Kentucky Medicaid members can change their managed-care organization until Dec. 12

The Kentucky Medicaid open enrollment period has begun, giving members an opportunity to change the managed-care organization that handles their coverage.

Medicaid members can switch MCOs until Friday, Dec. 12.  Members who don't want to switch plans don't need to take any action. New coverage for those who switch plans goes into effect Jan. 1.

If you are considering switching your plan, but want to keep your current doctor, check in with your current doctor to make sure they will accept the health plan you are planning on switching to before you make the change, advises Kentucky Voices for Health.

To learn more about your benefits and options call MCO Member Services: Anthem  at 855-690-7784; Coventry Cares at 855-300-5528; Humana at 855)-852-7005; Passport at 800-578-0603; or Wellcare at 877-389-9457.

To switch your plan, you must call Kentucky’s Medicaid Member Services at 1-855-446-1245 between 8 a.m. and 5 p.m. Eastern Time Monday through Friday.  For more information click here.

Study shows Kentucky among national leaders in reducing uninsured percentage because of federal health reform

The percentage of adults under the age of 65 who do not have health insurance decreased by double digits in approximately half of Kentucky's counties, says Enroll America, which released county-level data showing who the Patient Protection and Affordable Care Act has helped most, Kevin Quealy and Margot Sanger-Katz report for The New York Times. "In 2013, the uninsured rate was 19.4 percent, but this year it has fallen to 10.8 percent."

For an interactive county-level map click here; below is a screenshot of the map, showing one Kentucky example and the stark difference in states that expanded Medicaid and those that did not.

"The areas with the largest increases in the health insurance rate, for example, include rural Arkansas and Nevada; southern Texas; large swaths of New Mexico, Kentucky and West Virginia; and much of inland California and Oregon," Quealy and Sanger-Katz write. "Each of these trends is going in the opposite direction of larger economic patterns. Young people have fared substantially worse in the job market than older people in recent years. Blacks and Hispanics have fared worse than whites and Asians. Rural areas have fallen further behind larger metropolitan areas."

About 10 million Americans who had no insurance in 2013 signed up for Obamacare this year, and the national uninsured rate for adults under 65 dropped from 16 percent to 11 percent, Quealy and Sanger-Katz write.

"People with the lowest incomes tended to benefit the most from the law," Quealy and Sanger-Katz write. In states such as Kentucky "that expanded Medicaid, low-income people can get insurance without having to pay a premium. And for middle-income people who qualify for tax credits to help them buy insurance, the subsidies are most generous for those lowest on the income scale. Poorer people were always the least likely to have insurance because their jobs rarely offered it and private premiums were often unaffordable." (Read more) Here's an enlargement of a section of the above map, focusing on Kentucky:

As school-lunch debate puts attention on rejected meals, we might consider a bigger problem: food wasted at home

The new nutrition rules for school meals have led some students to throw away food they're served. Schools across the country are estimated to waste $1.2 billion worth of food every year, based on extrapolations from a study the National Institutes of Health conducted in Boston schools. That's a lot of wasted food and money, but students and their families waste even more food at home, George Jones writes for WFIE-TV in Evansville.

According to the U.S. Department of Education approximately 49.8 million pre-K through 12th-grade students will attend public schools this year. Each student is estimated to waste about $33 worth of federally funded lunches per year. "The average person in the general population wastes almost that much in total meals during one month," Jones reports.

Americans threw away $161 billion worth of food in 2010—nearly one-third of the available food supply, according to the U.S. Department of Agriculture. That means the average person discards $372 worth of food each year, or four times as much as students.

"Sometimes people say it's the family and parents making choices, but it's the larger system we're in that making this problem," aid Pamela Koch, director of the Laurie M. Tisch Center for Food, Education and Policy at Columbia University. "They're working so many hours they think they don't have time to shop and cook healthy. And the most inexpensive foods are the ones that are not the most healthy for them."

Rising obesity rates and fast food consumption show that adults aren't eating well-balanced meals, much less school-aged individuals. The School Nutrition Association supports the rules requiring reduced-fat and fat-free milk and more fruits and vegetables, but "feels serving only whole grain breads and requiring children to take food they don't otherwise each is burdensome for schools," Jones reports.

"You're never going to be able to promote healthy diets for kids if they don't get healthy options across the board," SNA spokeswoman Diane Pratt-Heavner said. "It's the students who are unfamiliar with those healthier choices who are not responding well."

Students part of the Montgomery, Ala., group called E.A.T. (Education, Act Transform) were much more receptive to trying new foods—such as radishes—when they went through the process of planting and harvesting them. "They come here, and now they have an understanding," E.A.T. South Executive Director Denise Blake Green said. "They've seen the cycle—planting, harvesting, cooking, composting. When they leave here, food looks different to them." (Read more)

End of Daylight Saving Time, which can disrupt sleep pattern, is a good time to review your sleep habits, experts say

Sunday, Nov. 2, is the end of Daylight Saving Time this year and for those who already sleep poorly, it might mean further disruption to their sleep patterns.

Turning our clocks back one hour in the fall can be disruptive to our sleep patterns, says Sabrina Brem, an instructor at Columbia University School of Nursing, making a few suggestions to help with the transition:

Going to bed and getting up at the same time every day is the "single most important thing" to getting a good night's sleep, she says.

"Plus or minus two hours can be OK, but you’ll have the best sleep if you can stick to a very similar routine seven days a week," Brem said.

It is also important to avoid stimulating activity before bedtime, which means no exercise, television, iPad, iPhone, tablet, or bright screen of any kind. If you like to read before bed, Brem suggests an actual book or a device with e-ink.

Brem also suggest no caffeine six hours before bedtime and no alcohol three hours before bed.

“Lots of people will say a cocktail helps them fall asleep, and it does,” says Brem. “The trouble is usually that cocktail will also cause you to have fitful sleep, wake up frequently, and feel unrested in the morning.”

The National Sleep Foundation adds these tips to Brem's suggestions to get a good nights sleep:

• Create a bedtime ritual.
• Avoid naps, especially in the afternoon.
• Exercise daily.
• Create a soothing sleep environment, which includes cool temperatures and no light.
• Make sure your mattress has not exceeded its life expectancy - usually 9-10 years.
• Avoid cigarettes and heavy meals at bedtime.
• If you can't sleep, get up and do something relaxing until you are tired.
• Speak to your health care provider if you are still having trouble sleeping.

KET will look at how Kentucky communities are fighting back against the heroin epidemic

Heroin use is sky-rocketing in certain areas of Kentucky and many communities are fighting back with local solutions.

Host Renee Shaw and guest will share how communities are coming together to save lives, expand treatment options and prevent others from becoming addicted on the next episode of KET's "HealthThree60" program Monday, Oct. 27 at 9 p.m. ET; and Wednesday, Oct. 29 at 3 p.m ET.

KETKY will air the show on Wednesday, Oct. 29, at 3 p.m.; Thursday, Oct. 30, at 11 p.m.; and Friday, Oct. 31, at 9 a.m. All times are Eastern.

Students at elementary school in Bowling Green create walking trail to promote health and education

Ribbon cutting ceremony for walking trail
Wednesday, Oct. 22 at T.C. Cherry Elementary School.
Photo: Miranda Pederson/Daily News

Students at T.C. Cherry Elementary School in Bowling Green came up with the idea of creating a walking path around their school in April and when they showed up for school in August, it had become a reality, Laurel Wilson reports for The Daily News in Bowling Green.

