Researchers find genetic biomarker that could indicate mental illness in women

Patients' behaviors and feelings often serve as identifying factors for psychiatric disorders, which can make diagnoses difficult. Researchers at the University of California San Diego School of Medicine have discovered that the over-production of specific genes may indicate mental illness in female psychiatric patients, according to a study published in the journal EBioMedicine.

The gene XIST, which deactivates one of the two X chromosomes in cells responsible for storing genetic material, works too hard in female patients who have mental illnesses such as bipolar disorder, major depression and schizophrenia. According to the study, over-production of XIST and genes from the inactive X chromosome are common factors in patients with psychiatric disorders and rare chromosome disorders like Klinefelter syndrome and Triple X syndrome.

"There has been an utmost urgency to identify biomarkers for mental illness that could significantly impact research and drug development, said XianJin Zhou, assistant professor in the UCSD Department of Psychiatry and lead author of the study.

About half of the participants—most of whom had a family history of mental illness—had unusually higher levels of XIST and other genes related to the X chromosome. Zhou and his team said stopping the abnormal activity of the inactive X chromosome may be a new strategy for treating those with psychiatric disorders. "These results are powerful in that early diagnosis of mental illness could possibly happen with a simple blood test, leading to better interventions, therapy and treatment options," Zhou said.

Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death

Many people who have a heart attack initially ignore the symptoms or dismiss them. For the best chance of survival and preserving heart function, you should not ignore these symptoms, and should get help quickly.

Heart disease is the leading cause of death in the U.S. and Kentucky. Nationwide, it causes about one in four deaths. The age-adjusted death rate from heart disease in Kentucky is 208.2 per 100,000 per year, according to the federal Centers for Disease Control and Prevention.

Below are some questions and answers about the symptoms and treatment of heart attacks and narrowed aortic valves, as reported by Gina Kolata for the New York Times.

How do you know if you are having a heart attack? Most people feel pain, pressure or squeezing in their chest and about one-third of people have symptoms in addition to or instead of chest pain that include abdominal pain, heavy sweating, back pain, neck and jaw pain, nausea and vomiting, Kolata reports. WebMD adds pain that radiates down one arm, indigestion or a choking feeling, extreme weakness, anxiety or shortness of breath, and rapid or irregular heartbeats to the list.

How can you decide if symptoms other than chest pain are actually from a heart attack? If your symptoms come on suddenly, or if they worsen over a period of hours or days, call 911 and get to an emergency room. "The best time to treat a heart attack is within one to two hours of the first onset of symptoms," says WebMD. "Waiting longer increases the damage to your heart and reduces your chances of survival."

Do women have different symptoms than men? "Probably not," Dr. Mary Norine Walsh, vice president of the American College of Cardiology, told Kolata. Walsh noted that women, however, are more likely to delay seeking treatment and doctors are more likely to dismiss their symptoms, especially if the woman is younger.

The American Heart Association says women often attribute signs of a heart attack to the flu, acid reflux or the normal aging process, even though it is the number one killer of women. It also noted that symptoms in women can be subtler, like shortness of breath, upper back pressure that feels like squeezing, lightheadedness or actually fainting.

What should you do if you are having heart attack symptoms? Call 911 for an ambulance to take you to the emergency room immediately. Do not drive yourself and do not have a friend or family member drive you unless you have no other choice. Kolata notes that paramedics are trained to treat heart attacks and are less likely to get stuck in traffic.

How can you find out if your local hospital is able to treat heart attacks quickly? Don't waste time fighting with your paramedic when you are having a heart attack, they will know the best place to take you, Kolata writes.

That being said, some hospitals are faster than others in treating heart attacks, but the time to research this information is before you are in the throws of a heart attack, Kolata writes. To find out this information, she suggest you ask each hospital what its "door to balloon time" is, which will tell you how long it takes the hospital to open a blocked coronary artery with a balloon after you arrive at the emergency room. If they don't have this information, ask if they take certain steps to speed up treatment. For example ask: Do paramedics transmit a patient's electrocardiogram to the hospital en route?; Does the ER doctor read the EKG and send out a single call to summon the cardiology team?; And are the team members on call required to be within 30 minutes of the hospital?

What are the symptoms of a severely narrowed aortic valve? There are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting, according to cardiologists. They also noted that these symptoms are often mistakenly attributed to the normal process of aging.

How can a doctor know if symptoms are caused by a narrowed aortic valve? The doctor will listen  for a heart murmur in the patient’s chest and can order an echocardiogram, which will reveal the narrowed artery and the extent of the damage.

Should everyone with a severely narrowed artery have it replaced? Not everyone should undergo treatment, Kolata reports, so ask your doctor if you are a good candidate. The latest treatment is a transcatheter aortic valve replacement, or TAVR, which allows doctors to replace valves without doing open-heart surgery. High risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement, but sometimes elderly patients whose health is compromised are not good candidates.

More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized — and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Study finds that one dose of HPV vaccine that targets only cervical cancer is as effective as three doses, now recommended

By Melissa Patrick
Kentucky Health News

A study has found that one dose of the human papillomavirus vaccine Cervarix appears to be as effective in preventing HPV infections that lead to cervical cancer as do three doses, the recommended course of vaccination. Only 25 percent of Kentucky adolescent women initiate the vaccination, and fewer than one in nine of those who do get three does, according to the Kentucky Cancer Consortium.

"Many women around the world and in the U.S. don't get the full three doses that are recommended, so this is promising news," said Elisia Cohen, an associate professor of communication at the University of Kentucky, who does extensive research on community strategies to improve adolescent and adult vaccinations. However, she cautioned that the drug Cervarix is "only 1 percent of the U.S. market" and that the findings from this study do not apply to Gardasil, the drug most commonly used in the U.S.

Dr. Diane Harper of the University of Louisville, one of the researchers, said in a news release, “Kentucky is one of the states that has not had a program in place to make Cervarix available to all of its citizens, and has very low three-dose completion rates of Gardasil.”

Most health departments and physicians choose Gardasil over Cervarix because it protects against four strains of HPV: two strains that cause 70 percent of all cervical cancers and two strains that cause genital warts and oral and anal cancers, concerns for males as well as females. Cervarix only protects against the two strains that cause cervical cancer. "Generally, the thinking is that protection against four strains is better that two," Cohen said.

