Baptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort

Baptist Health has become the first stand-alone health-care provider to sign on as a founding partner in Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Baptist will work with SOAR to develop and implement health and education initiatives for residents of Appalachian Kentucky and has committed $150,000 to the initiative over the next three years, the organizations said in a press release.

“Baptist Health understands Eastern Kentucky because we have a proven and time-honored commitment to the health and well-being of our people,” Stephen C. Hanson, chief executive officer of Baptist Health, said in the press release. “Our participation in SOAR reflects this pledge. Besides Richmond, we’ve also got hospitals in Corbin and Lexington, along with outpatient facilities, doctors’ offices and other services all over Eastern Kentucky, the rest of the commonwealth and indeed throughout the region."

The University of Kentucky was the first founding sponsor of SOAR, pledging $300,000 over the next three years and winning the right to use the UK HealthCare brand on SOAR materials as well as the university's general logo.

Gov. Steve Beshear and Congressman Hal Rogers formed SOAR in the fall of 2013 to create strategic plans to improve Eastern Kentucky's economy and quality of life.

“Our primary objective is creating and maintaining jobs across eastern Kentucky, and in order to do that, we need a healthy and well-educated workforce,” Beshear said in the release. “I’m pleased that Baptist Health understands the key connections among our efforts and the critical role that health will play in the future of this region."

Researchers discover why common blood-pressure medicine doesn't work for some people: your kidneys don't want to lose salt

Each year, more than 120 million prescriptions are written around the world for thiazide drugs, which lower salt to treat high blood pressure. High blood pressure affects 28 percent of Kentucky adults, according to the state Department for Public Health. Thiazide drugs often save lives but are ineffective in some patients and only work for a time in others. A study by University of Maryland School of Medicine researchers has found a key reason for the failure.

Thiazides prevent salt from moving through the kidney, causing it to expel salt and water. However, the researchers found that the kidney seems to know "that it's losing too much salt and activates mechanisms to retain salt in other ways," said Paul Welling, a professor of physiology at the University of Maryland.

The researchers studied an animal model designed to prevent salt retention, which imitated the thiazides' effects. They discovered almost 400 genes that alter their activity to assist regulation of the kidney's salt control. Eventually, it might be possible to make drugs that affect the body's mechanisms that control how the body interacts with thiazides.

Welling and his colleagues also may have discovered a "biomarker" that could allow doctors to easily find out in which patients thiazides will not work. When the kidney is working against the thiazides, a certain molecule increases in the urine. "Now that we know more about these novel pathways and processes, we can begin to find new ways to help patients with high blood pressure," said Dean E. Albert Reece, vice president for medical affairs at the University of Maryland.

Study suggests that adolescent exposure to alcohol can negatively affect learning, memory and behavior in adulthood

A study at Duke University suggests that repeated exposure to alcohol during adolescence causes long-lasting changes in the part of the brain that controls learning and memory. The study, published in the journal Alcoholism: Clinical & Experimental Research, helped explain how exposure to alcohol before the brain has fully developed can cause cellular and synaptic abnormalities and negatively affect behavior. Kentucky is ranked 9th in the nation for the percentage of children who drank alcohol before age 13 (25.1 percent), according to the state Department for Public Health.

"In the eyes of the law, once people reach the age of 18, they are considered adult, but the brain continues to mature and refine all the way into the mid-20s," said lead author Mary-Louise Risher, a post-doctoral researcher in Duke's Department of Psychiatry and Behavioral Sciences. "It's important for young people to know that when they drink heavily during this period of development, there could be changes occurring that have a lasting impact on memory and other cognitive functions.

Studies had shown that animals exposed to alcohol at an early age do not perform as well in memory tasks as those not exposed to it. The new study, which involved exposing young rodents to alcohol and waiting for them to grow into adulthood, found that the exposure also affects the hippocampus, the area of the brain that controls memory and learning. The researchers measured a cellular mechanism called long-term potentiation, which involves the strengthening of brain synapses being used to learn new tasks or bring up memories. Ideally, LTP should be high, especially in young people. The researchers found that the adult rodents exposed to the alcohol during adolescence had higher levels of LTP, which may seem to be a positive outcome but is actually not.

"If you produce too much LTP in one of these circuits, there is a period of time where you can't produce any more," said senior author Scott Swartzwelder, a Duke professor. "The circuit is saturated, and the animal stops learning. For learning to be efficient, your brain needs a delicate balance of excitation and inhibition—too much in either direction, and the circuits do not work optimally."

The researchers also observed a structural change in individual nerve cells: those exposed to alcohol at a young age have brain cells that appear immature, even in adulthood. "It's quite possible that alcohol disrupts the maturation process, which can affect these cognitive functions later on," Risher said. She also noted that the immature appearance of the cells might be associated with behavioral immaturity.

Federal agency offers a consumer-friendly website that ranks patients' experiences in your local hospitals

Consumers now have access to a website that ranks 3,500 hospitals around the country on patients' experiences to help them choose a hospital and better understand the quality of care participating hospitals offer, according to a Centers for Medicare and Medicaid Services press release.

The 12 star ratings on Hospital Compare are based on 11 of the publicly reported measures from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, and a summary rating for the survey. The survey asks patients questions about nine topics:communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care. This survey information is self-reported by patients and will be updated quarterly.

“The patient experience star ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality,” Dr. Patrick Conway, acting principal deputy administrator for the CMS, said in the release.

Consumers already have access to Medicare star systems to rate nursing homes, dialysis centers, private Medicare Advantage insurance plans and certain situations for physicians and group practices, but are they using it?

Not much, according to a recent Kaiser Family Foundation poll. It found that only 31 percent of those polled had seen any information comparing doctors, hospitals, and health insurance plans in the past 12 months. When asked specifically if they had seen information comparing prices or quality across plans and providers, fewer than 1 in 5 people said they had seen such information, and fewer than one in 10 reported using such information.

CMS said the website helps meet goals of the Patient Protection and Affordable Care Act, which calls for transparent, easily understood and widely available public reporting. The agency also reminds consumers that the site is just one tool to help them make a decision abut which hospital to use, and encourages them to talk to their health-care providers about hospital quality, and to use "multiple factors" when deciding about a hospital, such as clinical outcomes and other publicly reported data that is on the website.

To see the rankings:

• Go to the Hospital Compare website
• Type in your ZIP code, or the name of a particular hospital
• Click on "Search"
• Choose three hospitals, by clicking on the "Add to Compare" button
• Click on "Compare Now," located at the top of the screen
• Click on "Survey of Patients' Experiences"
• Scroll down and view star ranking and additional information results

This is a screen shot of the final screen, with a bar of options to click on.

Study shows that removing a clot that causes a stroke leaves victims with higher functional independence

In Kentucky, strokes cause about 5 percent of deaths, and the state had the 11th highest stroke mortality rate in 2009, according to data from the Kentucky Cabinet for Health and Family Services. Fewer than 40 percent of severe stroke victims regain functional independence if they get only the standard drug intervention, but a study has found that also removing the clot both helps restore blood flow to the brain and can lead to more favorable long term outcomes.