The Leadership Bowling Green class "took it to the next level," T.C. Cherry Principal Kory Twyman told Wilson.

The Leadership Bowling Green program is a nine- month leadership-development program coordinated by the Bowling Green Area Chamber of Commerce. Over the summer, the 2014 leadership class constructed a 1/3-mile gravel path around the school for its class project - bringing to fruition a project chosen because it "would have the largest impact on the community by promoting health and education," class president Jason Marshall told Wilson.

Seven signs along the path reinforce the seven habits students learn as part of "The Leader in Me" curriculum: Be proactive; begin with the end in mind; put first things first; think win-win; seek first to understand, then to be understood; synergize; and sharpen the saw.

Students can take pride in the fact that they helped make the walking trail happen, Twyman.told Wilson. “It made them aware that even as 9-, 10-, 11-year-old children, they have a voice and people are listening,” he said.

Study finds that signs that connect calories to activity are more effective than nutrition labels to change behavior

Most Americans don't adjust their bad eating habits after reading nutrition labels, but when they are provided information that is easy to understand, like connecting the amount of exercise needed to burn a certain number of calories, many do make healthier choices, according to a recent study from Johns Hopkins University's Bloomberg School of Public Health.

“People don’t really understand what it means to say a typical soda has 250 calories,” Sara N. Bleich, lead author of the study, said in a release.  “If you’re going to give people calorie information, there’s probably a better way to do it."

Bleich, associate professor in the Department of Health Policy and Management at the Bloomberg School, explained that the research findings, printed online in the American Journal of Public Health, found that when you explain calories in an easily understandable way, you can encourage behavior change.

The study found that teens who saw printed signs explaining the number of miles they would need to walk to burn off the calories in a sugary drink were more likely to leave the store with a lower calorie beverage, a healthier beverage or a smaller size beverage. And these healthier choices persisted after the signs came down.

These findings could be important to chain restaurants next year when they will be required to display calorie counts on their menus, a requirement of the Patient Protection and Affordable Care Act. Researchers say in the release that "policymakers may need to rethink  how that information is communicated."

The research involved posting one of four signs with easy to understand nutritional information at six different corner stores in African-American neighborhoods in Baltimore.

The signs focused on sodas, a commonly purchased item among teens. The signs pointed out that a 20 oz. bottle of soda, sports drink or fruit juice contained 250 calories, or had 16 teaspoons of sugar, or would take 50 minutes of running to work off those calories or would take five miles to walk the calories off.

The research found that when teens saw any of the four signs, they were more likely to choose a drink with fewer calories. The most effective sign was the one that told shoppers they would have to walk five miles to burn off the drink calories, Bleich said in the release.

“This is a very low-cost way to get children old enough to make their own purchases to drink fewer sugar-sweetened beverages and they appear to be effective even after they are removed,” Bleich says. “Black adolescents are one of the groups at highest risk for obesity and one of the largest consumers of sugary beverages. And there is a strong scientific link between consumption of sugary beverages and obesity. Using these easy-to-understand and easy-to-install signs may help promote obesity prevention or weight loss.”

This simple solution could also be applied in Kentucky where 18 percent of Kentucky's high school students are obese, according to the 2013 Kentucky Youth Risk Behavior Survey, in which15 percent of them reported drinking a can, bottle, or glass of soda three or more times per day during the seven days before the survey.

In a report for PBS, KET's Renee Shaw looks at the influence of health-care reform on the U.S. Senate race

Kentucky is a state "where both the economy and health care poll as high issues and where the state’s exchange under the health care law ... has a very different reputation than the law does when it’s called Obamacare," KET's Renee Shaw reports in a segment for PBS "NewsHour."

Courier-Journal Political Writer Joe Gerth explained the disconnect for the national audience: "Five letters, O-B-A-M-A. You have to look at the polling on Obama. His favorability rating in Kentucky is somewhere around 29 percent. He’s not liked. People don’t like his policies. They don’t like him personally. And that’s played a huge role in why Obamacare is viewed so negatively."

Shaw interviews small-business owner Charles Howard of Chaplin, who doesn't like the law, and Kendell Nash of Louisville, who does. Shaw concludes, "Kentucky is full of strong feelings on the health care law, but it’s not clear how much those will affect the election. Like much of the nation, the state is getting ready for the next round of open enrollment on its health care exchange. That will be the next test of the health care law here. Enrollment starts two weeks after the midterm election."

Anyone returning from an Ebola-stricken country will be monitored by health authorities for three weeks

All travelers who arrive in the U.S. from the Ebola-stricken countries -- Sierra Leone, Guinea and Liberia -- will be closely monitored for 21 days by public health officials, Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, announced Wednesday, Oct. 22.

These measures took effect immediately in the six states that receive approximately 70 percent of travelers from Est Africa: New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia. All other states that receive travelers from the region, including Kentucky, will implement these policies "over the following days," a CDC release said..

Kit for travelers entering U.S. from West Africa

Travelers who have been in these countries will get a kit at the airport with an explanation of what Ebola symptoms are, a thermometer and instructions on how to use it, and specific contact information to report symptoms. These people will also be required to maintain daily contact with state and local officials for the entire 21 days following the last possible date of exposure to the Ebola virus.

"These new measures I'm announcing today will give additional levels of safety so that people who develop symptoms of Ebola are isolated quickly," Frieden told reporters.

These measures are in place only for travelers without symptoms. Those showing symptoms will be isolated and, if need be, transported by trained medical personnel. If a traveler is considered "high risk," but not yet showing symptoms, Frieden said he or she would be quarantined and not permitted to travel via public transportation.

New York and New Jersey have taken this new policy a step further and now require all medical workers returning from West Africa who had contact with Ebola patients to be quarantined for 21 days. Illinois will require people who have traveled to West Africa and have come into direct contact with someone infected with the Ebola virus to "undergo a mandatory 21-day home quarantine," Ray Sanchez and Elizabeth Cohen report for CNN.

New York Mayor Bill de Blasio said the policy could backfire. "These individuals who are going there to serve are the people who will end this crisis," de Blasio said. "We can't have the illusion that we can turn away from it and some day it may end. If we took that attitude, this would be a truly devastating global crisis."

In Senate race, McConnell and Grimes differ on health care

By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications

               The U.S. Senate race between Republican Sen. Mitch McConnell and Democrat Alison Lundergan Grimes has seen the candidates focus on several key issues, including the coal industry, the minimum wage and health care.

               The health-care issue has been almost unique among Senate races in that Kentucky is generally seen as a success story for the Patient Protection and Affordable Care Act. In August, Gov. Steve Beshear said 521,000 of Kentucky’s 4.3 million citizens had signed up for health coverage through Kynect, the state’s health insurance marketplace created under the law.

               According to a Gallup-Healthways poll, published in August, Kentucky reduced its percentage of uninsured more than any other state besides Arkansas, and lowered the percentage of uninsured in the state from 20.4 percent to 11.9 percent, thus covering two of every five uninsured Kentuckians.              

