Official praises needle exchanges and medication-assisted treatment for addiction: 'Treatment works. Recovery is possible.'

Scott Hesseltine

Scott Hesseltine, the new vice-president of addiction services at Louisville's Seven Counties Services, talked on Kentucky Educational Television about needle exchanges and a new model of addiction treatment that combines medication assisted treatment with an abstinence-based model of care.

"We are in the midst of a tragic public-health crisis and it's claiming the lives of our citizens at astronomical rates," he said, noting that more than 1,000 people die from drug overdoses in Kentucky each year and that the state has the highest rate of hepatitis C in the nation.

Seven Counties Services provides behavioral-health services, primarily for people on Medicaid, in Jefferson County and six neighboring counties: Henry, Oldham, Trimble, Spencer, Shelby and Bullitt.

The interview on "Connections with Renee Shaw" was part of KET's "Inside Opioid Addiction" initiative, which is funded in part by a grant from the Foundation for a Healthy Kentucky. It aired in June.

Hesseltine, who came to Seven Counties Services from the Hazelden Betty Ford Foundation, a nationally recognized drug and alcohol treatment center, commended Kentucky's "forward thinking" in passing an anti-heroin bill last year.

Among other things, the bill allows needle exchanges to decrease the spread of infectious diseases, like hepatitis C and HIV, that are commonly spread by drug users sharing needles. They require both local approval and funding and have met with some resistance because many think they condone or perpetuate drug use.

Asked about that, Hesseltine said research shows that needle exchanges do what they are meant to do -- reduce the incidence of infectious disease among intravenous drug users.

He noted that Justice Secretary John Tilley, who was instrumental in passing the heroin bill as a state representative, said at a recent community forum in Corbin that research found that addicts who are involved in needle exchange programs are five times more likely to enter treatment.

"And we know treatment works and recovery is possible, so any avenue to slow the spread of disease and to help more people find the solution in recovery is a positive thing," he said.

Another point of contention among some lawmakers is that some of the state's needle-exchange programs don't adhere to a needle-for-needle exchange, which they say was the intent of the law,but instead provide as many needles as the addict needs for a week.

Hesseltine said the needs-based model decreases needle sharing and thus disease, so "Needs-based is more appropriate; it is more evidence based."

Hesseltine told Shaw that while working at Hazelden, he was part of an initiative that completely "altered the way we provided care." The new program, called COR-12, combines medication-assisted treatment with the 12-step abstinence model, which had been the only accepted recovery treatment program at Hazelden.

Hesseltine brought the new model with him to Seven Counties Services and said he likes to call it "medicated assisted recovery." He said "It has to be done appropriately so we are helping to stabilize someone from their biological symptoms of addiction so they can then engage in the recovery process."

Hesseltine told Shaw that addiction isn't curable, but is treatable.

"I would say it is a chronic disease that can be put into remission with structure, support, accountability and behavioral interventions," he said. "Curable? No, but like diabetes -- not curable, but certainly manageable."

Shaw asked if any addict is beyond reach. "Only someone who is not alive," Hesseltine replied. "Treatment works. Recovery is possible." He said that is why access to naloxone, the overdose-reversal drug branded as Narcan, is so important.

Asked what policy changes he would like to see, Hesseltine listed increased funding for drug treatment, "high level" models of care that shift addiction services to local communities, and repeal of the Medicaid rule that doesn't allow any reimbursement for mental-health and substance-use-disorder residential treatment facilities with more than 16 beds.

With treatment, Hesseltine said, "People can go from a pitiful and incomprehensible demoralization, a state where they have no hope to one of having hope, to being a productive member of society and to really regaining a place where they feel good about themselves and they are leading a life full of joy and freedom."

Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse

By Al Cross
Kentucky Health News

In a state that once had more tobacco farms than any other, Kentuckians in all regions of the state support policies that discourage use of the product, according to the Kentucky Health Issues Poll.

"Such policies could greatly improve Kentucky's overall health," says the Foundation for a Healthy Kentucky, which co-sponsors the poll each fall. It issued a package of reports that broke down a wife range of previously reported poll results on a regional basis.

Kentucky has fewer than 5,000 tobacco farms, down from a high of 60,000 in 1982, but still has one of the nation's highest smoking rates, 26 percent. That leads to an estimated $2 billion in annual health-care costs.

In every region of the state, a majority (ranging from 59 to 70 percent) of people polled said it would be "difficult" or "very difficult" to make the most important change in their personal health behavior, which for most smokers would be to stop smoking.

"Kentucky adults in every region recognize that improving diet, getting more exercise and quitting smoking could help improve personal health, but the changes are difficult," said Susan Zepeda, president and CEO of the foundation. "Policies around these areas could help all Kentuckians improve their personal health."