"The outcomes are the difference between patients being able to care for themselves after stroke and being dependent," said Demetrius Lopes, surgical director of the comprehensive stroke center at Rush University Medical Center.

The traditional treatment for ischemic stroke—a stroke that involves clots in vessels bringing blood to the brain—is intravenous tissue plasminogen activator (tPA), a medication to dissolve the clot. However, doctors can also perform thrombectomy, a minimally invasive procedure to remove the clot that is allowed only in clinical trials.

In the study, patients with severe ischemic strokes were split into two groups. One group received only tPA, while the other group received tPA as well as thrombectomy. After 90 days, those who received both treatments had less disability and had a functional independence rate of 60 percent, compared to 35.5 percent of those who received only tPA. Also, patients who received thrombectomy had better blood flow rates in the brain.

"Ethically, we can't deny patients a treatment when we have such strong evidence it's better for them," Lopes said. Now thrombectomy is a standard treatment for severe strokes at Rush and some other locations. The study is published in the online edition of the New England Journal of Medicine.

Elementary-school students prompt Middlesboro smoking ban

UPDATE, May 20: The council passed the ban with one member opposing it. Gary Mills said, “I don’t think it’s the government’s right to intrude on businesses owned by individuals. If the public doesn’t like it, they won’t come. . . . This is too intrusive by the government.” Two non-smoking business owners expressed similar sentiments.

The Middlesboro City Council has approved on first reading an ordinance that would ban smoking in public, enclosed spaces. "It remains unclear if the ban would apply to the use of e-cigarettes and vaping products," William Tribell reports for the Middlesboro Daily News.

The ordinance was prompted in part by a March presentation and petition from a group of Middlesboro Elementary School students involved in Destination Imagination, "a volunteer-led, educational nonprofit organization whose purpose is to inspire and equip students to become the next generation of leaders," Tribell writes. "The team was awarded the DaVinci Award for Outstanding Creativity for their efforts and will now compete at the world competition May 20 in Knoxville."

The students drafted the ordinance after researching those in other cities, Tribell reports: "In their presentation to the city council, the team said that 33 percent of Bell County’s population smoke, and they discussed the health effects it has on the community at large."

"The council voted unanimously in favor of the ban ordinance, and it will go up for a second-reading vote at their meeting on May 19," Tribell reports.

Southern Kentucky physician expands his in-school clinics; already in Russell County, will be in Adair County next year

Dr. Eric Loy
(Columbia Magazine photo)

An entrepreneurial physician in Southern Kentucky has developed a way to deliver school health services that could have a broader impact on communities.

Cumberland Family Medical, based in Burkesville, has clinics at the five schools in Russell County and now has a deal to do likewise with the four in adjoining Adair County.

Dr. Eric Loy, who owns the clinic, "said that the agreement could have an important impact on the community both short term, by helping create a healthier and more focused student body; and long term, by creating a culture where people get acclimated to seeing doctors and nurses for physicals and regular checkups on a consistent basis," Wes Feese reports for The Adair Progress.

“We have a chance to change the culture of health care in Kentucky,” Loy told the Adair County Board of Education, which voted to spend $80,000 next year on the clinics. That is "roughly the same cost the district currently pays for school nurses," Feese reports. "If the trial run next year is successful, both parties will have options to continue the agreement."

"Cumberland Family Medical will pay two-thirds of the nurse expense and will bill the insurance of the patient," Toni Humphress reports for the Adair County Community Voice.

School Supt. Alan Reed complimented the dedication and service of the county’s school nurses but said costs to employ them were “soaring,” Feese reports. Reed said of Loy's plan, “This is kind of a novel approach, and from all we’ve seen, we really like it. It cuts down on time and any barriers for a kid getting health care.”

Loy agreed, saying, “A lot of times that’s the barrier, that it’s hard [for parents] to miss work.”

School principals said sick students may have to sit in an office or lobby all day because working parents are unavailable to come pick the students up and take them to a doctor. "Director of Pupil Personnel Robbie Harmon said that this move could have a bigger long-term impact on the community than any project he’s worked on in his time in the school system."

Loy's in-school clinics are manned by a full-time nurse practitioner who travels between schools, and is overseen by a physician. "Loy said that all forms of insurance would be accepted, and that all children would be seen and treated, regardless of their ability to pay," Feese reports. "He also said that the clinics could help out with insurance enrollment."

Adair County had one of the state's highest percentages of people without health insurance until the federal-state Medicaid program was expanded under federal health reform. The uninsured rate has dropped dramatically, but some families are still without health coverage.

Anthem gives $140,000 for 3-county program to cut smoking by pregnant women, still at 21.9% in Ky., among highest in U.S.

Health departments in Christian, Hopkins and Madison counties will start a program called Giving Infants and Families Tobacco Free Starts, with a $140,000 grant to the state health department from the Anthem Foundation.

The GIFTS program was created to help decrease the number of women who smoke during pregnancy and reduce exposure to secondhand smoke for the pregnant woman and her infant, a state news release said. Smoking before and during pregnancy is the single most preventable cause of illness and death among mothers and infants, according to the federal Centers for Disease Control and Prevention.

“Tobacco use is a serious problem in Kentucky, but it is an even more serious issue for women who smoke during pregnancy,” said Dr. Ruth Shepherd, director of the state health department's Division of Maternal and Child Health. “Smoking during pregnancy and infant exposure to secondhand smoke create numerous risks for babies, including pre-maturity and low birth weight, and risks for developing certain conditions like asthma.”

Smoking rates among pregnant Kentucky women dropped from 26.3 percent in 2004 to 21.9 percent in 2013, but that is still among the highest rates in the U.S. In 2013, 13.3 percent of Kentucky births to smoking mothers were premature, compared to 10.2 percent of births to mothers who did not smoke. Even more striking were these numbers: 13.6 percent of babies born to smokers had low birth weight, compared to only 7.5 percent of those born to non-smokers.

The GIFTS program includes a screening tool for assessing tobacco dependence; screening for depression, social support and domestic violence; individualized counseling and support; referral to a service that helps smokers quit; and educational materials, including relapse prevention and the risks of secondhand smoke exposure in the home.

“Reducing the amount of tobacco use and secondhand smoke exposure is not only crucial for improving the health of our state,” state Health Commissioner Stephanie Mayfield said in the news release. “We are thrilled to receive this grant from the Anthem Foundation and look forward to building on the success of GIFTS and working toward reaching our state’s health goals.”

Smokers using electronic cigarettes are less likely to quit smoking than those who don't use the devices, California study finds

The sudden increase in use of electronic cigarettes has prompted questions about whether they actually help people quit smoking. A study published online in the American Journal of Public Health found that individuals who use e-cigarettes are actually less likely to quit smoking than those who do not. In Kentucky, 24 percent of adults and 41 percent of those aged 18 to 29 reported using e-cigarettes, according to a Kentucky Health Issues Poll.