In addition to funding the expansion of Medicaid, the law requires Americans to either purchase private health insurance or enroll in some form of government assisted health care like Medicaid; requires insurance companies to cover people with pre-existing conditions and provide 10 elements of coverage in each policy; allows parents to keep their children on their health insurance until they are 26; and requires businesses employing 50 or more full time employees to provide health insurance, a provision that President Obama has suspended for a year.

McConnell says he wants to repeal the law “root and branch,” but has been more lenient toward the idea of keeping Kynect. In the Senate race debate on KET, McConnell suggested that Kynect was merely a website. However, repealing the law could pose issues for the newly insured in Kentucky because private insurance under Kynect uses federal tax credits, and provides free Medicaid coverage to citizens who earn up to 138 percent of the federal poverty level.

According to Douglas McSwain, a Lexington-based litigation attorney who specializes in constitutional and health-care law, the uprooting of the law would result in drastic changes to Kynect.

               McSwain said repealing the ACA “root and branch” would mean cutting the federal tax subsidies that are essential to Kynect’s survival.

“You take the exchange tax credit away, do you think for a minute that the website is going to stand?” McSwain asked.  “Nobody is going to buy policies.”

At a Kentucky Farm Bureau forum in August McConnell said Congress should have passed laws allowing health insurance to be sold across state lines, limiting malpractice lawsuits and making it easier for businesses to form health-insurance groups.

               McSwain said the law allows formation of such groups, and interstate regulation “is conceivable” but “The problem is we don’t have the infrastructure, regulatory-wise, to do that without having reached a compact or an agreement” among the states.

               A study on the effects of malpractice reform, published by the New England Journal of Medicine, found that Texas, Georgia and South Carolina did not see a significant reduction in the amount of doctor-ordered tests and scans after enacting reforms.  A five-person team of doctors performed the study, collecting data from 1997 through 2011.

               Grimes has only publicly discussed health reform on select occasions, taking a similar strategy to many Democrats in the 2014 midterm election because of the unpopularity of “Obamacare” and its namesake.  When she does mention health care, she talks about fixing and streamlining the law, as she did during the KET debate.

“I will not be a senator that rips that insurance from their hand,” Grimes said in reference to the half a million Kentuckians who’ve gained coverage under Kynect.  She said McConnell was in a “fictional fantasyland.”

Grimes has also talked about supporting an extension of Obama’s “grandfathering” of insurance policies that don’t comply with the law after he was criticized for not keeping his campaign promise that Americans could keep their doctor and health plan if they liked them.

               That controversy and other aspects of the law have led to negative feelings among Kentuckians about Obamacare.  A poll by Marist College for NBC News showed Obamacare had a 33 percent approval and 57 percent disapproval rating among Kentuckians, while Kynect had 29 percent approval and a 22 percent disapproval., while 29 percent of those polled said that they had never heard of Kynect and 21 percent were unsure of how to rate it. 

               At last report, about 80,000 Kentuckians had bought private insurance through Kynect and about 440,000 had used it to get on Medicaid – 320,000 of whom were eligible under the new rules and 120,000 under the what state officials call “old Medicaid.” 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, and fall to the reform law's floor of 90 percent in 2020.

Cheyene Miller of London, Ky., wrote this story for “Covering the U.S. Senate Race,” a special course in the University of Kentucky School of Journalism and Telecommunications.

Medicaid expansion boosts preventive care

More Kentuckians than ever are using preventive care services since the state expanded Medicaid on Jan. 1, reports FamiliesUSA, a lobby for federal health reform that included the expansion.

Recent data from the state Cabinet for Health and Family Services show a 37 percent increase in the use of preventive care services since 2013, report Andrea Callow, a Medicaid policy analyst and Katie Supko, a Medicaid intern for FamiliesUSA. Of particular note is that more Kentuckians are getting screened for diseases that kill so many of us.

In 2013, Kentucky ranked first in cancer deaths and sixth in all premature deaths. It ranked 41st in annual dental visits and 45th in overall health status.

Since the expansion, which has provided coverage to more than 450,000 Kentuckians, the cabinet reports a 30 percent increase in breast cancer screenings, a 3 percent increase in cervical cancer screenings, a 16 percent increase in colorectal cancer screening and a 37 percent increase in adult dental visits.

Screenings and check-ups allow medical providers to identify health issues before they advance, and improves the chance that treatment will be successful. For example, with early detection, the five-year survival rate for breast cancer, the leading cause of cancer death in women, is 90 percent, and the rate for cervical cancer is nearly 100 percent, the writers note. Screenings for colon cancer, the second leading cause of cancer deaths in the U.S., have a five-year survival rate higher than 90 percent if detected early, but only 40 percent of colon-cancer diagnoses are made during this early stage.

At least one study, over two years in Oregon, found no preventive health benefits from expanding Medicaid, but advocates say it will work in the long term. "Medicaid expansion makes preventive care possible," the authors write. "Kentucky’s decision to expand Medicaid will undoubtedly reap the state many benefits, from a drop in the uninsured rate to an increase in economic activity" by expanding health-care jobs. "But the access to critical preventive care services may be the benefit that gives Kentucky a much-needed boost in the health status of its residents."

Rural Ky. hospitals make sure they are ready for Ebola

Rural hospitals in Kentucky are making sure they are prepared in the event they get a patient with the Ebola virus, Bill Estep reports for the Lexington Herald-Leader.

The risk of Ebola coming to rural Kentucky is low and there have been no cases in the state, according to officials of the state Department of Public Health, but rural hospitals are getting ready just in case, Estep reports.

It's not known where a patient might enter the health care system, so every hospital must be prepared, State Health Commissioner Stephanie Mayfield, told Estep.

Hospital officials all over the state have told Estep that they are making sure they are prepared in case they get an Ebola patient, saying they are reporting up-to-date daily information on dealing with Ebola to their employees; staying apprised of what the state health department and the federal Centers for Disease Control recommend; updating patient-screening processes to help determine the risk of Ebola, reviewing isolation procedures; taking stock of protective gear; and providing staff education.

"The protocol for rural hospitals would be to put an Ebola patient in isolation, then contact the local or state health department for guidance on whether to transfer the patient," Joe Murrell, chief executive officer at the 25-bed Wayne County Hospital in Monticello, told Estep, because "most rural hospitals don't have the resources to treat an Ebola patient for a long period."

But is this level of preparation enough?

Health care workers continue to be concerned because the two nurses in Dallas who were caring for the infected man from Liberia who has since died, and now have Ebola, "reportedly got the virus despite wearing protective gear," Estep writes.

Initially Dr. Tom Frieden, director of the CDC, said any hospital could safely take care of Ebola, Kimberly Leonard reports for U.S. News & World Report. “You need a private room with a private bathroom, and rigorous, meticulous training and materials to make sure that care is done safely so caregivers aren’t at risk,” he said, Leonard writes.

But Linda Greene, an infection prevention manager at Highland Hospital in Rochester, N.Y., and a member of the Professionals in Infection Control and Epidemiology Regulatory Review Panel, told Leonard, "Despite the best efforts, we do know in many hospitals that infection-prevention control measures are under-resourced,” and "There may be need for even more specialization than we initially thought."

But Greene goes on to say that despite these challenges,"Every hospital, however, should be able to screen and identify a patient at risk and immediately put them into isolation as necessary and do the initial triage, Leonard reports.

This is what Kentucky hospitals seem to be doing, despite concerns of some that it might not be enough.