She said Gardasil 9, which will protect against 90 percent of HPV strains that cause cervical cancer as well as pre-invasive cervical cancer lesions, has just been approved by the U.S. Food and Drug Administration and is going through its labeling process, and will be recommended for both boys and girls.

HPV is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals, according to the federal Centers for Disease Control and Prevention.

The study, published in The Lancet Oncology, analyzed data from two large trials of Cervarix. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. All of the women were evaluated, regardless of how many doses of the vaccine they received, for the effectiveness of the vaccine for a period of four years. The analysis found that the protection from one dose was similar to that achieved by three doses of the vaccine.

“Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series,” the researchers wrote.

The CDC recommends HPV vaccination for girls 11 and 12 years old, and catch-up vaccination for females from 13 to 26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose.

Study outlines historical barriers to tobacco prevention in Kentucky and other tobacco-growing states

A University of Kentucky College of Nursing study published in The Milbank Quarterly has shown that five major tobacco-growing states—Kentucky, North Carolina, Virginia, South Carolina and Tennessee—fall behind the rest of the states in enacting laws to reduce tobacco use.

Tobacco and the diseases it causes affect those five states more than others across the nation, and tobacco is the leading cause of preventable death in the U.S. Those states also have fewer smoke-free laws and lower tobacco taxes, which are two evidence-based policies that help reduce tobacco use, write the authors, Amanda Fallin and Stanton A. Glantz.

The researchers used five case studies chronicling the history of tobacco-control policy "based on public records, key informant interviews, media articles and previously secret internal tobacco industry documents available in the Legacy Tobacco Documents Library," they write.

They found that beginning in the late 1960s, tobacco companies focused on creating a pro-tobacco culture to block tobacco-control policies. However, since 2003, tobacco-growing states have seen passage of more state ad local smoking bans, partly because the alliance between tobacco companies and the tobacco farmers dissolved and hospitality organizations stopped objecting to such bans. National Cancer Institute research projects also built infrastructure that led to tobacco-control coalitions. "Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states," the researchers write.

To continue the progress, health advocates need to teach the public as well as policymakers about "the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced," Fallin and Glantz write. Kentucky once had about 50,000 tobacco farmers; today it has about 5,000, and production is dominated by large farmers. The study is behind a paywall; to read its abstract, click here.

Half again as many Kentucky newborns were hospitalized for drug dependency last year as the year before

Mother Samantha Adams and her newborn Leopoldo Bautista,
10 days old, spend quality time inside the Louisville Norton
Healthcare child care center for children experiencing drug
withdrawal. (Photo by Alton Strupp, The Courier-Journal)

Increasing drug abuse drove up hospitalizations of drug-dependent newborns in Kentucky by 48 percent last year, to 1,409 from 955 in 2013. "The latest numbers represent a 50-fold increase from only 28 hospitalizations in 2000," reports Laura Ungar of The Courier-Journal.

"The seemingly never-ending increase every year is so frustrating to see," Van Ingram, executive director of the state Office of Drug Control Policy, told Ungar. "It's a horrible thing to spend the first days of your life in agony."

"These infants are born into suffering," Ungar writes. "They cry piercingly and often. They suffer vomiting, diarrhea, feeding difficulties, low-grade fevers, seizures — and even respiratory distress if they're born prematurely."

Drug-dependent newborns are becoming more common nationwide, Ungar notes, but "Vanderbilt University researchers publishing in the Journal of Perinatology [a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies] say rates are highest in a region encompassing Tennessee, Mississippi, Alabama and Kentucky."

While the increase is blamed mostly on illegal drug use, the Vanderbilt study found that 28 percent of pregnant Medicaid recipients in Tennessee filled at least one painkiller prescription, Ungar writes: "Legitimate use not only raises the risk of having a drug-dependent baby, it can sometimes lead to abuse and addiction."

While Medicaid now pays for behavioral-health and substance-abuse treatment, "Drug treatment for pregnant women is sorely lacking," Ungar reports. In Kentucky, only 71 of the 286 treatment facilities listed by the U.S. Substance Abuse and Mental Health Services Administration treat pregnant women. 

Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate

By Molly Burchett
Kentucky Health News

The U.S. Supreme Court ruled Thursday that the tax subsidies provided under the Patient Protection and Affordable Care Act are legal in every state.

While the ruling has no effect on Kentucky, and would have had no direct effect if it had gone the other way, it sets the table for continued political debate about health policy in Congress and in Kentucky's race for governor.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the 6-3 majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

The law says the federal government can pay subsidies to help people afford insurance bought through “an Exchange established by the State.” The lawsuit argued that Americans in the 34 states using the federal exchanges were not eligible for the subsidies, which are crucial to the law's success, helping to make health insurance more affordable, reducing the number of uninsured Americans. Proponents of the law say not providing subsidies to individuals in those 34 states relying on the federal exchange would have upended the law, notes CNN.

President Obama called on critics to accept the law as permanent, saying after the ruling, "The Affordable Care Act is here to stay."

But Senate Majority Leader Mitch McConnell, R-Ky., called Obamacare “a rolling disaster for the American people,” with a “multitude of broken promises, including the one that resulted in millions of Americans losing the coverage they had and wanted to keep. Today’s ruling won’t change the skyrocketing costs in premiums, deductibles, and co-pays that have hit the middle class so hard over the last few years.”

Maps: Percentage uninsured in 2012, above, and 2014, below

Obama countered, "The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course." He added, "The law has helped hold the price of health care to its slowest growth in 50 years" and "Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records."

A White House fact sheet noted that the law also expanded "access to preventive care, including immunizations, well-child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs."

Since Kentucky established its own exchange, Kynect, for buying subsidized health insurance or signing up for Medicaid, the ruling may seem moot for Kentuckians. However, it establishes some of the facts for a health-care policy debate in the governor's race between Republican Matt Bevin and Democratic Attorney General Jack Conway.

The exchanges and the expansion of the federal-state Medicaid program are choices for the states, and Bevin has said that if elected he would shut down Kynect and end the Medicaid expansion, which has covered about 430,000 Kentuckians. The federal government is paying their entire cost through next year; in 2017 the state would start picking up a small share, rising to the law's limit of 10 percent in 2020.