The policy getting the strongest support in the poll was tobacco-free school campuses, favored by 85 percent statewide. Fewer than a third of Kentucky's school districts have such policies, but enough do to cover almost half the population.

A statewide ban on smoking in workplaces got 66 percent support. Such a ban is unlikely during the administration of Gov. Matt Bevin, who says the issue should be decided locally. About a third of the state's population lives in jurisdictions with comprehensive smoke-free ordinances; another 10 percent or so live in places that have ordinances with varying exceptions.

There was little difference among the five regions in polling on the two issues.

The poll found regional differences in the percentage of Kentucky adults who said they had no insurance, from 18 percent in Western Kentucky to 8 percent in Eastern Kentucky. The statewide uninsured rate reported at the time of the poll was 13 percent. Other surveys have showed the number in the single digits statewide, after expansion of the Medicaid program under federal health reform.

Health reform also provided subsidies for buying insurance, but some consumers have complained about high deductibles and co-payments. In Northern Kentucky, 34 percent of poll respondents said they had difficulties paying their medical bills in the previous 12 months. The figure was 31 percent in Appalachian Kentucky, 30 percent in Greater Louisville, 25 percent in Western Kentucky, and 22 percent in Greater Lexington.

"An increasing number of Kentuckians have health insurance, but many are still delaying or simply can't afford necessary health care," Zepeda said.

Federal health reform was most popular in the Louisville area, at 44 percent support, and least popular in Northern Kentucky, with 33 percent. Generally, the more impact people said reform had on them, the more likely they were to support it. Three of five Northern Kentuckians said they had not been affected by the reforms but only 45 percent in the Louisville area said that.

There are bigger differences in the impact of drug abuse. One-third of Eastern Kentucky residents in the poll reported reported family members or friends struggling with prescription drug abuse, but only 16 percent in Western Kentucky said so.

Heroin use has caused problems for 35 percent of respondents' families and friends in Northern Kentucky, 17 percent in Greater Louisville, 14 percent in Greater Lexington, 10 percent in Eastern Kentucky, and 8 percent in Western Kentucky.

The regional reports for Eastern Kentucky, Greater Lexington, Greater Louisville, Northern Kentucky, and Western Kentucky, and associated news releases, are available at http://healthy-ky.org/news-events/press-releases.

The poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,608 adults from throughout Kentucky was interviewed by landlines and cell phones. The statewide poll has a margin of error of plus or minus 2.4 percentage points, but the smaller regional samples have higher error margins. The complete data file, codebook and survey instrument will be posted by June 30 at http://www.oasisdataarchive.org/ with other data files from previous polls.

CDC boss Tom Frieden, at SOAR, gives examples of how communities can improve health, such as smoking bans

By Al Cross
Kentucky Health News

PIKEVILLE, Ky. -- Speaking to a region with some of the nation's poorest health, the top federal public-health official gave examples of how individual communities and states have made themselves healthier.

"Health is not just about health, it's about society," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told more than 1,000 people at the Shaping Our Applalachian Region Innovation Summit in Pikeville. "Healthy societies are more productive, and productive societies are more healthy."

Referring to Kentucky's high rates of disease and factors that cause them, Frieden said bringing Eastern Kentucky's health statistics up to the national average would save more than 1,000 lives a year.

Frieden cited six communities that have tackled specific health issues, such as obesity, lack of physical activity, heart health, smoking and teen pregnancy.

Obesity is one of SOAR's three main health targets, but it's not an easy one, Frieden said. He said Somerville, Mass., reduced obesity in children under 6 by 21 percent by making it a community issue, with creation of farmers' markets for local produce, construction of walking paths and the mayor leading community walks.

"Physical activity is the closest thing to a wonder drug," Frieden said, because it helps prevent heart disease, strokes, diabetes and cancer, improved mood and lengthens life.

The leading preventable cause of death is smoking, Frieden said, calling for ordinances and laws making workplaces smoke-free. "Nobody should have to risk getting cancer to come to their job," he said.

Heart disease is the most preventable major cause of death, Frieden said, explaining how Minnesota and Grace Community Health Centers in Knox, Clay, Leslie and Bell counties have improved heart health by improving treatment of high blood pressure, or hypertension. "It's the single most important thing" to do for heart health, and it's simple, Frieden said, because the medicine is inexpensive and taken once a day with few if any side effects.

Frieden said the CDC thinks a lot about teen pregnancy because "Teen pregnancy perpetuates a cycle of poverty." He said Spartanburg, S.C., reduced teen pregnancy by 61 percent from 2001 to 2014 partly because South Carolina's Medicaid program paid for long-acting, reversible contraception immediately after delivery, and was the first state to give full reimbursement for post-partum insertion of intrauterine devices for birth control. Kentucky Medicaid doesn't cover such services.