Kevin Kavanagh, a Somerset physician and board member of Health Watch USA, told Estep that there are still "unanswered questions" about care for patients with Ebola, citing "his understanding that the CDC still doesn't know how the Dallas nurses got infected despite wearing protective gear" and "what plans hospitals have to dispose of the medical waste" and the "extent of the knowledge about how the disease spreads."

News media blamed for most of Ebola scare; experts continue to say that risk of infection is low

The reaction of many Americas regarding the Ebola virus has gone beyond what is medically necessary, but is a natural reaction to fear, Maggie Fox reports for NBC News.

Medical experts told Fox that while the federal Centers for Disease Control and state health departments are taking appropriate measures to keep an eye on people who were in direct contact with Ebola patients, some actions "may be excessive," such as Cleveland-area schools closing after a middle-school worker "traveled home from Dallas on Frontier Airlines Tuesday on a different flight, but perhaps the same aircraft" as the Ebola-infected nurse, Fox reports.

“They are taking drastic steps for a risk that is rather remote,” said George Kapalka, professor of psychological counseling at Monmouth University in New Jersey.

Blame for this fear is placed on the news media and politicians, Fox reports. Media are “undoubtedly complicit in stoking this fear, not by covering the story — that’s fine,” risk perception expert David Ropeik told Fox. “They are complicit by burying all the qualifiers about how minimal the risk is.”

So how risky is Ebola?

“The only individuals potentially at risk for Ebola in the United States right now are those who have traveled to affected areas of West Africa or who have been directly involved in treating cases of Ebola or close contacts to a symptomatic patient with Ebola," Stephanie Mayfield, Kentucky's public health commissioner, said in a press release.

Mafudia Suaray, a family physician at Rutgers Robert Wood Johnson Medical School, says the risk of getting Ebola in the U.S. is "very low." She explains that "Ebola is a virus that is spread from person to person through contact with bodily fluids, including saliva, tears, sweat, urine, blood, stool and semen. It is not spread through the air. ... The virus cannot be spread through contact with intact skin and a person must have symptoms of the disease to spread it to others."

Adam Cole of NPR created a visual to show how unlikely an Ebola infection is, based on the reproduction number of the virus, which indicates how many people one person might infect. It says that for every person who has Ebola will infect two others, but direct contact with a bodily fluid is required.

And the reason that officials, including the CDC Director Thomas Frieden, think Ebola will be contained in the U.S. is because our public health system is good and Ebola isn't contagious until symptoms are present, allowing time to isolate those who have come in contact with anyone who has been infected, and thus stopping the spread of the disease, Michaeleen Doucleff reports for NPR.

Suaray reminds us in the release that "common sense prevention measures should always be the priority, whether for Ebola or for more common illnesses such as the cold and flu." Wash your hands, stay home if you have fever, see a health care provider if your fever is high, cover your face with your arm or a tissue when you cough or sneeze and talk to your doctor if you plan on traveling to an infected region.

Nine hospitals in Kentucky get maximum Medicare penalty for readmissions; they blame socioeconomic factors

Article updated 10/20/2014
Nine hospitals in Kentucky, eight of them in Appalachia, have been hit with the highest penalty possible by Medicare for high rates of patient readmission.

This is the third year the program has fined hospitals, under the federal health-reform law, for having too many patients return within 30 days for additional treatment.

This year, the maximum penalty is a 3 percent reduction in Medicare payments for all patient stays in the fiscal year beginning Oct. 1. Last year, the cut was 2 percent. The fines are based on readmissions from July 2010 through June 2013.

Kentucky hospitals fined the maximum amount this year are the Appalachian Regional Healthcare hospitals in Harlan, Whitesburg and Hazard; Memorial Hospital in Manchester; Methodist Hospital in Henderson; Pineville Community Hospital in Bell County; Three Rivers Medical Center in Louisa; Monroe County Medical Center in Tompkinsville; and Westlake Regional Hospital in Columbia. All except Henderson are in Appalachia, and most are in Eastern Kentucky.

“Some of the specific challenges that have faced hospitals in Eastern Kentucky is that they see a greater proportion of patients who have suffered from heart attacks, heart failure and pneumonia,” Elizabeth Cobb, vice president for health policy at the Kentucky Health Association, told Kevin Halpern of the Middlesboro Daily News.

Cobb also said the region has "higher numbers of chronically ill patients, who require a greater amount of hospitalization," and that high rates of obesity and smoking, which affect how well a patient does after discharge, as well as a lack of oupatient services in rural areas, also contribute to readmissions. The formula for calculating readmission penalties does not take such problems into account.

Nationwide, 2,610 hospitals received a readmissions penalty, but only 39 were hit with the full 3 percent. In Kentucky, 63 hospitals, about two-thirds of the state's total, were penalized, with the average penalty being a 1.21 percent reduction in payment, according to an analysis of federal records from Kaiser Health News.

Halpern, citing KHA, reported that Kentucky represented a "disproportionate share of (the) hospitals receiving the maximum penalty, with nine hospitals, representing 23 percent of the total."

KHA supports pending legislation that will require the Centers for Medicare and Medicaid Services to adjust its program to account for socioeconomic conditions that "are beyond a hospital's control," Halpern reports. Opponents say "hospitals that have many readmissions are providing substandard care and should not be let off the hook," Kaiser's Jordan Rau reports.

The penalties have forced hospitals to provide better follow-up care for their patients after discharge in efforts to avoid readmission. The days of handing a patient a written discharge plan and expecting the patient to follow them without follow-up are quickly becoming a thing of the past, Rau reports.

Instead, hospitals are finding ways to ensure patients are not readmitted like ensuring outside doctors monitor discharged patient's recoveries; providing free medication for those who can't afford them; or sending a nurse to a patients home to make sure they are taking care of themselves.

But some hospitals are still struggling with these new guidelines, resisting many such efforts because they aren't paid for these services, Rau reports, and some continue to readmit patients because it has been financially beneficial to the hospital in the past.

Medicare officials estimate that $17 billion of the $26 billion Medicare pays for readmissions is a result of "potentially avoidable readmissions," Rau reports.

Telemedicine helps reduce waits for mental-health patients in ER and provides better health-care access in schools

Health professionals have used telemedicine to help delay Alzheimer's disease and reduce hearing loss in Appalachia, especially among children. Now the new approach is helping students access health care, and mental-health patients to get faster medical attention in emergency rooms.

AMD Global Telemedicine has been establishing telemedicine systems in schools, which allow "providers to care for students on-site with few clinicians to support it," Katie Wike writes for Health IT Outcomes. So far "the Center for Rural Health Innovation in western North Carolina used the technology to support 14 school-based programs and provide care to 4,000 students.

The health-care provider can ask the questions during the exam, and "it doesn't assume the presenter knows the questions to ask," said CRHI Executive Director Amanda Martin. This approach allows one nurse practitioner to provide care to thousands of children. Some Kentucky schools are already using the telemedicine platform, Wike reports.

Sometimes when patients seek mental-health care in emergency rooms, no psychiatric services are available. In this case, hospitals often contact and wait for a provider to arrive or send written evaluations for review, Karla Paris writes for Health IT Outcomes. Now KentuckyOne Health has a telemedicine program that gives faster response times for those requesting mental-health care. For example, patients who visit Louisville's Ss. Mary & Elizabeth Hospital for mental-health care will be able to videoconference with professionals from Our Lady of Peace Hospital. "Patients can then be referred for admission at Our Lady of Peace, another outpatient program or care center," Paris reports.