The study, conducted by researchers from the University of California San Diego School of Medicine, discovered that smokers who use e-cigs are 59 percent less likely reduce cigarette use and 59 percent less likely to stop smoking altogether, compared to smokers who have not used e-cigs.

"Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting," said Wael Al-Delaimy, professor and chief of the Division of Global Public Health in UC-San Diego's Department of Family Medicine and Public Health. He said the research showed the hypothesis was false, and more studies are required to find out why these people can't stop smoking. "One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes," he said.

E-cigs don't contain tobacco, but smoking them releases ultra-fine particles and volatile organic compounds such as heavy metals. The study also found that women and those who smoke daily are more likely to have tried e-cigarettes.

New treatment for symptoms of advanced Parkinson's disease approved by FDA and unveiled at UK

Portable infusion pump used
to deliver Parkinson's drug

The University of Kentucky unveiled a new treatment for people with advanced symptoms of Parkinson's disease at a news conference April 21 and invited one of the first patients to participate in the clinical trial to share how this treatment has improved his function and productivity.

The new, trademarked, treatment, Duopa, provides a continuous 16 hour dose of levodopa, which is the "gold standard" drug to treat Parkinson's disease ,using a special gel preparation, is put directly into the small intestine by a portable infusion pump. It was developed by AbbVie Inc. and approved by the U.S. Food and Drug Administration in January.

"This treatment extends our ability to manage the signs and symptoms" of Parkinson's, said Dr. John Slevin, professor of neurology and vice chair of research at UK's Kentucky Neuroscience Institute. Slevin also worked with international investigators to test this treatment and is the lead author of the study, which is published in the Journal of Parkinson's Disease.

Parkinson's is a chronic and progressive disease of the nervous system that is characterized by motor symptoms such as tremors,slowness, stiffness and impaired balance and coordination. It can also cause non-motor symptoms such as sensory deficits, cognitive difficulties and sleep problems.

The cause of Parkinson's is unknown and there is no cure, but it is known that the disease process involves the death of nerve cells in the brain that produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination.

Slevin said that there are many challenges in treating the symptoms of Parkinson's as it progresses. In addition to the continued loss of nerves in the brain, he said levodopa looses its effectiveness over time and the dose level begins to fluctuate. He also noted that over time patients will get a side-effect from the drug called dyskinesia, or involuntary muscle movement.

Another challenge, which he said prompted the development of this treatment, is that the muscles that control digestion are also affected by the disease, which creates an inconsistency in the blood level of levadopa that can be turned into dopamine in the brain.

This new treatment alleviates this challenge by placing the drug directly where it is absorbed in the intestine, allowing "The blood level, and thereby brain level (to remain) constant and that reduces the probability of having intermittent dyskinesia," Slevin said.

Marion Cox

"We are extremely pleased with the results," Slevin said in a press release. "Patients with advanced Parkinson's disease treated via this new method demonstrated marked improvement in symptom fluxuations and reduced dyskinesia."

Marion Cox, a 70-year-old Georgetown farmer and former real estate developer, who has had Parkinson's for 16 years, participated in the clinical trial for three years and said that this treatment has given him a "new lease on life."

"It was the best thing that ever happened to me. The improvements have been that great," Cox said. Later saying, "I can do anything I want to do. I can horseback ride. I've got a team of horses that I drive. I've got lots of farm equipment, excavating equipment that I drive. Before I went on the trial I was still doing those things, but unbelievably slow."

Dr. Michael Karpf, Becky Cox, Marion Cox, Dr. John Slevin

Dr. Michael Karpf, UK's vice president for health, said he was proud to be part of a major health center committed to doing clinical trials: "What UK HealthCare has to do is to not (just) practice the standards of care, we have to move the standards of care forward." Cox will be the first patient in Kentucky to receive Duopa after FDA approval.

Becky Cox, Marion's wife of 25 years, said the treatment "saved him from an early retirement." She noted that before Duopa, he had been taking an "unmanageable" number of pills to treat his symptoms, but now, after he hooks up to the pump in the morning, "It is a set it and forget it kind of thing. ... He is off and running like he always used to be, so that has been a great blessing."

Because this treatment involves an invasive procedure and because most people with Parkinson's disease respond well to oral medication initially, Slevin said this treatment is meant for those with advanced Parkinson's symptoms. He also said the cost for this treatment is still being determined, but it was already approved by Medicare. He noted that the next step will be to train other medical centers in how to deliver this treatment.

The National Parkinson Foundation website says 1 million people in the U.S. have the disease, with 50,000 and 60,000 new cases diagnosed each year. Kentucky has 14,000 people with it, Tony Bucalo, Parkinson's neuroscience account executive at AbbVie, said after the news conference.

Kentucky re-bidding Medicaid managed care contracts to address complaints of patients, advocates and health-care providers

By Melissa Patrick
Kentucky Health News

State officials are re-bidding Medicaid managed-care contracts that cover more than 1.1 million Kentuckians. The news came as a delight and surprise to many health-care providers and patient advocates.

“I was both stunned and thrilled by the announcement. I did not know it was coming,” Sheila Schuster, a Louisville mental-health advocate, told Tom Loftus of The Courier-Journal. “A number of the changes that they say will be part of the new contracts are things those of us in the behavioral health community have brought up time and time again.”

Kentucky changed to Medicaid managed care from a traditional fee-for-service model in 2011 to fill a projected budget overrun of $166 million. Health Secretary Audrey Haynes said in a news release that doing so has "saved Kentucky taxpayers more than $1.3 billion in state and federal funds" and had also improved the delivery of health care to the Medicaid population.

"However, after several years of experience, we determined it was time to retool, rebid and strengthen the contracts to appropriately address concerns expressed by advocates and healthcare providers," Haynes said.

The transition to managed care has been met with consistent complaints from both patients and providers, despite efforts of the cabinet to work through the issues and keep the channels of communication open between providers, the cabinet and the managed-care organizations.

Two passionately debated bills in the recent legislative session challenged some practices of the current MCOs: one seeking an appeals process for denial of payments and the other removing a cap of "triage fees" for emergency-room services that MCOs later deem not to be emergencies.

Both issues have been challenging to the financial health of rural hospitals. State Auditor Adam Edelen addressed many such issues in a recent report on the financial health of rural hospitals.

“We are pleased to see the cabinet taking steps to improve and strengthen managed care contracts, many of which we recommended in our recent report on the financial strength of rural hospitals,”Edelen told Insider Louisville.

Some requirements for the new contracts include: required statewide coverage; standardized rules among the MCOs; improved administrative processes; increased oversight of claim denials; continued expansion of behavioral health services; incentives for MCOs to work with Medicaid patients to decrease emergency-room use and improve their health; and increased penalties to assure contract compliance. Click here for the Cabinet for Health and Family Services' complete Request for Proposal.

“I’d like to say that they heard the voice of the people,” Schuster told Insider Louisville.“If you look at the Medicaid Advisory Council, those meeting are every two months and it’s the same litany of complaints and concerns every darned time with no response. The only thing I can think of is it’s a gesture by this outgoing administration to get things right so that regardless of who comes in next year, there are strong contracts in place. I applaud them for it, and I’m stunned.”

