Drug-resistant infections are a grave threat but are loosely monitored; Ky. health facilities must now report them electronically

By Melissa Patrick
Kentucky Health News

Antibiotic-resistant infections are considered one of the gravest threats to humanity, but such infections and the deaths they cause are not routinely reported, hindering the battle against them, Ryan McNeill, Deborah J. Nelson and Yasmeen Abutaleb report for the Reuters news service.

Reporting on their detailed investigation, they write: "Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them."

“You need to know how many people are dying of a disease,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a Washington-based health policy research organization, told Reuters. “For better or worse, that’s an indicator of how serious it is.”

The report noted many reasons such infections are omitted from death certificates, from poor training in how to fill out the forms to a reluctance of health-care facilities to mention them because "counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage."

The federal Centers for Disease Control and Prevention estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and another 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use, but these numbers are "mostly guesswork" based on "few reported deaths from drug-resistant infection," Reuters reports.

Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, told Reuters that the agency settled on “an impressionist painting rather than something that is much more technical . . . because of our profound concern about the seriousness of the threat.” They said they are working to improve the estimates.

The numbers of uncounted deaths from drug-resistant infections “speak to what can happen when we don’t allocate the necessary resources to bolster … our public health safety network,” U.S. Sen. Sherrod Brown, D-Ohio, told Reuters. “When we see discrepancies in reporting, are unable to finance a workforce to monitor infections, and can’t even soundly estimate the number of Americans that die from [antibiotic-resistant infections] each year, we know we have a problem.”

Brown recently introduced a bill that would require the CDC to collect more and better data on superbug infections and death rates.

Wide variation in tracking

Reuters did a survey of the nation's health departments and found a wide variation in how seven leading superbug infections are reported, if they are at all.

It found that 17 states report C. difficile infections; 26 states report methicillin-resistant staphlycoccus aureus (MRSA); fewer than half report carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat;" and 24 states do not regularly track deaths due to antibiotic-resistant infections. "States that said they do track deaths generally do so for only a few types of drug-resistant infections, and not consistently," Reuters reports.

As of Oct. 1, a new regulation requires Kentucky health-care facilities to report a long list of drug-resistant infections to the Kentucky Department of Public Health electronically. The regulation also requires simultaneous data reporting to the CDC, and allows the agencies to share the data.

"This regulation on encouraging health-care facilities to report is extremely important to track these infections, to learn how to stop these infections and to identify problem areas in the state that need to be addressed," Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, said in a telephone interview with Kentucky Health News.

Kavanagh said proper reporting will allow examination of the methods health-care facilities use to fight these infections and determine whether they are effective or not. He called the matter a "huge, huge issue in nursing homes."

In the Reuters survey, U.S. health departments reported about 3,300 deaths from drug-resistant infections in 2003-2014, but the news service's own analysis of death certificates found 180,000 such deaths during the same time period. More than 20,000 were in California and more than 5,000 were in Tennessee, both states that do not require reporting of deaths linked to such infections.

Reuters found that Kentucky health departments only reported nine deaths related to health care acquired infections between 2003-2014, but Reuter's investigation found 3,027.

Patient-safety advocates petitioned the CDC in 2011 to add a question about hospital-acquired infections to its standard death certificate, which is used by many states, and have been told that it will be considered the next time the CDC revises its certificate.

Little progress made

Over-prescription of antibiotics and their overuse in farm animals has worsened antibiotic-resistant infections. Also, more people are living with weak immune systems and spending more time in health-care facilities, where most most of these infections occur.

Kavanagh said better reporting could indicate whether the overuse of antibiotics in agriculture plays a large part or a small part in the problem.

Reuters reports that in 2001, a task force led by the CDC, the Food and Drug Administration and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to tame the problem. The plan included creating a national surveillance program and speeding the development of new antibiotics. But little progress has been made toward these goals.

A new national plan to combat this problem was introduced in 2014. Congress followed in 2015 with "a $160 million increase in the CDC’s budget to bolster research, drug development and surveillance of superbugs by the states," Reuters reports. But the news service found that states often come up against strong institutional resistance and laws that shield the health-care industry when it comes to surveillance.

Study finds Kentucky hospitals had 77% less charity care in first two years of Obamacare; ER visits were about the same

An ongoing report of federal health reform's effect on Kentucky says hospitals have significantly less charity care and care to the uninsured than they did before the reform was implemented.

"Thousands more Kentuckians had insurance in 2015 than in 2012, and that led to a huge drop in the value of the charity care hospitals provided," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "Charity care and uncollected bills comprise a significant portion of uncom­pen­sated care provided by Kentucky hospitals, and hospitals in other states that, like Kentucky, have expanded Medicaid also have seen large decreases in the charity care."

The Foundation for a Healthy Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 over a three-year period to study the impact of the Patient Protection and Affordable Care Act in Kentucky.

Hospital Charity Care and Self-Pay Charges in
Dollars (millions), Kentucky, 2012-2015

In 2013, prior to implementation of the reform law and the state's expansion of Medicaid to those who earn up to 138 percent of the federal poverty level, Kentucky hospitals provided nearly $2.6 billion dollars in uncompensated care. This dropped to $942 million in 2014, and to $522 million in 2015.

Kentucky hospitals provided almost 77 percent less charity care and care to the uninsured for Kentuckians in 2015 than they did in 2012 suggesting that Kentucky hospitals are now being paid for a larger percentage of care they provide to low-income patients who previously were uninsured, says the release.

The study also looked at potentially avoidable hospital admissions and usage of emergency departments.

It found that hospitals saw a decrease in admissions for two chronic conditions, high-blood pressure and asthma, but saw an increase in admissions for diabetes.

The report also found that nearly 25 percent of Kentuckians used an emergency department in 2014, a decrease from 30.4 percent in 2012.

Kentucky's rate for emergency-department use is significantly higher than the national average of 18.2 percent. It is higher than two neighboring states, Missouri and Virginia, and about the same as Arkansas, Illinois, Indiana, Ohio, West Virginia, and Tennessee.

ED visits in the past year by age, Kentucky, 2012-2014

About 29 percent of those who used the emergency department said it was because of a medical emergency; almost 29 percent said they did so because other facilities weren't open when they needed care; and 18 percent only named a specific health condition. Seven percent said they were following a doctor's order, 3 percent said they were nearby, and 3 percent said they were taken there by first responders. Eight percent gave other answers.

Elderly Kentuckians continued to report the highest rate of emergency visits at 32 percent, and were the age group with the least decline from 2012 to 2014.

People 65 and over are on Medicare. The report found that more people on public insurance plans used the emergency department than did people on private plans, 48 percent and 19 percent respectively.

"ED utilization reflects the greater health needs of the surrounding community and may provide the only readily available care for individuals who cannot obtain care elsewhere," the report says. "Many ED visits are ‘resource sensitive’ and potentially preventable, meaning that access to high-quality, community-based health care can prevent the need for a portion of ED visits."

This semi-annual report also analyzed data regarding health coverage, access to care, cost of care, quality of care and health outcomes and included the results of a spring 2016 Kentucky Health Reform Survey of non-elderly Kentucky adults. Click here for a copy of the report.

Congress includes Zika funding in stopgap spending bill

McConnell with other GOP Senate leaders,
John Barrasso of Wyoming and John Cornyn
of Texas (Getty Images photo by Alex Wong)

Congress has finally appropriated $1.1 billion to fight the Zika virus, as part of an emergency spending bill needed to keep the government operating as the new fiscal year begins Oct. 1.