2014 Kentucky Rural Health Day observance includes a photography contest; submissions are due by Nov. 7

Part of the 2014 Kentucky Rural Health Day celebration this year is the "Bridges to Rural Health" Photo Contest.

Participants are asked to submit photos that express this year's theme, "Bridges." Whether you depict this with a photograph of one of the many beautiful bridges in Kentucky or creatively (a bridge can be many things) the organizers say to submit pictures that depict what rural means to you.

Only Kentucky residents are eligible to participate in the contest and all photos must have been taken in Kentucky. Submissions are due by 11:59 p.m. Eastern Time on Friday, Nov. 7. Click here for contest details. For more information email chris.salyers@uky.edu or follow the Kentucky Office of Rural Health on Facebook.

Boone County school bans all food at school birthday celebrations, partly in an effort to combat childhood obesity

Burlington Elementary School in Boone County has banned all food during birthday celebrations, including ice cream and cake, as part of its new wellness policy, Jessica Brown reports for The Cincinnati Enquirer.

Celebrations are still allowed and can include non-food treats, Brown writes. Burlington is one of very few schools to make this move in efforts to make sure students are getting healthy food at school and to also decrease celebration time, which takes away from classroom time.

"We're finding it's difficult to be the first," Valerie Bailey, who is on the PTA and on the committee that helped craft the policy, told Brown. "Parents say it's not fair. But we hope it sends a message to the parents and kids, especially with the obesity rate being so high, and puts a bug in their ear."

"To be clear, the federal government does not ban birthday cake. Nor does it ban pizza parties or bake sales – all notions that have gotten a lot of attention in recent years," Brown writes.

The Healthy, Hunger-Free Kids Act does require all schools to have a "wellness policy," which is determined by the individual schools and is where some schools have created this type of restriction.

Burlington's main goal when it revised its wellness policy was to address the growing childhood obesity rate, Brown reports.

"About 37 percent of our children are at risk (for obesity) or obese," Kathy Reutman, who is in charge of making sure the wellness policies for Boone County schools meet federal guidelines, told Brown. "It's not up to us to tell parents what to do," she said. "But when children are in our care we make sure that nothing gets in the way of them and their learning. Food allergies or too much sugar get in the way of that."

Students have gotten creative at Burlington to accommodate this change, with one student bringing in jump ropes for the class for a jump rope party to celebrate his birthday, Brown notes.

The Enquirer reports that they have found only one other local school district with a similar rule, Southgate, a one-school district in Campbell County and reports that while rare locally, birthday-cake bans are "springing up elsewhere across the country."

A close call with his heart helped a 36-year-old man change his life; UK opening cardiovascular unit to help those like him

A lifetime of eating poorly and smoking a pack of cigarettes a day landed one man in the hospital with a heart condition that usually kills half of its victims; but quick thinking, surgery and a complete turn around in his lifestyle will hopefully allow him to reach his goal of walking his daughter down the aisle when she grows up, UKNow reports.

Jarrett Spriggs

Jarrett Spriggs told the University of Kentucky news service that if he skipped breakfast, he typically ate a "fast-food combo meal, plus an extra sandwich and two extra-large sweet teas" for lunch, followed up with only meat and potatoes for dinner and plenty of snacks, often a full-size bag of chips, and sugary drinks in between. Add to that ... a pack of cigarettes a day.

"A recipe for disaster," says the release.

The disaster hit in May when Spriggs, 36, woke up with "terrible chest pains" that "moved from my chest to my left arm," he said in the release. And despite the immediate 911 call, he and his wife Amy thought this would simply be a case of "expensive heartburn."

But instead, Spriggs was experiencing a rare type of a "deadly condition" called ascending aortic hematoma, which occurs when a tear develops in the inner wall of the main artery that carries blood from the heart. His specific condition is known as an aortic dissection and it often causes patients to bleed to death before they can reach a hospital, says the release. This is the same condition actor John Ritter died from in 2003.

Spriggs survived a five-and-a-half-hour hour surgery in which a portion of his diseased aorta was replaced with a tube made of cloth.

“Jarrett is a very lucky man, because the mortality rate for an aortic dissection is 50 percent, and the variant Jarrett experienced is pretty rare,” Dr. Hassan Reda, his UK HealthCare cardiothoracic surgeon, said in the release. “He acted quickly to get help, and he got to the right place.”

Post-surgery, Reda told Amy that Spriggs "had the heart tissue of an 80-year-old man and without some drastic changes, he likely would not live to see his 50th birthday."

This prognosis has led to some drastic changes in Spriggs' life. He told UKNow that it was a "wakeup call from God."  He immediately quit smoking; he now uses a diet and exercise phone app; and has involved the entire family in his efforts. He has lost almost 50 pounds in five months and says his motivation is to be alive to walk his daughter, who in now 10, down the aisle.

The UK Chandler Hospital is opening a new 64-bed cardiovascular unit in December to help patients like Spriggs. It not only incorporates many elements that already exist in the hospital, according to the release, but will add new features to improve patient recovery.

One of these new features is a guided walking path within the unit for patients and visitors to use. "Research demonstrates that when patients begin exercising in the hospital they are more likely to continue that activity at home," says the release.

The unit will also offer a "state-of-the-art interactive TV system in every patients room that will provide patients with information and educational materials about their diagnosis, their care team and their treatment plan." The information will also be available on patients' home computers.

“Cardiovascular disease, smoking, obesity and physical inactivity are the modern plagues of our society,” Dr. Alison Bailey, director of preventive and ambulatory cardiology and cardiac rehab at UK's Gill Heart Institute, said in the release. “The good news is that these are almost always reversible diseases that can be treated, if not cured. The goal of cardiovascular rehabilitation is to help patients shift back into a healthy lifestyle in a safe, fun environment.”

McConnell runs anti-Obamacare ad with doctor who connects pre-existing condition with cancellation of insurance

U.S. Sen. Mitch McConnell is running his first re-election commercial focused on the federal health-reform law, featuring a Somerset physician saying “As a doctor, I see how Obamacare hurts patients’ access to care.” She says McConnell is working for “common-sense health care reforms,” which are not specified, and is leading the fight to repeal the law.

Sandy Schuldheisz adds that her son has diabetes and her plan was “cancelled under Obamacare. Like many, we now pay more for less coverage.” That may cause an incorrect inference. "The Affordable Care Act also prohibits insurance companies from dropping or denying coverage to Kentuckians because they have a pre-existing condition, such as diabetes," notes Joe Sonka of Insider Louisville. Many policies were canceled because they didn't meet the law's requirements.
Sonka, a McConnell critic, reports that he "requested more background information on Schuldheisz’s personal situation from the McConnell campaign — such as her premium rate before and after, and whether she received insurance through her employer or individually," and the campaign has not provided it.

Gov. Steve Beshear told Sonka in a written statement, "We don’t know the specifics of the doctor’s claim about her family’s plan being canceled (although many folks with health insurance policies prior to ACA were allowed to maintain those older plans if they chose to). We do know that she could have shopped for affordable health insurance on kynect, and may have even qualified for a discount. The vast majority of Kentucky families who shopped on kynect qualified for some kind of payment assistance or subsidy. Finally, the ACA required insurers to offer standard, robust benefits such as preventive care and vaccinations, mental health coverage, maternity and infant care, and prescription drugs."