Youth injuries from e-cigarettes spike; FDA is starting to regulate them, but study authors say not enough to protect children

By Melissa Patrick
Kentucky Health News

The number of young children swallowing or being exposed to the liquid nicotine used in electronic cigarettes has "skyrocketed," jumping 1,500 percent from 2012 to 2015, one co-author of a recent study says.

"E-cigarettes and liquid nicotine can cause serious poisoning, and even death, among young children," Dr. Gary Smith, co-author of the study, told Randy Dotinga for HealthDay. "Like other dangerous poisons, they should be kept out of sight and reach of children, preferably in a locked location."

The research, published online May 9 in the journal Pediatrics, follows an announcement that the U.S. Food and Drug Administration will now regulate e-cigarettes. The rule bans the sale of e-cigarettes to minors, requires health warnings on all packaging and advertisements and requires manufacturers to get federal approval on all products introduced to the market after Feb. 15, 2007. It does not address marketing or advertising. The measure goes into effect Aug. 8, and gives affected industries two years to comply.

E-cigarettes, which are battery-powered devices that heat up fluid that includes nicotine and other ingredients such as flavors and chemicals, have become increasingly popular. They are now the most common form of nicotine use among teenagers. Researchers found that it is the liquid nicotine that poses the greatest danger to children.

The study looked at calls to the National Poison Data System about nicotine and tobacco products from January 2012 to April 2015, and focused on calls about children under the age of 6. The NPDS received 29,141 calls for nicotine and tobacco product exposure during this time, averaging 729 child exposures per month.

It found about 14 percent, or 4,128 of the calls were about exposure to e-cigarettes and involved children aged 2 or younger. Most of the exposures were due to ingestion.

"Children exposed to e-cigarettes had five times higher odds of a health care facility admission and almost 3 times higher odds of having a severe outcome than children exposed to cigarettes," says the report. "One death occurred in association with a nicotine liquid exposure."

"These are not trivial exposures. There were comas, seizures, and even one death in the 40-month period we studied, and these exposures were predictable and preventable," Smith told MedPage Today. "E-cigarettes and vaping liquids are products that should never have entered the market without adequate consideration of the harms they could cause to young children."

Smith, also the director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Ohio, told HealthDay that more needs to be done.

"Other prevention steps include prohibiting the use of flavors, as was done for cigarettes since 2009, restricting the use of packaging and labeling attractive to children, ensuring that liquid nicotine compartments on e-cigarettes are child-resistant, and limiting the concentration and/or quantity of nicotine in refill products," he said.

Gregory Conley, president of the American Vaping Association, a nonprofit group dedicated to education about e-cigarettes and vapor products, told HealthDay that the concern about e-cigarettes is "overblown."

He told HealthDay that the child who died "consumed a homemade nicotine liquid concoction that's much stronger than retail versions." He also pointed out that the number of cases have declined since this study was conducted, saying that this is likely due to increased publicity about the risk.

Co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children's Hospital, encouraged parents of young children who vape to treat liquid nicotine like a poison, suggesting that they keep refill containers "up, away and out of sight, preferably in a locked location" and to not leave vaping devices laying around.

Study authors encourage parents to call the Poison Help Line immediately, at 1-800-222-1222, if their child has been exposed to e-cigarettes.

WellCare provides twist-on naloxone nasal atomizers for free, encourages those who know addicts to have naloxone on hand

WellCare of Kentucky and the Kentucky Pharmacists Association have teamed up to provide 1000 twist-on naloxone nasal atomizers for free, in hopes of making it easier for people to administer the drug.

Dr. Paul Kensicki

"We believe this will make it easier, and less intimidating, for people with no medical background to administer it in an emergency situation," Paul Kensicki, medical director of behavioral health at WellCare of Kentucky, said in op-ed released by Wellcare.

WellCare will provide the atomizers to pharmacists, who will then distribute them to Medicaid recipients and individuals with no insurance coverage.

Kentucky's 2015 anti-heroin law allows pharmacists to dispense naloxone (brand name Narcan), a drug that can reverse the effects of a heroin overdose, without a prescription.Traditionally, the drug has been given as an injection, but the atomizer transforms the syringe to allow it to be administered as a nasal spray.

Naloxone immediately reverses the effects of an opioid overdose by physiologically blocking the effects of the drug. It has no side effects and cannot be abused. "It’s nothing short of a miracle drug," Kensicki writes. "It can absolutely save a life."

More than 1,000 Kentuckians die each year from drug overdoses, with more than 200 of these deaths from heroin. It has become a more common cause of death than car accidents in Kentucky.

