Students with tooth problems don't do as well in school

More evidence shows students who have dental problems struggle more in school. A new study of almost 1,500 disadvantaged students in Los Angeles public schools found those who had had recent tooth pain were four times more likely to have a low grade-point average (below 2.8) than those who didn't have problems.

Another recent survey found that one in nine American children ages 9 to 11 have untreated tooth decay in their permanent, adult teeth. A 2011 study in North Carolina concluded students with poor oral health were three times more likely to miss school because of dental pain.

Parents and policy makers should be concerned with the findings, says Matt Jacob for the Pew Center on the States. In California, about 504,000 children missed at least one school day in 2007 because of a toothache or another oral health-related problem. (Read more)

State's largest health care system says it will end contract with Coventry Cares

KentuckyOne Health, the state's largest health-care system with almost 200 hospitals, physician groups, primary care centers and other agencies, is canceling its contracts with Coventry Cares, one of the state's four Medicaid managed-care organizations. Terminations will be effective Nov. 1 for Jewish Hospital & St. Mary's HealthCare and Saint Joseph Health System.

The decision came after Coventry sent a letter announcing it would terminate its contract July 18 with Our Lady of Peace hospital in Louisville. Coventry also terminated its contract with Taylor Regional Hospital in Campbellsville, another KentuckyOne facility, reports Valarie Honeycutt Spears for the Lexington Herald-Leader. She notes that Our Lady of Peace serves high-risk patients with intellectual disabilities. It is one of the largest private, non-profit psychiatric hospitals in the country.

"We feel Coventry Care's actions will ultimately hinder and prevent the care our communities need and deserve," said Barbara Mackovic, a KentuckyOne spokeswoman. "That is especially true when a plan would put our most vulnerable patient populations at Our Lady of Peace at risk."

Issues with Coventry Cares have been mounting ever since it started administering Medicaid Nov. 1. The company, the state and Appalachian Regional Healthcare fought in court after Coventry threatened to terminate its contract. TCoventry temporarily extended its contract, but in in May the firm announced it would also end contracts with Baptist Healthcare System.

Managed care has saved the state money but has caused major headaches, including delayed provider payments and overly-burdensome preauthorizations. Coventry alleges "that it has too many high-risk patients and that the state needs to adjust the risk model so Coventry can receive more money for sicker patients," Spears reported in May. (Read more)

Legislative committee delays vote on state insurance exchange, though the move is only symbolic

Kentucky legislators have made another symbolic move against creating a health insurance exchange, with the Interim Joint Committee on Health and Welfare delaying a vote on its creation until next month's meeting. The exchange is one of the cornerstones of the Patient Protection and Affordable Care Act and would allow individuals earning up to to 133 percent of the federal poverty level to buy health insurance through a state-run marketplace.

Rep. Addia Wuchner, R-Florence, made the motion to table the vote on the order Wednesday, saying she does not have enough information about the cost of the exchange and how it will operate. "All we have is the executive order" from Gov. Steve Beshear creating the exchange, Wuchner said. The exchange must be in operation by Jan. 1, 2014. The first year, it will be paid for by the federal government. The second year, it will cost $67 million, but the state will use grant money to pay that sum, reports Beth Musgrave for the Lexington Herald-Leader. In the long term, fees from insurance companies are supposed to pay the costs.

If the committee opts to reject the order, Beshear can override it, Musgrave reports. It's the second time the legislative has acted against the creation of an exchange. Earlier this summer the Capital Projects and Bond Oversight Committee voted along party lines against a lease that would have housed employees of the exchange. Finance Secretary Lori Flanery has the power to overturn the vote and rent the space. (Read more)

Sodas losing fizz in schools, but exclusive deals remain

New research from the Robert Wood Johnson Foundation shows more than half of middle and high schools have purged the pop since the 2006-2007 school year. That year, 53.6 percent of high schools and 27.4 percent of middle schools gave students access to soda. In the 2010-2011 those numbers dropped to 25.3 in high schools and 12.5 percent in middle schools, reports Sarah Kliff for The Washington Post.

"You have policymakers at the state level, and also more local, moving policies into this directions," said researcher Yvonne Terry-McElrath. "You have policymakers at the state level, and also more local, moving policies into this direction. I also think you're seeing movement from parents and individuals who are becoming more aware of what is and isn't healthy."

That is the case in Kentucky. Under a state law passed a few years ago, students can only buy school-day-approved beverages — 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving — during the school day. It may benefit reporters to ask school administrators though if there are vending machines at school that sell soda after the school day is finished, however. 