Conway has acknowledged questions about whether the state can afford to pay its share, but to “say you’re going to kick a half a million people off of health insurance based on what we may or may not be able to afford in 2021 is irresponsible.” A Conway spokesman said he "appreciates the court's careful consideration of this case and agrees with today's decision," reports the Lexington Herald-Leader.

The Herald-Leader's Mary Meehan interviewed officials and experts for a package of questions and answers about the law and Kentucky. It is published at http://www.kentucky.com/2015/06/25/3917832_in-light-of-the-supreme-court.html.

Outgoing Gov. Steve Beshear, a Democrat who expanded Medicaid, said in a statement that the decision “reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for health-care coverage through Kynect since January 1, 2014.”

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in a release, "While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians – and all Americans – have timely access to safe, effective and affordable quality care." Zepeda said Kentuckians continue to work on ways to improve and protect Kentuckians' health, such as reforming the way we pay for care and making health care cost and pricing more transparent.

"As people who have forgone care too long because of its expense now gain access to care, it will place a larger short-term burden on the health-care system, which approaches like these can help to address," said Zepeda. "The Affordable Care Act permits – and incentivizes – local health care innovation. We can and must shape Kentucky solutions to Kentucky’s health challenges."

The Homeplace at Midway opens, with cottages for nursing, assisted living, memory care; first 'Green House' facility in Ky.

By Kacie Kelly and Al Cross
University of Kentucky School of Journalism and Telecommunications

The Homeplace at Midway was formally opened Thursday, June 25, bringing to fruition a 16-year campaign for a nursing home in the Woodford County town of 1,700. For photos from its June 28 open house, click here.

Construction this spring (Christian Care Communities photo)

The Homeplace, which has four residential buildings that look like single-family homes, is more than a nursing home. Two of the buildings are for skilled nursing, but one is for assisted living and the other is for "memory care" or personal care of patients with dementia and other cognitive impairments.

“The Homeplace at Midway represents a new beginning for older adults in Kentucky and for communities across the commonwealth to embrace them as living treasures, not a burden or a challenge,” Dr. Keith Knapp, president and chief executive officer of Christian Care Communities, which built the Homeplace and will operate it, said at the ribbon-cutting ceremony.

Assisted living cottage (Photo by Kacie Kelly)

“We are extremely grateful to the City of Midway, the Midway Nursing Home Task Force, Midway College, state and local government agencies, our capital campaign’s Leadership Council and all our friends and supporters who championed this new direction and envisioned with us a new day when older adults would receive the highest quality care and support, without feeling their lives are being disrupted or overtaken,” Knapp said. “We trust that it will inspire other senior living providers to move in a similar direction.”

The Homeplace is the first facility in Kentucky built with The Green House model, which includes home-like environments and strong relationships with caregivers, with the goal of meaningful lives for residents. Dr. William Thomas, creator of the model, told the crowd at the event, “The Homeplace, with its emphasis on home, shows how care can be made more loving, community centered and effective.”

One of the two skilled-care cottages (Photo by Kacie Kelly)

Patients have been moving in all month. The staff at The Homeplace is trained to use the “best friend approach,” Laurie Dorough, the facility's community-relations manager, said in an interview. Staff and volunteers are to treat residents as they would treat a best friend.

Knapp said at the ribbon-cutting, “Each resident will have a private bedroom and bath and share, just as people do in any home, the kitchen, living room, den and porch areas. It’s all designed to give residents the freedom to set their own daily routines and to live life to its fullest, while receiving the individual care they need – within each cottage.

The assisted-living cottage is larger than the others, to provide room for more activities and “the potential for spouses to live there,” said Laurie Dorough. “It’s kind of the first step out of independent living,” she said. The cottage has an open kitchen where residents can get involved with meal preparation or “come out and see what’s cooking.”

Skilled-care cottage bathroom lift system (Photo by Kacie Kelly)

The skilled-nursing cottages have bedrooms with medicine cupboards rather than medical carts, and a bathroom lift system (photo at right) that takes the resident straight to their own bathroom. The bedrooms are relatively small, an incentive for residents to spend more time in the communal living space.

The Homeplace campus, across Weisenberger Mill Road from Midway College, also includes an administrative cottage and the Lucy Simms Lloyd Gathering House for special gatherings, worship services and activities.

Between the cottages is the courtyard, with lighted walking paths from building to building, a gazebo, and space for outdoor activities. “Our hope is to maybe start a community garden,” said Dorough.

The long campaign for a nursing home, led by the Midway Nursing Home Task Force, began to see success in 2010 when Louisville-based Christian Care agreed to be the developer. Christian Care has facilities in 11 Kentucky cities, and a church-outreach program with more than 230 churches as partners.

The Homeplace will have a partnership with Midway College, which becomes Midway University July 1. “We are excited to work with Midway College to not only provide learning opportunities for students but also for the residents of The Homeplace,” said Tonya Cox, the facility's executive director.

The Homeplace will be offering internships and other learning opportunities for students. This partnership will also benefit residents, Cox said: “Our residents will also have the opportunity to attend events and classes to foster their lifelong learning.”

Cox said The Homeplace aims to provide “unique long-term care in a way that honors their preferences and desires to be home.” More information is on the facility's website. It will host an open house from 1 to 3 p.m. Sunday, June 28.

Aetna is close to a deal to buy Humana, Bloomberg reports

Getty Images, via CNBC

Health insurer Aetna "is said to be closing in on a deal to buy" Louisville-based Humana Inc., Julie Hyman reports for Bloomberg News, "and a deal could come "as soon as this weekend."

Humana is also expecting an offer from Cigna Inc., but Humana's board of directors "prefers the Aetna offer," Hyman reports, citing unnamed people familiar with the negotiations. The deal has been discussed for weeks, but Aetna didn't make a formal proposal until this week.

The last major obstacle to a deal may have been the Supreme Court's ruling today that people in all states are entitled to tax subsidies for health insurance under the Patient Protection and Affordable Care Act, Hyman suggests, noting higher stock prices for health-insurance companies.

"Shares of Humana rallied more than 8 percent after trading was briefly halted for volatility," Reem Nasr of CNBC reports.

