Free-standing emergency departments could be the solution to keeping hospital services in rural areas

The tribulations of rural hospitals in Georgia, and the response, could signal a new direction for saving such facilities. Four rural hospitals in Georgia "have closed in the past two years, and several more either have closed or significantly reduced services since 2001," Bob Herman reports for Modern Healthcare. "Nationwide, more than two dozen rural hospitals have shut down since 2013. For people in rural areas, a closed hospital means they have to travel farther, sometimes hours, for care. And that could mean life or death in situations such as cardiac arrest, car accidents, workplace injuries and other emergencies."

Republican-led Georgia, where officials have refused to expand Medicaid under federal health reform, "has proposed a regulatory change that some observers think could help rural hospitals across the country," Herman writes. Republican Gov. Nathan Deal said in March that "financially struggling rural hospitals can offer fewer inpatient services and still keep their hospital licenses. In essence, they can convert into free-standing emergency departments that stabilize and transfer patients to bigger hospitals. Under Deal's proposal, these rural facilities also could offer other basic services such as labor and delivery."

Some people are critical of the idea. Brock Slabach, a senior vice president at the National Rural Health Association, "said the financial sustainability of free-standing rural EDs in Georgia as outlined by Deal would be low," Herman writes. Salbach told him, “Emergency departments would be nice for access, but that doesn't provide (insurance) coverage. These rural communities are still going to be having problems of paying for these services. We need to try to find a way to expand coverage to these poor populations in a way that's not going to be called Obamacare.”

There are somewhere between 400 to 500 EDs in the U.S., Herman writes. Most "are affiliated with a hospital or health system, serving as a feeder for patients needing inpatient care. The EDs usually are within 20 miles of a full-service hospital. More recently, for-profit ED companies have been building in affluent suburbs, targeting privately insured patients who see the EDs as more convenient than making an appointment with a primary-care physician."

The problem is that few are located in rural areas, Herman writes. For urgent-care centers and free-standing EDs to survive in underserved rural areas the “operating model will need to adapt,” said Alan Ayers, a vice president for Concentra, the urgent-care subsidiary of giant Louisville-based insurer Humana Inc. "They will have to use mid-level clinicians including physician assistants and nurse practitioners, reduce operating hours, and offer other high-volume services such as primary care and occupational medicine. That could help rural facilities offset the typically high fixed costs, Ayers said."

"Perhaps the most feasible solution for rural areas is a hybrid model, mixing lower-level emergency care with primary-care services," Herman writes. "An example is Carolinas HealthCare System Anson in Wadesboro, N.C., a town of 5,800. In 2012, Carolinas HealthCare System—a large system based in Charlotte, N.C., with $4.7 billion in annual revenue—decided to overhaul Anson Community Hospital, a Hill-Burton facility with 125 staffed acute-care and nursing beds."

"The system spent $20 million and downsized the hospital's inpatient capacity from 30 beds to 15," he writes. "The new facility, which opened in July, offers 24/7 emergency care in addition to the limited number of acute beds. Carolinas officials said Anson's major innovation and attraction is that it uses a patient-centered medical home model, offering residents access to primary-care providers with the help of a patient navigator." (Read more)

Claims that health-reform law is putting Kentuckians out of work don't hold up to scrutiny, economic experts say

"Key Republicans running for election Nov. 4 say the federal Affordable Care Act is putting Kentuckians out of work, but employment data and interviews with Kentucky-based economists suggest otherwise," John Cheves reports for the Lexington Herald-Leader.

The objects of Cheves's scrutiny are a television commercial for U.S. Rep. Andy Barr, R-Lexington, saying Democratic challenger Elisabeth Jensen "supports Obamacare, which has decimated Kentucky jobs," and an opinion piece, by Sen. Mitch McConnell saying "There are so many stories about businesses holding back from expanding or hiring — or even cutting back on their workforces — it's hard to even count."

McConnell's anecdotal assertion proves nothing, and Barr's appears to be false. Cheves notes that Kentucky has gained 3,600 health-care jobs during the last year and quotes experts: Manoj Shanker, an economist at the state Office of Employment and Training, who said the law "is expected to be a net gain for the economy . . . and not just for doctors and nurses. It will mean the creation of jobs in other areas, including clerical staff for processing claims, more receptionists, more pharmacy technicians and clerks, more janitors, orderlies and ambulance drivers."

Glen Mays, a University of Kentucky public-health professor who studies health economics, told Cheves, "I think the law is definitely going to stimulate the health-care segment of our local economies, especially where we've seen substantial drops in the numbers of people who are uninsured. People who were forgoing medical care because they did not have insurance now can access it."

KET will discuss asthma Monday night: living with it, its environmental affects, and available resources to deal with it

KET's current "Health Three60" program is "Easing the Burden of Asthma," discussing a disease that hospitalizes more than 6,000 Kentuckians a year. After debuting on KET Sept. 29 at 9 p.m., it will air on KETKY Sept. 30 at 2 p.m., again on KET Oct. 1 at 3 a.m., again on KETKY Oct. 1 at 9 a.m., again in KET Oct. 2 at 4 a.m. and KETKY Oct. 2 at 4 p.m. (all times EDT).

Host Renee Shaw and guests discuss what it means to live with asthma, daily asthma management and the need for better education and support. They will also explore how the environment affects asthma, both outdoors and indoors.  One segment will look at a pioneering initiative at the Ashland-Boyd County Health Department, which sends health professionals into the homes of people with asthma to help them improve their indoor air quality and reduce asthma triggers. It will also discuss how smoke-free laws help people with asthma. Another segment will look at how to access and utilize resources to help with asthma, such as the Kentucky Asthma Partnership.

Guests on the program include Beth VanCleave, asthma educator at Kosair Children's Hospital, Louisville; Connie White, deputy commissioner of the Kentucky Department for Public Health; David Mannino, professor, University of Kentucky College of Public Health; James Sublett, co-founder of Family Allergy and Asthma and president-elect of the American College of Allergy, Asthma and Immunology.

Kentucky school officials make foods look more appetizing and easier to eat, in order to decrease food waste

Some school districts are working to keep fruits and vegetables from being thrown out by students who seem to be unhappy with their school lunches that must follow stricter nutrition guidelines to get federal subsidies. "The key to getting students to eat healthier is to make the food look appetizing and easy to eat," Rich Suwanski reports for the Messenger-Inquirer in Owensboro.

A recent study by the Harvard School of Public Health in four low-income schools in Massachusetts found that while the guidelines had increased fruit and vegetable consumption, students threw away 60 percent of fresh vegetables and 40 percent of fresh fruits.

Lisa Sims, Daviess County Public Schools nutrition director, and Lisa McCarty, Owensboro Public Schools human resources and food services officer, are trying to keep that from happening in the county. Sometimes it's as simple as "like cutting up the fruit to make it easier to eat," Sims told Suwanski. "Even high school kids won't eat apples and oranges whole because it's more work, and they've got a short amount of time for their lunch break, so we slice the fruit and bag it. They could eat a whole apple if they wanted to, but that's not what their lunch break is all about. It's about socializing, too, and we realize that."

McCarty told Suwanski that the Owensboro schools don't see a lot of wasted fruit and vegetables, but they pay attention to what is being thrown out, and then figure out why. She told him they sometimes will swap out items to foods the students like better and make sure that the foods they serve look appealing.

Federal guidelines have also required schools to increase whole grains and decrease the sodium in their menus. The whole grain mandate began this year. Sims and McCarty told Suwanski that those changes have been a challenge, but by making them gradually, the students have adjusted. Shifts have been made toward offering whole-grain breads, biscuits, pizza crust, pasta and even the breading on the chicken.