"People who know someone who is using opioids, such as a spouse, parent or a roommate, should have naloxone readily available in case they discover an overdose in progress," Kensicki writes.

He notes that patients may be at the most risk of an overdose during recovery, because if they relapse their bodies aren't able to process the same amount of the drug they had been accustomed to before trying to quit.

"Making naloxone available does not mean it is “okay” to use heroin, and we are certainly not removing all the risks of addiction," Kensicki writes. "But we are giving friends and families a tool they can use to help save their loved ones in emergency situations – buying people the time they need to fight their addiction."

Kentucky's life expectancy, a basic measure of health status, is 76; it fluctuates as many as 9 years from county to county

By Danielle Ray

Kentucky Health News

A life lived in Kentucky is expected to vary up to nine years in length depending on the county in which it's spent.

Life expectancy is perhaps the most basic measure of a community's overall health. Health researchers say life expectancy is driven by a complex web of factors that influence health: opportunities for education and jobs, safe and affordable housing, availability of nutritious food and places for physical activity, and access to health care, child care and social services.

The state average is 76 years. Twenty-four of 120 Kentucky counties exceed that figure, mostly in the counties near Louisville, Lexington, Frankfort, Bardstown, Elizabethtown, Owensboro and Bowling Green, with a few exceptions. Oldham County has the state's highest life expectancy, 79 years. Nine counties (Fayette, Jessamine, Scott, Garrard, Shelby, Bullitt, Meade, Boone, and Calloway) share a life expectancy of 78.

Differences become more apparent moving east along the Bert T. Combs Mountain Parkway and down its KY 15 extension. In general, the starkest comparisons in the state exist between the metropolitan areas of Louisville and Lexington versus southeastern Kentucky counties. Only one Eastern Kentucky county, Morgan, has a life expectancy equal to the state’s. Others range from 70 (Perry, Breathitt and Wolfe counties) to 75, mostly found in counties in northeastern Kentucky.

Eastern Kentucky counties are not the only ones with below-average numbers. Other counties ouitside that region with life expectancies of 74 or below are Fulton, Webster, Muhlenberg, Gallatin, Carroll, Casey, Monroe, Metcalfe, Cumberland and Clinton.

The numbers are on a Kentucky life expectancy map released Monday by researchers at the Virginia Commonwealth University Center on Society and Health and the Robert Wood Johnson Foundation. It shows that chances to lead a long and healthy life can vary dramatically by county.

“Health differences between communities are rarely due to a single cause,” the researchers said in a press release. “The health differences shown in these maps aren’t unique to one area. We see them in big cities, small towns, and rural areas across America,” said Derek Chapman, the VCU center’s associate director for research.

The map is the latest effort by the Robert Wood Johnson Foundation to raise public awareness of the many factors that shape health, particularly social and economic factors.

Another is the County Health Rankings, done annually by the University of Wisconsin Population Health Institute. The rankings don’t provide a comprehensive explanation for life expectancy, but they provide helpful correlations.

For example, Harlan County, with a life expectancy five years below the average, ranks 117^th in overall health outcomes and last in health factors. The county has rates of smoking, obesity and teen births that are higher than statewide. It also has less access to exercise opportunities. The rankings show that the county's unemployment rate is nearly 14 percent, more than double the state's. In addition, 43 percent of Harlan County children live in poverty, compared to the statewide figure, 26 percent.

The complete rankings are available at the County Health Rankings web site.

The state Department for Public Health says it and partners have several efforts underway to tackle the many factors that shape health:

•          Promotion of farmers’ markets and their acceptance of federal food assistance benefits such as SNAP, WIC and Senior Farmers’ Market Nutrition Program Vouchers, incentive programs to help with affordability and community outreach.

•          Promotion of walking and walkability by providing communities with targeted training and technical assistance to develop pedestrian plans.

•          Protecting youth from tobacco exposure through the “100 percent Tobacco Free Schools” program, which provides guidance to districts that wish to reduce tobacco use by students and staff.

Experts say local efforts are needed, too. “We must build a society where everyone, no matter where they live, the color of their skin, their financial or family situation, has the opportunity to lead a productive, healthy life,” said RWJF President and CEO Risa Lavizzo-Mourey.  “There’s no one-size-fits-all solution. Each community must chart its own course, and every person has a role to play in achieving better health in their homes, their communities, their schools and their workplaces.”

KET programs focus on oral health, 'just as critical to the well-being of Kentuckians' as problems that have a higher profile

Kentucky Educational Television has turned its attention to oral health, which it says is "just as critical to the well-being of Kentuckians" as the state's "alarmingly high rates of cancer, heart disease, diabetes, and obesity."