Senate Majority Leader Mitch McConnell of Kentucky "unveiled a stopgap spending measure last week that indulged several Democratic demands, including a meticulously constructed deal on Zika funding and the elimination of several contentious policy riders," Mike DeBonis reports for The Washington Post.

Those riders included a prohibition on Zika funding for Planned Parenthood in Puerto Rico, where the virus is rampant, and a waiver of environmental rules on spraying for mosquitoes. They spread Zika; so does sexual contact.

"The short-term spending bill was a triumph for Democrats, who were able to exact numerous concessions from Republican leaders who were determined to avoid a distracting government shutdown in the middle of campaign season," DeBonis writes. "That has prompted grumbling from House conservatives, in particular, and increased GOP pressure on McConnell and Ryan to draw a harder line when the stopgap expires in December."

Kentucky Sen. Rand Paul, who has much in common with House conservatives and is running for re-election against Lexington Mayor Jim Gray, voted against the bill.

How much do motorcycle helmets reduce the risk of head injuries? A lot, UK study shows

Image from Fox News

It goes without saying that wearing a helmet can reduce the risk of head injuries while riding a motorcycle, but a study at the University of Kentucky backs it up with hard numbers.

Motorcycle helmets "are associated with a 69 percent reduction in skull fractures, 71 percent reduction in cerebral contusion, and 53 percent reduction in intracranial hemorrhage," and "a 20 percent reduction in cerebral concussion," says a release from the UK College of Public Health.

Dr. Michael Singleton, an assistant professor of biostatistics, examined accident data to compare helmet protection against skull fracture, cerebral contusion, intracranial hemorrhage and cerebral concussions of motorcycle operators, and hospital billings from 2008 to 2012, to estimate the relative risks of each type of head injury for helmeted versus unprotected motorcyclists.

Kentucky once had a law requiring motorcyclists to wear helmets, but the legislature repealed it at the behest of state Sen. Dam Seum, a Republican from Louisville.

Though there was little doubt that wearing a helmet increases safety, Singleton said helmeted motorcycle operators may still be at risk. "Current motorcycle helmets do not protect equally against all types of head injury," he said.

UK College of Public Health study links diabetes to poor blood flow in the brain, but not to Alzheimer's disease

Diabetes has been linked to cerebrovascular disease, a cognitive disorder that restricts blood flow to the brain, according to a study at the University of Kentucky. Though cerebrovascular disease "is associated with stroke and ruptures that cause brain damage," the study shows that patients diagnosed with diabetes can also develop the disease.

While the study seems to settle the dispute about diabetes' linkage to the disease, researchers say it found "no significant correlation." to Alzheimer's disease, something prior research had indicated. Researchers collected samples from over 2,300 autopsied human subjects with and without diabetes.

Dr. Erin Abner, an associate professor in the UK College of Public Health, was a lead investigator in the study. Abner says the research could help prevent cerebrovascular disease in patients diagnosed with diabetes.

"While diabetes is without question both a major public health issue and a risk factor for cognitive impairment and dementia, our study suggests that cognitive dysfunction related to diabetes is likely to be preventable and underscores the idea that heart health is brain health," she said.

There is no clear answer why diabetes can cause cerebrovascular disease, but researchers "suspect this process involves many factors, including insulin resistance, hypertension and abdominal obesity," the release said.

Leitchfield passes smoking ban to take effect Jan. 1

Grayson County (Wikipedia image)

Leitchfield, the seat of Grayson County in west-central Kentucky, will become smoke-free on New Year's Day.

The Leitchfield City Council voted 4-1 on Sept. 19 for the ordinance to prohibit smoking in enclosed public places starting Jan. 1, Matt Lasley reports for the Grayson County News-Gazette.

Mayor William Thomason said the delayed start date will allow those who will be affected by the ordinance time to plan and prepare for it, Lasley reports. The ordinance does allow some exemptions.

The new law requires “No Smoking” signs to be displayed anywhere that smoking is prohibited and says local and state police will enforce the ban, with penalties for smokers up to $50 plus court costs and penalties for businesses that "willingly fail to prohibit smoking" to increase progressively up to $250 plus court costs.

A motion for a countywide smoking ban died for lack of a second reading in the Grayson County Fiscal Court in January despite strong support from local schools, the Kentucky Cancer Program and the local hospital, Twin Lakes Regional Medical Center. A hospital spokesperson said in an e-mail to Kentucky Health News that the hospital has continued to be a strong advocate for a local smoke-free law.

Smoke-free advocates in Kentucky have shifted their focus to local smoke-free policies since last fall's election of Republican Gov. Matt Bevin, who has said smoking bans should be a local issue.

Two-thirds of Kentuckians support a statewide smoking ban and have since 2013, according to the latest Kentucky Health Issues Poll. About one-third of the state is protected by comprehensive smoke-free workplace laws, according to the Kentucky Center for Smoke-free Policy.

Just over half of Ky. students are in schools with 100% tobacco-free policies; Warren, Russell county districts share successes

The state Department of Public Health has created videos to showcase the success of two Kentucky school districts in becoming 100 percent tobacco-free schools in hopes of encouraging other school districts to do the same. So far, 35 percent of Kentucky's school districts and 51 percent of the state's students are covered by such policies.

“School districts want to hear from their peers and hear from colleagues who have gone through the process already,” Elizabeth Anderson-Hoagland, youth policy analyst with the Kentucky Tobacco Prevention and Cessation Program, said in a news release. “By demonstrating that others have successfully adopted the policy and experienced positive results, we are able to encourage more school administrators to consider going tobacco free.”

The videos are of Russell County Public Schools, which approved its tobacco-free policy in July 2014 and Warren County Public Schools, which passed its policy in April 2015.

Warren County  Supt. Rob Clayton said in the release that a tobacco-free policy "fit perfectly into our core values, one of those being to ensure student and staff safety." Russell County Supt. Michael Ford said the decision to become tobacco-free was part of a "conscientious stance which favors better health for our youth and, I believe, readies them for the modern day workforce."

Kentucky has room for celebration and for concern when it comes to its teen smoking rates.

According to the 2015 Kentucky Youth Risk Behavior Survey, Kentucky's teen cigarette smoking rate is at a historic low, dropping nearly 10 percentage points over the past decade to 16.9 percent from 26.2 percent. However, this is still the third-highest teen-smoking rate in the nation, following West Virginia at 18.8 percent and Iowa at 18.1 percent  The national rate is 10.8 percent.

The survey also found that 23.4 percent of Kentucky's teens use electronic vapor products, near the national average of 24.1 percent.

State health officials attribute the 10-year decrease, in part, to tobacco-free school policies, which encourage districts to create campus environments where tobacco and alternative nicotine products are strictly prohibited on all school property and during school-related trips 24 hours a day, seven days a week.

Sixty Kentucky school districts, 646 schools and a little over half (51 percent) of the state's students are protected by comprehensive tobacco free policies.

Most Kentucky adults (85 percent) support 100 percent tobacco-free schools, including 89 percent of adults who have never smoked, 84 percent of former smokers and 80 percent of current smokers, according to the latest Kentucky Health Issues Poll. 

Strongly enforced 100 percent tobacco free school policies can reduce youth smoking by up to 30 percent, says the release.