Sonka writes that Schuldheisz's home Pulaski County "ranked among the top fifth in Kentucky counties with the largest estimated decrease in their uninsured rate" as a result of Obamacare. "As of this April’s signup deadline, 8,134 residents in the county had signed up for health care coverage through the state exchange. Based on Kynect estimates that 75 percent of their enrollees did not previously have insurance, this means Pulaski County’s percentage of uninsured residents may have fallen from 18 percent to under 7 percent."

Ky. Rural Health Assn. gives UK's James Norton the Dan Martin Award for Lifetime Contributions to Rural Health

James Norton of the University of Kentucky is this year's recipient of the Dan Martin Award for Lifelong Contributions to Rural Health, which honors a health care professional who has shown a long-standing commitment to solving health challenges in rural areas across the state, UKNow reports.

James Norton

This year the Kentucky Rural Health Association presented the award, a handmade and locally crafted dulcimer, to Norton prior to the annual conference, since he was traveling abroad during the September conference when it is normally presented. Norton is a past president of the KRHA and has served on the committee that chooses the recipient of this award.

"It's really gratifying," Norton said of receiving the award. "You do this for a long time, and it's nice to have your peers convey to you that they think what you've done has value in the long pull."

Norton is the associate dean for educational engagement at UK College of Medicine; leads the Western Kentucky Initiative, which places third-year medical students in rural clinical sites in Western Kentucky; is the director of CE Central, which manages continuing education for doctors and pharmacists; and serves on state and national boards that include the National Rural Health Association and on groups that are part of the Association of American Medical Colleges.

 "For over 30 years, Dr. Norton has been a major contributor and leader in developing programs directed to developing future health care providers for rural and underserved communities," Linda Asher, chair of the KRHA selection committee, said in the release.

Started in 2003, the award is named after its inaugural honoree Dan Martin of the Trover Foundation in Madisonville.

Kentuckians like Kynect coverage as long as it's not called 'Obamacare,' and some don't like to talk about it

By Molly Burchett
Kentucky Health News

Sticks and stones may break your bones, but words will never hurt you -- unless you're talking about the word "Obamacare" and its impact on the U.S. Senate race in Kentucky, the only Southern state to have both expanded Medicaid and set up its own health-insurance exchange under the federal health-reform law.

"The Affordable Care Act, known as 'Obamacare,' is a lightning rod in Kentucky, even though the state had one of the most successful rollouts in the nation," Al-Jazeera America reports in a five-part series on political issues in the state. The polarizing word is affecting the race between Senate Republican Leader Mitch McConnell and Democrat Alison Lundergan Grimes.

"In a state where 65 percent of registered voters disapprove of President Obama, even those who have signed up for coverage through Kynect don't want to think of it as Obamacare," Libby Casey and Philip Maravilla report.

In May 2013, Democratic Gov. Steve Beshear announced that he would use Obamacare to create the state health-insurance exchange and expand Medicaid rolls to cover Kentuckians earning up to 138 percent of the federal poverty level. That qualified hundreds of thousands of Kentuckians for the federal-state program, including Frank Dixon of Benham in Harlan County.

Dixon's 52-year-old body is damaged from decades working as a mechanic in coal mines where he injured his back, rotator cuff and shoulder. Like many Kentuckians who have worked hard to earn a good living all of their lives but lost jobs due to the mining industry or economic downturn, Dixon is thankful to have medical coverage and food stamps but "kind of ashamed to say it," he told Al-Jazeera:

"When asked if he supports Obamacare, Dixon lets out a long sigh and fidgets in his chair. “I don't know how to answer that,” he said. “Some things are left unsaid.” An NBC/Marist poll conducted in May found 57 percent of Kentuckians surveyed said they disliked Obamacare. But when asked about Kynect, only 22 percent disapproved. And yet they’re basically the same thing."

Republicans have more than taken notice of this sentiment, which may also be the reason Grimes hasn't made Kynect's success part of her campaign unless she is asked about it.

"Obamacare has been demonized by its opponents," Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky and publisher of Kentucky Health News, told Al-Jazeera. "And it’s easy to demonize because the first three syllables of the word are a word that most Kentuckians don't like."

Cross said that for Grimes to run on a platform of supporting the law would be risky, but could pay off: "I hope they do engage on the issue of health care because this state in many ways is the least healthy state in the country."

Aside from the questions of demonization and branding, Kentucky's health system has serious challenges, and the influx of Medicaid patients covered by Obamacare has come with new challenges for both patients and doctors, such as delayed approvals and burdensome paperwork from insurance companies.

Facing delays in preauthorization, some newly covered patients like Dixon are questioning the value of their Medicaid coverage. Others are just thankful to finally be able to see a doctor, Casey and Maravilla report.

How contagious is ebola? Not very, experts say

This story was updated Monday, Oct. 13
Several days ago, Thomas Eric Duncan died from ebola after arriving in Dallas from Liberia. He didn't appear to be ill during his journey or soon after he arrived. "Various news outlets are reporting that travelers arriving in the United States from West Africa would have their temperatures taken and be asked to answer questionnaires ascertaining any possible exposure," Kris Hickman writes for the Association of Health Care Journalists.

This story, among other ideas circling the news, has caused worry, but do people really have a reason to panic? Contagion potential is indicated by the reproduction number, which refers to the number of individuals to whom an infected person is likely to pass a disease. Epidemiologists have estimated that ebola's reproduction number is between 1.5 and 2. Measles, one of the most contagious diseases in the world, has a reproduction number of 18, and HIV has a reproduction number of 4.

The calculations are based on how long infected individuals are contagious and how much of the virus is needed to pass the diseases, among other factors, "but these data indicate that ebola is, in fact, controllable with appropriate and timely responses from the public health sector," Hickman writes.

Ebola is transmitted through contact with bodily fluids, but only when the patient is showing symptoms. The fatality rate is approximately 50 percent, particularly without proper treatment. "Reporters tapping into public health experts who can explain the concept of reproduction number should be able to show how containable the disease is and put it into proper perspective," Hickman writes.

While it is well-documented and understood how e-bola is spread, Peter Jahrling, chief scientist at the National Institute of Allergy and Infectious Diseases, is concerned that the disease has mutated to become more contagious, Julia Belluz reports for Vox.

Jahrling is worried that the "mutations of the virus that are circulating now look to be more contagious than the ones that have turned up in the past, " Belluz writes.  His Liberian team has found that the patients in Liberia have a much higher "viral load," which means that they have more virus in their blood - and that could make them more contagious. He told Bulluz that they were continuing to run test on their patients in Liberia, and they continued to show high "viral loads." When asked what this means, he said, "Right now, we just don't know."

The state Department for Public Health has prepared materials to" help hospitals, public-health agencies, health-care organizations and other coalitions in their preparedness for Ebola, Jack Brammer reports for the Lexington Herald-Leader. The materials are online at www.Kyha.com/kha-ebola-updates.