The current contracts with Anthem, Aetna's Coventry Cares, Humana's CareSource , Passport and Wellcare expire on June 30, 2015 and proposals for the new contracts are due by May 5. The statewide contracts will be awarded to multiple MCOs for a one-year period with four, one-year renewal option, according to the news release.

Kentucky's suicide rate is above the national average; experts say we need to ignore the stigma and become educated about it

Kentucky's suicide rate is higher than the national average, and an expert says we must create an open dialogue about it and provide more education if we want this rate to decrease, Kat Russell reports for The Paducah Sun.

"People commit suicide when they see no way out from whatever the situation is," Dr. Laurie Ballew, medical director at Paducah's Lourdes Behavioral Health Institute, told Russell. "Usually people feel hopeless, they see no light at the end of the tunnel, and that hopelessness is a key factor in someone following through with the act of killing themselves."

Russell did an in-depth look at suicide in McCracken County, where the newspaper and its owner, Paxton Media Group, are based. "McCracken County is ranked 13th in the state as far as suicide, so if you take into consideration all of the (120) counties in Kentucky, we're pretty high," Ballew said. Click here to find out where your county ranks.

Kentucky has 15.5 suicides per 100,000 people, compared to 12.5 nationwide. It is the 10th leading cause of death in Kentucky and the second leading cause of death in people 15 to 34, according to the according to the federal Centers for Disease Control and Prevention, Russell reports.

McCracken County Sheriff Jon Hayden told Russell that his department investigated 31 suicides in each of the last two years and five so far this year. The Paducah Police Department reported 31 suicides in 2013 and 35 in 2014, and six suicides this year. The local 911 dispatch center told Russell that it had fielded more than 540 calls threatening suicide and more than 130 attempted suicides since Jan. 1, 2013.

"We get calls multiple times per week, threatening suicide either with medication or a weapon of some sort," Hayden said, noting that most of the calls do not result in suicide and the individual usually gets the help they need.

WebMD lists these warning signs of suicide, which are especially concerning if a person has attempted suicide in the past:

• Always talking or thinking about death
• Clinical depression that gets worse
• Having a "death wish," tempting fate by taking risks that could lead to death.
• Losing interest in things one used to care about
• Making comments about being hopeless, helpless, or worthless
• Putting affairs in order, tying up loose ends, changing a will
• Saying things like "it would be better if I wasn't here" or "I want out"
• Sudden, unexpected switch from being very sad to being very calm or appearing to be happy
• Talking about suicide or killing one's self
• Visiting or calling people to say goodbye

Drug and alcohol abuse also can be factors, Ballew told Russell. "What do those things do? They decrease our inhibition, they decrease our filter that tells us 'Oh no, you don't want to do that.'"

Ballew told Russell if a person's behavior changes are milder, "sometimes showing that person support and compassion can alleviate some of his or her suffering and encourage them to get help," but it is important to seek medical attention for "severe cases."

"If you have an individual who just gets more and more depressed, who won't get out of bed or gets to the point where they can't get out of bed, then you (should) call an ambulance or get them to a hospital and have them admitted," Ballew said, stressing the importance of education and open discussion.

"Emotional illness can hit anybody," she told Russell. "We're all humans. ... Anybody can feel hopeless or helpless at any time. If we could reduce the stigma that is attached to depression and mental illness and suicide, then I think people who are suffering might see that maybe there is some hope. But the only way to prevent something is to be educated about it."

Pilot salad bar will determine whether other Jefferson Co. schools follow suit in bid to increase students' veggie and fruit intake

The Jefferson County Public School system is pilot-testing a salad bar at Atherton High School to entice students to eat more vegetables and fruits, a goal of the new federal nutrition standards, Allison Ross reports for The Courier-Journal.

Photo from TheProduceMom.com

"We're always looking for new ideas to increase participation or attract students to come through the serving line," Terina Edington, assistant director for nutrition services, told Ross.

Many of Kentucky's children are falling far short of the daily recommended four and a half cups or more of fruits and vegetables, a shortcoming that one study says will contribute to early heart disease. The Centers for Disease Control and Prevention 2013 State Indicator Report on Fruits and Vegetables found that only 50 percent of Kentucky adolescents reported eating fruit and 43 percent reported eating vegetables with a median intake of one time per day for both.

Salad bars were once common in Jefferson County schools, but concerns about portion control and contamination concerns caused them to "slowly disappear," Edington told Ross. Many schools across the country continue to "remain leery" of adding salad bars because of such health concerns, Ross writes.

This trial will help the district determine whether it will put salad bars in other schools. Cafeteria modifications for the salad bar at Atherton cost $400, Ross reports.

A push for schools to add more salad bars has been led by First Lady Michelle Obama's "Let's Move" initiative, which co-sponsors a "Salad Bars 2 Schools" program that has donated more than 4,000 salad bars to schools, Ross reports. "A 2014 evaluation of that program found that 57 percent of participating schools saw an increase in student participation in school lunch, and 78 percent reported buying more fruits and vegetables."

The school's Facebook page said that the salad bar would have diced ham, turkey breast, fajita chicken strips, cucumbers, baby spinach, radishes and four types of dressings, with the lettuce and meat portions pre-measured, while the other ingredients will be self-serve.

Atherton High parent Lynn Greene told Ross that she is "thrilled my child has a healthy option," saying she hopes other schools will also get salad bars.

Proposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate

A three-year research project to determine factors that can support a culture of health in Appalachia and whether that knowledge can be translated into actions that address the region's health disparities has released its Request for Proposal to invite proposals from qualified research teams and consultants who would like to work on this project.

The project,“Creating a Culture of Health in Appalachia: Disparities and Bright Spots,” is sponsored by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky and will run through the end of 2017.

The research for this project will identify Appalachian “bright spots,” where health outcomes are better than would be expected based on unemployment and poverty rates and other community factors, and try to figure out why. Researchesr will also try to determine why health outcomes in some communities are not as good as would be expected.

The request for proposals offers detailed guidelines for submissions, which are due June 8. Applicants are encouraged to register for a webinar, detailed on the RFP, to be held May 7 at 10 a.m. EDT. Click here for more information.

Mount Sterling follows lead of another KentuckyOne Health hospital, in Bardstown, to host monthly 'Walk With a Doc'

Saint Joseph Mount Sterling is the second KentuckyOne Health hospital to host monthly "Walk With a Doc" events as part of a nationwide program that promotes walking as a great way to improve your health, while at the same time offering a place to get to know your local physicians in an informal setting as you walk together. The program also offers a complimentary health screenings at the event, says a news release from KentuckyOne Health.

Flaget Memorial Hospital in Bardstown, also part of KentuckyOne Health, began its "Walk With a Doc" program in March.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein and even reduce risks of bone fracture. Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer," says the release.

The Mount Sterling walks begin at 9 a.m. on Saturday, April 25 at Easy Walker Park, located at 1395 Osborne Rd. For more information call 859-497-5556.

