State task force will look at substance abuse, mental health care for military members, veterans and families

To help the increasing number of veterans and military service personnel who are needing treatment for substance abuse and mental health issues in Kentucky, a task force has been assembled to come up with strategies that show the most promise in providing care.

The team, made up of military personnel as well as health care experts, will go to a conference in Washington, D.C., to gain learn what is working elsewhere. The goal is to strengthen statewide behavioral health care systems and services, a press release from Gov. Steve Beshear's office says.

Over the past three years, the number of veterans seeking mental-health care has risen dramatically, according to the U.S. Department of Veterans Affairs. About 335,000 veterans live in Kentucky. There are also 45,000 active-duty personnel in Kentucky and about 8,400 members of the Kentucky Army National Guard and Kentucky Air National Guard.

"This is an extremely important and timely topic that requires collaboration across federal, state and local lines," said Col. David Thompson, executive director of the Kentucky Commission on Military Affairs. Task force members include Thompson; Maj. Gen. Edward W. Tonini, Kentucky adjutant general; state Rep. John Tilley, D-Hopkinsville; representatives from the Cabinet for Health and Family Services, the Kentucky Department of Veterans Affairs, military and civilian health facilities and the Kentucky court system. (Read more)

Female life expectancy in several Eastern Ky. counties declined

The life expectancy of the average U.S. female increased 1.7 years from 1999 to 2009 -- 79.6 to 81.3 years. Good news on the whole, but Daily Yonder reporters Bill Bishop and Robert Gallardo went a little farther in their analysis of the data from the Institute for Health Metrics and Evaluation at the University of Washington. They found that rural women hardly kept up, and some even lost ground in the decade while their urban sisters obviously gained from widespread health advances.

Bishop and Gallardo report, "The solid gain in longevity was matched in only 168 rural or exurban counties, or 6.5 percent of all the counties outside the cities." That is, while women in most of the nation were living longer lives, in many rural counties -- some 622 of them, in fact -- their longevity shortened in the same decade. Several of those counties were in Eastern Kentucky. The 622 counties represent some 24 percent of rural counties and exurban counties (or counties in a metro area where more than half live in rural census tracts), women lived shorter lives in 2009 than in 1999. You can see a similar map and charts for rural men here. (Click on the above map for a larger image)

As the Yonder writers point out, "The map shows that rural and exurban women are not keeping up with the health advances enjoyed in the rest of the country. In more than 95 percent of rural and exurban counties, changes in female longevity in the last 10 years failed to match the gains experienced in the rest of the country." The largest decreases in female life expectancy between 1999 and 2009 were clustered in Oklahoma, Eastern Kentucky, West Virginia, Alabama and Georgia. (Read more)

County boards of health are being told to take a more active role in improving the health of their communities

Christian County's health director told the county Board of Health last week that it "needs to spend less time on the health department’s budget and more time addressing big questions of community health," Nick Tabor writes for the Kentucky New Era. "The past four years, we haven’t talked about a lot of health issues. That’s going to change,” Director Mark Pyle told the 12-member board, which is appointed by the state secretary of health and family services.

Other county health boards may be hearing likewise, as their departments seek national accreditation (required by 2020, under a recent state law) and more attention is focused on the boards' stautory responsibility for the health of their communities. (Photo from the Knox County Health Department, which had a cake to celebrate the recent opening of its new building)

Accreditation steers health departments away from a “silo” model in which they worry only about its own affairs, Assistant Christian County Health Director Laura Hammons said. Pyle said their department needs to help build a “community health system” involving all all local organizations involved in health matters, from the Red Cross to the YMCA. (Read more)

County health boards should "assume responsibility for educating their population about improving their health status," be "highly visible and proactive," and play a leading role "in developing healthy community coalitions and partnerships," the statewide Friedell Committee for Health System Transformation said in a report, "The Role of Public Health and the Health of the Community," published in May.

Partly as a result of the committee study that led to the report, "Actions have been taken to increase training for local boards of health, including presentations by the commissioner of public health at board meetings and several training sessions at the state level for board members," the report said.

The report notes that KRS 212.240 requires county health departments, under supervision of county health boards and the state, "formulate, promote, establish, and execute policies, plans, and programs to safeguard the health of the people of the county and establish, maintain, implement, promote, and conduct facilities and services for the purpose of protecting the public health." To download a PDF of the report, click here.

