Study finds exercise is good for the heart at all ages, even among those who are obese; Ky. is a sedentary and obese state

Consumer HealthDay photo

Exercise not only lowers the risk of heart damage in middle-aged adults and seniors, but can also reduce the levels of heart damage in those who are obese, according to a new study.

"The protective association of physical activity against [heart] damage may have implications for heart failure risk reduction, particularly among the high-risk group of individuals with excess weight," lead author Dr. Roberta Florido said in an American College of Cardiology news release.

Kentucky adults struggle with obesity and sedentary lifestyles, and the state leads the nation in heart disease.

Thirty-five percent of Kentucky's adults are obese, and one-third of them reported in 2015 that they hadn't had any physical activity or exercise in the 30 days before they were surveyed. And 27.5 percent of Kentucky's seniors are obese, with 39 percent of them reporting no physical activity in the 30 days prior to the America's Health Rankings survey.

The study, published in the Journal of the American College of Cardiology, examined more than 9,000 people without heart disease between the ages of 45 and 64. Researchers then grouped the participants according to how much exercise they got based on the American Heart Association's recommended guidelines of at least 75 minutes a week of vigorous activity, or 150 or more minutes of moderate to vigorous activity.

Then, to measure damage to the heart, they assessed blood levels of high-sensitivity troponin T, a marker of heart damage that has been shown to be associated with future heart failure.

"Individuals with lower levels of physical activity were significantly more likely to have elevated levels of high sensitivity troponin, suggesting higher heart damage," says the release.

For example, the study found that those in the "intermediate" category of activity (those who exercised, but less than the AHA recommendations) were 34 percent more likely to have heart damage and those who did not exercise at all were 39 percent more likely to have heart damage than their peers who met the guidelines for exercise.

Further, the researchers looked at the role of exercise on the troponin levels of obese adults and found that the obese participants who got the recommended level of physical activity had lower levels of troponin compared to those who did not exercise at all, "which indicates that the protective association of physical activity and heart damage may be stronger among individuals with obesity, a group at particularly high risk for future heart failure," says the release.

"Promoting physical activity may be a particularly important strategy for heart failure risk reductions among high risk groups such as those with obesity," Florido said.

After their child died from a drug overdose, a Kentucky family joined those who are choosing to tell the truth about addiction

By Traci Thomas
Kentucky Health News

The obituary for Katherine Bryant Reynolds, published in the April 5 Lexington Herald-Leader, was engagingly frank: "To honor Katie's life as her forever supportive family, we will strive to reduce the stigma and further the understanding that addiction is not a severe character flaw to be punished and shamed, rather a tragic chronic relapsing brain disease deserving of respect and compassionate treatment."

The Bryants are among many bereaved families across the country choosing to publicly expose addiction as a cause of their loss. Their choice to replace "died suddenly at home" with "died after a long struggle with addiction" challenges the shame often associated with substance abuse.

Katherine Bryant Reynolds

Katie, originally from Richmond, was 37. She lost her battle to drug addiction in her Lexington home on March 28. According to the Fayette County coroner, her death "was a result of poly drug abuse including levels of opiates above the therapeutic range and methamphetamine," her mother, Luanne Bryant, told Kentucky Health News in an email.

"Our being open was right for us. Right for Katie," Bryant said. "If we name something and bring it into the light, we can begin to rob it of its power to destroy. I hope others will, too."

Kentucky is one of five states in the nation with the highest rates of death linked to overdose: 29.9 per 100,000. West Virginia has the highest rate at 41.5 per 100,000, and neighboring Ohio has the same overdose death rate as Kentucky.

State officials have taken several steps to deal with the issue, but Bryant said society is offering no real solutions to the opioid epidemic, "often undermining recovery and endangering those with addiction."

She explained, "Effective and affordable resources have not been made available to our family. From drug court to multiple touches with social services and treatment facilities, to repeated incarceration with abundant access to drugs while incarcerated, the current system is broken and the toll it is taking on individuals and their families and the cost to society is devastating."

Katie Bryant with mother Luanne and sister Kennedy Konshak

Though frustrated by the lack of resources and grappling with the loss of her daughter, Bryant said Katie will be remembered as a young woman full of spirit, spunk, courage and ideas of intellect.

"By sharing Katie’s cause of death, we were refusing to play into stigmatizing opiate addicts by behaving as if this particular disease is shameful and addicts are only statistics," Bryant said. "If the families of the victims of fatal opiate addiction included that in obituaries, maybe people in general would better grasp how opiates are ravaging generations of young people and their families."

Business interests weigh in on behalf of Medicaid expansion

By Al Cross
Kentucky Health News

Medicaid, a 52-year-old program that seems to be in line for big changes from elected officials who question its cost, is getting some help from a seemingly unlikely source: business interests.

"Medicaid works" is the message of the Modern Medicaid Alliance, a national group that comprises mainly health advocacy organizations but also includes the Kentucky Association of Manufacturers. That may sound like Big Business, but many Kentucky manufacturers are small and don't provide health insurance for their employees, many of whom are eligible for the expanded form of Medicaid that took effect in 2014.