Stranger donates kidney after knowing recipient 5 minutes; could boost living kidney donations, which have better odds

Two strangers were randomly asked to take part in a five-minute demonstration of living art. It led to one of them donating a kidney to the other, Bailey Loosemore reports for The Courier-Journal.

The  idea of the demonstration, produced by Transylvania University faculty members for the 2013 IdeaFestival, was to ask two strangers to talk for five minutes, and then post a "burning question" on Twitter.

After five minutes of discussion, a University of Louisville employee, identified only as Kathy, told Loosemore that she thought about how she wanted to do something important and  decided her burning question was, "What's next?"

Jackie Thomas (C-J photo by Alton Strupp)

Jackie Thomas, a retired teacher and dialysis patient since 2011, was also wondering "What's next?" She had recently been placed on a kidney transplant list, but had already started looking into living donations, in which a healthy person volunteers to donate one of their organs, because the wait is so long to get a kidney from a deceased donor, Loosemore writes.

But Thomas said she wasn't sure how she was going to ask someone for a kidney until Kathy asked, "What's next?" She thought "Wow, that is really a powerful question," and replied with a burning question for Kathy's Twitter feed: "Would you like to donate a kidney to me?"

Kathy said yes. "I think my question about what's next was kind of in my head, and this was kind of an answer. OK, I can donate a kidney," she told Loosemore. She asked that her last name not be revealed because she did not want the focus to be on her.

The offer left Thomas speechless, Loosemore reports: "I said to her, 'I've only known you for five minutes, and you're going to give me a kidney?' She said 'Yeah,' and she looked really serious. ... So I thought, 'Here is the answer to my prayers, maybe.'"

Because living donations are all voluntary, Thomas did not know for certain if the transplant was really going to happen until the day of the surgery, April 8, 2014.

Kathy, who told Loosemore that she meets Thomas for lunch at least once a month, said she has no regrets.

"It's a really personal decision," she told Loosemore. "I'm not going to go out and say everybody should donate a kidney, but I think people should know for a healthy person, it's relatively risk-free and it's not that painful. And if they're really interested in doing something that makes a big difference in someone's life, educate themselves, but definitely think about donating a kidney, because it's not that bad."

Loosemore reports that more than 100,000 Americans are on waiting lists for kidneys and that in 2014, living donations made up only 32 percent of transplanted kidneys -- and only 25 percent in Kentucky, according to data from the Organ Procurement and Transplantation Network. So far in Kentucky this year, there have been 13 kidney transplants, eight from deceased donors and five from living donors; last year, there were 109 from deceased donors and 36 from living.

"The benefits of living kidney donations far outweigh the risks, with living kidneys lasting twice as long as those from deceased donors and the surgeries causing little pain," Loosemore writes, quoting Dr. Mike Hughes, a transplant surgeon who works for University of Louisville Physicians and operates at Jewish Hospital — the only one in Louisville that does transplants.

Jewish Hospital continues to promote its donor champion program, in which family members are asked to request kidneys for recipients who may feel too uncomfortable to do so, and plans to hold an informational forum later this year, in an effort to raise awareness, Loosemore reports.

The forum and the donor-champion program "will help identify barriers that lead to fewer donations and will help encourage those who want to take the next step," Loosemore writes. Jewish Hospital's transplant director, Laurie Oliver, told her that living donations will become "the standard of care at some point in the future, if we can do that."

Click here to learn more about living kidney donation from the National Kidney Foundation. To learn how to donate a kidney through Jewish Hospital, call 502-586-4900.

Burgin, in heart of Kentucky, is state's 40th school district to go tobacco-free; ban, won by students, applies to vapor products

Burgin Independent Schools, in the heart of Kentucky, will be the latest 100 percent tobacco-free schools in the state, and the first in Mercer County, which has a strong tobacco heritage.

The Burgin Board of Education voted April 8 to ban all tobacco use, including vapor products, on school grounds and during school-related student trips, Robert Moore reports for The Harrodsburg Herald. The policy becomes effective July 1 and includes any building or vehicle owned or operated by the board and applies to any renters of school property.

Burgin will be the 40th Kentucky school district to become fully tobacco-free. Kentucky has 173 public- school districts, with 1,233 public schools, according to the state Department of Education.

The Kentucky 100 percent Tobacco-Free Schools website says, "Studies show that schools with 100 percent tobacco-free school policies for three years of more have 40 percent fewer smokers than those in non-tobacco free school districts." The 2013 Kentucky Youth Risk Behavior Survey found that 18 percent of Kentucky youth smoke, and 47 percent of them have smoked at least once.

"I’m really proud we’re going to be a tobacco free campus," board member Priscilla Harris told the Herald after the meeting. "We want to set a good example." The independently owned weekly newspaper recently did a three-part series on tobacco in the county, including Burgin students' efforts to get tobacco banned.

Kentucky 100 percent Tobacco Free Schools map, with Burgin added

School nutritionists' lobbying group, freshly funded by grocery makers, wants more funding and flexibility with school-lunch rules

School nutrition officials want more flexibility with new school lunch rules to cut down on the waste of unwanted food, Spencer Chase reports for Agri-Pulse, a Washington newsletter. Julia Bauscher, president of the School Nutrition Association, told the House Education and Workforce Committee that the organization supports the rules, but needs more funding to enforce them  and more flexbility to serve foods students will eat. (USDA graphic)

"SNA is requesting 35 cents more in federal funding for each lunch and breakfast that is served in the school lunch program, up from the additional six cents the government provided when the new standards were put in place," Chase writes. Bauscher told the committee, “That will help school food authorities afford the foods that we must serve, but unfortunately that won't make students consume it.”

Bauscher, who said SNA wants Congress "to soften the bill's target levels for more whole grains and less sodium in school meals," said that "in many cases, the new requirements have forced school lunch programs outside of budgetary constraints, forcing them to ask school districts to make up the difference. According to SNA, school districts will absorb $1.2 billion in new food and labor costs in 2010," Agri-Pulse reports. SNA has drawn major funding from some food manufacturers.

Chase writes that 51 percent of students qualify for free or reduced lunches, the first time the number has topped 50 percent in at least 50 years.

Fate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.

Chiropractors cite research recommending 'conservative treatments' for low-back pain before prescribing painkillers

Recent research has questioned the effectiveness of acetaminophen for the treatment of spinal pain. In response, the American Chiropractic Association recommends that patients and health-care providers take a conservative approach to back pain. According to a study published in the British Medical Journal, the commonly administered painkiller isn't helpful for diminishing low-back pain.

According to a report released by the federal Centers for Disease Control and Prevention, Kentucky ranks among the top five states for opiate painkiller prescriptions written per 100 people, Deborah Highland reports for the Bowling Green Daily News.

"Research supports the use of more conservative treatments as a first-line defense against pain," said ACA President Anthony Hamm. "This sensible approach not only reduces healthcare costs but may also help some patients avoid riskier treatments altogether," he said in a news release that has exercise tips, posture recommendations and injury prevention techniques to help people maintain healthy backs throughout life.