"Little by little, we've been changing to whole grain and there's not a lot of reaction against it, " Simms told Suwanski. "Actually, we're kind of surprised to see them taking the whole grain pasta."

Lots of research has established that children with egg allergies can still get a flu shot; those with asthma especially should

Flu season can start as early as October, and  children with egg allergies are now encouraged to get a flu shot, especially if they have asthma, according to a news release from the American College of Allergy, Asthma and Immunology.

Children with egg allergies may have been told in the past to not get a flu shot because of a possible reaction to trace amounts of eggs in which the vaccine is produced, but recent research now says that the vaccine is safe for these kids.

“We now know administration is safe, and children with egg allergies should be vaccinated,” Michael Foggs, president of the American College of Allergy, Asthma and Immunology, said in the news release. “We recommend that, as with any vaccine, all personnel and facilities administering flu shots have procedures in place for the rare instance of anaphylaxis, a life-threatening allergic reaction.”

The release says "a large number of research studies published over the last several years have shown that thousands of egg-allergic children, including those with a severe life-threatening reaction to eating eggs, have received injectable influenza vaccine as a single dose without a reaction."

More than 21,100 children under the age of five are hospitalized annually because of the flu, with only 55 percent of children ages 5-17 getting a flu shot, according to the Centers for Disease Control and Prevention, says the release.

Foggs especially recommended that children with asthma get the vaccine, because even though they are not more likely to get the flu, it can be more serious for those with asthma, says the release.

"Children with asthma really need to get the flu vaccine," Foggs said in the release. “Asthma sufferers are among the most vulnerable because the flu compromises their airways even further than they already are.”

State's commissioners of education and health urge Kentucky's school boards to make their campuses smoke-free

The commissioners of Kentucky’s education and health departments have jointly signed and sent letters to all 173 school superintendents in the state asking them to pass full smoking bans "to protect the health of students," Devin Katayama reports for Louisville's WFPL.

Education Commissioner Terry Holliday and Health Commissioner Stephanie Mayfield Gibson said in the letter that "only 36 school districts, including Jefferson County, have passed comprehensive smoking bans that prohibit smoking anytime on any school property, in school vehicles and during field trips," Katayama writes.

The state has decreased its student smoking rate to 18 percent, down from 24 percent in 2011, according to the most recent Youth Risk Behavior Surveillance System report, but that still leaves Kentucky near the top, ranking 6th place in youth smoking. The national average is 15.7 percent.

“Are we pleased it’s decreasing, of course. Are we resting on our laurels and said great job? Absolutely not, we have more work to do," she told Katayama.

Kentucky schools teach nutrition with hands-on-learning

Visiting dairy cows, growing food in the air and being the first school in the state to grow its own garden on school grounds are just some of the efforts Kentucky schools are making to help their students learn more about nutrition.

Shelby County's Heritage Elementary School joined schools in 40 countries in the 15th annual World School Milk Day on Sept. 24, where they learned about the nutritional importance of milk, Ashley Wilkins reports for The Sentinel-News of Shelbyville.

The students learned from the Southeast United Dairy Industry Association in the cafeteria, which was decorated in a cow-related theme while the cafeteria employees wore cow costumes and provided milk to the students. The students also enjoyed stick-on milk mustaches and were able to pet and view calves outside on the playground.

“Lots of kids don’t have a lot of opportunities to see dairy cows up close,” SUIDA's Kathy Belcher told Wilkins.

Students in the Eastern Elementary School Wellness Club in Barren County are learning about nutrition not only in this club, but with its hydroponic tower garden, adding a second one this week, Bobbie Hayse reports for the Glasgow Daily Times.

The Wellness Club meeting was led by fourth-grade teacher Cathy Bishop, who asked the students if they had talked to their parents about what they had been learning about health. They also talked about who had met their goal of not drinking any sodas that week, and also about the importance of making healthy choices such as getting plenty of sleep, drinking plenty of water, making good food choices, exercising and limiting screen time.

“We need to try to make healthy choices, and try to take care of our bodies the best we can because this is the only body we get,” Bishop said. “The habits we start today are going to make a difference for the way our body feels a long time down the road from now."

Nutritional learning in the club is reinforced with growing plants in the tower gardens, which are vertical systems that grows food hydroponically with aeroponics, a process for growing food in an air and water environment, Hayse reports.

Jennifer Turner, a dietitian who helped the students plant seeds and build the tower garden, told Hayse, "Research shows that if kids have a hand in growing and making food, they are more likely to try it."

Beaver Dam Elementary School in Ohio County is the first school in the state to have a garden on school grounds, through donations from businesses and individuals, Lisa Autry reports for WKU Public Radio.

Kindergarten teacher Becky Gaither, who helped start the garden project, told Autry that "students learn the value of hard work by maintaining the garden and they get to enjoy the harvest." She said that the students had already made pizzas in the classroom with cherry tomatoes and herbs harvested from the garden.

Kentucky Agriculture Commissioner James Comer visited the school on Thursday to recognize the school as having the state’s first certified “Ready, Set, Grow” garden and said he hoped the "concept will expand statewide," Autry reports.

UK gets historic $1.8 million grant to fight obesity in six highly obese counties: Clinton, Elliott, Lewis, Letcher, Logan, Martin

The Cooperative Extension Service at the University of Kentucky is getting $1.8 million in federal funds over the next three years to fight obesity in several of the Kentucky counties most affected by the problem.

"Researchers and extension personnel in UK's College of Agriculture, Food and Environment and College of Public Health will work in six Kentucky counties that have obesity rates higher than 40 percent ... Logan, Clinton, Lewis, Martin, Letcher and Elliott," Katie Pratt writes for UKAgNews.

The work will focus on reducing chronic disease rates, advocating healthier lifestyles, reducing of health disparities and supervising health-care spending. It will be overseen by the federal Centers for Disease Control and Prevention.

"This is the first time the CDC has directly funded a Cooperative Extension program," said Ann Vail, director of the UK School of Human Environmental Sciences, part of the College of Agriculture, Food and Environment. "The grant will support building and strengthening collaborations between extension and public health personnel at the university, community and state levels."

Extension agents, state extension professionals, local health departments, UK public-health specialists and community health coalition members will create programs designed to reduce obesity rates and improve residents' overall health. Strategies will be modified to fit the needs of each county.

The grant from the U.S. Department of Health and Human Services is part of $4.6 million that the agency "has dedicated to this program, which has resulted in awards to six land-grant universities," Pratt reports.

Researchers say aggressively treating pre-diabetes could stop or delay future diabetic complications

Treating pre-diabetes as if it is diabetes could delay or prevent future related health complications, according to doctors from three leading research institutions and the American Diabetes Association, says a press release from the University of North Carolina School of Medicine.

The researchers writes in the journal Diabetes Care that "by not devising a treatment strategy for people with pre-diabetes, doctors run the risk of creating a pool of future patients with high blood sugar who then become more likely to develop serious complications, such as kidney disease, blindness, amputations, and heart disease."

Type 2 diabetes is diagnosed with a fasting blood sugar of 126 or higher; most of these patients are treated with medication. Prediabetes is diagnosed with sugar levels between 100 and 125, and the release says such patients are usually not treated aggressively.

"Diabetes is generally diagnosed and first treated about 10 years later than it could be. We waste this critical opportunity to slow disease progression and the development of complications," lead author Lawrence Phillips of Emory University said in the release.

Kentucky ranks 17th in diabetes, according to the 2014 "State of Obesity" report. The report projects that there will be an increase of 51 percent of people with diabetes in Kentucky by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. The Kentucky Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes.

“We need to screen and track patients with pre-diabetes to manage their blood sugar more aggressively,” John Buse, professor of medicine and director of the UNC Diabetes Care Center, said in the release. “We’re very confident this would spare our patients serious health issues down the road.”