“We strongly encourage every school district to adopt 100 percent tobacco-free school policies,” Senior Deputy Health Commissioner Connie White said in the release. “Smoking, which is the leading cause of lung cancer, heart disease and a host of other chronic diseases, is one of the biggest public health challenges facing our state. We owe it to our young people to create healthy environments where they won’t be exposed to tobacco and its detrimental health effects. Not only will it create a healthier, safer learning environment, it will further decrease the chances of them becoming smokers.”

For more information call (502) 564-9358. The Russell County School District video can be found here: https://youtu.be/imkcxDXiugI The Warren County School District video can be found here: https://youtu.be/xQ6-kucZUVs.

Health-insurance premiums for 2017 will be more expensive

By Trudy Lieberman, Rural Health News Service

Recently I got a note from a reader of these columns who lives in Warren, Ohio. He had seen conflicting reports about next year’s insurance premiums. The man was skeptical of an article he had read, which reported that insurance premiums are cheaper than they were in 2010, and that the Patient Protection and Affordable Care Act will cost $2.6 trillion less than estimated. Somehow that didn’t compute with what he had read about premiums going up.

He was right to be skeptical, and his comments are important because they zoom right in on the spin that’s been circulated by various interest groups that want to portray Obamacare’s upcoming fourth-year enrollment season as a gloom-and-doom disaster in the making or the federal government’s not-to-worry scenario insisting health insurance really is affordable.

There’s been much media speculation about high premium rates, and for the most part, the press has favored the not-to-worry scenario. Media have passed that message along with comments such as this from Anne Filipic, the head of Enroll America, a group that signs up people for Obamacare, who argued high premiums are a predictable course correction and a “one-time resetting.” Or this from Kathryn Martin, acting assistant secretary for the U.S. Department of Health and Human Services, who told reporters, “Headline rate increases do not reflect what consumers actually pay. The vast majority would continue to have affordable options.”

Insurance premiums are going up for the 24 million Americans who buy their coverage in what’s known as the “individual” insurance market, and in many states and counties rates are going up a lot. In Colorado, for instance, the insurance commissioner just approved increases of 20 percent or more on average for Coloradans who buy their coverage in the individual market, and in rural areas of the state some increases will top 40 percent.

About half the people in the individual market will buy Obamacare policies through their state’s shopping exchange and most will get a tax subsidy to defray some of the premium cost. The other half who buy in the individual market are not eligible for subsidies. Double-digit increases will matter a lot to them since rates must be the same for identical coverage sold on or off the state exchange.

Yet, too many media stories have omitted the fact that the unsubsidized group will get no help. Instead they’ve planted the notion that premiums are affordable. In its messaging effort, the government has said that about three-quarters of those buying on the exchanges should be able to pay $75 or less a month for a policy after taking subsidies into account. The government used the same pitch used last year when officials said 70 percent of shoppers could get insurance for $75 or less per month after subsidies.

Statements like those, however, are misleading because they overlook the total costs of care that includes the high deductibles, co-pays, co-insurance and high out-of-pocket spending limits. That expense is usually not part of anyone’s talking points.

We don’t know if rates will remain high or whether this year is an aberration, as the government and others claim. We do know that for those who have to pay the premiums, they may be unaffordable.

Affordability, of course, depends on your budget. What’s affordable to a policy analyst in Washington D.C., may not be to someone in rural Indiana. Since the subsidies are larger and most helpful to families with lower incomes, around $30,000 or $40,000, those with even slightly higher incomes may have a tougher time.

A major reason for the high rates this year is that a lot of sick people with heavy medical needs signed up for policies, and their claims have hit insurers’ bottom lines pretty hard, so hard that many have decided not to sell polices. Blue Cross Blue Shield of Nebraska just announced it was not selling Obamacare policies next year on the state exchange even after the state had approved increases of more than 30 percent. Big insurers like UnitedHealth Group and Aetna have left the exchange market in Kentucky and many other states, reducing choices and increasing costs.

As for Obamacare costing $2.6 trillion less than expected, that’s true, according to the Congressional Budget Office. There are many reasons – the recession, less Medicaid spending because 19 states did not expand their programs as the ACA intended, and shifting more of the cost of care to patients themselves through high deductibles.

No one knows whether lower spending growth will continue. One thing, though, is certain. Families will continue to pay one way or another.

What has been your family’s experience with high insurance premiums? Write to Trudy at trudy.lieberman@gmail.com.

American Medical Association says Humana takeover by Aetna would reduce health-insurance competition in Kentucky

Humana Inc.'s proposed takeover by Aetna Inc. would hurt health-insurance competition in 57 metropolitan areas in 15 states, especially Kentucky and Georgia, says an analysis by the American Medical Association. It cites Louisville-based Humana's large share of the Kentucky market and said the threat is mainly to policyholders in preferred provider organizations (PPOs).

"The AMA, no friend of the insurance industry to begin with, is stepping up the already mounting pressure on Aetna as it attempts to buy Humana, and [on] Anthem, which is trying to take over Cigna," Bruce Japsen reports for Forbes magazine. "The U.S. Justice Department in July sued to block both deals, saying they would hurt competition and raise prices for consumers. . . . The insurers deny the AMA’s contention and are challenging the government’s lawsuits."

Across the various forms of insurance, the AMA analysis saw a threat to overall competition in the Louisville, Lexington and Elizabethtown markets. It saw a threat to the HMO market in the Clarksville, Tenn., market, which includes the Hopkinsville area. It saw lesser threats in the Evansville, Ind., and Huntington, W.Va., markets, which include parts of Kentucky.

U.S. attorney general hears from Central Ky. families of overdose victims, who offer suggestions on what needs to be done

U.S. Attorney General Loretta Lynch attended events in Lexington and Richmond this week as part of the first national Prescription Opioid and Heroin Epidemic Awareness Week, Bill Estep reports for the Lexington Herald-Leader.

In Lexingon, families who have lost loved ones to drug overdoses shared their stories with Lynch: stories about lying awake at night wondering if their addicted son would make it home, stories of desperation in the search for treatment, stories about the difficulties in paying for treatment and stories about the death of their loved ones.

“We cry every day,” said David Greene of Lexington, whose son Domonique, 23, died of a heroin overdose last October, leaving behind a baby daughter.

Drug overdose deaths in Kentucky rose to a record 1,248 in 2015, compared with 1,088 in 2014, according to the latest annual report from the Kentucky Office of Drug Control Policy.

Members of the group USA HEAT, which stands for U.S. Attorney's Heroin Education Action Team, met Lynch in Lexington at the office of U.S. Attorney Kerry Harvey, whose office helped to set up the group.

The group was created to help members share their stories to increase understanding of heroin and painkiller abuse, and have since presented "to more than 2,500 people at schools, churches and other locations, including the federal prison in Manchester," Estep reports.

In addition to their personal stories, members of the group told Lynch what they thought was needed to fix the problem, including more efforts to educate parents about the issue; "more effective prevention education for young people; better ways for families to find treatment resources; treatment that lasts long enough; quick access to treatment in the moments of clarity when addicts reach for help; and more affordable treatment options," Estep writes.

Harvey told Estep that he was not aware of a similar program in any other U.S. attorney’s office, and his office told Estep that Lynch mentioned trying to replicate it.

“Their stories were devastating, but their resolve to spare other parents the same fate is inspiring,” Lynch said at the University of Kentucky.

Before meeting with the USA HEAT members, Lynch was part of a discussion about heroin and opioid abuse at Madison Central High School, where about 500 students from Madison Central, Madison Southern and Richmond Model Laboratory high schools attended.