KET's John Gregory, in a story about three recent programs, notes that two in five Kentucky children have never been to a dentist and "Poor oral health can contribute to other physical problems like diabetes, cardiovascular disease, and possibly even Alzheimer’s. It can impact how students learn."

“There’s thousands of children on a daily basis attending school with pain that is totally preventable,” Louisville health-care consutant Lacey McNary said on KET's "Connections" with Renee Shaw. “It is really hurting them with their success rates in school and otherwise overall well-being.”

McNary and Dr. Laura Hancock Jones, a dentist with the University of Kentucky's Western Kentucky Dental Outreach Program, blamed the lack of dentists in rural Kentucky and the refusal of many dentists to accept Medicaid, which covers 1.3 million Kentuckians.

But there are more longstanding factors, such as smoking, which makes periodontal disease six times more likely, and eating habits. "Jones says foods rich in carbohydrates and beverages that are high in sugar create the perfect breeding ground for bacteria that feed tooth-eating acids," Gregory reports.

And Jones says we have other bad habits, too: "She says studies show that almost a third of the population never flosses, and brushing and flossing twice a day is recommended. She adds that fear also contributes to bad oral health outcomes."

Other recent reports from KET have reported on a study of the state's oral health, the importance of good oral-health practices to seniors, and how the use of dental sealants in schools with high-risk populations has helped improve oral health.

The latter program featured Dr. M. Raynor Mullins, professor emeritus at UK's College of Dentistry, who "was instrumental in getting dental sealants added to Kentucky’s Medicaid program as a preventive service in the 1990s and has been involved with numerous oral health outreach initiatives across the state during the past 40 years," Gregory reports.

“A tooth has multiple surfaces … smooth surfaces and pit-and-fissure surfaces,” Mullins explains. “Smooth surfaces are the sides of the teeth, and fluorides are very effective about strengthening them. On the other hand, you have these pits, crannies, and fissures on the tops of the teeth and in certain locations on the sides of the teeth, where they are very susceptible to the infection of tooth decay. Sealants are very effective in preventing pit-and-fissure decay.”

Bacteria that can't be treated by any antibiotic now in U.S.; Kentucky ranks first in one type of antibiotic-resistant infection

A colorized scanning  of E.Coli
Credit: CDC/Jancie Haney Carr

For the first time, researchers have found a person in the United States carrying bacteria that can't be treated by "last resort" antibiotics.

The antibiotic-resistant bacteria found in the 49-year-old Pennsylvania woman's urine was from a strain of E.coli bacteria that is resistant to an antibiotic called colistin, a last-resort drug with serious side effects that is used only when other antibiotics don't work.

For example, colistin is used to treat the superbug carbapenem-resistant Enterobacteriaceae, commonly called CRE, which health officials call a "nightmare bacteria."

Nearly half of patients who become infected with CRE die from it, Lena H. Sun and Brady Dennis report for The Washington Post.

The Pennsylvania woman was able to be treated with other antibiotics, but the discovery of the colistin-resistant strain has placed health officials on alert.

Health officials say it's not time to panic, but there is great concern that this colistin-resistance gene could spread to other bacteria that are also antibiotic-resistant creating many more bacteria strains that are untreatable, reports the Post.

The colistin-resistant strain was first found in pigs, raw pork and a few people in China in November. It has also been found in Europe.

“It basically shows us that the end of the road isn’t very far away for antibiotics — that we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections for which we do not have antibiotics,” CDC Director Tom Frieden told the Post.

Separate research found that the same colistin-resistant strain was found in a sample from one pig intestine in the United States. Colistin is widely used in Chinese livestock, but is not used in the United States, though plenty other antibiotics are, Tom Philpott reports for Mother Jones.

"Around 80 percent of the antibiotics sold in the United States go to livestock farms, and of that, 60 percent are considered crucial to human medicine," Philpott writes. Farmers mostly use antibiotics to help their livestock grow faster.

Yohei Doi, an infectious-disease doctor at the University of Pittsburgh, told the Post that he thought the widespread use of the antibiotic in Chinese livestock is likely what has led to the bacteria evolving and gaining resistance to the drug, and then leaping from livestock to humans through food.

Dr. Kevin Kavanagh, a retired physician and chairman of HealthWatch USA, said he isn't convinced that the U.S. pig was infected by livestock from China. He noted that colistin is commonly used to treat CRE, cystic fibrosis and that a form of colistin can be found in many over-the-counter topical antibiotics.

"It's probably more likely that the pig in the U.S. obtained this from the farmer's medicine cabinet than from another pig in China," Kavanagh said.