Evidence for this study comes from clinical trials where "lifestyle changes and/or glucose-lowering medications decreased the progression of pre-diabetes to Type 2 diabetes," says the release. The future development of diabetes also remained less in those who implemented these changes and then withdrew from them compared to a pre-diabetic control group who did not get any interventions.

Patients who achieved a normal glucose level, even for a short time during the trials, showed a "substantial reduction in subsequent development of Type 2 diabetes," says the release.

The authors say in the release that based on this evidence diabetes management should change to include regular screening in adults for pre-diabetes and early Type 2 diabetes and if a patient has either one of these conditions and is determined to benefit from treatment, they should get "management that will keep their blood glucose levels as close to normal as possible."

Study finds that early memory loss can be a predictor of dementia

Experiencing memory loss early in life could be a cause for concern about dementia later in life.

Research from the University of Kentucky's Sanders-Brown Center on Aging has found that "self-reported memory loss is a strong predictor of clinical memory impairment later in life," says a university press release. The study was published online Sept. 24 in the journal Neurology.

The research was led by Richard Kryscio, associate director of UK's Alzheimer's Disease Center. It involved 531 people with an average age of 73 and free of dementia, says the release. Participants were asked about changes in their memory in the prior year and were given an annual memory and thinking test for 10 years. After death, the participants' brains were examined for evidence of Alzheimer's disease.

The study found that 56 percent of the participants reported changes in their memory by age 82. This group was nearly three times more likely to develop memory and thinking problems. In all, about one in six participants developed dementia during the study, with 80 percent of that group reporting early changes in memory.

 "What's notable about our study is the time it took for the transition from self-reported memory complaint to dementia or clinical impairment -- about 12 years for dementia and nine years for clinical impairment -- after the memory complaints began," Kryscio said in the press release. "That suggests that there may be a significant window of opportunity for intervention before a diagnosable problem shows up."

Kryscio said in the release that while all memory issues should be reported to a doctor, there "isn't cause for immediate alarm if you can't remember where you left your keys."

Lexington is considering whether to add electronic cigarettes to its anti-smoking ordinance

The Lexington-Fayette Urban County Council will discuss whether to expand its smoking ban to include electronic cigarettes, possibly as early as Oct. 7 at the General Government Committee meeting, Beth Musgrave reports for the Lexington Herald-Leader.

Berea, Bardstown, Danville, Glasgow, Manchester and Richmond have banned included e-cigarettes in smoking bans; on Oct. 6 Versailles may do likewise. (The city is replacing a Woodford County Board of Health regulation that was ruled unconstitutional.)

Amy Barkley, chairwoman of the Smoke-Free Kentucky Coalition, told Musgrave that cities and states updating their anti-smoking ordinances to include e-cigarettes is "part of a trend," and "Lexington has always been the leader in smoke-free policy in this state."

But e-cigarettes have changed the terms of smoking-ban debates. Tony Florence, co-owner of 723 Vapor Store in Lexington, which sells e-cigarettes, told Musgrave, "It's ludicrous to try to ban something that is trying to help people kick a horrible habit," Florence said. "The way that I look at it, if you are anti e-cigarette then you are really pro-lung cancer."

Gorton, who is a registered nurse, told Musgrave that she supported an amendment to the smoking ordinance because the Fayette County Board of Health recommended it. Gorton also noted that the state now bans all tobacco products, including e-cigarettes, on most state properties and that Rupp Arena and the attached Lexington Convention Center do likewise.

Supporters of e-cigarette ordinances say the devices are not effective in helping people stop smoking and "not much is known about the effects of electronic cigarettes," Musgrave reports. Barkley also told Musgrave that because e-cigarettes look like real cigarettes it "undermines the enforceability of smoking ordinances."

The Food and Drug Administration does not regulate e-cigarettes. Smoke-free advocates, including Barkley say that "until the FDA regulates e-cigarettes, it's best to include them in smoking bans," Musgrave writes.

But Florence told Musgrave that "the federal government hasn't acted on e-cigarettes for a reason: The research is not conclusive."

CDC sending full-time senior staffer to E. Ky. to help health departments tackle the region's chronic, serious health problems

The federal Centers for Disease Control and Prevention will place a full-time employee in Eastern Kentucky to help public health departments battle the region's serious, chronic health problems, the area's congressman said Tuesday.

Republican Rep. Harold "Hal" Rogers of Somerset, chair of the House Appropriations Committee, said CDC Director Dr. Thomas Frieden, who spent three days with him in his Fifth Congressional District last month, told him he would assign a senior staffer to the job.

Beshear, Rogers (Melissa Newman photo)

Rogers made the announcement at a meeting of the executive committee of Shaping Our Appalachian Region, the economic-development effort he started with Democratic Gov. Steve Beshear. In a meeting at Natural Bridge State Resort Park, the panel heard reports from chairs of SOAR's working groups, which held "listening sessions" around the region this summer.

The Health Working Group "recommended pushing a statewide ban on smoking indoors in public; asking the Centers for Disease Control and Prevention to study poor health in the region and the emerging research on a correlation between mountaintop mining and health problems," Bill Estep reports for the Lexington Herald-Leader.

The working group's PowerPoint slide said, "Invite the CDC to form a task force to accurately map the current state of health in Eastern Kentucky and to create a strategic health plan for the region; start the 'Healthy 5 for the 5th' campaign for individual health in an effort to promote wellness in the region; explore Coordinated School Health programs for our entire region; ramp up oral-health efforts to encourage school-based oral health services are underway in every school district in the region."

Kentucky doctors treat an increasing number of babies suffering from drug addiction given to them by their mothers

Neonatal abstinence syndrome, or NAS, is becoming such a widespread problem that many medical professionals are calling it an epidemic and a public-health crisis. In 2001, 67 Kentucky babies were hospitalized for drug withdrawal, and in 2013, 955 were, according to the Cabinet for Health and Family Services, Justin Madden writes for The Lexington Herald-Leader.

Baby Sheena, who has neonatal abstinence syndrome, in

treatment at the University of Kentucky Children's Hospital.

(Lexington Herald-Leader photo by Mark Cornelison)

Henrietta Bada, a neonatologist at the University of Kentucky Children's Hospital, said babies born with NAS are eager to eat, "but then you give them their formula or their feedings, but they just cannot." She said they can't "coordinate their suck-swallow reflexes . . . If they are not treated, then they end up with weight loss, dehydration," and are sicker than if they had only been going through withdrawal.

Bada said she can treat the babies with medication, but she wants to make sure they go to a safe home: "Babies have to go home to a mother that is capable of taking care of him or her." There isn't enough care for mothers dealing with drug addictions, she said, "and the lack of care continues after the baby is born." She also noted that at least 80 percent of the medical bills are paid through Medicaid, "which can cost as much as $60,000."

The Kentucky Perinatal Association and the state's Department for Public Health are working together to make standardized treatments for mothers and babies, The Associated Press reported earlier this month. Officials also continue to look for ways to solve the state's drug problem.

Eric Reynolds, a neonatologist at Kosair Children's Hospital in Louisville, pointed out that NAS isn't always a result of a mother abusing drugs. "We need better treatment options for the pregnant mothers who have a legitimate medical reason to be on these types of medications," he said.

Reynolds and Bada said endeavors to fight NAS begin with education, and Reynolds added that the long term effects of NAS are not yet known because it's early in the epidemic, Madden writes.

McConnell seeks 'timely and fair review' of plan for Medicare coverage of CT scans for those at high risk for lung cancer

U.S. Sen. Mitch McConnell asked Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner to "give a timely and fair review to determine whether low-dose computerized tomography (CT) scans should be covered by Medicare for patients at high-risk for developing lung cancer," a press release form his office said.