"Dozens raised their hands when Lynch asked how many knew someone who had overdosed. Far fewer raised their hands when she asked how many people had survived," Estep writes.

Alex Elswick, who is in long-term recovery from addiction to heroin and pain pills, told the students he got hooked after he had his wisdom teeth removed and received pain pills, Estep reports. “You don’t know what you’re in for” when using drugs, he warned them.

Kayla Greene told students to not use any drugs, even marijuana, saying that her son used marijuana but eventually moved to pills and heroin.

Lynch told one student who asked what to do if they had a friend with a drug problem to tell a trusted adult about it. “You’ve gotta get in between your friend and that problem,” she said.

At UK, Lynch announced $8.8 million to improve state prescription monitoring systems, including Kentucky's system.

President Barack Obama has called for $1.1 billion in new federal spending to fight opioid abuse, with a large part of it going to make medication-assisted treatment more widely available. "The administration estimated in June that Kentucky would get up to $18 million over two years to boost access to treatment for opioid abuse if Congress approves Obama’s budget request."

Lung transplant recipient who battled bureaucracy to get coverage, dies five days after being widowed; funeral Sunday

"Katie Prager, the Kentucky lung transplant recipient whose story with her late husband, Dalton, touched millions, has died," reports Cheryl Truman of The Lexington Herald-Leader. Katie and Dalton met online and married in 2011. "Both had cystic fibrosis, and both had lung transplants that failed."

(Lexington Herald-Leader photo.)

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Katie, 26, died in her Flemingsburg home early Thursday, a family member said.

Debra Donovan, Katie's mother, said it was Katie's wish to be surrounded by loved ones in her final moments. “Early this morning she gained her wish of being at home, in her bed, surrounded by her mom, dad, brother and her dogs, dying peacefully away from the hospital, tubes, IVs,” Donovan, wrote Thursday morning on Facebook.

"By the time Katie's close-knit Fleming County family gave her a Christmas-in-September party on Saturday, she was underweight, her once-abundant blonde hair sparse, her color waxen." Truman writes. "She had made a decision to discontinue all life-extending measures except for dialysis and had entered hospice care. She was sleeping a great deal, using an oxygen tank and getting weaker by the day."

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Hours before the start of the family gathering, Dalton died in his hometown of St. Louis. "He had been trying to get to Kentucky to see his wife, who was in Hospice care after her own failed lung transplant, one last time," Truman writes.

Read more here: http://www.kentucky.com/news/local/counties/fayette-county/article102599882.html#storylink=cpy

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Katie and Dalton received national attention because they both had "the Burkholderia cepacia infection, which limited the number of surgery centers specializing in their conditions," Truman writes. "Dalton received his lung transplant in November 2014. Katie, after a lengthy bureaucratic snafu over insurance coverage, received her new lungs at the University of Pittsburgh medical center in July 2015." Both transplants were unsuccessful.

"During the Saturday Christmas party, Katie said that she believed in an afterlife and would see her husband again," Truman writes. "At the family gathering in Ewing after Dalton’s death, Katie said, 'I’ll see him soon.'”

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Visitation for Katie will be 4 to 9 p.m. Sunday at Elizaville Christian Church in Flemingsburg. Funeral services will be at 10 a.m. Monday at the church.

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Read more here: http://www.kentucky.com/news/state/article103380187.html#emlnl=Afternoon_Newsletter#storylink=cpy

Annual health forum looked at connections between health and the economy

The relationship between health and the economy in creating healthy communities was the focus of the 14th annual Howard L. Bost Memorial Health Policy Forum in Lexington Sept. 19. The theme of the Foundation for a Healthy Kentucky conference was "Health as an Economic Driver."

Through a series of TED-style talks, breakout sessions and a keynote address, the forum explored the relationship between health and the economy, offering insights on how anchor institutions can contribute to local economies; the high cost of health care and the lack of price transparency for consumers; and how racial inequities affect the cost of health care.

Health systems as employer and purchaser

Health systems can work as economic drivers in communities through buying local, hiring local and helping employees to live local.

Robert Eckardt

That's what three anchor institutions in Cleveland, Ohio, have done with the help of The Cleveland Foundation, Robert Eckardt, executive vice president of the foundation, said during his TED-style talk. The institutions are Case Western Reserve University and its School of Medicine, University Hospitals of Cleveland and the Cleveland Clinic.

The neighborhoods around the highly profitable anchor institutions are among the poorest in the state, Eckardt noted. His foundation asked the institutions to become stronger partners with the communites through a three part strategy: "Buy local, hire local and live local." The institutions have changed their hiring protocols to hire locally, adding a six-month training program to make it possible, and have agreed to work with three worker owned co-operatives.

Eckardt said foundations can be a "safe space" to help institutions think about their role in the community, noting that many of them have never even considered this an option or a responsibility. "I encourage you to think about how anchor institutions can change their perspective from an internal one to an external one," he said. 

Health care costs

High-deductible, consumer-driven health plans are designed to encourage patients to become more active consumers of their health care by seeking out best price and value, but often this information isn't readily available, said AJcScheitler, manager of stakeholder relations at the UCLA Center for Health Policy Research.

AJ Scheitler

Scheitler said an analysis of health-care costs in Los Angeles found the cost of a circumcision varied between $175 at a reputable clinic that does 20 to 30 circumcisions a day and $3,000 at a local hospital.

She said the cost of care in the U.S. is much higher than in other countries, citing an article by David Lazarus of the Los Angeles Times that told the story of a woman's experience getting a four-shot treatment for rabies in four different facilities that costs less than $20 overseas, and ran more than $5,000 in the U.S.

She mentioned a Reuters analysis of drug prices that found Americans pay seven and a half times more for their insulin than people in Great Britain, and a study published in the Journal of the American Medical Association that found the average cost of insulin in the U.S. more than tripled between 2002 and 2013, jumping to $736.09 from $231.48.

"We have no idea what we are paying for," she said, and though there is beginning to be some price transparency, it is not enough to be effective yet. 

Social justice, health and the economy

Adewale Troutman

Dr. Adewale Troutman, who identifies himself as a social justice and human rights activist, pointed out during his TED-style talk that poor communities with no employment or educational opportunities have poor health outcomes.

"It has been proven quite clearly that the most important number in your (health) profile is not your blood pressure, not your blood sugar or any of that," he said. "The most important number is your zip code. Where you live is the most important factor in your health outcomes."

Among other things, Troutman is the former president of the American Public Health Association with ties to Kentucky as a former associate professor in the University of Louisville School of Public Health and Information Sciences and former director of the Metro Louisville Department of Public Health and Wellness.

Troutman also noted how health inequities increase the cost of care, citing a study by Thomas A. LaVeist of John Hopkins University that examined the direct and indirect costs of providing health care to a sicker and more disadvantaged population.

The report says, "More than 30 percent of direct medical costs faced by African Americans, Hispanics and Asian Americans were excess costs due to health inequities, more than $230 billion over a four year period. And when you add the indirect costs of these inequities,the tab comes to almost $1.3 trillion."

"When you look at the issue of economics and health, it is quite clear that the relationship is very, very strong," he said.

Gail Christopher

Dr. Gail Christopher, a national expert in holistic health and diversity, also emphasized the importance of improving racial inequities as a way to improve health outcomes and to create savings in health care.

"The lions share of the cost savings that this country would experience if we were to achieve racial equity . . . are health care cost," she said in her keynote speech.