Pain and fever reducer acetaminophen, most-used drug in U.S., is found to reduce positive emotions and reduce psychological pain

Ohio State University researchers discovered a new side effect of acetaminophen, a leading over-the-counter pain reliever: it also blunts positive emotions. Other research revealed that it helps reduce psychological pain. The drug has been used in the U.S. for more than 70 years and is best known by the brand name Tylenol.

In the Ohio study, participants took Tylenol or a placebo, then looked at very pleasant or very disturbing photos. Those in the experimental group reported weaker emotions than those in the control group. On average, those who took the placebo rated their level of emotion when viewing the photos at 6.76 on a scale of 10, while people who took the pain reliever averaged 5.85.

"Rather than just being a pain reliever, acetaminophen can be seen as an all-purpose emotion reliever," said Geoffrey Durso, the lead author of the study and a doctoral student in social psychology.

Balwin Way, an assistant psychology professor who conducted the study with Durso, said those who took Tylenol didn't seem to be aware they were reacting differently. "Most people probably aren't aware of how their emotions may be impacted when they take acetaminophen," he said.

Acetaminophen, found in more than 600 medicines, is the most common drug in the U.S., according to the Consumer Healthcare Products Association. Every week approximately 52 million American adults, 23 percent of the population, use a medicine with acetaminophen in it. Durso said researchers don't know if other pain relievers like ibuprofen and aspirin have similar effects, but they plan to study that question.

As income taxes are filed, half who got Obamacare subsidy will have to pay part of it back; almost as many will get a refund

By Melissa Patrick
Kentucky Health News

This week will go down in history as the first time the Internal Revenue Service enforced the Patient Protection and Affordable Care Act's tax penalty for those who can afford insurance but didn't buy it.

The penalty for those who don't qualify for an exemption is $95 per adult and $47.50 per child, or 1 percent of your income, whichever is larger. The penalty will increase next year to the greater of $325 per adult or 2 percent of household income.

"Ever since its passage, the mandate that every American have health insurance has been at the heart of the controversy over the ACA," Elaine Kamarck writes for the Brookings Institution. It was an issue long before the law passed; in the 2008 presidential primaries, Hillary Clinton favored it and Barack Obama opposed it; as president, he changed his mind.

Tens of thousands of Kentuckians who got subsidies to help pay for their health insurance through the Kynect exchange will probably be surprised to find that they will have to repay some of the subsidy, or that they will get a refund, depending on the difference in their actual income level and the income that was recorded at the time they bought insurance. Most incomes were likely based on an estimated income for the year. Generally, if you overestimated your 2014 income, you will get a refund. If you underestimated it, you will have to repay some or all of the subsidy, which was subtracted from the "sticker price" of insurance to calculate your premium.

Infographic from Kaiser Family Foundation

A study by the Kaiser Family Foundation estimates that 50 percent of Americans who got 2014 tax subsidy will owe some money, and 45 percent will receive a refund. The foundation estimates the average repayment will be $794 and the estimated average refund to be $773.

Some reasons for the income differences are getting a raise, losing a job, and working a different number of hours; and non-job factors such as a change in family size as a result of births, deaths or divorce. These changes should be reported when they occur, so subsidies can be modified, but often aren't, says the Kaiser Family Foundation.

John Ydstie of NPR reports some real examples of policyholders facing these surprises. He tells the story of one person who makes $30,000 a year who decided to take less than her estimated $250-a-month premium subsidy because of her uncertainty about the program, and is getting a $3,900 refund. He notes that most people on Obamacare can't afford to do this.

Ydstie also tells the story of a young woman whose monthly subsidy dropped to $60 from $250 after she married her longtime partner in 2014 and their combined incomes bumped them into a different category. They have to pay back $1,800 but are hoping the amount will be adjusted to $400, to apply only to the months they were married; this has not yet been determined.

As the IRS implements the law, it is faced with budget, staffing, and operational cuts, Kamarck writes: "Given the staff limitations of the IRS and the complexity of reporting and reconciling the government subsidies in the law with people’s income there is likely to be confusion, frustration and, most importantly, a lot of people who find out that their tax refund is a great deal smaller than they anticipated." She suggests that the IRS, in order to survive the first tax season with the ACA, "give taxpayers a break whenever it can."

Electronic cigarettes are 'high on every school system's radar right now,' Western Ky. school official tells Henderson newspaper

This story has been updated to reflect recent data about teens and e-cigarette use.

School officials in northwestern Kentucky are trying deal with an increase in the use of electronic cigarettes by students, Erin Schmitt reports for The Gleaner in Henderson.

Union County Schools spokeswoman Malinda Beauchamp told Schmitt there had been 16 discipline referrals of students using e-cigarettes at Union County High School and 26 at Union County Middle School this year. There is no data from previous years for comparison, but school officials "have noticed the rise" and want to be proactive in preventing more usage, Beauchamp said.

Schmitt reported on e-cigarette usage at other schools in the region and found 15 to 20 incidents at Henderson County High, but only a few incidents in North Middle School, South Middle School and Central Academy, according to Julie Wischer, public information officer for Henderson County Schools.

The Webster County Schools did not have exact numbers of incidents of usage, but has e-cigarettes listed under its policy as a tobacco product or paraphernalia, Todd Marshall, Webster’s director of pupil personnel, told Schmidt. Though it’s a new issue, Marshall said, “It’s high on every school system’s radar right now.”

A recent report by the Centers for Disease Control and Prevention found that the number of high school students who tried e-cigarettes has tripled in one year, to more than 13 percent, while smoking of traditional cigarettes dropped to 9.2 percent from more than 13 percent, CBS News reports.

“Many users of marijuana prefer e-cigs or vapes because it’s smokeless, odorless and easy to hide or conceal,” Henderson County Supt. Patricia Sheffer told Schmitt. “This ‘vaping’ is a concern in our schools and elsewhere among youth, because it can produce a nearly instant ‘high’ with little or no detection."

The preventive measures include: a Facebook message to parents and students from her about the dangers of e-cigarettes, which not only involves nicotine usage, but also marijuana, alcohol and other drugs that can be ingested through the device; updating policies, procedures and the student code of conduct to include prohibitions on e-cigs and vapor devices on school property; a commitment to find out how the student got access to the device; and a required drug and alcohol screening if caught, with parent-paid counseling if the screen is positive.

Crittenden County Elementary School is latest school in area to restrict nuts to protect the health of those with nut allergies

This story has been updated to include information about other Western Kentucky schools with nut restrictions.

Peanut butter and jelly sandwiches are a lunchbox staple for many American children, but they can also pose a serious health risk to those with peanut and tree-nut allergies, especially in the young. The risk has prompted the Crittenden County school district to become the latest in the area to restrict the use of nuts at the Crittenden County Elementary School in Marion.

"Peanut and tree nut allergies plague an estimated 19 million Americans and the number of children with peanut allergies in the U.S. has nearly doubled in just over a decade," The Crittenden Press noted.

