Williamsburg in line to pass smoking ban next month

An ordinance imposing a smoking ban in Williamsburg is ready for a City Council vote. The council listened Monday to the first reading of the ordinance, required before a vote, which could follow the second reading, planned for Feb. 11. If approved, the ban would take effect immediately, reports Mark White of the Corbin-Whitley News Journal.

The new ordinance says “Smoking shall be prohibited in all enclosed areas within all enclosed buildings open to the public and within places of employment,” reports John Ross of The Times-Tribune of Corbin. “Enclosed buildings” includes libraries, bars, bingo houses, child- and adult-care facilities, public and private educational facilities, gaming facilities, restaurants, pool halls, lobby areas and hallways in all multi-residential buildings, such as apartments and condominiums, and hotels and motels, Ross reports. In December 2011, the Corbin City Commission implemented a ban that prohibits smoking in similar locations and within 25 feet of main entrances and exits.

Ross's account of the meeting included no negative comments. Mayor Roddy Harrison said, “I know both sides of the issue — but our job is to protect everybody.” Harrison said he found extensive research to back up the negative effects of secondhand cigarette smoke while researching the ordinance.

School nurses start getting scarcer, due to Medicaid problems

By Molly Burchett
Kentucky Health News

Students in many Kentucky counties will find it harder to see a school nurse due to changes in the state Medicaid program and lack of payment from managed-care companies.

Takirah Sleet, 7, and school nurse Michelle Marra looked at Takirah's
lunch tray to calculate her insulin dosage at Lansdowne Elementary
in Lexington. (Lexington Herald-Leader photo by Pablo Alcala)

In Crittenden County schools, budget woes have forced the Pennyrile District Health Department to request additional money from the school district to keep its school health clinics fully-staffed and open, reports Jason Travis of The Crittenden Press. Allison Beshear, director of the health department, told Travis one reason from the budget crunch is a lack of payment from Kentucky Spirit, which owes the health department $266,000.

Without additional money from the school district, Beshear says, the health department cannot maintain the current level of service at school clinics through the end of the school year.  Proposals have been made to offer services to the district that entail reducing clerical staff without reducing the number of nurses; but in order to do so, trained school staff would have to handle daily medication distribution and help to answer the phones for the clinic.

"Kentucky Spirit has filed two appeals with the Cabinet of Health Services and the Finance Cabinet in which it claims to not be financially responsible for healthcare given in school clinics," reports Drew Adams of WKMS-FM in Murray reports in a story about similar problems in Hopkins County.

Other school districts facing similar problems include those of Bell, Clark and Pike counties. Eleven school health clinics in Bell County could be shut down by the end of this school year, reports WBIR-TV of Knoxville. In Clark County, a lawsuit between the state and Kentucky Spirit has put a halt to reimbursement for health services provided in county schools, reports Rachel Gilliam of The Winchester Sun.

Last month, the Pike County Board of Health filed a lawsuit against Kentucky Spirit because the managed-care firm has stopped reimbursing the Board of Health for school-nurse programs, reports Jordan Vilines of WYMT-TV in Hazard. The money has to be reimbursed in order to provide school nurses.

“I think having someone in the school to ensure that our children are healthy is imperative for the quality of life of our kids, especially in a very rural area," Pike Judge-Executive Wayne T. Rutherford told Vilines.  He said that without reimbursement, school nurses could lose their jobs, which would leave hundreds of kids without immediate medical care.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

Participating in a clinical trial can give patients access to advanced health care

Access to advanced care does not require big bucks or Cadillac insurance; it is offered on a limited basis through trials of new medical procedures at the University of Kentucky.  People in the university's health-service region can access cutting-edge health care through participation in clinical trials, according to a UK press release. The University of Louisville also does clinical trials.