County health board members include three physicians, a dentist, a nurse, a sanitary engineer, an optometrist, a veterinarian, a pharmacist, a lay person "knowledgeable in consumer affairs," the county judge-executive and a person appointed by the county fiscal court. If a county lacks one of the categories, another consumer representative can be appointed. For a PDF of the law, click here. For an index of all the laws on county health programs, click here.

Cafeteria workers wear fruit costumes to promote healthy eating

Wanna get kids to eat more fruit and vegetables at lunch time? Dress up in a banana suit. That's what cafeteria workers do at an elementary school in Hallandale Beach, Fla. (MCT photo by Mike Stocker)

"They love it," said intern Ericka Floyd while wearing the yellow costume. "Some kids want to bite me."

Floyd and other workers have put on the costume, as well as others depicting corn, grapes, carrot and watermelon, to encourage kids to eat more healthy, reports Robert Nolin for the Fort Lauderdale Sun Sentinel. "We're trying to attract attention to the concept that fruits and vegetables are good for you. They're good to eat, they're fun," said Darlene Moppert, a nutritionist who helps feed about 140,000 students each day.

Moppert said kids need to be prodded to eat healthily because "their consumption of fruits and vegetables is not where it needs to be." In addition to the costumes, Moppert hosts focus groups to see what students like to eat; do "plate waste" studies; and buy fresh produce from Florida farmers. She also working with popular menu items like pizza, burgers and chicken nuggets to make them more healthy. "We're taking what kids like and are familiar with and making it in a form that's a little healthier," she said. (Read more)

UK medical center is fifth in the nation to be recognized for out-of-body respirator help for babies, children and adults

Because they use extracorporeal (out-of-body) membrane oxygenation, or ECMO, to support patients, the University of Kentucky's Albert B. Chandler Hospital and Kentucky Children's Hospital have been awarded a triple designation from the Extracorporeal Life Support Organization. UK is just the fifth medical center to receive the triple-designation honor, reports UK's Allison Perry. (UK photo)

ECMO uses an artificial lung device that gives "cardiac and respiratory support to patients whose heart and lungs are so severely damaged that they can no longer function," Perry reports. "It can also serve as a bridge to transplantation, allowing patients to not only survive, but to become stronger and healthy enough to undergo the transplant surgery." The technique is used on neonatal, pediatric and adult patients, hence the triple designation.

"This designation is another example of the expertise and advanced technology available for neonatal to adult patients who require complex care that can only be provided at top academic medical institutions," said Dr. Michael Karpf, UK's vice president for health affairs. (Read more)

Tobacco use higher in rural areas; several factors include tobacco companies' targeting of rural youth, Lung Assn. says

Tobacco use is higher among rural communities than in suburban and urban areas, and smokeless tobacco use is twice as common. According to the American Lung Association, rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction, death and disease.

In its latest health disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” ALA says the increased tobacco use is associated with lower education levels and lower incomes, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.

The exposure to secondhand smoke is also likely to be higher, since rural communities are less likely to have smoke-free air laws in place, and that probably makes residents less likely to ask individuals not to smoke in their homes or other indoor places they control.

The report also pointed out that the tobacco industry "spends millions of dollars targeting rural youth," and "these young people are less likely to be exposed to tobacco counter-marketing campaigns. Rural tobacco users are also less likely to have access to tobacco-cessation programs and services to get the help they need to quit. Promotion of the availability of state counseling services by phone and online resources also lags in rural communities."

To read the full report, go here.

Pikeville newspaper spotlights local doctors and pharmacists charged in prescription pain-pill epidemic, forecasts more action

The Appalachian News-Express, the thrice-weekly newspaper in Pikeville, has turned the spotlight on Pike County physicians and pharmacists who are aiding and abetting the abuse of prescription painkillers. We have to wonder if more reporting like this from local news media wouldn't help fight the problem, which has become epidemic in Kentucky, especially in the east.

"Prescription drug abuse has dominated news headlines across the state over the last several weeks and new cases are leading officials to believe that more and more cases will be filed against physicians in and around Eastern Kentucky," the 2,200-word story begins. "Officials on both the state and federal level have been busy over the last year in taking action against a number of medical professionals, both in and around Pike County."

The full story by Chris Anderson is available only to subscribers, but is available to members of the Kentucky Press Association who subscribe to its Kentucky Press News Service.