Though schools are getting rid of soda in high numbers across the country, a lot of them still have relationships with Coke or Pepsi, something reporters can find out by simply asking administrators.

Photo by Paul Robert Lloyd, via Flickr

A 2005 survey found nearly half of elementary schools and about 80 percent of public high schools nationwide had pouring rights contracts with one or the other of the soda companies, which gives them exclusive rights to supply all the beverages in school snack bars, vending machines, school stores and at sports events.

The upside for the schools can include funding for field trips, gym uniforms, SMART boards and other perks, reports blogger Tom Philpott for Mother Jones. Philpott cites one study that shows students living in states with laws that limit junk food sales gained less weight — an average of about 2.25 pounds for a 5-foot child — than those that didn't. A study in California showed students consumed 158 less calories each day in schools where sodas were banned and new nutritional regulations were implemented in cafeterias.

But one study of 20,000 students found no correlation between obesity rates and access to soda at school. "The research is pretty mixed," Terry-McElrath said.

Kentucky's obesity rate and ranking are better than last year, but the figures may not be truly comparable

The percentage of Kentucky adults who are obese is smaller than its was, but the state is still 10th in the country, according to a new, influential analysis by Trust for America's Health and the Robert Wood Johnson Foundation. The report found 30.4 percent of Kentucky adults are obese, an improvement from last year's 31.5 percent and the state's sixth-place ranking. The numbers do not include the percentage of adults that are merely overweight.

The statistics are based on data collected through telephone surveys by the Centers for Disease Control and Prevention. The surveys this year included people who only have cell phones, not land lines. Such people tend to be younger, so officials warned about putting too much stock in comparing this year's ranking from last year, reports Barb Berggoetz for the Indianapolis Star.

Mississippi has the highest obesity rate in the country at 34.9 percent, followed by Louisiana (33.4) and West Virginia (32.4). Twenty-six of the 30 states with the highest rates are in the Midwest and South.

"Obesity has contributed to a stunning rise in chronic disease rates and health care costs. It is one of the biggest health crises the country has ever faced," said Jeffrey Levi, executive director of Trust for America's Health. "The good news is that we have a growing body of evidence and approaches that we know can help reduce obesity, improve nutrition and increase physical activity based on making healthier choices easier for Americans. The bad news is we're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in terms of health and savings."

In 2006, obesity-related medical costs were $147 billion or the equivalent of 10 percent of total medical spending, a 2011 study in Health Affairs found. Most of it is spent on treating diseases related to obesity, like diabetes.

The ranking is the first part of the 2012 "F as in Fat" report, which analyzes state obesity rates and efforts to address the problem. It will be released in full in September. For the first time, the report will include forecasts about obesity rates in 2030 in each state. It will also look at the potential impact of a 5-percent reduction in body mass indices. (Read more)

Doctors' letter to the editor about the importance of physical activity is worthy of consideration from all Kentucky newspapers

Given its timeliness and message, Kentucky Health News encourages editors of Kentucky newspapers to consider publishing this compelling letter.

Physical activity — a daily staple

To the editor:

The 2012 London Olympics were a feast. Nobody with a hunger for sports, national rivalries or stories of individual struggles and accomplishment should have left the table unsatisfied. The Games served up a bounty of the very best.

After the feast, though, we need good, daily nutrition. Seeing the world's best athletes break records and vie for top honors, we can take their example and weave physical activity, exercise and sport into our daily lives. There's only one Usain Bolt, but millions of us run full-tilt through our careers and family life. The gymnastic magic of Gabby Douglas can inspire our headlong tumble through competing obligations and the flexibility to get it all done.

Translating Olympic activities into everyday life is more than a metaphor. With sedentary lifestyles linked to one in four deaths from non-communicable diseases, and with preventable conditions consuming unsustainable portions of health care costs, we must act individually and as a society to keep ourselves fit and healthy.

Food for thought

The facts are undeniable, and the evidence continues to mount. As the Games were poised to begin, no less an authority than The Lancet published a series of articles that underscore the extraordinary peril of physical inactivity for global health and national economies. Experts from Harvard, the Centers for Disease Control and Prevention, and around the world made the case for urgent action: "In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences."

The reality is that the United States will not be able to grow it economy fast enough or large enough to pay for the treatment of rising levels of highly avoidable diseases and conditions, many of which are related to low levels of physical activity. This calls for collective action to encourage and enable all people to become and remain more active, whether through activities of daily living, exercise or sports.