Clinical trials are necessary to evaluate a drug, device or mode of therapy for a disease. UK investigators recruit individuals willing to contribute to science to participate in various types of trials; some may require participants with specific conditions, while others require healthy participants.  These participants are able to reap the benefits of advanced medical treatment while gaining access to top clinicians and the latest medical information.

"I would tell anyone who has a condition and is thinking about becoming part of a clinical trial that it is one of the most empowering things that people can do," said Dr. Leslie Crofford, chief of the UK Division of Rheumatology and director of Center for the Advancement of Women's Health. "It allows you to learn about a condition that may afflict you or a family member. It allows access and contact with investigators that are very knowledgeable about the condition. It allows a sense that you are doing something active to help not only yourself, but other people with the condition."

As a research insititution, UK is careful about the safety, privacy and oversight of clinical trials and it's important that participants understand the trial methodology, purpose and procedures. The UK Center for Clinical and Translational Science has compiled a helpful list of questions for clinical-trial participants. There are several ways to connect with clinical-trial opportunties and anyone can view currently available clinical trials at the university. Participants may also connect with clinical trials through their physician, or through national listings. (Read more)

Among health providers having difficulty with Medicaid managed care, Cumberland Valley District Health Department stands out

The financial struggle that recently led to 14 layoffs and an increase in furlough days for the Cumberland Valley District Health Department continues. Other health departments have reported such difficulties, but it may be one of those hurt most.

With its deficit standing at $503,266,  a review of the department’s financial summary from the latter half of last year shows that a large part of the deficit is caused by lack of payments from Kentucky Spirit, a Medicaid managed-care company, according to an article in the Manchester Enterprise.

As recently as September, Kentucky Spirit owed the department over $300,000 for Medicaid services that had been provided. In the December report, Kentucky Spirit had only paid $698 and has since quit cooperating with the state, according to the Enterprise.

Adding to the cash flow problem, another managed-care firm pays a month late, according to department Interim Director Lynett Renner. She said that since 2011, health departments must also pay back to the state a Medicaid match, and are the only health care providers that must do so. 

Those factors, she said, are why the layoffs plus an increase in furlough days are necessary. Beginning Jan. 21, employees will be on a 32-hour workweek. In addition to those two money-saving actions, the department has also eliminated two positions, director of nursing and director of environmental services, the Enterprise reports. 

"What we do touches the lives of everyone in our country,” said Renner and the district will provide its services however it can.

New U of L public-health dean has rural health background

Craig H. Blakely, dean at the School of Rural Public Health at Texas A&M University, has been named dean of the University of Louisville School of Public Health and Information Sciences. U of L has a role in rural health in Western Kentucky, overseeing the Area Health Education Centers in the region.

Blakely, who has a Ph.D. and a master's in public health, has researched and published extensively regarding access to care and rural health. His research has focused on under-served expectant mothers and juvenile delinquents, and includes substance-abuse prevention and community-based change. Blakely has also evaluated major initiatives such as a school-based prevention program targeting at-risk youth.

Blakely’s expertise will be invaluable in tackling issues like obesity, access to care, disease management and much more, said Dr. David L. Dunn, U of L's executive vice president for health affairs. Blakely’s appointment is effective April 1 and is subject to approval by the U of L Board of Trustees. He replaces Richard Clover, who has led the school for 10 years.

Childhood obesity is linked to more immediate health problems than doctors formerly realized

While a plethora of research on childhood obesity has linked it to long-term health problems, a new UCLA study focuses on the condition's more proximate consequences, showing that obese children are at a greater risk for immediate health problems than previously thought. That's important for Kentucky, which ranks poorly in many health measures and is third highest in child obesity. (Photo by Tara Kaprowy)

"This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity," said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA.

Compared to kids who are not overweight, the study found that obese children have nearly twice the risk of having three or more reported medical, mental or developmental conditions. Specific medical conditions included bone, joint and muscle problems; asthma; allergies; headaches; and ear infections. Obese children also reported a greater tendency toward emotional and behavioral problems, higher rates of grade repetition, missed school days and other school problems, ADHD, conduct disorder, depression, learning disabilities, and developmental delays.