Humana is an attractive buy because "a great deal of its business — 73 percent of its premiums revenue — comes from contracts with the federal government," David Mann reports for Louisville Business First. "That means Humana is flush with Medicare business, which is a fast-growing category in the industry as many baby boomers are reaching the eligibility age. Its competitors, including Aetna, don't have nearly as much of this business."

"Consolidation among the country's top insurers follows a massive consolidation among providers in pharmacy, hospital and patient care, which has increased the leverage against insurers like Humana and Aetna," Grace Schneider reports for The Courier-Journal.

Doctor discusses myths about sun exposure and sunburn

As the weather grows warmer and more people spend longer periods of time outside in the sun, it's important to understand the dangers of sun exposure. "Ultraviolet radiation is a known carcinogen, which means, similar to cigarette smoking, it can cause lasting damage to the body," said Dr. Holly Kanavy, assistant professor of medicine at the Albert Einstein College of Medicine and director of pharmacology at Montefiore Health System. Kanavy discussed five myths people often believe about sun damage:

Myth 1: Some people believe they only need to protect themselves from the sun during peak hours. Although extra precautions should be taken between the hours of 10 a.m. and 4 p.m., people are susceptible to damage from the sun anytime it's out.

Myth 2: Some people think if children do not get burned, they must be wearing enough sunblock. However, young children are particularly susceptible to sun damage and should wear and reapply SPF 30 or higher sunblock. Hats and sunglasses as well as clothing are also helpful, but wet clothes don't offer much protection from the sun.

Myth 3: Some individuals think sun exposure is required to obtain vitamin D. In truth, it only takes 10-15 minutes of sun exposure several times per week. Some people do not wear sunscreen because they're trying to get vitamin D. However, that isn't necessary because it takes sunscreen about 20 minutes to start working, and people can get their vitamin D intake during that time. Also the vitamin can be acquired through certain foods.

Myth 4: Some people believe that the only important factor to look for in sunscreen is the SPF. However, people should make sure their sunblock protects against both UVA and UVB rays. UVA rays age the skin and can cause skin cancer. To make sure a sunblock protects against both kinds of rays, look for the words "broad spectrum" and ingredients like avobenzone, oxybenzone, zinc oxide and/or titanium oxide.

Myth 5: Some people think sun protection is unnecessary indoors or on cold days. However, temperature doesn't affect radiation, and UVA rays can go through clouds and glass. UVA rays don't cause tanning, but can cause damage.

Kanavy also recommended steps to take after getting sunburn. "Immediately after a burn, take a cool shower and keep the burn moisturized," he said. "Ingredients like vitamin C and vitamin E can help control damage."

Annual health policy forum set Sept. 28 in Bowling Green

This year's annual Howard L. Bost Health Policy Forum "will offer new insights and opportunities from a range of civic sectors for a shared vision, policies, and actions for community health," says its lead sponsor, the Foundation for a Healthy Kentucky.

"Local, regional, and national speakers will share their knowledge and experiences in building healthy communities, with a focus on transportation and housing, education, food systems and policy, and employers and workplaces," the foundation says. "TED style" speakers will make presentations on each of the forum's four focus areas: education, food systems and policy, employer/workplace, and transportation/housing.

The forum will be held at the Sloan Convention Center in Bowling Green on Monday, Sept. 28. For the registration website, click here.

Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers

A drug that was supposed to help people get off heroin has "created a new cash-for-pills market and a street trade" that state officials are trying to stop, Mary Meehan reports for the Lexington Herald-Leader.

The drug is buprenorphine, the active ingredient in the brand-name drugs Suboxone and Subutex, which became more popular in 2012, when the state cracked down on "pill mills" that were freely handing out prescriptions for painkillers. "A lot of the pill mills morphed into facilities that dispense these prescriptions," Dr. John Langefeld, medical director for the state's Medicaid program, told Meehan.

Also, Meehan writes, the Patient Protection and Affordable Care Act required insurance plans to cover treatment for substance abuse, and "as more Medicaid patients and others got health-insurance coverage, more people obtained prescriptions for buprenorphine, Langefeld said. . . . According to a state report, one user obtained prescriptions from nine doctors."

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Lexington Herald-Leader chart by Chris Ware from state data

Use of the drug in Kentucky "has increased 241 percent since 2012," Meehan reports. "And 80 percent of the prescriptions for it were being written by 20 percent of the state's 470 certified prescribers, said Dr. Allen Brenzel, medical director of the state's Department of Behavioral Health. . . . Since 2011, 10 doctors have been sanctioned by the Kentucky Board of Medical Licensure because of problems prescribing Suboxone."

Suboxone is supposed to be taken in conjunction with therapy and drug testing. "a patient receives a controlled dose of a legal drug as the dose is tapered by a physician for a safe and effective withdrawal," Meehan notes. However, "doctors started to see Suboxone patients on a cash basis, asking for as much as $300 for an office visit that included a prescription for the maximum allowable amount of Suboxone. Patients often received no therapy or drug testing. Some patients were on the maximum dose indefinitely, Brenzel said." Some doctors prescribed the drug with other painkillers, creating an illegal market.

To prevent such abuse by unscrupulous doctors, the medical-licensure board has issued regulations that require "more physician education and the requirement that the drug be prescribed only for medically supervised withdrawal and not be given to pregnant women," Meehan writes. "Patients should also be closely monitored and drug tested. If those rules are not followed, a doctor can face sanctions or restrictions to his medical license."

Suboxone was in the national news recently because the accused killer in the Charleston, S.C., shootings was arrested for illegal possession of it four months ago at a South Carolina shopping mall, the Herald-Leader notes.

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Lake Cumberland District Health Department using polls in an effort to get school boards to make campuses tobacco-free

Countywide smoking bans are unlikely to pass anytime soon in most of rural Kentucky, but more county school districts are making their campuses tobacco-free. Now a multi-county health department is trying to get rural school boards to do that, with public-opinion polls showing that county residents overwhelmingly favor the move.

Department logo has been altered to
show Clinton County in yellow.

The Lake Cumberland District Health Department conducted the poll in Clinton County, and said it found that 86.55 percent were in favor and 7.16 percent were opposed. The rest had no opinion.