On an individual level, we will each benefit from meeting at least minimum guidelines for physical activity. The payoff is improved health and quality of life for the individual, greater productivity in the workplace, and lower health costs for all of us. The alternative is unthinkable.

That's food for thought, indeed. As we push back from the table, still savoring a 17-day feast of athletics and achievement, let's make a menu of physical activity part of our daily lives. Anything less is too hard to swallow.

Janet Walberg Rankin, president, American College of Sports Medicine
Dr. Robert Sallis, chair, "Exercise is Medicine" Global Initiative

State Fair taking precautions to prevent spread of swine flu

With cases of swine flu popping up in adjoining states to the north, officials are taking precautions to prevent the disease from spreading at the Kentucky State Fair's Swine Pavilion. The fair starts Thursday. (Photo by Kristin Sherrard, Carrollton News-Democrat: Turner Slaton of Madisonville wins the reserve light crossbred champion ribbon at the Kentucky State Fair in 2009.)

University of Louisville epidemiologist Forrest Arnold has advice for fairgoers:

• “Stay out of the face of a sick pig.” The flu is transmitted most often via the eyes, nose or mouth, so keeping your face out of a pig’s face is advised.
• “Wash your hands frequently.” Always a good recommendation to prevent illness, washing your hands is especially important after you have been around pigs.
• “Be sure your children limit exposure to pigs’ faces and wash their hands immediately after viewing them.” Children especially enjoy the livestock shows at the state fair, so it is important that they follow precautions as well.
• “Be aware if you are at a greater risk.” The Centers for Disease Control and Prevention warn people at high risk of contracting any flu, such as those 65 or older, pregnant or with chronic conditions such as asthma or diabetes, to avoid contact with pigs entirely.
• “Continue to enjoy eating pork and pork products.” Swine flu is not transmitted by eating pork that has been cooked to a temperature of at least 170 degrees.

The state veterinarian's staff will be inspecting all swine — between 650 and 675 pigs — and looking for signs of flu, which includes coughing, sneezing and labored breathing. Animals showing symptoms will be evaluated and tested for the disease. Exhibitors coming from out of state must show a certificate of veterinary inspection with 72 hours of arrival, The Courier-Journal reports.

"We are certainly prepared for the slightest sign of any outbreak, and of course, the public will be notified immediately should anything occur," said Harold Workman, president of the Kentucky State Fair Board.

This year has seen 158 reported cases of swine flu, 130 of which were in 19 counties in Indiana. There have been 30 cases in Ohio and one each in Indiana and Hawaii. The disease is spread by pigs coughing or sneezing in the proximity of humans. Symptoms in humans, which can last from three to eight days, include coughing, fever, sore throat, runny nose, body aches, nausea and diarrhea. (Read more)

Legitimate pain patients having trouble getting prescription drugs because of 'pill mill bill,' some doctors say; hearing Wednesday

With lawmakers set to review the regulations of the "pill mill bill" Wednesday, doctors are saying some legitimate patients are having trouble getting access to prescription drugs as a result of the legislation. 

The law is aimed at cracking down on illegal pain-management clinics and curbing prescription-drug abuse. It requires physicians to use the state's prescription-drug monitoring system, KASPER, before prescribing certain drugs. 

But some doctors worry they may face criminal charges or penalties for prescribing the drugs or making clerical errors, reports Scott Wartman for the Kentucky Enquirer, an edition of The Cincinnati Enquirer. As a result, "There are already doctors saying no more prescriptions on green prescription pads," said Dr. Gregory Hood, a Lexington internist and governor for the Kentucky chapter of the American College of Physicians. The legislation also "adds layers of more work they or their staffs already have to do," said Dr. Elmer Martin, a Covington pediatrician who is the medical director of HealthPoint Family Care.

But state officials say the only criminal penalties in the bill would result only "from someone operating a pain clinic without a doctor's license and for intentional failure to input data into the state's prescription drug tracking system," Wartman reports. Since July 20, the number of KASPER reports requested by doctors has grown to 20,000 per day from 3,000. The reports show a patient's prescription history to indicate "doctor shopping."

The number of drugs prescribed has increased exponentially in Kentucky. "Last year there was enough doses of hydrocodone prescribed "to treat every man, woman and child in the state with 50 doses," said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. Still, even physicians who supported the bill, like Dr. Robert Klickovich, say it needs to be tweaked. "Specialists may not be present in rural communities and if primary care physicians fear prescribing, even though in the appropriate case, for fear of a punitive action, they may hesitate to treat a patient," he told Wartman. (Read more)

About 290,000 more Kentuckians would be eligible for Medicaid if state expands program, Urban Institute study finds

About 289,000 more people in Kentucky would be able to get health insurance if the state opts to expand its Medicaid program up to 138 percent of the federal poverty level, as authorized by federal health-care reform, a new report from the Urban Institute has found. Just how many more Kentuckians would be affected by the possible expansion had previously been uncertain, with varying estimates.