Experts in infectious diseases have called for action to curb the overuse of antibiotics in livestock worldwide. They have also warned that if these antibiotic-resistant bacteria continue to spread, treatment options could be severely limited.

Kavanagh  recognized the importance of research around the overuse of antibiotics in livestock but said that he thought more emphasis should be placed on the human side of healthcare related to antibiotic-resistance bacteria than the agriculture side of it.

 "The foremost emphasis should be placed on controlling antibiotic usage, controlling the spread of these organisms and surveillance of these organisms. ... We don't really know how many infections exist because we have a fragmented reporting system, but you know how many cows there are in each county," he said.

The federal Centers for Disease Control and Prevention estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year, and 23,000 die.

Kentucky ranked first in MRSA cases, July 2014 - June 2015.

HealthWatchUSA

Kentucky has one of the highest prescribing rates of antibiotics in the nation and also leads the nation in another antibiotic resistant infection called MRSA (methicillin-resistant staphylococcus areus).

"Overuse of antibiotics has got to stop," says Kavanagh said. "The use of antibiotics needs to be curtailed to only when it is necessary. ... Every time you take an antibiotic you remove your good bacteria and run a real risk of activating a superbug in your body which can cause you extreme harm and even death. You should only take antibiotics when you have to take them."

Pharmaceutical companies have stepped away from developing new antibiotics because they aren't very profitable. But William Schaffner, medical director of the National Foundation for Infectious Diseases, told WebMD, "The Infectious Diseases Society of America has been working with Congress and with industry to create incentives for the pharmaceutical industry to reopen its antibiotic research laboratories."

In addition, "Late last year, as part of a broader budget deal, Congress agreed to give hundreds of millions of dollars to the federal agencies engaged in the battle against antibiotic-resistant bacteria," reports the Post.

Prevention is the key to surviving tick season in Kentucky, which runs through August; here are some tips

By Melissa Patrick
Kentucky Health News

With outdoor summer activities in full swing, it's important to remember that tick season, which runs from mid-March through August in Kentucky, is upon us.

American dog tick

Ticks hang out in tall grass, woods, low-hanging tree limbs and weeds just waiting to attach themselves to you or your pets to "feed," a polite way to say they want to suck some blood. And while that is reason enough to avoid them, the real problem is that ticks can carry potentially life-threatening infections, like Lyme disease, Rocky Mountain spotted fever and Erlichiosis.

"The most prevalent tick-borne disease in Kentucky is and has been for a long time Rocky Mountain spotted fever," or RMSF, Grayson Brown, director of the University of Kentucky Public Health Entomology Laboratory, told Kentucky Health News. "We get somewhere between 10 and 30 cases of that a year."

RMSF is transmitted by the American dog tick, which is about the size of a pencil eraser. It is the second most common tick in the state, according to Kentucky Pest News. The greatest risk of getting RMSF in Kentucky is in the western part of the state, near the Land Between the Lakes, said Brown.

RMSF usually begins with a sudden onset of fever and headache that appear from two to 14 days after being bitten by an infected tick. Other symptoms can include nausea, muscle pain, lack of appetite and a rash that occurs two to five days after the fever. RMSF can be fatal in the first eight days of symptoms if not treated correctly, according to the federal Centers for Disease Control and Prevention.

Lone Star Tick, all images Wikipedia

Kentucky's most common tick is an aggressive biter called the lone star tick, which is also about the size of a pencil eraser, says Kentucky Pest News.

The saliva from this tick can produces painful, itchy areas that can become infected from scratching. It can transmit Erlichiosis, a Lyme-like disease that can cause fever, headache, chills, muscle pain and in some cases a rash. These symptoms usually show up one to two weeks after being bitten by an infected tick. It can also transmit RMSF.

And though it is not very common, Kentucky is also home to the blacklegged tick, which is known to transmit Lyme disease. This tick is much smaller than the other two more common ones.

"The number of Lyme disease cases is increasing quite rapidly, with 13 or so last year that were reported," Brown said. "The blacklegged tick is found most commonly around rivers and so the river areas, along the Ohio River, the Kentucky River . . . that is where the biggest risk is going to be.

Black-legged Tick

Symptoms of Lyme disease can range from mild to severe and include fever, headache, fatigue and a skin rash that looks like a bull's-eye, although not everyone has this rash, says the CDC. If left untreated, the infection can spread to joints, the heart or the nervous system. Lyme disease is most prevalent in the Northeast, Mid-Atlantic and Upper Midwestern states, so be mindful if you travel.

Infection from these diseases is unlikely in Kentucky because very few ticks in the state are infected with their respective diseases. And even if the ticks are infected, they must be attached and feeding for at least 12 to 24 hours to transmit its infection, says Kentucky Pest News. This makes self-inspection and prompt removal of ticks an important line of defense against these diseases.