"Lung cancer has the highest mortality rate of all cancers in the United States," Mconnell said. "Additionally, my home state of Kentucky has the highest state mortality rate of lung cancer in the country, and the disease claims the lives of approximately 3,000 Kentuckians every year."

CT scans should be used to detect lung cancer early in individuals who who have a high risk for the disease, the U.S. Preventive Services Task Force recommends. High-risk individuals are those between 55 and 80 who have smoked a pack of cigarettes each day for 30 or more days. The task force noted a significant reduction in deaths from the disease as a result of early detection through CT scans. (Read more)

Comer encourages Kentucky schools to serve fresh local foods on 'Farm Fresh Fridays'

State Agriculture Commissioner James Comer wants Kentucky schools to offer fresh, local foods for students on Farm Fresh Fridays. The program will launch with Farm to School Month in October, according to a Department of Agriculture press release.

School food-service directors have been asked to provide at least one Kentucky Proud fruit or vegetable each month. Students will be encouraged to talk about their Farm Fresh Fridays activities through social media, and hopefully will learn about local food through the program.

"Serving fresh local foods to our school children will provide them the nourishment they need to grow up strong and healthy," Comer said. "It also will provide educators a way to teach them about where their foods comes from. At the same time, buying farm-fresh foods helps local farmers make a living."

During the 2011-2012 school year, the Farm to School Program distributed local foods in about 702 schools to approximately 364,000 children. To read more about the program, go to www.kyagr.com or contact Tina Garland at 502-382-7505.

Chickenpox outbreak reported at Crab Orchard

Five students at Crab Orchard Elementary School in Lincoln County have been diagnosed with chickenpox, putting the county school system on alert, Ben Kleppinger reports for The Interior Journal in Stanford. Eva Stone, the schools' health coordinator, told the newspaper that the students had been diagnosed with by at least four health-care providers, and an unknown number of siblings under school age have also been diagnosed.

"A letter was sent home to Crab Orchard parents earlier this week, notifying them of the diagnoses and informing them on how to identify the symptoms," Kleppinger reports. "The letter encouraged parents to make sure their children are vaccinated against chickenpox and warned that people with chickenpox should avoid contact with others who have not had the illness or the vaccination. The chickenpox vaccination is about 80-85 percent effective after one dose, so a second vaccination is routinely recommended, according to the letter."

Edelen says rural hospitals are top issue for rural U.S. and rural Kentucky; says some pols in state want to give up on rural Ky.

By Molly Burchett and Melissa Patrick
Kentucky Health News

BOWLING GREEN, Ky. – State Auditor Adam Edelen has finished his series of town-hall meetings across the state to get a better understanding of the struggles faced by rural hospitals, but this isn't the last you will hear from him about the brewing crisis among these hospitals – a crisis that he says is not just a Kentucky problem but "the most important issue facing rural America."

Hours before his last town hall, in Bowling Green on Sept. 19, Edelen told Kentucky Health News that the tour was not just about assessing the finances of these hospitals, because he has heard politicians in both parties say "We just have to give up on rural Kentucky. . . . I'm passionate about not giving up on rural Kentucky."

Challenges faced by rural hospitals are very different than those faced by suburban or urban hospitals, Edelen said, so a "one-size-fits-all" approach won't keep Kentucky's rural hospital network in vibrant or sustainable.

He noted that Medicare and Medicaid reimburse hospitals at below the cost of providing care, with the expectation that they will make it up from private payers, but such payers are in short supply at many rural hospitals because the economic recovery is "nonexistent in rural areas."

Changes in the health-care system

Some rural hospitals are expressing concerns about the expanding Medicaid rolls under the Patient Protection and Affordable Care Act, but Edelen said in the interview that most of the complaints he heard are about Kentucky’s move to put Medicaid under managed care in 2011.

He said in Bowling Green that Kentucky rolled out in six months what should have taken 18 months, creating a "extraordinarily complex" and costly Medicaid system that still has no-pay and slow-pay issues. Then came the PPACA, generally known as Obamacare, creating an unprecedented level of complexity.

The extra administrative overhead is particularly difficult for small hospitals and health-care providers, he said, and payment disputes with managed-care companies can be existential threats to community hospitals with small cash reserves. The Nicholas County Hospital in Carlisle closed in May.

"We've got a number of hospitals in Kentucky who have less than 15 days of cash reserves," Edelen said. "One hospital in particular told me that leaders meet weekly to figure out about who's getting paid and how much just to keep the doors open. . . . County officials are afraid they are going to lose their hospital, while the cabinet says all is well."

Cabinet for Health and Family Services Secretary Audrey Haynes said in an email, "There is little doubt that Kentucky's health-care industry has gone through tremendous transformation since November 2011." She said managed care within and "many other important changes . . . have created a health-care delivery system with more accountability; increased focus on prevention and early detection; decreased use and high costs of our emergency rooms for non-medical emergencies; and are actually treating and managing both mental and physical healthcare of our Medicaid consumers to achieve healthier outcomes."

Haynes added, "With the assistance of managed care, we saved Kentucky taxpayers $1.3 billion of state and federal funds in the last biennium budget ending June 2014," while providers "had a record revenue year, receiving over $3.4 billion." She concluded, "I realize the implementation of managed care has not always been easy for our hospitals and other health-care providers, but we continue to work closely with them and make adjustments and improvements."

Edelen said in the interview that hospitals "know their business models have to change," but health-access to care is still an issue, and if hospitals close, those issues will grow. He said he understands that not all rural hospitals can survive, but "You gotta try."

He also said rural hospitals are needed to deliver on the promise of Obamacare: "What's the good of having everybody insured if there's no one to provide care?" What's the government doing to soften the blow coming with these health-care changes?"

Kentucky is not alone

Kentucky has handled implementation of the reform law better than other states, Edelen said, but there are still big problems that no one is thinking about.

Like other rural hospitals across the country, community hospitals in Kentucky have long relied on federal subsidies of facilities with high numbers of Medicaid patients and uninsured people. Since the reform law was designed to cut the number of uninsured, it will also phase out Disproportionate Share Hospital (DSH) Medicaid payments to hospitals by 2020.

Kentucky's DSH money shrank by 4.2 percent in the fiscal year that ended June 30. The allocation is determined federally, but state officials have considerable discretion in how the cuts are applied to individual hospitals.

"I fear that the disappearance of DSH payments could be a death knell for Kentucky's rural hospitals," which would have serious economic repercussions for their communities, Edelen said. "We have an opportunity to be a thought leader here because this is going on all over the nation."

Nationwide, many rural hospitals are closing down just like the hospital in Nicholas County. Reuters reported that 24 rural hospitals have closed across the country since the start of 2013, double the pace of the previous 20 months, leaving whole communities without quick access to acute care.

"This needs to be an issue for rural America in the 2016 presidential campaign," Edelen said. "Now that the Farm Bill's passed, this is the most important issue facing rural America, and the competition's not even close."

Not just a health-care problem

Research shows rural hospitals contribute significantly to local economies. Health care accounts for 15 percent to 20 percent of all jobs in rural communities,  Dr. Mary Wakefield, now the administrator of the federal Health Resources and Services Administration, told a congressional hearing in 2000. Furthermore, health services and schools are important quality-of-life factors for attracting and retaining employers and retirees.

"When you lose your rural hospital you lose not only one of the primary employers in a county, but you tend to lose the leading corporate citizen," Edelen said in the interview. "You lose things like ambulance services and providers networks and then the burden on health departments becomes more pronounced; that is not sustainable long term."

For prosperity, a community needs an educated work force, a healthy economic environment and a network that provides health care, he said. "These are the things that are the non-negotiables in the 21st Century if you are going to bring prosperity to every part of Kentucky," he said in Bowling Green.