Making a campus tobacco-free means that members of the public are not free to smoke at school athletic events, so the poll also asked, “Would you like to see our school become tobacco-free at all events?” The results were virtually the same: 85.3 percent answered yes and 8.7 percent answered no, even though one-fourth to one-fifth of the county's residents smoke and it has a long history of raising tobacco.

"The results are perhaps surprising to some, considering the rate of tobacco usage in the county," reports the Clinton County News. The poll of 749 residents has an error margin of plus or minus 3.6 percentage points.

The department also surveyed 100 teachers in the school system and found that 77 percent would "definitely" support making the schools 100 percent tobacco-free.

The health department presented the survey and other findings to the Clinton County Board of Education June 15, but the board took no action. The department noted that a recent survey found that 28 percent of the county's students in eighth through 12th grades had used smokeless tobacco in the previous 30 days. "That level was the highest in the Lake Cumberland District," the Clinton County News reports.

The Casey County Board of Education adopted a smoke-free policy after a poll by the health department showed 70 percent of the county's residents favored it, the Casey County News reported.

Merger mania: Aetna bids for Humana; Cigna may want it too; Anthem has bid for Cigna; UnitedHealth makes a play for Aetna

Aetna Inc. has made a bid to buy Louisville-based Humana Inc.,"one of a number of recent moves by big health insurers to find merger partners," Dana Mattioli and Liz Hoffman report for The Wall Street Journal.

The proposal was made in "the last few days," the Journal reports. "It isn’t clear how much Aetna indicated it would pay. Humana has a market value of $30 billion. The company hired Goldman Sachs Group Inc. to help it field takeover interest, people familiar with the matter have said."

Meanwhile, Aetna has been approached by another big insurer, UnitedHealth Group. "It isn’t clear what, if any, Aetna’s response was," the Journal reports. "News of the Aetna proposal comes the same day Anthem Inc., another of the five big managed-care companies, said it boosted its takeover offer for Cigna Corp.,"offering $47.5 billion. "Anthem went public with the bid after the two sides failed to reach agreement, and is seeking to put pressure on Cigna through Cigna shareholders."

"Cigna itself is eyeing Humana, people familiar with the matter have said. The five big managed-care companies are jockeying for deals that will enable them to get more efficient and better respond to changes in the health care landscape in the U.S.," the Journal reports.

"Humana, which has an estimated 12,000 employees and roughly 2,000 contractors in Louisville and the immediate region, has been seen as an attractive target in the health-insurance industry because of its well-run business running Medicare Advantage programs," Grace Schneider reports for The Courier-Journal. The company is valued at $30 billion.

"The company's membership rolls have surged to more than 3 million in the last year," Schneider writes. "That growth comes when health care reform has forced providers — hospitals, doctors, pharmacies, among them — to consolidate to increase their leverage and clout in an increasingly competitive health care segment. For the same reason, health insurers are now looking to consolidate."

Biotech firm buys UK professor's anti-overdose nasal spray

Pharmacy Professor Daniel Wermeling at the University of Kentucky invented a nasal spray to fight heroin overdoses, and a biotech firm has bought the product, which may be on the market within six months, pending approval by the U.S. Food and Drug Administration. The device "contains a single dose of a mist form of naloxone and delivers the drug in a way similar to how Flonase is used to treat allergies," Mary Meehan reports for the Lexington Herald-Leader.

The product is on a fast track for approval because of the rising rates of heroin overdoses across the country, said UK Provost Tim Tracy, former dean of UK's pharmacy school. Wermeling doesn't know exactly when his product will be on the market, but he said the FDA approved another fast-track, anti-overdose therapy after only 14 weeks. The fast-track program speeds development of drugs to treat serious or life-threatening conditions. "Last year, 233 people [in Kentucky] died with heroin in their systems, according to the state medical examiner's office," Meehan notes.

Wermeling has been developing the project at UK since 2009 with the help of more than $5 million in federal and state tax dollars. Tracy said Indivior PLC, the spinoff pharmaceutical company that bought the nasal spray, will be able to manufacture, market and distribute the product. Right now, emergency responders and hospitals must draw naloxone, branded as Narcan, in a syringe to provide the correct dose.

Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud

Former Dr. Fred Gott of Bowling Green was arrested.
(Photo: Miranda Pederson, Bowling Green Daily News)

Twelve people in the western half of Kentucky, including three doctors, have been charged with Medicaid fraud in what the federal government calls its biggest-ever "takedown" of the problem, Andrew Wolfson of The Courier-Journal reports.

The indictments allege "a half-dozen schemes involving nearly $8 million in alleged fraudulent billings," Wolfson writes. "The offenses include $5 million in false billings for muscle-relaxant injections that were never delivered to patients, as well as a staged car wreck in which three people allegedly conspired to get controlled substances and fraudulent reimbursements."

In another case, Wolfson reports, "a medical practice that treated car wreck patients is accused of using the DEA numbers of nurse practitioners to order hydrocodone for herself and falsely billing it to an insurance company. Nationally, the sweep resulted in charges against 243 people, including 46 doctors, nurses and other licensed medical professionals."

John Kuhn, acting U.S. attorney for the Western District of Kentucky, told Wolfson that about $1 billion of annual Medicare and Medicaid expenses are fraudulent. Medicare is the federal health-insurance program for people over 65; Medicaid is the federal-state program for the poor and disabled.

Former Dr. Fred Gott of Bowling Green, a 63-year-old cardiologist, was charged with "conspiracy to dispense controlled substances, health care fraud and money laundering," Deborah Highland reports for the Bowling Green Daily News. "The Bowling Green-Warren County Drug Task Force opened an investigation into Gott’s practices after Warren County Coroner Kevin Kirby alerted the task force about drug overdose deaths involving Gott’s patients, task force director Tommy Loving said."

Trimble County parents protest 'humiliating' treatment of students whose school lunchroom accounts are in the red

Parents in Trimble County are demanding that the county schools stop serving cheese sandwiches to students whose lunchroom accounts are in the red, Kayla Vanover of WAVE-TV in Louisville reports.

"Embarrassing, humiliating and 'flat out wrong' is how parents described the school's policy to take a student's lunch right off the lunch table and toss it because the child's parents had not replenished their account to cover the meal," Vanover reports.