Getting a tick borne disease in Kentucky "is something like the risk of getting struck by lightning," Brown said.

The best way to avoid being bitten by ticks is to use "common sense precautions," Brown said. Here are some tips:

• Keep grass and shrubs trimmed, and clear away any overgrown vegetation in your yard;
• Don't walk through uncut fields, brush and overgrown areas;
• Walk in the center of hiking trails;
• Wear light-colored clothing, which make it easier to spot ticks;
• Wear long pants tucked into boots or socks and tuck your shirt into your pants;
• Place a band of duct tape, sticky side out, around your lower legs to trap ticks;
• Use tick repellent that has DEET or picaridin in it or use permethrin-based clothing sprays;
• Do a body and clothing check at the end of each day;
• Take a warm soapy shower after potential exposure;
• Check your pets.

It is also important to promptly and properly remove ticks by grasping them as close to the skin as possible with tweezers and then pulling straight out with gentle, even pressure. Multiple sources say to not use petroleum jelly, gasoline, hot matches or other "folk" methods to remove ticks. Once removed, wash the bite area, apply antiseptic and cover with a Band-Aid.

The CDC has recommended washing tick-infested clothes and then drying them for one hour, but new research, published online in the journal Ticks and Tick-borne Diseases, says putting dry, tick-infected clothes in a hot dryer and spinning them for six minutes will kill them, Ann Lukits reports for The Wall Street Journal.

Brown said May is the month when you are most likely to encounter "pathogen-bearing ticks," but you can still get infected at other times. Tick season generally runs through August

He also noted that tick-borne diseases primarily occur in rural settings because wildlife, especially deer, often covered in ticks, and field mice, because ticks can transmit diseases to them and then the infected mice can infect other ticks as they feed.

"So if you are really worried about those things," Brown said, "pay attention to the wildlife that you have or that you attract to your property."

Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers

By Melissa Patrick
Kentucky Health News

A health-care advocacy group says the redesign of the Medicaid program should build on the expansion of eligibility and not include any more costs for patients.

“Kentucky has made tremendous gains in improving the health of its people since the expansion of Medicaid. More Kentuckians are receiving preventive services, substance use treatment and other critically needed care than ever before,” Emily Beauregard, executive director of Kentucky Voices for Health, said in a news release. “Any changes to the program should build on this success.”

Under federal health reform, then-Gov. Steve Beshear expanded Medicaid to households with incomes up to 138 percent of the federal poverty level, which added about 400,000 more Kentuckians to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020. In all, about 1.3 million Kentuckians get free health care through Medicaid.

Gov. Matt Bevin has said the state can't afford to have more than a fourth of its population on Medicaid and has charged his administration to come up with a revised program that will improve health outcomes while making the expansion financially sustainable. Bevin hopes to accomplish this through a waiver from the federal government.

Bevin has said he favors a waiver program like Indiana's, which includes premiums and co-pays in some tiers of coverage, but has also said that he is not limited by this model and will develop a waiver to best fit the needs of Kentucky.

Kentucky Voices for Health is a coalition  of organizations that favor federal health reform, some of of which lobby the government. It said changes should engage consumers in their care and develop new ways to deliver care, without any obstacles to coverage such as premiums.

“Coverage is foundational,” Rich Seckel, executive director of Kentucky Equal Justice Center, said in the release. “It empowers us with tools to achieve and maintain health.”

The coalition also said the program should focus on coordination of care in areas with high use, and build on Kentucky's Health Data Trust, which provides complete and transparent information about healthcare utilization and outcomes to improve public health and quality of care delivery. Click here for the full report.

The group stressed the importance of meaningful stakeholder input to ensure the waiver is designed to meet the unique needs of Kentucky. So far, the administration has had no formal stakeholder meetings on the issue.

Under federal law, states seeking a waiver must hold at least two public hearings; one before it is submitted to the Centers for Medicare and Medicaid Services and the second after CMS accepts the application.

Amanda Stamper, press secretary to Bevin, told The Courier-Journal that the administration welcomed "this sort of thoughtful input," and when asked if the waiver would include any premiums or co-pays said, "Everything is on the table and no decisions have been finalized."

Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture

By Melissa Patrick

Kentucky Health News

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of in the County Health Rankings for the state have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map)

Clinton County ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. “We recognize that. We saw that in our kids,” Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a report to be aired soon about the coalition.“And if we don’t change something now, we’re going to be going to the funeral home for kids a lot younger.”

So, with the help of the Foundation for a Healthy Kentucky, they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children.