Edelen told the audience of about 120 that he wanted them to go home and talk about this issue in their communities to make Frankfort, with its "fifteen-minute attention span," pay attention. "Kentucky at its core is always going to be a state with a rural character," he said.

The auditor's office is compiling a report that will also include a financial "stress test" of 66 rural hospitals. Edelen said he aims to release it in November or December. "I want to clearly define the problem," he said, "and then facilitate a conversation to solve the problem."

He said in Bowling Green, "What this is really about in a nutshell is whether the political leadership in Kentucky is going to give up on rural Kentucky."

Obamacare seems to be no plus for Kentucky Democrats, perhaps mainly because of the word's first three syllables

Though the federal health-reform law has helped cover more than half a million Kentuckians and cut the state's uninsured population by half, "there is little evidence it will help" Kentucky Democrats in the Nov. 4 elections, reports Abby Goodnough of The New York Times, who has been following Obamacare's implementation in the state.

“The campaign by the Affordable Care Act’s critics against it has been very effective in demonizing the phrase Obamacare and anything to do with the president,” Democratic Gov. Steve Beshear told Goodnough. “So I think you find a reluctance on the part of people, even though the law is benefiting them, to publicly acknowledge it.” Beshear noted that President Obama is highly unpopular in the state, and Goodnough notes that no one applauded during the six minutes that he spoke about the law at the Kentucky Farm Bureau's Country Ham Breakfast at the state fair last month.

Interest groups and Republican candidates in Kentucky "have run more than 10,000 broadcast television spots here since January 2013 that mention the law in a negative way, according to Kantar Media’s Campaign Media Analysis Group," Goonough reports. "Kantar found only one positive television ad, from Elisabeth Jensen, the Democrat challenging Rep. Andy Barr in the state’s Sixth Congressional District."

Many Democrats have urged their nominee for the U.S. Senate, Secretary of State Alison Lundergan Grimes, to use the issue, but "far from flaunting Kentucky’s strong enrollment numbers, Democratic candidates — most notably Ms. Grimes — have remained reticent about the law, even its successes."

Republican Sen. Mitch McConnell's re-election campaign hasn't run any advertising lately about the law, but still calls it the worst legislation in American history and says he wants it repealed "root and branch." But he has yet to explain, if that unlikely event happened, what would happen to the state exchange where more than 521,000 people got on Medicaid or bought private insurance policies.

Goodnough says McConnell has "hedged" on that, and links to an earlier story by her Times colleague, Jonathan Martin, who wrote: "When I pressed him about the politics of taking away Medicaid from those individuals that now have it, he suggested that was unlikely – even while still faulting Beshear for the decision. 'I don’t know that it will be taken away from them,' McConnell said of the expanded Medicaid coverage. Speaking about Beshear and Kentucky’s state government, he added: 'They’ve made the decision to expand it; they’re gonna have to pay for it.'"

Carroll County schools will make campuses tobacco-free in 2015, even including outdoor sporting events

The schools in Carroll County, once one of Kentucky's tobacco strongholds, have begun preparing students, parents, teachers and football fans for smoke-free school campuses starting July 1, 2015.

"This ban will apply on district property at all times, in all places and to all people, including at sporting events and inside vehicles," schools spokesman Carl Roberts writes for The News-Democrat in Carrollton. "The ban also will apply to electronic cigarettes. . . . The district is making every effort to inform students, staff and community members of the transition."

That includes signs, social media, print publications, district memos, and announcements at sporting events, Roberts writes. "At sporting events throughout this school year, cards will be distributed to spectators that provide information about the tobacco-free policy. The cards also will include information on smoking/tobacco cessation classes."

Only 35 of the state's 173 school districts are tobacco-free, but some others are planning to impose bans next year, and more may after this year's school-board elections are out of the way.

Carrollton, which once had several tobacco warehouses, was visited in 1998 by then-President Bill Clinton to explain what his administration wanted to about smoking and help tobacco farmers.

Barren River Health Dept. accredited; joins 5 others in Ky. (Franklin, Fayette, Madison, Northern Ky. and Three Rivers)

The Barren River District Health Department has joined five others in Kentucky with national accreditation.

The Public Health Accreditation Board announced Sept. 18 that the Bowling Green-based agency and nine other health departments had been accredited, bringing the total number to 54.

Kentucky health departments previously accredited are Franklin County, Lexington-Fayette County, Madison County, Northern Kentucky and Three Rivers (Carroll, Gallatin and Owen counties). The Barren River department serves Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Simpson and Warren counties.

"Public health departments play a critical role in protecting and improving the health of people and communities," the board said in a news release. "Health departments provide a range of services aimed at promoting healthy behaviors; preventing diseases and injuries; ensuring access to safe food, water, clean air, and life-saving immunizations; and preparing for and responding to public health emergencies. To receive accreditation, a health department must undergo a rigorous, multi-faceted, peer-reviewed assessment process to ensure it meets or exceeds a specific set of standards and measures. The peer-review process provides valuable feedback to inform health departments of their strengths and areas for improvement so that they can better protect and promote the health of the people in the communities they serve."

Health-care forum examines 'incredible change' in Kentucky's health-care system, looks forward to more access to care

By Molly Burchett and Al Cross
Kentucky Health News

What does health-care reform mean to Kentucky? What impact has Medicaid expansion had? Can we work together to do care differently in Kentucky? Answers to these questions and more were offerd by national, regional, and local health care experts Sept. 16 in Louisville at the Foundation for a Healthy Kentucky's annual Howard L. Bost Health Policy Forum.

This year's topic was "Doing Care Differently," but as foundation chair David Bolt, deputy director of the Kentucky Primary Care Association, told the crowd, "It could have just as easily been named after the Bob Dylan song, 'The Times They Are A-Changin'."

As a health-care provider for 44 years, Bolt said, "I have lived through almost every change since the implementation of Medicare and Medicaid. And I am actually excited about the changes I see on the horizon." He said he thinks the late Dr. Bost would look at what Kentucky is doing and say," It's about time we moved away from a treat-'em-and-street-'em mentality to integrated health care delivery services and systems rooted in accountable outcomes and founded in a value-drive system of improving health."

One of the biggest recent changes in Kentucky health care is Gov. Steve Beshear's expansion Medicaid at the beginning of the year, which offered coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level. As a result, Medicaid is now the largest health-care payer in the state, serving 1.1 million Kentuckians, one out of every four, Cabinet for Health and Family Services Deputy Secretary Eric Friedlander told the crowd.

"We had incredible enrollment. It's an incredible change." said Friedlander. "We hope it is a change for the better."

Friedlander said enrollment in every county exceede estimates for the state by the accounting firm PriceWaterhouse Coopers, based on estimates from the Congressional Budget Office. Those estimates anticipated 55 percent of eligible persons enrolling in the first year, leveling out at 70 percent in future years. Instead, enrollments through June were almost double the prediction.

Medicaid paid more than $284 million to Kentucky health-care providers in the first half of this year for treating the newly eligible Medicaid beneficiaries, with hospitals receiving 48 percent of those reimbursements, Friedlander said. He said that number will be $1 billion to $2 billion by the end of the year. (Medicaid payments sometimes take months to complete.)

The federal government is paying the entire cost of the newly eligibles through 2016. State officials have said that they won't be able to update cost estimates for 2017 a few more months because additional data must be collected about enrollees after the insured population has stabilized.

"Medicaid expansion is not static," Friedlander said. "It is dynamic, and the individuals that make up that enrollment are constantly changing."

Friedlander said employment in Kentucky health care has increased by 3,800 jobs, but the study estimated that 7,600 jobs would be added in the first year. This means enrollment is almost double what was projected yet job expansion is almost half. That undercuts Beshear's contention, based on the study, that Medicaid expansion will pay for itself by adding heath-care jobs.