Of those eligible, 56,000 are parents and 232,000 are adults who don't have dependent children, the report found. Those who are between the ages of 35 and 54 have the most to gain in the state, with 78,000 newly eligible Kentuckians falling into that age bracket. The report, funded by the Robert Wood Johnson Foundation, says about 15 million more people nationwide could get health insurance under Medicaid expansion.

Gov. Steve Beshear has said he will expend the program if the state can afford it, and is studying how much it would cost. The federal government will pay all the costs for the new eligibles at the through 2016, but by 2020, states will be responsible for 10 percent of those costs. For current eligibles, the state pays and would continue to pay about 30 percent.

Though much of the discussion on expansion is based on whether states can afford it, "Exclusively monetary calculations ignore the potential human, financial and productivity benefits associated with improved access to affordable health care for the millions of low-income adults who lack health insurance coverage and their families," the study's authors conclude. (Read more)

Papa John's CEO says new health law will raise price of pizza by 11 to 14 cents; Courier-Journal says that's worth it

Papa John's found and CEO John Schnatter.
Courier-Journal photo

Papa John's CEO John Schnatter did more than put the Affordable Care Act under the microscope this week, he threw it in a hot oven, saying the law will increase the price of a pizza by 11 to 14 cents. But an editorial in The Courier-Journal argues all Schatter did was prove the law's value. 

"That's a bargain if it means thousands of Papa John's employees in all 50 states are going to be getting health coverage and we're not going to have to foot the bill when hardworking but uninsured pizza chefs get ill and end up in the hospital," the editorial reads.

Schnatter's comments drew national attention and were the focus of stories by 60 media outlets, reports Chris Otts for The Courier-Journal. They were also the brunt of the joke in a segment on Comedy Central's "The Colbert Report." "Fourteen cents," said host Stephen Colbert. "That's three times the value of a Papa John's pizza."

Schnatter's comments were answers to questions from a stock analyst about the cost of health care for the company. "We're not supportive of Obamacare, like most businesses in our industry," he said. "But our business model and unit economics are about as ideal as you can get for a food company to absorb Obamacare."

The law "requires that businesses with 50 or more full-time-equivalent employees offer health benefits to those employees and their dependents or face penalties," Otts reports. The law could mean Louisville-based Papa John's International and its franchises will have to provide health care coverage to its employees, most of whom work part time. About 14,400 of Papa John's 16,500 employees work in company-owned stores. (Read more)

Kentucky rated worst in country for power-plant pollution

Kentucky was ranked first in the country for the amount of pollution from power plants in 2009 and 2010, a study by the Natural Resources Defense Council found.

The Paradise Fossil Plant in Muhlenberg County, left, run by the Tennessee Valley Authority, was ranked the nation's top power-plant polluter in 2010. American Electric Power's Big Sandy plant in Lawrence County was ranked fifth, and the Mill Creek station of Louisville Gas & Electric was seventh.

The NRDC's initial report showed a huge increase in Kentucky power-plant emissions from 2009 to 2010, but after The Courier-Journal raised questions about it, the report was corrected. The corrected figures showed that the state remained No. 1 in power-plant pollution. (Read more)

Searching for a fundamental 'particle' of mental health

The discovery of the Higgs particle, which gives matter its mass, was a huge breakthrough for scientists since "confirming its existence was imperative to a full scientific understanding of the world," and its has an equivalent that has yet to be found when it comes to mental health, forensic psychiatrist Erik Roskes writes for The Crime Report.

The equivalent of the "Standard Model" of mental health — Higgs plays an essential part in the "Standard Model" of physics — is a world in which "people are not penalized for their illnesses but rather than an array of tools from which to choose and which they can use to become mentally healthy," Roskes writes.

Though those tools have not yet been identified, there are paths down which researchers are going to find them, including molecular and pharmaceutical research; psychotherapies and rehabilitation. Research has led to pharmaceutical approaches, "not perfect, but far preferable to a world without them," he writes. It has led to cognitive therapy to treat depression, anxiety and, in some cases, psychosis. It has also led to advances in rehabilitation of mental illnesses and developmental disabilities like autism.

Like the search for the Higgs particle, finding its equivalent in the world of mental health is worth the search, Roskes concludes. (Read more)