death was not clear," Boffetta said. "Our analysis confirms the protective nature of this substance, especially in elderly patients."

Sunlight, as well as food and supplements, provide vitamin D. Because elderly people generally get less sun, they're more likely to have a vitamin D deficiency. Though researchers don't yet know how much vitamin D is ideal, the study results do argue that people with a vitamin-D deficiency are more likely to die early than those who don't have such a deficiency, Boffetta said.

Researchers use data from eight different studies including 26,018 men and women between ages 70 and 79. During the study, 6,695 participants died—2,624 from cardiovascular diseases and 2,227 from cancer. Participants with the lowest levels of vitamin D had a risk ratio of 1.57, which was double the death risk of the people with high concentrations of the vitamin.

"Vitamin D's protective effect is clear," Boffetta said. "If our results are confirmed in additional studies, it could lead to recommendations for greater vitamin D supplementation in foods and to a better understanding of its role in cancer prognosis." (Read more)

July is Minority Mental Health Month; experts discuss mental-health complications among African Americans

By Melissa Landon
Kentucky Health News

July is Minority Mental Health Month. KET's Renee Shaw interviewed Sycarah Fisher, associate professor in the College of Education at the University of Kentucky, and Shambra Mulder, an assistant professor in the School of Education at Kentucky State University, about challenges and differences professionals face in providing care for African Americans with mental health conditions. The show is available online and airing on KET's secondary channels.

"Getting the right diagnosis and treatment for mental health issues are difficult tasks, and can be even more challenging for ethnic and racial minority groups," Shaw said at the beginning of the interview on her weekly show, "Connections."

Fisher said mental illness is particularly stigmatized in African American communities and other ethnic or racial groups, perhaps because some "feel like getting help, especially from medical professionals, makes [them] weak, and [they're] expected to be strong and be able to take care of [themselves]."

Mulder agreed, adding that "The church and spirituality play a big role in the African American community," so those who seek medical help might be seen as lacking the faith to be healed. It may also have to do with the lack of minorities working in the field, she said. Research shows that African-Americans are more inclined to seek or stay in therapy if they have a minority therapist.

Fisher discussed ways more minorities might be recruited to the field. She called that "a very, very big task," noting that it can be uncomfortable to be the only African American in a program. Even the students who do make it into Ph.D. programs have more difficulty graduating, she said. Many programs are seeking grants to bring in minority psychologists.

Mulder added that if people haven't seen or heard of many black psychologists, they might think it's really difficult or might not think they couldn't do it. Shaw clarified that they weren't saying a doctor must be black to understand a black patient, it's just that mental health is a sensitive issue that people are sometimes uncomfortable discussing.

Fisher said it's important for people, especially African Americans, to talk about their disorders and treatments and how it is helping so that others will feel comfortable seeking medical attention that they need. Mulder said that even taking medication can be stigmatized.

Adding to the problem is that racial and ethnic minorities are more often misdiagnosed. Fisher "A lot of measures that are used to identify different types of behavior disorders aren't normed on African American samples," Fisher said. "We're taking and giving measures to African-American individuals, but yet when we're comparing them to different cultural groups."

Mulder agreed, adding that some people may not want to be forthcoming about their symptoms. If they will not accurately explain what they're dealing with, it's difficult to make the correct diagnosis. Shaw pointed out that this and other factors can lead to delayed treatment, which can have serious consequences. Fisher said, "The earlier you intervene, the better your outcomes are going to be. . . . The longer you wait, the more severe the problem behaviors are going to get."

The experts also discussed diagnosis of children. Shaw asked how professionals perceive the difference between a child who has a mental health issues and a child who is being abused or something similar. Fisher said environmental factors must be addressed, and Mulder said, "The behavior might be age appropriate, but the environment might not be age-appropriate," such as asking kindergartners to sit for a long time.

Shaw said people may wonder what schools can do to help. Fisher said a school psychologist's job is to make sure the student can function in the school environment. They may not have enough time to talk with the students and provide all the help they need, so they can "rally the troops" and "connect our services with the services they're receiving in the community."

Mulder noted that although it's important for school psychologists to make sure students are diagnosed so they can get the help they need, doctors are supposed to notice the early symptoms in young children. Later on, teachers may notice something is amiss but usually only if it is externalized behavior. Parental input is also important although they often don't have sufficient knowledge of what symptoms would be. Schools are moving to a more preventative approach, Fisher said. Teachers will report things that disrupt the classroom and miss the internalized behaviors.

Click here to watch the show.

WKYT anchor Sam Dick finishes radiation treatment for recurring prostate cancer; encourages others to monitor their health

Photo from www.mediabistro.com 

Longtime WKYT-TV anchor Sam Dick believed that his battle with prostate cancer was over, but found out six months ago that some of the cancer remained. He reported on his diagnosis and treatment as he neared the end of a seven-week course of radiation.

"Being told you have cancer is life-changing," Dick said. "Three and a half years ago, many of you followed my journey fighting prostate cancer and were very supportive as I decided to have surgery to remove the prostate. I was told by doctors at the time, I was cured."