As more Kentuckians get insurance, there may be shortages of primary-care doctors, especially in rural areas of states like Kentucky, reports Kaiser Health News. That need could be overstated, Sheila Schuster, a clinical psychologist and executive director of the Advocacy Action Network, said at the forum.

Kentucky has 3,929 advanced practice registered nurses, Schuster said, 54 percent more APRNs than in 2010. A new state law that took effect July 15 "removed a barrier that was keeping them from opening practices," she said. The law allows APRNs to prescribe non-narcotic drugs independently after they have prescribed under physician supervision for four years.

The law was passed after negotiations among the Kentucky Medical Association, the Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. Schuster suggested that other such compromises are needed to expand access to health care.

"We aren't playing very well with each other in the sandbox," she said, adding that turf battles need to be set aside to keep health-care innovation people-centered.

The forum was co-sponsored by KET, Louisville's Health Enterprises Network, the Kentucky Health Information Exchange, the Kentucky Medical Association and Leadership Kentucky.

Doctors and parents of children with cancer seek funding

Doctors and parents of young cancer patients made an emotional plea to state legislators Sept. 17 "to make funding for pediatric cancer a priority," Jacqueline Pitts reports for cn|2's "Pure Politics."

Lobbyist Jamie Bloyd told the Interim Joint Committee on Health and Welfare about her son, Paxton Bloyd, who was diagnosed with stage 4 Burkitt’s Lymphoma in March, and quoted Sen. Chris McDaniel, R-Taylor Mill, as telling the Bloyd family in the hospital “that $10 million of our budget goes to dental care for inmates. But zero dollars go to pediatric cancer research in Kentucky and I just think that is sickening, I think our kids deserve better than our inmates do.”

Max Wise of Campbellsville, who defeated Sen. Sara Beth Gregory of Monticello in the Republican primary, "attended the meeting with his son who is a pediatric cancer survivor," Pitts reports. "In an interview with Pure Politics after the meeting, Wise also noted some of the efforts discussed by Lucas as well as the St. Baldrick’s Foundation and said that there are encouraging signs that there are people looking to help find solutions."

“Government isn’t always the solution,” Wise said. “Maybe it is other organizations that chip in, if it is charities, if it's corporations,” Wise said. “It's little things along the way that everyone can chip in on this and it should not be ‘Let’s just look to government to solve this;’ there’s other sources out there which can play a big part.”

The meeting was held at the offices of the Foundation for a Healthy Kentucky in suburban Louisville.

Public hearing to be held in Bowling Green Sept .19 to discuss fiscal health of Kentucky's rural hospitals

On Sept. 19 in Bowling Green, state Auditor of Public Accounts Adam Edelen will hold the last of 11 public hearings, which have been held across Kentucky this summer, to talk about the financial health of rural hospitals.

These hearings, along with a study by the auditor's office, are meant to help understand the challenges that face small, community hospitals, which provide health care to 45 percent of Kentuckians and are key economic drivers in those communities, an Edelen press release says.

The auditor is looking at some 66 public, non-profit and for-profit hospitals in rural Western and Eastern Kentucky. His office will conduct a survey about the fiscal health of these hospitals and plans to issue a report later this year.

The hearing will be held at the Holiday Inn University Plaza, 1021 Wilkinson Trace, Bowling Green, on Friday, Sept. 19 at 11 a.m. CDT, following the conclusion of the Kentucky Rural Health Hospital Association annual meeting.

State won't estimate cost of greater-than-expected Medicaid expansion for 'a few additional months' – after Nov. election

By Al Cross
Kentucky Health News

The Republican-controlled state Senate's budget committee chair wants to know how much Democratic Gov. Steve Beshear's expansion of the Medicaid program will cost, since enrollment in the federal-state program has exceeded the administration's expectations.

Medicaid Commissioner Lawrence Kissner told Sen. Bob Leeper of Paducah in a letter Sept. 8 that the administration won't be able to update the estimates "until a few additional months have passed and more data [are] collected" and "after the newly insured population has stabilized."

That pushes the date for new estimates past the Nov. 4 election, in which Republicans are making issues of the expansion's cost and the federal health-reform law that allowed it. U.S. Sen. Mitch McConnell has mentioned it in attacking "Obamacare," and Republicans trying to take over the state House have done likewise.

When Beshear announced in May 2013 that he would expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, using entirely federal money for the first three calendar years, he said it would cost the state $30 million in the 2016-17 fiscal year and $70 million in the 2017-18 fiscal year.

Those figures were based on an estimate by the Price Waterhouse Coopers accounting firm that 308,000 Kentuckians would become eligible for Medicaid but only 188,000 would enroll by 2017, based on calculations by the Congressional Budget Office. But so far, about 320,000 people have enrolled, more than double the 148,000 that the firm estimated would sign up by June 30.

At last report, about 521,000 people had obtained coverage through the state's Kynect health-insurance exchange. About 80,000 of them bought private insurance, and 120,000 qualified for what state officials call "old Medicaid" for a variety of reasons: they were children, blind, disabled or had income less than 69 percent of the federal poverty level, the old limit for the program.

The federal government pays about 71 percent of "old Medicaid" costs and, until the end of 2016, 100 percent of the newly eligibles' coverage. In 2017, it will pay 95 percent of the new costs, falling to the reform law's floor of 90 percent in 2020.

Kissner told Leeper that the administration needed more experience with the new enrollees, and better estimates of projected employment in 2017-18, other "key economic indicators" and how many Kentucky households will have incomes above or below 138 percent of the federal poverty level.

Leeper could not be reached for comment. For a copy of Kissner's letter and related materials, click here.

Expert says Ky. is one of 13 states where people in individual insurance market are better off than before reform law

By Molly Burchett and Al Cross
Kentucky Health News

Most of the focus on Obamacare has been on people who are no longer uninsured, or those who had to get new policies, but Kentucky is one of the 13 states in which the Patient Protection and Affordable Care Act helped people in the individual insurance market, according to a study by a fellow of the Brookings Institution.

To make comparisons across states, assessing the health law's impact on coverage, costs and other factors, economics fellow Amanda Kowalski put each state in one of five groups based on how they implemented the law.

Kentucky and seven other states – Colorado, Connecticut, New York, Rhode Island, Vermont and Washington – as well as the District of Columbia, embraced the law completely by setting up their own health-insurance exchanges and expanding the Medicaid program to households with income up to 138 percent of the federal poverty level.

Overall, average premiums grew remarkably in these states, says Kowalski. On average, premiums in Kentucky rose by 16 percent, less than the national average of 24.4 percent, says the report. In the table, states with their own exchanges are represented by blue and states without their own are in red.

However, under Obamacare, premiums don't tell the whole story, because people earning up to 400 percent of the poverty level are eligible for tax credits that reduce their monthly premium cost. Kentucky’s average cost decreased 19 percent.

This cost decrease, combined with an increase in coverage, suggests that Kentucky’s individual market had been adversely selected. Adverse selection is the tendency for people to avoid buying insurance until they need it, which often drives up insurance premiums. Individual health-insurance coverage in Kentucky increased by 38 percent, with exchange enrollment representing 43 percent of the increase, Kowalski reports.

Kowalski compared states that allowed or did not allow renewal of non-grandfathered insurance plans, in response to complaints that cancellation of their plans contradicted the promise made by advocates of the law that if people “liked their plan they could keep it.” Kentucky and 26 other states grandfathered such plans, and Kowalski concluded that it cost people in their individual markets $220 a year because the people keeping non-grandfathered plans were healthier.

Kentucky was among 41 states that saw increased health-insurance markups, additional amounts charged by insurers beyond the average cost of paying claims. These increases appear to reflect uncertainty about the insurance market; insurance companies had to set premiums without knowing the health status of enrollees and likely protected themselves with markups.