After researching the issue and how other schools have dealt with it, the school's parent-teacher council and wellness committee created a policy that restricts but doesn't ban nuts, the Press reports.

The policy asks everyone to be aware that nut products are dangerous to some of the students and asks them to not send those products to school, Principal Melissa Tabor told the Press. She said at least five students have proven nut allergies.

Several other Western Kentucky schools have peanut restrictions,Genevieve Postlethwait reports for The Paducah Sun, including Carlisle County and Fulton County schools, with Paducah and Hickman County schools having restricted peanuts for varying periods of time in the past. (Story is behind a pay wall.)

"We do it on a case-by-case, year-by-year basis," Penny Holt,the district's nutrition director, told Postlethwait of Paducah schools' approach to restricting peanuts and other allergens. "If a child has an allergy that is that serious, we're not going to risk it," she said, noting that they are seeing an increase in all kinds of food allergies.

Another school, Heath Elementary, has a child with an airborne peanut allergy so the school does not serve any peanut products or cook with any peanut products, Sara Jane Hedges, food services director for McCracken County schools. told Postlethwait. Students are still allowed to bring peanut butter products, but " "It's just taken care of very carefully," Hedges said.

Crittenden County Elementary school's policy does not require school personnel to check backpacks or lunchboxes for nut-containing products, but if they see children have one of these products, they ask them to sit at a designated table for that day, where they can ask a friend to join them.

The school sent home a list of nut-free snacks, including safe name brands that do not contain peanut oil, to help parents re-think what to pack in their child's lunch or to send for school snacks or for school parties.

So far, the principal said, parents have been receptive to the policy, and one parent told her that they had successfully switched to a soy butter that tastes like peanut butter because their child wants peanut-butter sandwiches for lunch.

The policy states that those with severe allergies to peanuts or nut products may be at great risk of anaphylactic shock, "an allergic reaction causing swelling, difficulty breathing, itching, unconsciousness, circulatory collapse and sometimes death," if they ingest or are exposed to these products.

"Because of the possibility of cross-contamination, a campus-wide, comprehensive avoidance of foods containing nuts was deemed to be the best solution to reduce the health risks to students with allergens," Tabor told the Press.

Crittenden County School Supt. Vince Clark told the weekly newspaper that he supports the school's policy, despite the argument that it creates a burden to parents of students who love peanut butter.

“There are valid points on each side of the issue,” he told the Press. “Ultimately, we have to support efforts to offer a safer learning environment for the children.” (Read more)

Heart attacks are leading cause of death while on the job in Kentucky; being struck by objects is No. 2, and falling is No. 3

Heart attacks are the number one killer of Kentuckians who die on the job, according to a study conducted by the state Labor Cabinet.

The study found that in the last three years, 87 Kentuckians had fatal heart attacks while on the job. Their average age was 52. Ten of them were truck drivers, seven were machine operators and six were maintenance workers.

The study found that 28 of the victims were struck by an object, 19 fell, 17 had transportation crashes, 13 were being caught in or between objects, seven were electrocuted, and one each suffered hyperthermia or suffocation. Eight deaths in the workplace were from natural causes, such as stroke, brain aneurysm and failure of the pancreas.

Kentucky ranks 48th in the nation in cardiovascular deaths, with more than 12,000 per year, a state press release said. “Employers should do everything they can to raise awareness about cardiovascular health, and everyone needs to keep an eye on their blood pressure and cholesterol levels while paying close attention to diet and exercise,” Labor Secretary Larry Roberts said.

The study includes workplaces under the jurisdiction of the Kentucky Occupational Safety and Health Program, and do not include those monitored under federal agencies, such as the Mine Safety and Health Administration or the Federal Railroad Administration.

Event at UK library features discussion of Kentucky food traditions, how they are changing and how to capitalize on them

Story and photo by Melissa Landon
Kentucky Health News

Local food experts gathered at the University of Kentucky April 9 to discuss how Kentucky food tradition is changing and how to develop local food culture through businesses and other means.

"From Plows to Plates: A Journey Through Kentucky Foodways" was an event sponsored by the UK Libraries Special Collections Research Center. It included a panel discussion, book signings by local food authors and food samples. Panelists included anthropology professor John van Willigen, author of Kentucky's Cookbook Heritage: 200 Years of Southern Cuisine and Culture; Ouita Michel of Midway, chef and proprietor of several restaurants; Tiffany Thompson, horticulturist and manager of the College of Agriculture, Food and Environment's Community Supported Agriculture program; and Kristy Yowell, marketing manager of the Good Foods Co-Op in Lexington.

"I want to elevate Kentucky food culture way above restaurants," Michel said. "Restaurants are not food culture." She said Kentucky is known for its chain restaurants, such as Kentucky Fried Chicken, but she wants to focus on helping young chefs and small businesses succeed.

Emma Yetter talks about vegetables via community supported agriculture.

Yowell said, "We want to make affordable, healthy food for everyone. That shouldn't be a privilege."

Thompson said Kentucky's history has had a lot to do with tobacco, which is becoming less prominent. He said community supported agriculture, in which local residents agree to buy produce in advance, has much potential. "What can Kentucky agriculture do to positively influence health? Make more vegetables! CSA is growing, and I'm really excited about it."

The college's CSA Vegetable Program allows people to sign up to receive weekly seasonal vegetables throughout the spring, summer and fall. It costs $19 per week for the smallest "share" of vegetables, which is enough for a single person or a couple, said Emma Yetter, who works events and does deliveries for the program.

Associate Dean of Libraries Deirdre A. Scaggs, author of The Historic Kentucky Kitchen, said at the event that her inspiration for the book came from working in the Special Collections Research Center. She found old recipes, many of which were hand-written, and decided to try them out. She collected over 100 recipes, tested them and modified some of the instructions so a modern audience could understand them.

Most Kentuckians don't think insurance rates should be higher for the obese, but are divided on increasing smokers' rates

By Melissa Patrick
Kentucky Health News

By a very small margin, Kentuckians think insurance rates should be higher for smokers if the insurance company provides a free smoking cessation program, but most don't think rates should be higher for those who are overweight, says the latest Kentucky Health Issues Poll.

The poll, taken Oct. 8 to Nov. 6, found that 50 percent of Kentucky adults said it would be justified to set higher insurance rates for people who smoke, while 45 percent said it wouldn't be justified. Five percent were undecided. This finding was basically the same whether the person had insurance or not.

The poll's margin of error was plus or minus 2.5 percentage points, which applies to each number, so the results were right on the error margin. That means in 19 of 20 cases, the results would be the same if the entire adult population of Kentucky were asked the question.

The poll found that most Kentuckians who have never smoked (63 percent) said insurance companies should not set higher insurance rates for people who smoke. Former smokers, at 51 percent, were less likely to agree with that opinion.

With about 27 percent of Kentuckians smoking, Kentucky leads the nation in smoking percentage, lung cancer and lung cancer deaths, which collectively come with a price tag.