Christopher, vice president for program strategy at the W.K. Kellogg Foundation, said that the unifying factor that connects racial inequity to poor health outcomes is exposure to adversity and to stress.

"People who have access to education, people who have access to income, people who are not subjected to discrimination and adversity have better health outcomes," she said. "And when they have better health outcomes, they have fewer interactions with the health care system and therefore they spend less."

The forum is held in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.
Co-sponsoring partners with the Foundation for a Healthy Kentucky were Kentucky Educational Television, Health Enterprises Network, Kentuckiana Health Collaborative, Kentucky Center for Economic Policy, Kentucky Chamber of Commerce, Kentucky Hospital Association and the Federal Reserve Bank of Cleveland.

Nov. 11 Health Coverage Workshop offers something for all journalists, even their bosses

Kentucky faces many unique health challenges, but they don't get enough news coverage, which hamstrings the state and its communities from fully addressing their health problems. These challenges and how to tackle them from a news perspective will be addressed at the Health Coverage Workshop on Nov. 11 at Natural Bridge State Resort Park in Slade.

The workshop is open to any Kentucky journalist, from those who are just starting to cover health issues to those with years of experience in the subject matter, and it offers something for everyone: reporters, editors, news directors, publishers, photojournalists and everyone in between. The workshop is free, thanks to the Foundation for a Healthy Kentucky.

Specific health topics will include oral health, smoking, obesity and cancer, where to find information on these issues and how to localize it for your audience. Revenue building through special health sections will also be addressed.

Several guest speakers will discuss their areas of specialization. Van Ingram, of the Kentucky Office of Drug Control Policy, and Kentucky Health News Senior Reporter Melissa Patrick will talk about how to cover one of Kentucky’s biggest, most complicated problems: opioid dependency and the consequences that follow.

Al Cross, director of the Institute for Rural Journalism and Community Issues, will discuss several topics, including proposed Medicaid changes and their implications for your readers, as well as the basics of managed care organizations that handle Medicaid for the state.

Jennifer P. Brown of the Kentucky New Era in Hopkinsville and Sharon Burton of the Adair County Community Voice in Columbia will discuss, respectively, how a small newspaper can cover health and how newspapers can use health sections to gain revenue and serve readers who need more health information. Finally, Cynthia Lamberth of the Kentucky Population Health Institute will talk about how to look for health policy in all stories.

Natural Bridge has made available a small block of rooms for those participants who would like to arrive the night before. Call the park at 800-325-1710 to make a reservation.

To register for the workshop, complete this registration form as soon as possible.

Direct questions to Danielle Ray at dnray2@g.uky.edu.

Genetic testing is an option if you have a family history of breast cancer; regardless, if over 40 get an annual mammogram

October is Breast Cancer Awareness month, making it a good time to consider talking to your primary-care provider about genetic testing if you have a family history of breast cancer.

“Genetic testing is not recommended for all women, but can be helpful for those with a family history of breast cancer to determine if they are at risk,” said Dr. Mridula Vinjamuri of KentuckyOne Health in a news release. “There is only a small chance that your family carries gene mutations that cause breast cancer. However, gene mutations account for about five to 10 percent of all breast cancers, so it is beneficial for women with a family history to be tested for these genes.”

Genetic testing helps determine if you carry certain genes that are known to cause breast cancer, such as BRCA1, BRCA2 and PALB2. Testing involves your physicians sending either a blood or saliva sample to the lab.

KentuckyOne Health notes that about 12 percent of women get breast cancer, but about 55 to 60 percent of women with the BRCA1 gene mutation will get breast cancer by age 70 and an estimated 45 percent of those with the BRCA2 gene mutation will by age 70. Breastcancer.org says that those with the PALB2 gene mutation have a 14 percent risk of developing breast cancer by age 50 and a 35 percent increased chance by age 70.

These gene mutations are inherited from a person’s mother or father. The release recommends that the first family member who has breast cancer get the gene test first, because if they don't have the gene mutations, then other family members won't either. Men with these mutations also have an increased risk of breast cancer.

KentuckyHealth One also notes the importance of seeing a genetic counselor before having any genetic testing to discuss the potential risks, limitations and benefits of the testing.

While there is no medical risks associated with genetic testing other than the slight risks associated with having your blood drawn, there are some psychological risks. The release notes that some who are tested become anxious, angry, sad or depressed because of the uncertainty related to finding out they carry the abnormal genes; others feel a sense of inevitability, though this may not be the case; and others struggle over what they should do next.

“Being aware of how to reduce your risk for a breast cancer diagnosis is very important," said Dr. Mounika Mandadi of Louisville's James Graham Brown Cancer Center, which provides breast cancer genetic counseling and testing. “Our goal at the clinic is to raise awareness of breast cancer, decrease risk of diagnosis, and provide chemoprevention.”

The release added that as you weigh the risks and rewards of testing to remember: "All women older than 40 should receive an annual mammogram, regardless of genetic testing results, as aging women are at risk for developing breast cancer." And remember, men can also get breast cancer.

Several Kentucky hospitals are now certified as 'Sexual Assault Nurse Examiner' ready facilities

Three Kentucky hospital systems have become the first in the state to obtain certification that demonstrates their ability to provide 24 hour response for sexual assault victims.

The newly certified "Sexual Assault Nurse Examiner" facilities include all of the St. Elizabeth Hospitals in Northern Kentucky, Fleming County Hospital in Flemingsburg and Meadowview Regional Medical Center in Maysville. They have a SANE nurse on call 24 hours a day, seven days a week.

"This designation demonstrates a commitment to providing a higher standard of care for sexual assault victims by ensuring they will be examined and treated by someone with skills and expertise necessary when dealing with this type of crime. This is certainly step forward for victims' rights in Kentucky," Health Secretary Vickie Yates Brown Glisson said in a news release.

SANE nurses have advanced training in the forensic examination of sexual assault victims and are credentialed by the Kentucky Board of Nursing. The certification was made possible by the "Sexual Assault Forensic Evidence Act," which passed the 2016 General Assembly with bipartisan support. The SAFE Act also addressed the backlog of untested sexual assault evidence kits in the state. Following its passage, Gov. Matt Bevin proposed an additional $4.5 million for the state crime lab to help it meet new testing deadlines set by the bill.

"Making sure sexual assault victims receive quality, compassionate care in the immediate hours following an assault can help them begin the long journey toward healing," Eileen Recktenwald, executive director of the Kentucky Association of Sexual Assault Programs, said in the release. "KASAP commends these hospitals for recognizing the importance of SANE readiness and seeking the certification, and we hope others follow suit."

The state Cabinet for Health and Family Services is required to certify SANE-ready hospitals annually and to post the list on its website. This list is also provided to the Kentucky Board of Emergency Medical Services, which then shares it with local EMS providers.

Health advocacy group that opposes new Medicaid proposal to hold eight community forums across the state to discuss it

This story was updated on 9/23/16.

Kentucky Voices for Health will host eight community forums across the state to discuss Gov. Matt Bevin's proposed changes to the state's Medicaid program during the 30-day federal comment period, which ends Oct. 8.

Each event will feature a brief presentation about the proposed changes, allow time for questions and will provide an opportunity for attendees to discuss how the proposed changes will impact them, their families and their communities, according to the website.

KVH opposes the governor's new proposal, saying on its website blog that it is "costly, complex and greatly reduces access to care."