But six months ago his prostate specific antigen levels, which had stayed undetectable for two years after his prostate was removed, crept up, so he started daily treatments at Lexington Clinic's John D. Cronin Cancer Center. PSA levels can vary widely and can be unreliable, but are the best diagnostic tool available. "In my case, a rising number means cancer is likely still present," he explained. Dick's treatment was tailored to his medical condition and cancer history.

Dick has maintained his regular schedule of anchoring WKYT's evening newscasts and had told only a handful of people about the cancer's recurrence, but as he approached his last radiation treatment he said he wanted to remind others about the importance of watching for warning signs.

"We can't see the cancer cells in a situation when we're treating for a rising PSA after surgery, but we know where we need to treat because there is an overwhelming likelihood that the reason that the PSA is going up is because there is residual disease in the pelvis so that's our target," Dr. Janalyn Prows, a radiation oncologist, said in the WKYT report.

"It's not uncommon for men who've had their prostate removed because of cancer to find out years later some cancer" remains, but it's not what I expected, or centrality wanted," Dick said.

His father, journalist and author David Dick, battled prostate cancer for more than a decade before dying of it a few years ago. He referred to that and said, "I feel blessed. They had nothing like this available. The advances of medical technology are a blessing I'm taking advantage of, and I'm hopeful and optimistic it's going to work."

Dick will have his follow up PSA in two months. "At that time, we'll see where I am," Dick said. "Until then, I appreciate all the emails, Facebook posts, and notes of support and prayers. Thank you from the bottom of my heart!"

Prostate cancer is the second most common cancer among men after skin cancer, according to the American Cancer Society. For more information about it, click here.

Time on the tummy is important for infants' muscle development

Today's infants are spending too much time on their backs or in sitting devices, which is causing an increase in head and neck deformities and slowing down their motor development, Susan Effgen, a physical therapy professor at the University of Kentucky, writes for the Lexington Herald-Leader.

This is easily remedied by making sure infants spend most of their waking hours on their tummies, even during the first few weeks of life, Effgen suggests.

The American Academy of Pediatrics recommends that infants should sleep on their backs because it significantly reduces the chance of sudden infant death syndrome (SIDS).
While most parents may know that, any are not aware of how important it is for infants to spend time on their bellies, Effgen writes.

Time on their bellies allows them to learn to move and explore their environment, Effgen writes. You can encourage your infant when they are on their tummies by having them to lift up their heads and look around, giving them objects to reach for and encouraging them to prop up on their elbows or hands, These activities help to build strong back and neck muscles needed later for sitting, crawling, walking and talking.

If your infant doesn't like tummy time, Effgen suggest parents lie on their back and place the infant on their belly to let them practice for several days until they are used to this position. Eventually, practice tummy time together on a baby-proofed floor with fun, appropriate objects placed at their eye level.

Teens continue to use indoor tanning, in spite of risks; Ky. law lax

Kentucky teenagers are continuing to use indoor tanning in spite of the risks. Though tanning-bed use by children is illegal in 17 states and Washington, D.C., it is allowed in Kentucky. The Kentucky House passed a bill that would have made it illegal for those under 18 to use tanning beds, but it didn't pass the Senate. The law allows those under 14 to use tanning beds if accompanied by an adult, and those 14 to 18 can if they have a parental consent form.

Having a tan is a popular trend for those attending prom and other events like dances and graduation parties, Christine Fellingham writes for The Courier-Journal. "Usually, I go to a tanning bed before a dance," Naomi Popa, a 17-year-old Kentucky Country Day senior and occasional indoor tanner, told her. "I think it all started when one person went. Then everyone started going. If you're the only one who doesn't, you look so pale in comparison."

They continue tanning, even though doing so increases the risk of getting cancer. "Tanning-bed use can increase your risk of skin cancer by 59 percent," said Dr. Tamela Cassis, a Louisville dermatologist. In June the Food and Drug Administration sent a warning that minors shouldn't use tanning beds, and eventually all tanning beds will include a "black box" warning saying that those younger than 18 shouldn't use them, Fellingham notes.

Not everyone will pay attention. "We talk to parents and teens about the dangers of tanning all day long," Cassis said. "The youngest person I've treated to date for skin cancer was 16 years old. It required a wide local excision to cut it out. . . . It has made everyone in the family so much more aware. And like everyone else we see with skin cancer, he wishes he could take back the bad choices he made."

Young people face a lot of peer pressure to be tan because they often associate being tan with being attractive. According to a 2013 American Academy of Dermatology survey, 80 percent of people under 25 said they believe they look better with a tan. "I feel more confident with a tan," Popa said. "My skin clears up; I don't need as much makeup. I think I look better."

According to the academy, 2.3 million teens tan indoors every year, and 71 percent of those who use tanning salons are girls and women ages 16 to 29. In the past 40 years, skin cancer among females has increased eightfold, according to the Skin Cancer Foundation.  (Read more)