Comprehensive series looks at new angle of prescription pain pill epidemic: addicted newborns

The Courier-Journal's health reporter, Laura Ungar, is again delving into the prescription pain-pill epidemic in Kentucky, this time focusing on babies who are born addicted. For any reporter interested in writing stories about prescription pill addiction and the scope of the problem — stories that could be localized in every county in the state — Ungar's award-winning work is the place to start researching.

In a four-page piece, Ungar looks at:
• the limited options available to addicted moms
• the lack of funding available to fix the problem
• what to do for loved ones with a prescription drug problem
• the causes, symptoms and treatment for newborn addicts

There are also links to more recent stories pertaining to the issue here.

Ungar found hospitalizations for addicted newborns increased from 29 in 2000 to 730 last year, when there was a big jump. "It's a silent epidemic that's going on out there," said Audrey Tayse Haynes, secretary of the state Cabinet for Health and Family Services. "You need to say: 'Stop the madness. This is too much.'"

Nurse Tonya Anderson, an infant development/touch therapist at Kosair Children's Hospital, said she's seen as many as 14 of 26 babies in the special-care nursery where she works suffer from symptoms of withdrawal. "They are just agitated," she said. "They are screaming. They have tremors. Their faces — you have to grimace. They're in pain."

Those close to the problem say there is not enough treatment for addicts who are pregnant. But it's an investment worth making, Ungar suggests. One study showed the health-care costs for addicted newborns was $720 million in 2009, up from $190 million in 2000. Babies with addictions stay about 16.4 days in the hospital, which costs an average of $53,300 per infant. In 80 percent of those cases, Medicaid pays the bill.

Researchers estimate that more than 13,5000 babies were born addicted in 2009. "We knew that it was common, but we would not expect this problem would have tripled in the last decade," said Dr. Matthew Davis, an associate professor at the University of Michigan and one of the study's authors. "There are not many medical problems that have tripled in a decade — not obesity, not heart disease, not diabetes." (Read more)

New website explores and outs of Affordable Care Act; useful tool for reporters

One of the most complex and far-reaching pieces of legislation to pass in recent years is the Patient Protection and Affordable Care Act, the federal health-care reform law that, among other provisions, requires Americans to buy health insurance or pay a penalty.

But because of its complexity, journalists can shy away from delving into stories about it. With state insurance exchanges and Medicaid expansion sure to be hot topics during the election season and the legislative session, it’s important to have reliable sources of information about the law. The American Public Health Association has a website that answers many if not most of the questions reporters, and the public, often have.

The website:
• Reviews the fundamentals about the Affordable Care Act and links to information about Medicaid expansion, insurance exchanges and the individual mandate.

• Looks at the implementation timeline of the law.

• Includes fact sheets about the ACA’s prevention funding program, which allows seniors and others to get free preventive care including mammograms and other screenings.

• Breaks down the U.S. Supreme Court’s decision to uphold the law.

The website is a useful tool in any health reporter’s arsenal and is worth a look. (Read more)

41 percent of the time, Americans go to specialists instead of primary-care doctors for basic health needs, study finds

More than 40 percent of the time, Americans are turning to higher-paid specialists instead of primary-care doctors to deal with their basic health needs, including colds and fever, a new study has found.

Researchers at Mount Sinai Hospital in New York looked at data from more than 20,000 doctor visits in 1999 and 2007 that included information about why the patient had come to the doctor’s office. “Fifty-nine percent of those with primary care needs, the runny-nose group, were seen by a primary care doctor,” reports Sarah Kliff for The Washington Post. “Forty-one percent sought out care at a specialist.”

Researchers included gynecologists and internal medicine physicians in the specialists group, though they tend to have heavy primary care loads. But even without those two specialties, 27 percent of primary care appointments happened in specialists’ offices.

A 2010 study found primary care doctors earn a $69 hourly rate, compared to $92 per hour and $85 per hour that surgeons and ob-gyns earn, respectively. (Read more)

Hospitals can learn from revealing account of the attack of a superbug; sequencing germ's DNA seems to be key

Dr. Tara Palmore, deputy hospital epidemiologist at the
National Institutes of Health Clinic Center, left, and Dr.
Julie Segre, a geneticist with the National Human
Genome Research Institute. Both were integral in
pinpointing the spread of a superbug at NIH.
Associated Press photo by Patrick Semansky.