The governor's new Medicaid proposal was submitted to the federal government in the form of a waiver from federal rules, under a section of law allowing for demonstration programs. It mainly targets able-bodied adults who now qualify for Medicaid under the expansion of this program to those who earn up to 138 percent of the federal poverty level. It does not affect children, pregnant women, the medically frail and adults who were eligible for Medicaid before the expansion.

The proposal is designed to encourage participants to have a higher level of involvement in their health care, through premiums and "community engagement" requirements, and to save taxpayers money by reducing enrollment by about 86,000 people. All of these conditions are controversial and could be denied by the federal government. To date, no proposal with work requirements has been approved.

Bevin has said that if this new plan is not approved, "there will be no expanded Medicaid in Kentucky," a decision that would take away Medicaid coverage from 430,000 Kentuckians who now qualify under the expansion, but he has also said he is willing to negotiate with federal officials.

Six of Kentucky's congressional delegation have sent a letter to  the U.S. Department of Health and Human Services Secretary Sylvia Burwell in support of the governor's new Medicaid plan, asking that it be afforded "a fair and timely review and allow the Commonwealth the opportunity to demonstrate that the Kentucky HEALTH waiver proposal can improve health outcomes while also protecting the long-term viability of the Medicaid program."

Kentucky HEALTH is the official name of the governor's plan and stands for Helping to Engage and Achieve Long Term Health.

The letter was signed by Senate Majority Leader Mitch McConnell, Sen. Rand Paul, Rep. Brett Guthrie, Rep. Hal Rogers, Rep. Andy Barr and Rep. Thomas Massie, all Republicans.

Here's the schedule for the forums:

Sept. 26 - Morehead: Morehead Conference Center, 111 E 1st Street, 6-8 p.m.
Sept. 27 - Paducah: McCracken County Public Library, 555 Washington St., 6:30-8:30 p.m.
Sept. 27 - Lexington: Mary Queen of the Holy Rosary, 601 Hill N Dale Dr., 6:30-8:30 p.m.
Sept. 29 - Elizabethtown: Pritchard Community Center, 404 S. Mulberry St., 6-8 p.m.
Oct. 3 - Prestonsburg: Jenny Wiley State Resort Park, 75 Theatre Ct., 6-8 p.m.
Oct. 4 - London: First Baptist Church, 804 W. 5th St., 6-8 p.m.
Oct. 5 - Louisville: First Unitarian Church, 809 S. Fourth St., 6-8 p.m.
Oct. 6 - Covington: Kenton County Public Library, 502 Scott Blvd., 6:30-8:30 p.m.

Click here to submit your comments. Click here to see the full report.

KentuckyOne Health lays off several top executives

KentuckyOne Health laid off several top executives Sept. 16, the latest sign of trouble at the hospital company created by mergers four years ago.

Andrew Wolfson of The Courier-Journal called the firings "a bloodbath" and wrote: "In an internal announcement that wasn’t shared publicly, the Kentucky division of financially troubled Catholic Health Initiatives said it was axing leaders to “improve operational efficiency and ensure continued focus on patient care.”

The fired executives included Dr. Damian "Pat" Alagia, senior vice president and chief physician executive; Randy Napier, president of Frazier Rehab Institute and Southern Indiana Rehab Hospital, and Michael Spine, senior vice president of strategy and business development. "Velinda Block, system chief nursing officer, who had previously shared her decision to leave the company, decided to resign and her position will not be filled," just as Napier and Spine's will not, Wolfson reports.

The company's announcement said “These decisions were made to strengthen our resources and support the physicians, clinicians and team members who are delivering on the needs of patients and families every day.”

Wolfson notes, "KentuckyOne was formed in 2012 by the merger of Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System of Lexington, but it has had financial troubles ever since, and in February 2014 announced it was laying off 500 employees in Kentucky. Its Denver-based parent lost $125.9 million in the last quarter of 2015 and has run up billions of dollars of debt." Alagia told Wolfson that the moves made sense for the company.

KentuckyOne and its partner, the University of Louisville Hospital, have "come under attack on several fronts over the past few months," Wolfson notes. "Last month a jury returned a $21.2 million verdict against the company and its St. Joseph Hospital in London for conspiring with cardiologists to perform unnecessary heart procedures. . . .

"In June, triggered by a surgeon's complaint that U of L Hospital was so understaffed that it endangered patients, a state inspection last month found that deficiencies in nursing services specifically endangered three patients. A dozen nurses and doctors also told state inspectors that nursing and other staff shortages put patients at risk, according to the state's 30-page report released by the company, which said the hospital is safe and has made numerous improvements. A state inspection team concluded after a follow-up visit in August that the issues had been addressed. U of L Hospital also received the lowest possible score from the U.S. Centers for Medicare & Medicaid Services in a new rating system for hospitals.

"And in May, the Kentucky Supreme Court upheld a $1.45 million punitive damages verdict against KentuckyOne’s St. Joseph Hospital in London for patient dumping in a case in which it twice kicked out an indigent, paraplegic patient in agonizing pain – the second time wheeling him across the street to a motel, leaving him there without a wheelchair and telling him if he came back again the hospital would have him arrested. He died instead."

Kentucky's breastfeeding rate is one of the lowest in the U.S.

Photo: Kybreastfeeding.com
(Click link for more information)

By Melissa Patrick
Kentucky Health News

The federal Centers for Disease Control and Prevention says breastfeeding is a key strategy to improve public health, and Kentucky ranks 48th among the states in the percentage of mothers who breastfeed.

Studies show that children who have been breastfed have less risk of respiratory infections, Sudden Infant Death Syndrome, Type 1 and Type 2 diabetes, obesity and asthma. Mothers who breastfeed have a decreased risk of  breast, ovarian and endometrial cancers and heart disease, all conditions that plague Kentucky.

"I don't think we have any pill, any vitamin, any thing that we can take that can reduce the risk of all these diseases just at once. Like, take this pill once a day and you will be able to decrease all these diseases. There is nothing like that," Ana Maria Linares, an associate professor at the University of Kentucky College of Nursing, said in a telephone interview. "But we can give that to our babies with exclusive breastfeeding."

The American Academy of Pediatrics recommends that infants be only breastfed for the first six months, with continued breastfeeding alongside complementary foods for at least one year.

"Breast milk is especially adapted to be easily absorbed by the baby gut . . . and produces a specific microorganism in the gut that (will) protect the infant," Linares said.

The CDC's 2016 Breastfeeding Report Card says Kentucky's breastfeeding rates are slowly improving, but remain very low.

The U.S. Department of Health and Human Services sets Healthy People goals in a plan to improve the nation's health.

Six months after giving birth, 35.3 percent of Kentucky mothers reported  breastfeeding their infants some of the time, with only Louisiana (31.2 percent) and Mississippi (23.9 percent) having lower rates. Only 19 percent of mothers in Kentucky breastfed exclusively after six months; that was much closer to the national figure of 22.3 percent.

Two-thirds of mothers in Kentucky said they tried breastfeeding at least once, indicating a willingness to do so and perhaps a lack of support to continue, the report said. Nationally, 81 percent of mothers tried breastfeeding at least once.

"We are getting there," said Linares, the UK professor whose research focuses on breastfeeding. "I am really positive about that  because more and more mothers are willing to breastfeed now, at least give it a try. And that is a lot to say because before they wouldn't even consider it."

Rates for Kentucky mothers who have breastfed their infant for six months has improved by almost 34 percent since the CDC started publishing these report cards in 2007, up from 26.4 percent. And improved 153 percent for Kentucky mothers who breastfed exclusively for six months, from 7.5 percent. Data from the 2007 report came from 2004.