On May 20, Lori Ritchie's daughter "sat down to eat, but her hot meal was thrown away and she was given a cheese sandwich with a side," Vanover reports. "Ritchie said she doesn't blame the workers, but she said the policy needed to be changed a long time ago. Wednesday, a special called public meeting with the school board allowed other parents and community members to voice their opinions on the current policy, in hopes an agreement could be made."

Doug Joyce, grandfather of a student, told the board, "It is bullying. We throw kids out of school or reprimand them for bulling, so why should we let grown-ups bully kids like that?" A board member, unidentified in Vanover's story, said "We don't want any child to be embarrassed or receive an alternative meal, so we are really going to beef up the communication."

Republican legislators question cabinet's figures on managed-care payments and cost projections for Medicaid expansion

Audrey Haynes (cn|2 image)

"When Audrey Haynes sat down before the legislature’s Medicaid Oversight and Advisory Committee Wednesday, she expected the data she brought would persuade lawmakers that Kentucky’s expansion of Medicaid has been good for the state," Ronnie Ellis reports for CNHI News Service. "The secretary of the Cabinet for Health and Family Services, which administers the Medicaid program also may have expected her statistics to ease unhappiness with the state’s move to managed care for most Medicaid services."

"It didn’t happen," Ellis writes. "At least she didn’t persuade Republican members who openly questioned the validity of the cabinet’s data, a couple stopping just short of saying the cabinet is making up the numbers" about payments to providers by managed-care organizations, which it says are 99 percent on time. “The numbers do not appear to represent the reality on the ground,” Rep. Richard Benvenuti, R-Lexington, said after the meeting.

Sen. Ralph Alvarado

“I think those are false,” Sen. Ralph Alvarado, R-Winchester, said after the meeting. “I don’t know if they’re lying, but somebody is providing bad information.”

During the meeting, Alvarado read "segments of letters from providers who have not received full reimbursements from managed care organizations," reports Kevin Wheatley of cable channel cn|2's "Pure Politics."

"Haynes referenced a report from CHFS which showed that over 90 percent of Medicaid claims are being paid in a timely manner," reports the blog of the Kentucky Chamber of Commerce. "Sen. Alvarado replied that this statistic does not match what he is hearing from his constituents and medical providers." Haynes addressed the managed-care issue in her PowerPoint presentation, downloadable here.

Rep. David Watkins, D-Henderson, a retired physician and co-chair of the committee, "urged the panel to find ways to improve managed care."

Watkins said the managed-care organizations, which are insurance companies or their subsidiaries, should come before the committee to answer questions. “I’m not totally satisfied that they’re doing quite as good a job as your report here would portray,” he told Haynes. “I think they need to be more accountable. I think they need to be more responsive to the providers who actually are doing work in the field.”

The MCOs will appear before the joint House-Senate committee Aug. 19, Brad Bowman reports for The State Journal in Frankfort. For cn|2's three-minute clip of the discussion between Haynes and Alvarado, via YouTube, click here.

The Republican lawmakers also voiced skepticism, but offered no contrary evidence, about the cost of expanding Medicaid to households with incomes up to 138 percent of the federal poverty level, from the previous limit of 69 percent. Under the Patient Protection and Affordable Care Act, the federal government is paying the entire cost of the expansion until next year, when the state will begin paying a small part, rising to the law's cap of 10 percent in 2020.

Haynes noted projections for Democratic Gov. Steve Beshear's administration that the expansion would add $30.1 billion to the state's economy through 2021, and would pay for itself until then, even after the state starts picking up part of the cost. The numbers were not new; they were part of a study by Deloitte Consulting and the University of Louisville that Beshear released in February.

Republicans focused on the prediction that the expansion would cost the state a net $45 million in 2021. "I know that seems like a way long ways off and some of you may no longer even be in the position to deal with it, but some of us probably will and the taxpayers will," said Alvarado, a physician.

Haynes "stated that she believed with the financial boost to the economy through jobs, the costs will be offset," the blog of the Kentucky Chamber of Commerce reports.

“Now that we’re seeing the lowest unemployment that we’ve seen in our state in quite a number of years, I’m sure each of you are amazed at how that we’ve had all 120 counties in our state where the unemployment rate has gone down,” Haynes said. “As this state continues to generate revenue and hopefully, as is planned, this is a bridge program for people who basically are hard-working people, but their employer does not provide insurance or they have children and therefore that qualifies them from an income basis for Medicaid.”

Health department urges Kentuckians to walk regularly; state ranks high in obesity, low in physical activity

With summer here, the state health department is urging Kentuckians to adopt a regular walking schedule to connect with friends and neighbors and improve health and fitness in a state that ranks high in obesity and low in physical activity.

“Summer is the perfect time to renew your commitment to get outdoors and take a walk,” Health Commissioner Stephanie Mayfield, said in a news release. “We all know walking is healthy, but it’s also fun, relaxing, and a great way to connect with others. You can invite a friend or loved one out for a nightly walk after dinner, take care of weekend errands on foot, or invite neighbors or co-workers to start a regular walking group. The more you walk, the more you’ll connect and be part of building a stronger, healthier community.”

In Kentucky, 31.3 percent of adults are obese. “Obesity is linked to multiple chronic conditions, including diabetes, heart disease and stroke – and is one of the major chronic conditions affecting the health of Kentuckians,” said Elaine Russell, the Department for Public Health's obesity-prevention coordinator. “Regular walking could greatly reduce our state’s obesity burden.”

Russell's program and the Partnership for a Fit Kentucky have created a guide for obesity prevention and health policy for Kentucky communities, at http://www.fitky.org/wp-content/uploads/sites/2/2015/04/PA-Vision-Slidedoc.pdf. ). Kentucky is one of four states that will get technical assistance from America Walks to improve walkable community design, such as complete streets, lower traffic speeds, livable communities and economic benefits.

“We’re also working directly with communities and funding projects through a public health grant program to help cities and towns across Kentucky develop pedestrian plans,” Russell said. The department selected 11 communities for funding to start work on a pedestrian plan.

“We’re very excited about recent developments in obesity prevention and increasing physical activity in the commonwealth,” Russell said. “We hope everyone will not only become more physically active, but take some time to learn more about our vision and support our communities in their work to become more active, healthier places to live, work and play.”