The study provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, a UCLA release said. Halfon said these findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for health conditions associated with childhood obesity. (Read more)

If you're dieting, remember that alcohol has calories too

Alcoholic beverages could throw a wrench into your 2013 diet plan.  The National Center for Health Statistics reported late last year that American adults drink in an average of 100 calories daily from beer, wine and other alcoholic beverages, and almost 20 percent of men and 6 percent of women consume more than 300 calories daily from alcohol.

Men ages 20 to 39 consume the most alcohol, taking in about 175 calories per day on average, while women in the same age group consume about 60 calories daily per person.

"It is certainly not a good health strategy to have alcohol calories constituting a significant percentage of total calorie consumption," health advisers Dian and Tom Griesel say on Newswise, a research-reporting service. "This is especially true for women and those dieting who would be better off avoiding all alcoholic beverages until their weight goals are met or at most limiting alcohol to one drink no more than two days a week."

Griesel also said that current dietary guidelines recommend to consume alcohol in moderation, which means no more than one daily drink for women and two for men.  So, as you reach for the apple instead of candy, remember that there are empty calories in your drink of choice too. (Read more)

It's not too late to get your flu shot, and getting it could not only help yourself and your family but your neighbors

It's not too late to get your flu shot, even though the flu has hit earlier and more broadly than usual, experts say.

It generally takes about two weeks for a flu vaccine to be most effective, said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention. Getting the shot in mid-January might seem too late, but it's "better late than never," he said during a teleconference Friday.

The CDC says the flu has been widespread in Kentucky for more than five weeks, far more than last year. "Most of the country is seeing a lot of flu, and this may continue for several weeks," Frieden said. "We don't know if we are over the peak."

Getting a flu shot can protect your neighbors, too. The protection afforded by the current vaccine is an important tool in protecting the health of the general public. The flu can be serious, especially in senior citizens, those with other chronic health problems and children. This season's outbreak has led to the deaths of 20 children as of Friday.

The CDC has found that the current flu vaccine is 62 percent effective, meaning if you get vaccinated, "You are 62 percent less likely to get the flu," writes Mary Meehan of the Lexington Herald-Leader.

It is also important that people with flu symptoms seek treatment. Anti-virals such as Tamiflu can be effective in reducing the most serious symptoms, Frieden said. "If you get flu-like symptoms, it can really help you avoid serious illness, hospitalization or even death," he said.

Meehan's story includes advice for dealing with children and tips about how to avoid getting the flu. To read it, click here.

UPDATE: In response to the flu, the University of Kentucky today limited visitation at its hospitals: None will be under 18 or have any flu-like symptoms, and only two will be allowed in a patient’s room at a time. Visitors may be issued masks or other protective clothing, and other restrictions may be imposed in special care units such as women’s and children’s units, critical care and oncology units. "Compassionate visitation exceptions will be made on a case-by-case basis," a UK release said.

Molly Burchett is new chief writer for Kentucky Health News

Kentucky Health News welcomes a new reporter, writer and blogger: Molly Burchett, a master's student in health communication at the University of Kentucky.

Burchett graduated from Transylvania University in 2009 where she studied business and communication.  She was president of the Student Government Association and a yearbook editor.  Her jobs before UK included development director for a Lexington medical practice. She started her master's program in August 2012 and is focused on raising awareness about community health issues in ways that can encourage positive changes in health behavior.

She is from Prestonsburg, where her father and mother are the lead physician and manager of Prestonsburg Primary Care. She is a graduate of Prestonsburg High School. At KHN she follows Tara Kaprowy and Amy Wilson, who have both returned to freelance journalism.

Kentucky Health News is funded by the Foundation for a Healthy Kentucky but is independently reported and edited by UK's Institute for Rural Journalism and Community Issues.