Linares said Kentucky is working to teach health-care providers about the importance of breastfeeding and has increased its pre-natal education about breastfeeding. The state offers a peer-counseling program that puts mothers who have had a good breastfeeding experience in touch with new breastfeeding mothers.

"The peer counselor program is one of the most important programs in the state," because it provides support for mothers not only to start breastfeeding, but to also maintain it, Linares said.

The state is also working to get hospitals certified as "Baby Friendly," which, among other requirements, allows the mother and baby to have "skin-to-skin" contact for at least two hours, with has been proven to prompt breastfeeding.

Kentucky has three such hospitals: Norton Women's and Kosair Children's Hospital in Louisville, St. Elizabeth Medical Center in Northern Kentucky, and University of Kentucky Hospital in Lexington.

Linaes said that Kentucky has work to do on its societal views of breastfeeding, because some mothers still feel that they don't have enough support to do it, especially in public places. Kentucky has had a law since 2006 that allows mothers to breastfeed anywhere.

"We need to have a law that protects mothers so that they can have maternity leave, to stay home for at least one month so that they can establish breastfeeding," Linares said, adding that six months would be preferable.

Linares said the U.S. is one of only three developed countries that doesn't offer paid maternity leave, which she said creates a situation which poses a question for mothers: "Should I work or should I breastfeed my baby?" She cited a study indicating if 90 percent of U.S. mothers were able to breastfeed exclusively for the first six months, it would save the country "billions of dollars" and "many lives."

Super-powerful narcotics threaten even more fatal drug overdoses in region; six in Danville area spur community action

“If you’re putting a needle in your arm, you’re playing Russian roulette,” because so many super-powerful narcotics such as fentanyl are in the illegal drug trade, Dr. Eric Guerrant, emergency department medical director at Ephraim McDowell Regional Medical Center in Danville, told Laura Ungar of The Courier-Journal for a story on the threat and his community's reaction to it.

The elephant tranquilizer carfentanil, 100 times as strong as fentanyl, may be the biggest threat. While it "hasn’t been definitively identified in Kentucky or Southern Indiana, the powerful synthetic drug has been confirmed in eight overdose deaths in nearby Hamilton County, Ohio, which includes Cincinnati," he drug is suspected in dozens of overdoses, a few of them fatal, in the Louisville area and Mount Sterling, Ungar notes.

"Carfentanil is cheaper for drug dealers to use as an additive because a tiny amount is so powerful. Addicts typically have no idea what they’re taking, and it can be difficult to discern even if they die. Tests to confirm the drugs can take months," Ungar writes. "While routine toxicology tests can detect fentanyl, they don’t usually pick up carfentanil, said Mike Wynn, a spokesman for the Kentucky Justice and Public Safety Cabinet and the state medical examiner's office. So conceivably, carfentanil could already be here in Kentucky."

Ungar reports, "Officials say carfentanil may be just the closest of several drug threats on the horizon. Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said he’s also worried about related synthetic opioids W-15 and W-18, which are also many times more potent than heroin and have been found in Canada and Pennsylvania. Officials say Kentucky is particularly vulnerable to this new wave of powerful narcotics because addiction is so entrenched. Statistics from the U.S. Centers for Disease Control and Prevention ranked the state’s drug overdose death rate fourth-highest nationally in 2014 – 24.7 per 100,000, reflecting 1,077 deaths. State records show that even more Kentuckians – 1,200 – lost their lives to drug overdoses last year."

Six people in Boyle County overdosed on heroin in two weeks in July. “They were in cardio-pulmonary arrest,” Guerrant told Ungar. “Only one survived the initial resuscitation. They were all young adults. They were from all walks of life, too.” The deaths shook the Danville area into action. The Boyle County Agency for Substance Abuse Policy held a community meeting that drew more than 100 people, including church leaders, substance abuse treatment professionals, emergency workers and local politicians. "Local groups and organizations held a candlelight vigil on Overdose Awareness Day Aug. 31 and a 5K 'Run Against Addiction' a few days later. Danville resident Toni Ward launched a new group with a heavy Facebook presence called Families Into Getting Help Together, hoping to reach more young adults."

To raise awareness of the issue, President Obama has proclaimed Sept. 18-24 Prescription Opioid and Heroin Epidemic Awareness Week.

Louisville man, 73, first this year to die from West Nile virus; officials remind Kentuckians to wear bug repellent when outside

State health officials have confirmed that a 73-year-old Louisville man died from the West Nile Virus during the week ended Sept. 17.

Beth Fisher, spokeswoman for the Cabinet for Health and Family Services, told The Courier- Journal that this is the first death from West Nile reported in the state this year.

Symptoms of the virus may include fever, headache, body aches, skin rash and swollen lymph glands, according to the federal Centers for Disease Control and Prevention. There is no vaccine or specific antiviral treatment for the virus.

The CDC says people over 60 are at the greatest risk for a severe infection. In a separate article, The Courier-Journal notes that people with certain medical conditions, such as cancer, diabetes, hypertension and kidney disease, and anyone who's had an organ transplant also are at greater risk.

Health officials advise people to wear bug repellent and protective clothing outdoors and to stay indoors at dawn, dusk and early evening when mosquitoes are most active.

As coal declines in Central Appalachia, what is its legacy in health, including mental health?

As the coal industry declines, rapidly in Central Appalachia, there are "clues suggesting that health and mental-health issues will pose enormous challenges to the affected coal communities, and will linger for decades," Georgia State University biology professor Roberta Attanasio writes for The Conversation US.

Appalachia's death rates are higher than in the nation as a whole, Attanasio notes: "A study that examined the elevated mortality rates in Appalachian coal mining areas for 1979-2005 linked coal mining to 'socioeconomic disadvantages' and concluded that the human cost of the Appalachian coal mining economy outweighed its economic benefits."

A retired coal miner looks at Kayford Mountain in West
Virginia in 2007. (Photo by Andrea Hopkins for Reuters)

Attanasio notes research showing correlations between mountaintop-removal mining and poor health: "They show that when mountaintop removal increases, well-being decreases. However, they do not show that mountaintop removal directly causes a decline in well-being because of the nature of the pollutants and the nature of the exposure to them. Despite the intricacy of studying this area, links to adverse outcomes such as birth defects, cancer, and lung, respiratory and kidney disease, are undeniable."

Mountaintop mining may also affect some people's mental health, Attanasio writes: "People who gain a strong sense of identity from the land are most likely to experience negative outcomes. Environmental philosopher Glenn Albrecht coined the term solastalgia as 'a feeling of chronic distress caused by negatively perceived changes to a home and its landscape,' which he observed in his native Australia due to the effects of coal mining. People who experience solastalgia lack the solace or comfort provided by their home; they long for the home environment to be the way it was before. In a study of Australia published in 2007, Albrecht and collaborators documented the dominant components of solastalgia linked to open-cut coal mining in the Upper Hunter region of New South Wales – the loss of sense of place, the feeling of threats to personal health and well-being, and a sense of injustice and/or powerlessness."

Attanasio notes a survey-based study in Central Appalachian areas with and without coal "indicated that individuals who experience environmental degradation caused by mountaintop-removal mining are at increased risk for depression. The study showed that the odds of a score indicative of risk for major depression are 40 percent higher in areas subjected to mountaintop-removal mining when compared to non-mining areas. Furthermore, the risk of major depression is statistically elevated only in mountaintop-removal areas, and not in areas subjected to other forms of mining, even after statistical control for income, education and other risks."