KentuckyOne Health turns down ethics panel's request to remove or change cancer treatment banner advertisement

A Louisville cancer center features a giant banner that says: "FIGHT CANCER WITH 5 or FEWER TREATMENTS." The treatment, called CyberKnife and performed at the James Graham Brown Cancer Center, is a procedure that directs large doses of radiation accurately to tumors, but it only works for small, isolated tumors, Andrew Wolfson reports for The Courier-Journal.

Dr. Anthony Zietman, associate director of the Harvard Radiation Oncology residence program at Boston's Massachusetts General Hospital, agreed the banner is accurate but said it is misleading, falsely implying CyberKnife can cure cancer. "For the right person, it is a great treatment, but the banner implies it is for everyone," he told Wolfson, adding that fewer than 20 percent of cancer patients at his hospital are eligible for stereostatic radiosurgery treatment.

The University of Louisville Hospital's ethics committee voted unanimously on May 20 to request that KentuckyOne Health remove the banner or change it to give more context. "It is false and misleading advertising," said Dr. Larry Florman, a plastic and reconstructive surgeon who sits on the committee, which includes doctors, nurses and clergy. "It's almost like a scam."

The committee said in an email to KentuckyOne that cancer patients receiving traditional therapy were asking why their treatment included more than five sessions and why they couldn't receive CyberKnife treatments instead. KentuckyOne spokesman David McArthur said after talking with the chairman of the U of L Department of Radiation Oncology and examining clinical results, "We decided that keeping the banner in place is appropriate."

McArthur also noted that CyberKnife can fight cancer after just five or fewer treatments and that in almost three years, "all patients treated with it at the cancer center have received one to five treatments," Wolfson writes. "More than half were treated for metastatic cancer—cancer that had spread." McArthur added, "In the spirit of collaboration, we are looking for additional ways to ensure potential patients have the appropriate information to understand if CyberKnife is the right treatment for them."

Accuray is the Sunnyvale, Calif., company that makes CyberKnife. The company says the therapy is non-invasive and painless. In 2001, the U.S. Food and Drug Administration approved the system for use in any organ, including the prostate, lung, brain, spine, liver, pancreas and kidney.

Grants of up to $10,000 available for Kentucky communities to fight colon cancer; applications are due July 15

The Colon Cancer Prevention Project has a new "Project Innovation" grant program to help fund local innovative ideas to get more people screened for colon cancer in Kentucky and Southern Indiana.

Kentucky ranks first in colon-cancer diagnoses and fourth in colon-cancer deaths. It is estimated that 60 percent of deaths from colon cancer could be prevented if everyone were screened at age 50, according to the project's website.

The project, based in Louisville, is a partner in the national initiative to increase colon screening rates to 80 percent by 2018 and hopes to reach this goal by expanding into new communities through volunteer participation.

With this goal in mind, the project is offering up to $10,000 in grants to help individuals lead efforts to raise awareness in their communities about colon cancer and educate people about the importance of screening. The number of approved projects and the amount of funding will depend on the number of applications received and the perceived effectiveness of the project.

Anyone who creates a project to support the expansion of the Colon Cancer Prevention Project that will serve Kentucky or Southern Indiana can apply.

Projects should target African Americans or rural areas of Kentucky and Appalachia. Preference will be given to projects that focus on these counties: Whitley, Knox, Bell, Clay, Madison, Fleming, Morgan, Martin, Pike, Hopkins and Hardin. However, all applications will be considered.

Project requirements can be found online and applications will be accepted through July 15. For more information and access to the application, click here: http://coloncancerpreventionproject.org/help-kick-butt/project-innovation/

A leading authority on bullying in schools offers ideas for recognizing, preventing and dealing with it

By Melissa Landon
Institute for Rural Journalism and Community Issues

How do we recognize, deal with and prevent bullying, particularly in schools? A leading authority on bullying offered some ideas June 12 in a University of Kentucky training session called "The Meanest Generation: Teaching Civility, Empathy, Kindness and Compassion to our Angriest Children," at Eastern State Hospital in Lexington.

Malcolm Smith, right, between sessions

Malcolm Smith, founder and director of the Courage to Care Project who serves on the faculty of Plymouth State University, said one myth about bullying is that it only occurs in large schools. "Actually, I'm more worried about children in a rural school," Smith said. In rural areas, he said, bullying can be a huge problem because there's nowhere to hide, everyone is often into everyone else's business, and an issue can escalate into a feud when families get involved.

Smith defined bullying as a single incident or pattern of written, verbal, electronic or physical actions intended to harm a pupil or his or her property; cause emotional stress; interfere with that student's right to an education; or disrupt the school's operation. Smith debunked a common theory about bullying that became popular in the 1980s—that bullies lack self-esteem. "Bullies are not kids who have low-self-esteem," Smith said. "The average bully is the kid who is a narcissist." Smith believes that a person becomes narcissistic if he or she never learned to bond and love as a child.

He argued that a lack of empathy and rising narcissism—which is characterized by an overinflated view of one's talents and a high level of selfishness—are the true causes of bullying. Empathy is the tendency to react to other people's observed experiences. Research shows that 70 percent of current students score higher in narcissism and lower in empathy than they did 35 years ago. Smith believes this is related to the rise in technology, the culture of self-esteem, the decline of time spent playing—which is often when children gain social competencies—and the overexposure of children to meanness and violence through the media.

Bullies are more likely to have been involved in domestic violence and child abuse; are more likely to commit crimes, drink and smoke; and have a greater propensity toward becoming anti-social adults. Signs that a child is a victim of a bully include exclusion, fear, lack of friends, erratic attendance, depression, withdrawal or clinging to teachers and staff.

Because bullying is characterized by an imbalance of power between the perpetrator and the victim, Smith urged school counselors and teachers not to try mediating a bullying situation, especially not by talking to both the victim and the bully in the same room or worse, leaving them to "work it out." Smith said, "You have to educate the social-emotional deficit in the bully, and you have to comfort the victim." Instead of simply punishing the bully, an authority must discipline him or her, which involves teaching.

To properly discipline a bully, he or she must be required to take responsibility for the behavior and explain to the authority why the behavior was wrong. Then the student must discuss alternative actions that could have been employed. Finally, the student must not only apologize but also perform an act of kindness toward the student he or she bullied.