Get those eyes examined, or a 'sneak thief' might steal your sight

January is Glaucoma Awareness Month, so the Kentucky Optometric Association is emphasizing the need for an annual dilated eye exam.

Glaucoma is the second leading cause of blindness in the U.S., but awareness surrounding the disease is relatively low, says the American Optometric Association. A poll taken for the AOA "found that 90 percent of Americans incorrectly believe glaucoma is preventable, and 72 percent mistakenly think glaucoma has early warning signs," KOA said in a news release. "Regular eye exams are the first line of defense for early detection of glaucoma."

The optometrists' group says more than half of Americans who have glaucoma remain undiagnosed, mainly because people don'y get regular eye exams. “Glaucoma is often referred to as ‘the sneak thief of sight’ because it can strike without pain or other symptoms,” said Dr. Ben Gaddie, a Louisville-area optometrist who is president of the international Optometric Glaucoma Society. “Vision lost to glaucoma cannot be restored, so early detection and treatment are extremely important.”

Treatment for glaucoma includes eye drops and medicines to lower pressure in the eyeball. In some cases, laser treatment or surgery may reduce pressure. To find a optometrist in your area, through the KPA, go to www.kyeyes.org

Report: Electronic health records haven't cut health costs

The conversion to electronic health records isn't producing savings in health-care costs predicted by a 2005 report, and it's had mixed results in improving efficiency and patient care, according to a RAND Corporation report. The company's 2005 predictions helped drive growth in the EHR industry and encourage billions of dollars in subsidies from the federal government to hospitals and doctors to implement such systems, Reed Abelson and Julie Creswell of The New York Times report.

The 2005 report predicted that widespread use of EHRs could save the U.S. health care system at least $81 billion a year. "But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services," Abelson and Creswell write. Health care costs have risen $800 billion since the 2005 report, according to federal data.

Authors of the new report, published in this month's issue of Health Affairs, said they didn't attach dollar amounts to how much electronic record keeping has helped or hurt efforts to reduce costs. "But the firm's acknowledgement that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted," Abelson and Creswell report.

There are several factors why the switch has not created significant savings, report authors said. Those factors include use of commercial record systems, slow rates of system adoption, and the fact that electronic records "do not address the fact that doctors and hospitals reap the benefits of high volumes of care," Abelson and Creswell report. (Read more)

FDA could require tamper-resistant painkillers; without such action, prescription-drug abuse problem would worsen

UPDATE, Jan. 14 : Laura Ungar of The Courier-Journal reports, "Addicts by the scores used to get a quick and easy high from snorting or shooting up the powerful narcotic OxyContin — until manufacturer Purdue Pharma developed a new version that’s harder to abuse. But with the company’s patent on its original drug set to expire in April, activists, lawmakers and doctors are worried that cheaper, easily crushable generic versions will flood Kentucky and worsen the state’s already-devastating prescription drug abuse problem."

The Food and Drug Administration will force generic manufacturers of powerful pain pills to switch to a tamper-resistant composition if it finds evidence the composition curbs prescription drug abuse and addiction, Alan Rappeport of The Financial Times reports. Public-health advocates worry that if generic versions of opiate pills are not made tamper-resistant, the prescription drug abuse epidemic may worsen.

If the agency finds tamper-resistance significantly deter abuse, it has legal authority to require generic drug makers to switch their opiate formulas. Just as manufacturers of some pain pills began switching formulas to make the pills harder to crush, easily crushable, generic forms of OxyContin and Opana were released. Purdue Pharma and Endo Pharmaceuticals, which make Opana, have hoped to extend patent life of their drugs by pushing the FDA to prevent generic makers from using old versions of their drugs. Generic makers argue this will keep patients from buying cheaper drugs.

The FDA said it will take a "flexible" approach to determining the effectiveness of tamper-resistant drugs because abusers are constantly finding new ways to avoid deterrents. (Read more)