Kowalski's analysis relies on data from the first half of 2014. "The national experience might evolve over time" and as regulations become more defined within the law itself, the impact of the law will be better understood, she writes.

The study may come as a surprise to critics of the law, who have focused on the many Kentuckians who had to get new health-insurance policies because their old once did not cover the 10 things the law requires.

Some critics continue to say those Kentuckians numbered 280,000, but that number is outdated and incorrect, according to the state Department of Insurance. It's more like 130,000.

"The 280,000 represented the number of people in the individual and small group markets at the time who potentially could have received a letter saying their health insurance policies were being discontinued because benefits were changing," department spokesman Ronda Sloan said in an email.

"Those receiving the letters were told the current plan didn’t meet the requirements of the ACA but were offered a new plan that did," Sloan wrote. "They also were free to shop around either on or off the exchange."

Of the 280,000 who could have been in jeopardy, "48,302 were in grandfathered plans, so they were not affected," Sloan wrote. "Another 63,832 were offered transitional relief (President Obama’s request that companies be given the option to extend policies). Most of the remaining group had an option to take early renewal, which would have continued their pre-ACA policies" through at least Dec. 1 of this year. "So, from our perspective, almost everyone in the original 280,000 group had some option to continue existing coverage – and all of them could have moved to an ACA-compliant plan either on or off the exchange."

Most overweight diabetics don't know how much to exercise for weight loss, and they don't exercise enough

By Melissa Patrick
Kentucky Health News

Many overweight people with diabetes don't exercise enough for weight loss, and they also don't have a clear understanding of the recommended amount of exercise, according to a study reported by the Health Behavior News Service, part of the Center for Advancing Health.

The study, which looked at the exercise habits in people with diabetes, found that men with diabetes exercise more than women with diabetes, and, not surprisingly, that diabetic women who are trying to lose weight exercise more than those who aren't. But no one in the study was exercising the recommended amount for weight loss, according to the study report, published in American Journal of Health Promotion.

“We were not surprised that, overall, people with diabetes trying to lose weight were not engaging in enough physical activity,” study co-author Gina Pariser, associate professor at Bellarmine University in Louisville, said in a press release. "This finding emphasizes the need for health care professionals to provide more detailed and individualized education on exercise.”

Kentucky ranks 17th in diabetes and fifth in obesity, according to the 2014 "The State of Obesity: Better Policies for a Healthier America" report. It also says that more than 80 percent of people with diabetes are overweight or obese.

"Adults who are overweight or obese are at an increased risk for developing diabetes," the release notes. "Regular participation in physical activity may not only help reduce weight, but also help treat diabetes, and may prevent consequences associated with physical inactivity."

Health-care professionals need to do more than just encourage their diabetic patients to exercise, the researchers say in the release.

“Education about specific amounts of physical activity is needed to achieve goals such as weight loss and blood sugar control,” Pariser said. “Plus, instruction in the use of tools to objectively measure the amount of physical activity, like pedometers, should be provided.”

This study analyzed the association between exercise and weight control in 733 adults with diabetes and 4,572 without diabetes. Participants used a device to measure their physical activity and were asked if they were trying to lose weight, trying to maintain their weight or neither trying to lose nor maintain weight. For more information about diabetes and exercise, click here.

Respiratory virus that is sweeping Midwest has found its way to Kentucky; frequent handwashing remains best defense

The respiratory virus that has been hospitalizing children in the Midwest has come to Kentucky, reports Chris Kenning of The Courier-Journal: "Kraig Humbaugh, deputy commissioner of the Kentucky Department of Public Health, said the Centers for Disease Control and Prevention recently confirmed that five of 10 cases it tested from Kentucky were enterovirus D68."

Enteroviruses are common and tend to peak at this time of year, and enterovirus D68, a less common strain of this common virus, causes mostly respiratory illness. The CDC says symptoms for enterovirus D68 can range from mild to severe respiratory illness and that mild symptoms look very much like a cold: fever, runny nose, sneezing, cough, and body and muscle aches.

But it is the severe respiratory symptoms that are causing hospitalizations, particularly among children with asthma or underlying medical conditions, Kenning notes.

"In Kentucky, the spike in respiratory illnesses was first noticed in the central part of the state several weeks ago. But it is now being reported elsewhere, including in Louisville, although D68 has not been confirmed in Louisville," he reports. No deaths have been reported in Kentucky or in other states, officials told him.

"Hospitals in Colorado, Missouri and potentially eight other states are admitting hundreds of children for treatment of an uncommon but severe respiratory virus," probably enterovirus D68, The Washington Post reports.

From mid-August to Sept. 12, 97 people in Colorado, Illinois, Iowa, Kansas, Kentucky and Missouri were confirmed to have respiratory illness caused by enterovirus D68, according to the CDC.

The virus is spread when the infected person coughs, sneezes or touches a contaminated surface. There is no treatment or vaccine for the virus.

The best ways to reduce your risk are: frequent hand washing; keeping unwashed hands off of your eyes, nose and mouth; avoiding contact with people who are sick; and disinfecting communal surfaces frequently.

Humbaugh told Kenning that he is encouraging families who have children with cold-like symptoms that cause difficulty breathing to consult with their doctor. If you're sick, he said, stay home.

Ky. newspapers support Beshear's expanded smoking ban for state-government sites, back statewide smoking ban

The Kentucky New Era in Hopkinsville stands firmly in favor of the executive order put in place last week to ban employees and visitors from using all tobacco products in most state government buildings, says a recent editorial, republished by the Georgetown News-Graphic.

The paper also joined in the governor's hope that the General Assembly in 2015 will pass a law barring smoking in workplaces and enclosed public spaces, saying, "It is time for Kentucky lawmakers to adopt a statewide smoking ban."

“When it comes to preventable illnesses and death, nothing in Kentucky is as devastating as smoking and tobacco use,” Beshear said. “Yet Kentuckians continue to use tobacco more than the residents of any other state. And as a result we lead the nation in cancer deaths.”

The New Era reminded its readers that the rights of nonsmokers who are exposed to secondhand smoke are just as important as the rights of the private business owners.  It also added that the complaint that smoking bans hurt businesses, doesn't hold up.

"Kentucky cities that have approved public smoking bans — including Hopkinsville — have proven that restaurants survive just fine without smoking sections," the New Era said. "In fact, many businesses gain customers who previously stayed away because they did not want to breathe secondhand smoke."

The editorial reminds its reader that the governor's executive order is a temporary solution and the real solution is to enact a smoking ban before the governor leaves office in December 2015. ANo smoking-ban bill has ever gotten a vote in either chamber of the legislature.

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.

Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.

Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

Depression should not be a taboo subject; rural Kentucky news editor details writes about her victory over it

By Tim Mandell
Institute for Rural Journalism and Community Issues

Depression is a subject people often shy away from discussing, but a large percentage of Americans suffer from, or have suffered from, serious depression. Around 50 million have become seriously depressed at some point during their lives, according to a report by the University of Kentucky Cooperative Extension Service. ­

The suicide last month of actor Robin Williams brought depression to the forefront of the national news for a few weeks, but as the national focus shifted to other stories, community journalists should continue to talk about depression, especially in rural areas where people might feel they will be ostracized if they express how they feel.

That’s why it’s important when journalists like Shelley Spillman, news editor of The Anderson News in Lawrenceburg, Ky., step forward and write columns detailing their own battles with depression. Spillman, who was inspired to write a column after Williams’ death and the suicide of a local man who suffered from depression, said in an interview, “This is not something we normally talk about and maybe we should. Maybe these people wouldn’t feel so alone."