Smith urged teachers and counselors to recognize and address bullying, explaining that it is not ever a good thing or a positive part of a growing experience, as some people think. He pointed out that adults in the workplace are protected by harassment laws and don't have to face bullying alone, so children shouldn't have to, either. He said to combat bullying, "model good social skills yourself, advocate for safer schools and better laws, work with your school parent-teacher organization, engage parents and students in prevention and work on culture and climate."

Retired UK professor Dr. Ardis Dee Hoven elected first female chair of World Medical Association

Retired University of Kentucky professor Dr. Ardis Dee Hoven, who was the president of the American Medical Association in 2013-14, was elected the first female chair of the World Medical Association at the organization's 200th council meeting in Oslo, Norway

For the past few years, Hoven was the chair of the AMA's delegation to the WMA and will now serve as the chair of the WMA for a two-year term. WMA represents physicians from 111 national medical associations.

"I feel fortunate to have the opportunity to do this," Hoven said in a UK news release. "I see myself not so much as a woman in this role but as a leader of a global organization of physicians who are working to support their peers around the the world and improve the lives of their patients."

Hoven earned an undergraduate degree in microbiology then a medical degree from UK. She finished her internal medicine and infectious disease training at the University of North Carolina at Chapel Hill. Now she is a member of the American College of Physicians and the Infectious Disease Society of America.

Hoven has received the University of Kentucky College of Medicine Distinguished Alumnus Award and the Kentucky Medical Association Distinguished Service Award, and in 2015, she was inducted into the Hall of Distinguished Alumni for UK. "Hoven hopes for the WMA to raise its profile internationally and increase the impact of its policies and advocacy on behalf of physicians and patients," the release says.

"I want to make our footprint bigger and our voice stronger," Hoven said.

Free screenings of new Kentucky colon-cancer documentary, plus Q and A, are scheduled in Louisville, Lexington and Hazard

The Colon Cancer Prevention Project is premiering its new documentary, "Catching a Killer: Colon Cancer in the Bluegrass," in three select cities, before it starts airing on KET this summer.

The 30-minute film, which features stories from Kentuckians who have been affected by colon cancer, will be shown June 18 at the Clifton Center in Louisville; June 23 at the Central Library in Lexington; and July 20 at the Perry County Library in Hazard. It includes stories from residents of Appalachia and Louisville, two areas where colon cancer rates are the highest.

All three events will run from 7 to 8 p.m. and include a question-and-answer session with expert panelists after the film is over. Free food, music and photos will be offered before the start of the film, from 5:45 to 6:45 p.m.

The Colon Cancer Prevention Project is Kentucky and Southern Indiana’s only nonprofit focused solely on work to end the second leading cancer killer among men and women. Colon cancer strikes 2,600 Kentuckians each year – making Kentucky one of the worst states in the country for colon cancer incidence – but it is highly preventable with screening.

"Catching a Killer" not only shares the heartfelt stories of our neighbors, but also shares information about screening options and resources in our state.

“Our goal is to make sure people get screened for this disease and avoid ever hearing the words: You have cancer,” Andrea Shepherd, the project's executive director, said in a news release. “We hope that after viewing this documentary, people get on the phone and start talking with their physicians and families about colon cancer screening.”

The events are free and open to the public. More information and an RSVP form is available on the project's website.

UK research project will create strategies to improve respiratory health for those living in Appalachian Kentucky

Public health researchers at the University of Kentucky will undertake a five-year long research project called "Community-Engaged Research and Action to Reduce Respiratory Disease in Appalachia," Sarah Noble writes in a UK press release.

Funded by the National Institutes of Health's National Institute of Environmental Health Sciences, the project will involve creating strategies to improve respiratory and environmental public health. Kentuckians living in Appalachian counties have the state's highest rates of serious respiratory illness.

"Adults in Appalachian Kentucky are 50 percent more likely to develop asthma or chronic obstructive pulmonary disease than the overall U.S. population," Noble writes. "As many as one in five adults in the region have received a diagnosis of asthma, and rates of COPD are nearly two-and-a-half fold the incidence of the disease in other parts of the country.

Although studies show associations between respiratory health problems and environmental contaminants, data doesn't yet include individual-level assessments or behavioral risk factors common in the area—such as smoking, poor diet and insufficient physical activity. The "Community Response to Environmental Exposures in Eastern Kentucky" project will fill those gaps.

The CREEEK project will include three steps. A community-based assessment will "identify the relationships between indoor air pollutants, behavioral and social determinants and the effects these factors have on risk of respiratory disease," Noble writes. That information "will be shared with local stakeholders in an effort to increase understanding of the environmental exposures present in the region," then the project will put in place "an environmental public health action strategy and will evaluate that strategy's ability to impact short-and long-term outcomes for respiratory health."

Combination of tobacco smoke and high radon levels increase Kentuckians' risk of getting lung cancer by a factor of 10

Red counties are expected to have an indoor radon level high
enough to require a radon mitigation system. (USEPA map)

Combined exposure to tobacco smoke and radon, an odorless gas that comes from small amounts of radioactive minerals in limestone bedrock, contribute to increased risk of lung cancer for Kentuckians.

Not only do high smoking rates and lack of smoking bans expose Kentuckians to high levels of tobacco smoke, the state's laws don't require testing and monitoring of radon, Elizabeth Adams notes in a University of Kentucky news release that gives this warning: "The risk of lung cancer increases 10-fold when a person is exposed to both high levels of radon and tobacco smoke." She gives two steps to reduce the risk:

Reduce exposure to second- and third-hand smoke. Do not allow smoking in your home or car, and ask smokers who go outside to smoke need to cover their clothes with a jacket before returning inside, or they will bring third hand smoke in with them. Of course, quitting smoking is the best way to protect your health and the health of your family.

Test your home for radon every two years. One can often obtain a free test kit from the health department or purchase one at a home improvement store. Renters can ask their landlord about radon testing. If the radon level reaches 4.0 or above, a radon mitigation system will become necessary. Opening windows or increasing ventilation won't solve the problem. Instead, call a certified radon mitigation company.

If someone living in your house smokes cigarettes, cigars or pipes, you might be eligible to participate in a UK research study examining the combined effects of smoke and radon. To learn more about the study, send an email to ukfresh@lsv.uky.edu or call 859-323-4587.