“The coalition came together [according to] Aristotle’s thinking, that the whole is greater than the sum of its parts,” Brewington told KET. “We have a lot of great groups, that do a lot of great things, but if everyone is going for the same goal, and the resources are not combined, you’re not going to accomplish anything. And once we get everybody together and on the same page, by combining resources, we’ve been able to do some great things.”

Paula Little, assistant superintendent and supervisor of instruction for Clinton County schools, told KET that the coalition recognized most of the county's health issues stemmed from obesity, and decided to focus their efforts on the children in the community to change their culture.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Little said.

Many of the coalition’s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day-care programs.

The coalition has worked with the schools to improve nutrition. Fruits and vegetables are now served every day with every meal. The schools also began offering supper to students during the school year and has since served over 6,400 meals. The program began last October.

Recognizing that an estimated 38 percent of Clinton County's children live in low-income families, the coalition launched a summer food program that delivers breakfast and lunch in a retrofitted school bus called the Bus Stop Café to areas in the county with high student populations.

The Healthy Hometown Coalition has also implemented school-based health clinics, which provides for the healthcare needs of students through a public-private partnership while they are at school. The clinics are run by the Cumberland Family Medical Center. In addition to providing clinical care, the clinics provide body mass index assessments and provide nutrition and obesity counseling.

“It’s about accessibility,” Brewington said. “It’s about the kid who has a cough and needs to see a doctor, but the parent can’t take off from work. ...It's about having healthcare right there where the child is the majority of the time."

Not mentioned in the KET report is that Clinton County schools implemented a comprehensive smoke-free policy last year that will go into effect in July. The policy will ban smoking on school property both during school hours and during school sponsored events, and also includes electronic cigarettes and all vapor products.

The coalition is working to change the culture of its community so that a healthy lifestyle becomes the norm, and not the exception.

“When you’re attempting to change a culture, and change the way people live, that’s a very long process,” Little said. “And it has to be something that’s consistent, that’s ongoing, and it has to be a message that children hear everywhere they go in the community.”

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the Clinton County News that often celebrates individual success stories. The coalition also sponsors community events, and has built a new playground.

“What makes me feel good about it is that I know there’s a real need here,” Speck told KET. “There’s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we’re making an improvement.”

Study finds most smokers are not satisfied with e-cigarettes and don't make the switch; study author wishes they would

image www.mirror.co.uk

Although e-cigarettes did help a small group of smokers quit smoking traditional cigarettes, most smokers who tried them didn't find them to be an acceptable alternative, says a recent study.

Study author Terry Pechacek told HealthDay News that smokers ideally would find e-cigarettes more appealing and less dangerous than traditional cigarettes, and suggested that traditional cigarettes should be "degraded" to encourage a switch.

"Even if they're only half as risky, there would be a huge public health benefit if we could switch 40 million smokers to them," said Pechacek, also a professor and interim division director of Health Management and Policy at Georgia State University in Atlanta.

The study, published in the journal Nicotine and Tobacco Research, is one of the first to look at whether smokers find e-cigarettes to be a satisfying alternative to regular cigarettes.It surveyed more than 5,700 Americans in 2014, and focused on the 729 current and former smokers who had tried e-cigarettes. Of the 585 current smokers who had tried e-cigarettes, 58 percent (337 people) self-reported that they didn't use them anymore and 42 percent (248 people), said they smoked both. Among the 144 former smokers, 101 had quit smoking altogether and 43 had switched exclusively to e-cigarettes.

"Greater than fivefold more current smokers did not find them satisfying and stopped using them," says the report, making it unlikely that e-cigarettes "will replace regular cigarettes unless they improve."

Pechacek told HealthDay that follow-up research to be released later suggest the problem is related to nicotine delivery, smell and flavor. In the big picture, "E-cigarettes may help a few people to quit, but mostly they don't. And the suspicion from these data is that they help keep people smoking. That is not something that the e-cigarette advocates want to hear," Thomas Wills, professor and interim director of the Cancer Prevention and Control Program at the University of Hawaii Cancer Center, told HealthDay.

The U.S. Food and Drug Administration acted to regulate e-cigarettes in early May. The rules ban the sale of e-cigarettes to minors, require health warnings on all packaging and advertisements and require manufacturers to get federal approval on all products introduced to the market after Feb. 15, 2007. It did not address advertising and marketing. The measure goes into effect Aug. 8, and gives affected industries two years to comply.

Gregory Conley, president of the American Vaping Association, told HealthDay that the rules will weaken the innovation of e-cigarettes.

He pointed out that the study did not establish if participants used an old model of e-cigarettes or a new one, which have become more appealing. He also noted that most smokers in the study who switched to e-cigarettes were more likely to use a "tank-style" device, which can deliver more nicotine and last longer than devices that look more like cigarettes.