Ky. confirms 10 flu cases; vaccination (not nasal spray) urged, but some experts tell seniors to wait a bit for best protection

image: www.lex18.com

State health officials report that Kentucky has 10 confirmed cases of influenza already this year, suggesting flu season could be starting early. The cases are in Bullitt, Fayette and Jefferson counties.

Flu season in Kentucky typically begins in October or November and runs through May. Public-health officials are encouraging Kentuckians to get a flu vaccine.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness," Health Commissioner Hiram C. Polk said in a news release.

While health experts agree that vaccination is the best way to prevent the flu and that getting a flu shot early is better than not getting one at all, some are encouraging those 65 and older to wait until at least Halloween to assure optimal protection later in the season, Julie Appleby reports for Kaiser Health News.

"That’s because a combination of factors makes it more difficult for the immune systems of people older than age 65 to respond to the vaccination in the first place. And its protective effects may wear off faster for this age group than it does for young people," she writes.

These experts are citing a study done during the 2011-12 flu season that found the effectiveness of the vaccine declines in the months following vaccination "primarily affecting persons age 65 and older."

Polk also encouraged common-sense precautions to protect against the flu, such as sneezing into your elbow or using a tissue that you throw away when you cough or sneeze; staying home when your are sick; and washing your hands frequently with soap and water.

Other suggestions include avoiding close contact with sick people; not touching your eyes, nose and mouth and keeping surfaces and objects that could be contaminated with germs disinfected.

The federal Centers for Disease Control and Prevention recommends flu vaccine for all individuals 6 months and older. However, it no longer recommends the nasal spray flu vaccine  because it has been shown to be ineffective during several of the past flu seasons.

People who are strongly encouraged to receive the vaccine because they may be at higher risk for complications or negative consequences, include:

• Children, age 6 months through 4 years;
• Pregnant women;
• People 50 years old or older;
• People 6 months and older with chronic health problems;
• Extremely obese people;
• People who live in nursing homes and other long-term care facilities;
• Health care workers, household contacts and caregivers of people who live  with a person at high risk for complications from the flu; and
• Out-of-home caregivers of children less than 5 years, but especially for caregivers of those who are less than 6 months old.

Flu is caused by a virus and is very contagious. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.Vaccination can be given any time during the flu season and the release notes there should be an adequate supply of the vaccine this year.

For more information on influenza or the availability of flu vaccine, please contact your local health department or visit http://healthalerts.ky.gov.

Howard L. Bost Health Policy Forum to be held in Lexington Sept. 19; focus will be on 'Health as an Economic Driver'

It's not too late to sign up for the 14th annual Howard L. Bost Health Policy Forum, titled "Health as an Economic Driver," to be held at the Marriott Griffin Gate Resort in Lexington on Monday, Sept. 19.

The annual forum is sponsored by the Foundation for a Healthy Kentucky in memory of Dr. Howard L. Bost, who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental-health services in Kentucky and created the vision for the foundation.

This year's event will open with remarks from the foundation's newly appointed president and CEO, Ben Chandler, followed by state Health Secretary Vickie Yates Brown Glisson. The keynote speaker will be Dr. Gail Christopher of the W.K. Kellogg Foundation.

The forum will also feature a series of TED-style talks and afternoon breakout sessions that will explore three facets of making health a focus of economic development and growth: health care as employer and purchaser; health care system costs; and how a strong economy is good for community health and vice versa.

A reception celebrating the foundation's 15th anniversary will follow the forum in the Marriott Griffin Gate Mansion. Click here to register.

Kentucky Health News reporter gets fellowship to report on rural health workforce issues, with a focus on nurses

Melissa Patrick

Melissa Patrick, reporter for Kentucky Health News, has been named 2016-2017 Nursing and Health Care Workforce Media Fellow for the Center for Health, Media & Policy.

Patrick, a former nurse, will focus on rural health issues that affect nurses and other health care providers within the evolving health care delivery system during her eight-month fellowship.

“We’re thrilled to welcome Melissa as this year’s media fellow. She is strongly committed to raising awareness about the role of nurses and other health care workers in the current and future health care system” Diana Mason, co-founder of CHMP, said in a news release.“This fellowship provides an opportunity to work with some of the top health journalists and nursing workforce experts, hone reporting and production skills, engage in cross-platform reporting, and contribute to the national conversation about health care delivery challenges in the years ahead.”

Patrick's main project will take a multi-part look into a shortage of school nurses throughout the state, a shortage of nurses to serve rural areas, the role of advance practice nurses in meeting some of Kentucky’s health needs and state policy issues impacting nurses.

The fellowship is supported by a grant from the Johnson & Johnson Foundation.

Dr. Michael Karpf to retire as head of UK hospital

Dr. Michael Karpf

Dr. Michael Karpf, who has led the University of Kentucky Medical Center during a decade of major growth, announced Wednesday that he would retire in 2017. At 71, his retirement was not unexpected.

"We have made considerable progress, and I feel that the original goals that we established have been achieved," Karpf said in a statement. "We have built a strong foundation for UK HealthCare," the medical center's brand. "Consequently, I think it is time for an organized transition to a new leader who has boundless energy to address the challenges of a rapidly evolving health care system."

During Karpf's 13 years at the helm, annual discharges from the hospital doubled to 37,789, and transfer of patients from other hospitals for sub-specialty care "astoundingly grew" from 1,000 to more than 18,000, annually, UK President Eli Capilouto said in a news release. "But numbers on tell part of the story."

Capilouto said Karpf, who is paid $882,000 a year, "grew partnerships with hospitals and physicians in 180 clinical locations across the state. . . . I am convinced that UK HealthCare is the greatest success story in modern academic health center history. This is not grandiosity. The numbers show it."

The greatest manifestation of Karpf's work is the new Albert B. Chandler Hospital Pavilion A, which he said will be more than 96 percent complete with projects authorized in June.

"Although Pavilion A is as technologically advanced as any hospital in the country, it is also an exceptionally empathetic facility – comfortable and comforting for our patients, their families, visitors, and, just as important, for our faculty and staff," Karpf said. "We will also have refurbished/repurposed four of the seven floors in Pavilion HA (Kentucky Children’s Hospital). Over the next 18 months we will finally have a state-of-the-art neonatal ICU that appropriately supports a superb NICU staff and faculty."

"Karpf’s emphasis on highly complex medical care, however, sometimes came at a price," reports Linda Blackford of the Lexington Herald-Leader. "In 2012, UK suspended its pediatric cardiology program after an uptick in mortality rates for babies, including at least two babies who died while in UK’s program. An internal review recommended better training for both doctors and nurses and a dedicated ICU. Earlier this year, Karpf announced a partnership where pediatric heart surgeries at UK would be performed by a heart surgeon with a primary appointment at Cincinnati Children’s Hospital."

Blackford adds, "Karpf also is part of a whistleblower lawsuit filed by UK surgeon Paul Kearney, who was stripped of his clinical privileges for using abusive language toward co-workers and one patient. Kearney alleges that Karpf targeted him after the surgeon started asking questions about the financial dealings of UK HealthCare and the Kentucky Medical Services Foundation," which UK contends is not a public agency.

Karpf came to Lexington from UCLA, where he ran that university's medical center. He said he and his wife Ellen will remain in the city, and he plans to "take a part-time faculty position working on health service and health policy issues."