"As journalists we’re part of the community too," she said. "I really enjoy people getting to know me, my real struggles in life and the things I’ve been through. It’s amazing how relating to people on a human to human level is one of the most difficult things to do. But it’s so important.”

In her column, Spillman wrote: “I, too, have suffered from the cold, metallic grip of depression. I know what it’s like to be in a room full of people and still feel alone. You’d give anything to feel the warmth of company without having to go through the mental gymnastics of plastering on a fake smile just so you don’t have to be berated with ‘are you OK?’ or ‘what’s wrong?’ It’s not their fault. Most people don’t know how to deal with people who suffer from depression. Even in our daily interactions people stop and ask ‘How are you doing?’ without sticking around long enough to hear anything other than a one-word utterance of ‘Fine.’”

“It does get better; give it time. I understand, though, that giving depression time, when a day with it can feel like carrying around the weight of a giant boulder, seems impossible, but you can. Sometimes when I think about my time with depression it seems so far away, like I’m at the fair soaring on one of those giant swings, examining bad memories of someone else’s life. I can feel black fog of depression permeating in my brain, trying to find a way back in, but I immediately recognize the intruder and sent it packing. Like I said, it’s a parasite, it’s always looking for a host to attach to.”

Spillman added, “You’ll find that you are a lot stronger than you may even realize now. You can make it out of this, and one day the clouds will part and you’ll be able to see the sun again. Let me tell you the sun feels glorious on your skin after a longtime in the dark.”

Spillman told The Rural Blog: “Readers who have called appreciate my honesty in my columns. It’s hard to put yourself out there and be that vulnerable, but I like for my columns to be honest and real. It’s a way for people to know who I am.” She said that writing a column like this is “a good way to get the ball rolling to get people talking about (depression).” She said she hopes columns like this can lead to there being more resources for people with depression, especially in small communities, and lead to depression being a subject that’s less taboo to discuss. (The Anderson News is behind a paywall but can be reached by clicking here.)

The Extension Service report details signs and types of depression, suggestions for those suffering from depression and suggestions for friends and family members of people who are depressed. Other valuable sources are available here, here, here, here and here.

Kids Count report says hard times in early childhood are more likely in Ky. than rest of U.S.; bad times have long-term effects

By Melissa Patrick
Kentucky Health News

One of every five children in Kentucky, by the time they are 5 years old, has experienced two or more adverse childhood experiences such as child abuse, economic hardship, exposure to violence, living in a household with mental illness or substance abuse, or where a family member has been incarcerated.

That is one of the major points of the 24th annual Kids Count report, released Tuesday by Kentucky Youth Advocates. The report is part of a state-by-state effort with county-by-county data; nationally, only one in eight children by age 5 have had two adverse experiences, defined as events or circumstances that can affect the quality of the child's adult life, including their health and length of life.

"The higher the total number of these events a child experiences, the higher the risk of obesity, chronic illness, substance abuse, smoking and mental health problems," the report says. Another study cited in the report found that "Children who had experienced four or more adverse events had lower incomes, lower education attainment and lost more days of work or school as adults due to problems with physical or mental health."

“We know when children experience traumatic events such as abuse and neglect or having an incarcerated parent, it negatively impacts their health and often causes barriers to success later in life. Kentucky leaders need to enact solutions to prevent these experiences in the first place and when they do happen, help children successfully recover,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release.

This report by Kentucky Youth Advocates measures 16 indicators to determine the overall well-being of children in Kentucky counties and focuses on four areas considered critical to well-being: economic security, education, health, and family and community strength.

The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Woodford, and Calloway; the lowest are Martin, Owsley, Wolfe, Clay and Elliott.

Overall Child Well-Being, based on four factors:
economic security, education, health, and family and community.

The 2011-12 survey said that Kentucky children are more likely to experience two or more adverse events  (30 percent) than children are nationally (22.6 percent). The four most common adverse events among Kentucky's children, says the report, are economic hardship, living with a parent or guardian who got divorced or separated, living with anyone who had a problem with alcohol or drugs, and living with a parent or guardian who was incarcerated.

This study evaluated four indicators of health: smoking during pregnancy, low-birthweight babies, children and young adults without health insurance and teen births.  Oldham and Boone counties scored higher than the other counties on health and Elliott County ranked last.

Overall Health: County Comparisons.  Based on county
scores for the four indicators in the report.  

The study found Kentucky has the highest rate of mothers who smoke during pregnancy, one in five, compared to states with comparable data, reporting that the county rates varied widely in this area with less than 14 percent of expectant mothers in Fayette, Jefferson, and Oldham counties smoked, compared to 40 percent or more of mothers in Clay, Elliot, Lee, and Owsley counties.

The percentage of low-birthweight babies in Kentucky, often a result of smoking during pregnancy, between 1994-2012 (8.7 percent) was found to be consistently higher than the U.S. percentage (8.0 percent).

“All parents want what is best for their children, and we know that smoke is bad for kids,” Bethany Hodge, a pediatrician in Louisville, said in the release. “Kentucky needs an indoor smoke-free law so working mothers-to-be do not have to choose between their jobs and protecting their unborn babies.”

One in eight under 26 lacked health insurance in this study, but this number is expected to decline.

“Kentucky has effectively connected young people to health insurance, especially with the outreach efforts of KCHIP over the past few years and kynect over the past year,” Brooks said in the press release. “It’s important to build on those successes with innovative ways to connect all young people to coverage. One solution is to automatically enroll youth aging out of foster care in Medicaid to make sure they maintain health insurance as they leave the state’s care.”

As for teen births, in 2012, Kentucky's rate of births to teen mothers (42 per 1,000) "substantially" exceed the national rate (29 per 1000).

Many of Kentucky's children face adverse childhood experiences related to economic security.

According to the report, Kentucky has now had four consecutive years in which more than one in every four children lives in poverty, which is consistently higher than the national average. It also reports that more than two in every five Kentucky children live in a high-poverty area.

The report says, " A family's earnings and its poverty status, the level of poverty in its neighborhood and the affordability of housing can all affect how a child grows, learns and ultimately succeeds as an adult."

Boone, Oldham and Spencer counties have the highest scores for economic security, while Lee, Martin and Wolfe have the lowest.

Economic security, based on scores for the four indicators in the report.

The results of the well-being of Kentucky's children around education are concerning.

More than half (51 percent) of Kentucky's children entering kindergarten are not adequately prepared for school and more than half  (51 percent) of its fourth graders are not proficient in reading and "therefore not on the path to high school graduation," according to the report. The study also found that over half (55 percent) of Kentucky eighth graders are not proficient in math and that one in seven Kentucky high school students did not graduate on time.

Oldham and Lyon counties "stand apart" at the top of the  education county comparison, with Clinton, Knox, Menifee and Clay counties ranking last.

Education, based on scores for the four indicators in the report. 

Family and community indicators in the report found that Kentucky is not putting as many youth in jail as in previous years; nearly one in five births were to moms without a high school degree; the number of children living in a single-parent home has grown to 37 percent from 35 percent; and over the course of 2013, over 12,700 children were placed in foster care due to abuse or neglect.

Oldham, Boone, Carlisle, Ballard and Spencer counties rank at the top of the family and community county comparisons, with Powell, Clay, Elliott, Owsley and Carroll counties ranked at the bottom.

Family and Community, based on scores for the four indicators in the report. 

The report recommends implementation of strong policies to combat children's exposure to adverse childhood experiences. "The best option for Kentucky is to find ways to prevent adverse childhood experiences. Ensuring safe, stable and nurturing environments will shield children from toxic stress and its deleterious effects," says the report.

Click here for the Annie E. Casey Foundation Kids Count Data Center, which includes current and historical data. Note that the indicators included in the 2014 rankings are different than those included in the 2013 County Data Book. Therefore, current rankings should not be compared to last year’s county rankings.