Smoking cost the state $1.92 billion a year for health-care expenditures directly as a result of tobacco use, which amounts to $988 million a year in total taxpayer cost from smoking-related expenses, or $591 per household, Wayne Meriweather, chief executive officer of Twin Lakes Regional Medical Center in Leitchfield, representing the Kentucky Hospital Association, told legislators in December.

The poll also found that the majority of Kentucky adults, 67 percent, think it is unjustified to set higher insurance rates for people who are significantly overweight. Opposition was higher, 77 percent, among those who reported being in fair or poor health; among those who said they were in excellent or very good health, only 58 percent were opposed.

Kentucky ranks fifth in the nation for adult obesity, with one in three Kentuckians considered obese, according the "States of Obesity" report. This also comes with a price tag.

A study in the American Journal of Health Promotion found that a morbidly obese employee costs his or her employer approximately $4,000 more in health care and related costs every year than an employee of normal weight.

The poll was sponsored by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati, and was conducted by the Institute for Policy Research at the University of Cincinnati. It surveyed a random sample of 1,597 adults via land lines and cell phones.

Tennessee churches encourage healthier living

Sulphur Wells Church of Christ in Henry County, Tennessee, a few miles away from Paris, Ky., is challenging people to eat and think healthier, Amber Hall reports for Public Radio International.

Bob Palmer, lead pastor at the church, said, "We do draw some hard lines on alcohol and tobacco use and tattoos—we think, 'Oh, you're not taking care of the our temple that God has given you.'" He said the church hasn't looked at the issue holistically. "We've just kind of picked out the things we weren't going to do anyway, and we feel self-righteous about that—that we don't do them."

Then Palmer saw the County Health Rankings, a project by the Robert Wood Johnson Foundation that measures health risks, Hall writes. He said that "when we confirm someone's spiritual health and give them a thumbs up and an A-OK, that's often the end of the rehabilitation process." However, he said if he were outside the church and had only the health indicator numbers to look at, "it might make me run in the opposite direction."

In Tennessee, the Governor's Foundation for Health and Wellness is helping groups such as churches improve health in evangelical hubs through the "Healthier Tennessee" initiative, which is a "wellness program and an online wellness tool that provides faith leaders with tips, ideas and actions to get their members healthier," Molly Sudderth, the director of communications at the foundation, said.

One of the suggestions is called Walk and Worship. "You can walk and pray for those you feel need extra prayers or are going through difficulties . . ." said Barabara Kelly, a public-health educator.

About 150 churches statewide are participating in Healthier Tennessee's "Small Starts" program, but none of the churches in Henry County have joined yet. Palmer said "there could be some stigma tied to healthy living in this largely conservative area," Hall writes.

"Right-wing religious folk have kinda viewed that as 'liberal' thinking," Palmer told him. "But that hasn't been correct, I don't think. At all. Just read through early Genesis, and the very first commission that God gives anyone is to essentially take care of this created world. We don't talk about that very often for some reason—to our detriment, and these numbers reflect that." (Read more)

Baby is born on Interstate 65 in Louisville during traffic blockage for President Obama's motorcade; father, nurse tell story

Nurse and EMT worker and baby
Photo from Floyd Memorial
Hospital Facebook page

A baby boy was born along Interstate 65 April 2 in Louisville because the road was closed for President Barack Obama's motorcade and they couldn't get to the hospital.

Because he stayed in Washington to announce the nuclear deal with Iran, Obama was three hours late, putting him in Louisville right at the beginning of rush hour and causing a traffic nightmare.

MetroSafe told WAVE-TV it received a call at 5:25 p.m. saying a woman was in labor on I-65. And just before 6 p.m., the baby, an 8-pound, 9-ounce boy, Arley Keith Satterly, son of Jessica Brown and Zakk Satterley was born, WHAS reports. “We couldn't get nowhere, so I called 911,” Satterly said.

After Brown and Satterly realized that the baby was coming and they were in "traffic gridlock," Satterly began to ask the cars around them for help, Shalanna Taylor reports for WLKY-TV. “I started asking people in different cars if they knew anything about having a baby,” Satterly said.

One of them was a nurse, Tonia Vetter, Gill Corsey reports for WDRB-TV. "I told the dad, I said, 'I'm a high-risk nursery nurse at Floyd Memorial'," the hospital in New Albany, Ind., Vetter said. "It actually happened very, very quickly. ... I think she pushed one time and the head delivered, and then she pushed again and the baby was born." Other drivers provided a shoestring for the umbilical cord and a blanket to keep the baby warm, Corsey reports.

"I've attended a lot of deliveries, but I've never delivered a baby on my own, and I've certainly never delivered one in the middle of an interstate," Vetter said. "God was definitely watching over me, the baby, the mom, because she could have hemorrhaged. The baby could of had a cord or a shoulder or any number of complications could've happened."

An ambulance took Brown and Arley to the University of Louisville Hospital, where a spokesperson said the mom and baby were doing just fine and were in good condition.

Living in a community with high income inequality is bad for your health, study says, and much of Ky. is high in inequality

A study by researchers at the University of Wisconsin for the Robert Wood Johnson Foundation found that not only factors such as smoking and crime rate but also income inequality influenced lifespan, Margot Sanger-Katz writes for The New York Times.

This close-up of a New York Times graphic shows income inequality in Kentucky,
Tennessee and parts of surrounding states. Lighter areas have less inequality,
and darker areas have more inequality.

"It's not just the level of income in a community that matters—it's also how income is distributed," said Bridget Catlin, the co-director of the County Health Rankings and Roadmap project. "The effect of inequality was statistically significant, equivalent to a difference of about 11 days of life between high- and low-inequality places," Sanger-Katz reports. "The differences were small, but for every increment that a community became more unequal, the proportion of residents dying before the age of 75 went up."

Other research shows that income inequality affects life expectancies of citizens in countries around the world. Why exactly this happens is debatable. One idea is that though money buys better health, "It makes a bigger difference for people low on the income scale than those at the top," Sanger-Katz writes. That means a having very few poor individuals in an area will improve average health more than having very few rich individuals will reduce it.

Another theory is that areas where wealthy individuals can "buy their way out of social services may have less cohesion and investment in things like education and public health that we know affect life span," Sanger-Katz writes. Also, some research indicates that living around richer people is stressful, causing mental health problems or cardiac disease.

To measure inequality, the researchers compared incomes of individuals living in a certain area who earned the 80th percentile with the incomes of those who earned the 20th percentile. They recorded all those who died before age 75 and the age at which they died, calculating "potential life years lost." A person who died at 70 would have lost five years of potential life.

"For every one-point increase in the ratio between high and low earners in a county, there were about five years lost for every 1,000 people," Sanger-Katz writes. "That's about the same difference they observed when a community's smoking rate increased by 4 percent or its obesity rate rose by 3 percent."

Through the Patient Protection and Affordable Care Act, Americans at the lower end of the income spectrum are receiving health insurance, at least in states like Kentucky that have expanded Medicaid eligibility, and researchers will track whether those provisions will reduce the effects of inequality in the coming years. (Read more)