Most Kentucky schools adapting well to new federal nutrition rules, USDA official with Kentucky background says

While one Kentucky school district has ditched the federal school-meals program and the money that comes with it, an official of the U.S. Department of Agriculture’s Food, Nutrition and Consumer Services says that most Kentucky schools are creatively and successfully implementing the required nutritional requirements.

Fort Thomas Independent Schools dropped out of the program, saying new nutrition rules caused more students to pack lunches or eat off campus. Fort Thomas Highlands High School is the only public school in Kentucky to allow students to leave for lunch, Chris Mayhew reports for the Community Press & Recorder in Campbell County.

Most schools in Kentucky are adapting well to the new rules, Deputy USDA Undersecretary Janey Thornton, former school nutrition director at Hardin County Schools, told the Kentucky School Board Association's Kentucky School Advocate.

Thornton praised Kentucky schools for their efforts in implementing the new nutrition standards in school meals, saying that many, like Hardin County, had already been moving toward healthier meals before the guidelines were put in place. She said the food service director in Hardin County told her that they had not seen any decrease in meal participation at all.

She said the Harlan County director told her that they had had a rough start, but after engaging the students in the process, like developing the menus and taking them to food shows, students had been more receptive to the changes.

"I’m hearing this all over the country – when kids are engaged, when they feel it is their cafeteria, it makes a huge difference," Thornton said.

Thornton said introducing fruits and vegetables that students, cooks and managers may have never seen has been a challenge for some districts, but many schools are creatively facing the challenge by offering samples, using high-school students as peer nutrition mentors, working with the Cooperative Extension Service to offer after-school programs and offering smaller portions.

Thornton said "recent studies show there is not greater food waste than previously," but that doesn't mean that directors don't always need to work on decreasing waste. She suggested that maybe a half-cup portion of vegetables could be broken into small bites of three vegetables or fruits to equal one-half cup, not just all of one thing the student doesn't like.

Asked about the complaints that some students, particularly high schoolers, are going hungry, Thornton said that if the students are eating what is available to them, "the calorie count now is more than the recommended calorie count before this went into effect."

Thornton noted that a nonpartisan national-security organization of 450 retired admirals and generals has said “We have to do something about how America eats. It is affecting (negatively) those who are trying to get into the military.”

One of the biggest challenges reported across the country is that students don't have enough time to eat their lunch; it takes longer to eat fresh fruit and vegetables than it does to eat processed food.

"We don’t want to teach kids to inhale foods because that is part of our problem," Thornton said in the interview. "When you eat so fast, you don’t realize when you are full. This is a challenge not just in Kentucky but nationwide."

First flu case reported in Kentucky; vaccination recommended for everyone over 6 months old, especially some groups

Kentucky's first positive lab-confirmed case of the flu has been reported in Jefferson County this week, according to the state Department for Public Health.

The best way to protect against the flu is to receive a flu vaccine, and it's best to get vaccinated early because the vaccine takes about two weeks to work, the department says. Still, you can get a flu vaccine at any time during the flu season.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness. It’s also extremely important to take simple preventive steps to avoid it," Health Commissioner Stephanie Mayfield said in a press release. “You should also follow the advice your mother gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze, and stay home when you’re sick.”

While the federal Centers for Disease Control and Prevention recommends that anyone over six months old get a flu shot, they especially recommend that these types of people get one because they may be at higher risk:

• Children
• Pregnant women
• People 50 years old or older
• People of any age with chronic health problems
• People who live in nursing homes and other long-term care facilities
• Health-care workers
• Caregivers of or people who live with a person at high risk for flu complications
• Caregivers of or people who live with children less than six months old

You should get a flu vaccination, which is available in either a shot form or a nasal vaccine spray, each season for "optimal protection," says the release.  The spray is recommended for "healthy, non-pregnant people aged 2 through 49," and is the best choice for children 2 to 8, but parents should get the shot for their child if the spray is not available.

The CDC also recommends that children under 9 who did not get a flu shot during the previous season get a second dose four or more weeks after their first vaccination.

A high-dose flu vaccine, designed to provide better protection against the flu, is available this year for those 65 and older, says the release. This age group should also ask their health care provider about the pneumococcal vaccines, which helps to prevent a type of pneumonia, one of the flu's most serious and potentially deadly complications.

Flu and resulting pneumonia cause between 20,000 and 40,000 deaths nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older, the release says. For more information on the flu or the availability of flu vaccine, contact your local health department or visit http://healthalerts.ky.gov.

Experts suggest ways to win public-policy changes to fight obesity

Though the obesity epidemic shows signs of stabilizing, it still carries national security risks—negatively affecting education, agriculture and transportation—and public policy change can incredibly important in reducing obesity, Richard Hamburg, deputy director of Trust for America's Health, said at the Southern Obesity Summit in Louisville Oct. 7.

Kentucky and 42 other states have adult obesity rates of at least 25 percent, according to The States of Obesity.

Leon Andrews, senior fellow of the Institute for Youth, Education and Families discussed work with First Lady Michelle Obama's Let's Move! campaign, in which all 50 states and over 450 school districts are participating. The initiative includes new nutrition standards for school meals and ideas for encouraging exercise. Andrews urged attendees to ask their elected officials to participate in the campaign if they aren't already. Share positive feedback and success stories with elected officials as well instead of just making requests, said Whitney Meagher, project director at the National Association of State Boards of Education. "They need to be reassured that they did a good job and that this is actually working."

Jasmine Hall Ratliff, a program officer for the Robert Wood Johnson Foundation, said every community has a slightly different culture of health, but everyone should have the option to make healthy choices no matter where they live. She recognized that fighting obesity is multifaceted, and children need to both eat better and move more. "There are many communities where access to healthy foods is impossible, and there are no playgrounds. We fund advocacy and policy change at various levels to make access to physical activity and good food the default instead of the exception." She recommended checking out preventobesity.net, a place to access resources and talk with other advocates.

Voices for Healthy Kids, a joint initiative of the American Heart Association and the Robert Wood Johnson Foundation, supports nonprofits working to prevent obesity through public policy, said Kim Milbrath, the initiative's southern regional manager. Its campaign focuses on policy in six areas: improving nutritional quality of snack foods in schools; reducing consumption of sugary beverages; protecting children from unhealthy food marketing; increasing access to affordable healthy foods; increasing access to parks, playgrounds and bike paths; and helping youth-serving programs increase children's physical activities. The initiative is funding projects in nine Southern states but not in Kentucky, at least yet.

Milbrath also offered practical advice for winning policy changes to fight obesity: Make sure you're including and informing the right people, including business groups, parents, school administrators, groups with political power and all those who share the goal. Messages should be carefully constructed to clearly express the purpose of the campaign and to personalize it to the audience's concerns. Recognize that contributions will vary, set clear expectations, decide exactly how the money will be used and include the issues important to the audience, like job creation.

State health department issues 'call for action' to fight childhood obesity, seeks help from child-care providers

The state Department for Public Health has issued a "call for action" to fight childhood obesity, a long-term health burden in which Kentucky continually ranks in the top 10 among states, and currently first among high-school students.

The department's obesity-prevention program and the Partnership for a Fit Kentucky are encouraging early-child-care providers, education professionals, parents and health advocates to help battle obesity through training, family engagement, and aligning policies to meet or exceed best practices. For the full call to action, click here.

"It's no secret that childhood obesity has reached epidemic proportions in this country, and many young people are already overweight by the time they enter elementary school," Health Commissioner Stephanie Mayfield said.