A candid account of how a superbug was contained at one of the nation's leading research hospitals indicates that fast sequencing of a germ’s full DNA can make all the difference.

Over a six-month period, Klebsiella pneumonia, or KPC, a germ that cannot be treated by most antibiotics, sickened 18 people at the National Institutes of Health. Six of them died and another five, though they survived the effects of the germ, died from the disease that originally brought them to the facility.

Infections at health-care facilities kill about 100,000 Americans each year. But, fearful of lawsuits, hospitals generally don’t reveal to the public when infections outfox control measures, reports Lauran Neergaard for The Associated Press. That changed this week when government researchers published the story of what happened at NIH.

Dr. Julie Segre, a senior investigator at NIH’s National Human Genome Research Institute, was in charge of the “genetic sleuthing that found the bug hiding in sink drains and, most chilling, even in a ventilator that had been cleaned with bleach,” Neergaard reports. A multidrug-resistant strain of Klepsiella bacteria has emerged that spreads easily between patients who are very ill, and it kills half of whomever it sickens.

On June 13, 2011, a research nurse checked the medical records of a study participant who was being transferred from a New York City hospital and was critically ill with a rare lung disease. She found the patient had KPC, prompting the hospital to put her in strict isolation. “Everyone entering her room donned a protective gown and gloves and rigorously washed their hands,” Neergaard reports. “Her medical equipment got special decontamination. All other patients in the intensive care unit had their throats and groins tested regularly to see if the bug was spreading.” All seemed to be clear and the woman was sent home two days later.

But three weeks later, a patient with cancer was found to have KPC, though he was never in the presence of the first patient. Ten days later, a woman with an immune disease also got sick with KPC. Both died from the infection.

Researchers wondered if the cases were related or if the patients were arriving already infected with KPC. Segre turned to DNA for answers. "As bacteria multiply, mistakes appear and are repaired in their genetic codes," Neergaard reports. "Sequencing that genome allowed Segre to follow differences in single genetic letters like a trail of the germ’s transmission and evolution." Using this method, Segre discovered the KPC appearing at NIH was the same strain that came from the New York patient. "Testing bacteria from the 17 additional patients who ultimately caught it shows the KPC was transmitted three separate times from Patient No. 1 and then spread more widely," Neergaard reports.

NIH completely overhauled its decontamination practices, but the bacteria continued to spread. By November, the bacteria appeared in two patients who were not even in intensive care. Finally, the hospital built a new isolation room and all 200-plus patients in the hospital were subject to rectal testing.

The contamination is now contained, but the account of it is giving pause to infection-control specialists around the country. “Absolutely this could happen in any hospital,” said Dr. Deverick Anderson, co-director of a Duke University infection control network. (Read more)

Hopkinsville council, absent a proponent, narrowly replaces smoking ban idea with plan to require posted smoking policies

The effort to pass a smoking ban in the largest Kentucky town without one may have hit a roadblock Thursday night. The Hopkinsville City Council forwarded a smoking ordinance that would merely require businesses to decide whether to allow smoking and post signs at every entrance announcing its policy. The council's vote as a committee of the whole was 6-5, and the one absent council member favors a typical smoking ban.

Mayor Dan Kemp, who can vote to break council ties and does not sit on the committee of the whole, "said after the meeting that he could not support the proposal because it leaves the current law unchanged," Carla Jimenez reports for the Kentucky New Era. The alternative ordinance is scheduled for first reading Sept. 18; a tie vote would block it, and a tie vote in favor of a smoking ban could be broken by Kemp to pass it.

As first presented to the committee, the ordinance would ban smoking in public places, with exemptions for private clubs, age-restricted establishments and businesses with 12 employees or fewer. The small-business exemption was removed on a vote of 10-1. "That left the ordinance as it originally came before the council for its first reading in June," Jimenez reports. But then the committee voted 6-5 for the alternative ordinance, proposed by Councilman Paul Henson, who argued, “We’re not abusing anybody’s rights. We’re not the bad guy, and yet we have the smoking ban, a smoking ordinance, on the books.”

Councilwoman Peggy Rogers-Everett disagreed, saying smoking is a hazard to everyone, and “Murder is illegal.” Henson and Councilwoman Ann Cherry and Henson laughed, and "Everett was not amused," Jimenez reports. Everett said, “I don’t find that funny. I don’t take that lightly.” (Read more)