Kentucky has 2,925 licensed child-care centers, licensed child-care homes or certified homes, so "The opportunity exists for these Kentucky centers to help reverse the growing childhood obesity epidemic," said Elaine Russell, coordinator of the agency's obesity prevention program. "These facilities offer a spectrum of opportunities for policy changes to directly address healthy foods and beverages, screen time limits, physical activity, breast-feeding support for Kentucky's children."

Supporting and educating families will be important for the success of an obesity-prevention project funded by the federal Centers for Disease Control and Prevention. Four thousand children in Boone, Campbell, Fayette, Jefferson and Kenton Counties are expected to benefit from the program the first year, and in 2015, 100 other early-care and education programs in other parts of the state will participate.

"We are all facing an epic battle against some of the highest levels of obesity and chronic disease in the country," Russell said. "If we don't act, we will be ignoring our responsibility to provide the foundation for a brighter, healthier state for future generations of Kentuckians."

The department is asking that those caring for young children join the call to action by going to the partnership's webpage or by emailing Rebekah.Duchette@ky.gov.

Kentucky is hosting the Southern Obesity Summit Oct. 5-7 in Louisville. For a story on it by Darla Carter of The Courier-Journal, click here.

Raw milk suspected as cause of bacterial infections among four children in Hardin County and one in Oldham County

Five children in the Louisville region were recently hospitalized with E. coli bacterial infections, and all had consumed unpasteurized milk, state health agencies found. Investigators have not yet proven that raw milk caused the infections, but "found raw milk was the only common factor among the sick children," Forrest Berkshire reports for The Kentucky Standard in Bardstown and The News-Enterprise of Elizabethtown.

Four of the children are from Hardin County, and one is from Oldham. All went to a hospital to be treated for complications of E. coli, which attacked their red blood cells and affected their kidneys. The Lincoln Trail District Health Department said tests of milk from the suspected dairy and distributors were negative for E. coli, a bacterium common to the intestinal tracts of mammals.

"Pasteurization is the process of heating a liquid such as milk to a high enough temperature to destroy disease-causing microorganisms," Berkshire explains. "It also increases the shelf life of milk by destroying spoilage microorganisms and enzymes."

The state Department for Public Health said, "DPH is stressing the dangers of unpasteurized milk after learning all the affected children had consumed it and because it is a known source of E. coli bacteria, as well as numerous other pathogens that can lead to illness."

Selling raw milk is illegal in Kentucky, but is available through a "herd share," which allows members to buy an interest in a cow that allows them to take the milk home. "Northern Kentucky U.S. Rep. Thomas Massie, a Republican, introduced two bills earlier this year he characterized as 'milk freedom legislation' and would strip the U.S. Food and Drug Administration of its authority to police raw milk sales," Berkshire writes. Supporters of raw milk say it helps people resist disease and promotes better growth, stronger teeth and better behavior.

However, the federal Centers for Disease Control and Prevention conducted a study over a decade that found "the risk of outbreaks caused by raw milk is at least 150 times greater than the risk of outbreaks caused by pasteurized milk," Berkshire reports.

Kentucky law requires milk must be pasteurized, and officials encourage buyers to check labels to make sure it is, and throw it out if pasteurization cannot be confirmed. "Even negative tests do not guarantee that raw milk is safe to drink," the CDC says on its "Raw Milk Questions and Answers" webpage. "People have become very sick from drinking raw milk that came from farms that regularly tested their milk for bacteria and whose owners were sure that their milk was safe." (Read more)

All adults over 45 should be screened for diabetes every three years, but only half are, and the poor are less likely to do so

Only about half of U.S. adults that the American Diabetes Association recommends to be screened for diabetes are actually being screened, according to a study published in the American Journal of Preventive Medicine.

The ADA recommends that all adults over 45 be screened for diabetes at three-year intervals, but the study found that only 53.2 percent of people in that age group had been screened in the last three years. "Up to one-third of people with diabetes are undiagnosed," the researchers noted in a release from Health Behavior News Service.

Kentucky ranks 17th among the 50 states in diabetes, according to the 2014 "State of Obesity" report. The study also found that screening was less prevalent in minorities and those with lower socioeconomic status, which is prevalent in Kentucky.

The ADA's president of health care and education, Marjorie Cypress, said in the release that she wasn’t surprised by the study’s findings. She explained some reasons why under-served and high-risk populations aren't screened and suggested it might be time to take screenings to where the people are.

“Fear keeps some people from being screened,” she said. “They’re afraid of what they may learn. Others only seek medical care when they are sick, and at that time they may not be screened for diabetes because the illness that brought them to a clinic is the priority at hand. Still others stay away from health care and screenings altogether because they don’t have health insurance, although that may be changing as more people gain coverage.”

Researchers reviewed self-reported responses from 21,519 adults taking part in the 2005-2010 National Health and Nutritional Examination and the 2006 national Health Interview Survey who were screened for diabetes in the last three years. The study found that 66.4 percent of participants were overweight, yet only 47.7 percent had a blood screening test for diabetes. 49.5 percent of participants were over age 45 but only 53.2 percent of them had been screened.

UK headache clinic among top 20, and affiliated orofacial pain program is only one in Midwest or South; they give relief

Headache sufferers often struggle with finding the right treatment, and some even find themselves on medications that don't work and become completely unable to function. One of those found relief at the headache clinic at the University of Kentucky.

Tonya Morgan, a 30-year-old chemist, got a debilitating migraine headache that wouldn't go away in 2011. Before she connected with the UK clinic, she had seen many doctors and was taking as many as 30 different types of medicine a day to no avail, and had been given a recommendation from the Cleveland Clinic after an 11-week evaluation, for "extremely risky brain surgery," says a UK news release. "I was so sensitive to noise that I could lie in my bed and hear my mother down the hall eating potato chips. Going to a restaurant, driving, going to church -- all of those became unbearable. I was miserable," Morgan said.

Her doctor is Dr. Siddharth Kapoor, director of the Headache Clinic at the Kentucky Neuroscience Institute at UK HealthCare. He and Dr. Jonathan Smith are part of the headache program at UK that is considered among the top 20 accredited programs in the country, according to the release. It uses a multidisciplinary approach; UK HealthCare's orofacial pain program, which complements the services of the headache clinic, is one of just 12 accredited programs nationally, and the only one in the entire Midwest and South.
Kapoor's strategy, says the release, includes spending enough time with the patient to find out as much as he can about their headaches and finding the most effective way to get rid of them. "Headache is an extremely complex neurological process, and there usually isn't a quick fix for pain relief," Kapoor said. "Unless you spend a lot of time with each patient, listening to their problems and asking a lot of questions, it's nearly impossible to find the right way to help them."

Kapoor tried several different treatments on Morgan before they found the most effective: radio-frequency ablation, during which a high-frequency electric current was targeted at specific nerves in the brain, destroying the tissue responsible for her headaches. She is now headache free and has resumed a "normal life," the release says.

Headaches and other chronic pain affect more than 36 million Americans, and many of them don't seek help -- or see doctors who aren't completely aware of the full range of pain management, according to the release. Smith said there are many myths surrounding headache causes, such as foods or changes in blood vessels in the brain, and the UK clinic can "attack headache on many fronts."