“Medicaid plays an important role in providing for the health of the local workforce and their families,” KAM President Greg Higdon said in a press release. “Programs like Medicaid are essential to ensuring that Kentucky residents are well and able to pursue employment and contribute to our state’s growth and productivity.”

The alliance is starting a Kentucky campaign that includes "organizing of Medicaid supporters, beneficiaries, and Modern Medicaid Alliance partners who will make the case to elected officials at all levels that Medicaid works," the release says. It also includes a digital advertising campaign and stories "of beneficiaries whose lives have been improved by Medicaid."

“Medicaid is essential to ensuring access to health care for Kentuckians who are economically vulnerable,” Jason D. Hall, Executive Director of the Catholic Conference of Kentucky, said in the release. “Pregnant women, children, the elderly, and the economically displaced receive essential health care services because of Medicaid. When people have health coverage, they utilize preventive services more and the emergency room less. Morally and fiscally, Medicaid is an essential program."

Under federal health reform in 2014, Kentucky expanded Medicaid to people with incomes up to 138 percent of the federal poverty line, adding about 440,000 to the program's rolls and bringing the total number of beneficiaries to 1.3 million. The federal government paid for the expansion through 2016; now the state pays 5 percent, rising in annual steps to the current law's limit of 10 percent in 2020.

Gov. Matt Bevin says the state can't afford that, and has asked the federal government to let the state impose rules such as work requirements and small, income-based premiums on beneficiaries. The Trump administration is expected to approve the changes and use them as an example for other states. The state estimates that the changes will leave the program in five years with 85,000 fewer people than it would have without the changes.

In Congress, much of the debate about health care has focused on Medicaid. "While political debates and policy discussions about health reform continue in Kentucky, the Modern Medicaid Alliance will educate policymakers and the public about the high-value care Medicaid delivers, Medicaid’s innovative solutions that are saving taxpayer dollars and increasing coverage, and the need for Medicaid to remain a strong safety net for the people of Kentucky," the release says.

Study concludes that diabetes may kill four times as many people as reported; 13.4% of Kentucky adults have diabetes

                             Medical News Today photo

By Melissa Patrick
Kentucky Health News

Diabetes may be responsible for nearly four times as many American deaths as reported on death certificates, which would move diabetes from the seventh-leading cause of death to the third, according to a recent study. Kentucky has the 12th highest diabetes death rate in the nation.

“We argue diabetes is responsible for 12 percent of deaths in the U.S., rather than [the] 3.3 percent that death certificates indicate,” lead study author Andrew Stokes of the Boston University School of Public Health, told Arlene Karidis of The Washington Post.

Researchers say this discrepancy occurs because diabetes is often the main underlying cause of death, but is not mentioned on the death certificate. For example, the death certificate may list heart disease as the cause of death, but doesn't note that the heart disease was caused by diabetes.

The study, published in the online journal PLOS One, analyzed findings from two large national surveys, one that provided levels of A1C, a test that shows average blood sugar over two to three months, and another that provided self-reported diabetes information. Researchers compared the death rates of the diabetics in the surveys to information on their death certificates.

While the study concluded that 12 percent of deaths were caused by diabetes, "by far the highest proportion of deaths attributable to diabetes, 19.4 percent, occurred among obese people, compared to only 8.8 percent among the non-obese." It also found that diabetics had a 90 percent higher death rate over a five-year period than non-diabetics, accounting for other factors.

Adult diabetes rates in Kentucky, 2013-15, ranging from 8 to 22 percent

About 13.4 percent of Kentucky adults have diabetes, compared to the national rate of 9.9 percent, according to the 2015 Kentucky Behavioral Risk Factor Surveillance Survey. And the federal Centers for Disease Control and Prevention estimates that as many as one in three Kentucky adults have pre-diabetes, and many of them don't know. Almost 35 percent of Kentucky adults are considered obese, which places them at a higher risk of diabetes and death from it.

“These findings point to an urgent need for strategies to prevent diabetes in the general population. For those already affected, they highlight the importance of timely diagnosis and aggressive management to prevent complications, such as coronary heart disease, stroke and lower-extremity amputations,” Stokes told Karidis. He added that a better understanding of the actual number of deaths caused by diabetes would improve "messaging, funding and policy decisions, such as taxation of sugar-sweetened beverages and sue of subsidies to make healthy foods more accessible."

                           Harvard Health Publications

Diabetes symptoms and tips to get moving

Diabetics either have Type 1 diabetes, in which the body doesn't make any insulin, or Type 2, in which the body has difficulty producing and using insulin. Insulin allows a person's body to use sugar that is found in food for energy, or to store it for later. It helps keep blood sugar levels from getting too high or too low.

Type I cannot be prevented, but Type II, which is more common, can be prevented or delayed with a healthy lifestyle, including maintaining a healthy weight and exercising regularly.

Early symptoms of Type II diabetes include increased thirst, frequent urination, feelings of unusual hunger, dry mouth and weight gain or loss, Medicine Net reports in a slideshow article. WebMD reports the same symptoms for Type I diabetes.

Other symptoms include headaches, fatigue and blurred vision, frequent yeast infections or urinary tract infections, itchy skin, or an infection or sore that takes a long time to heal. Vaginal dryness in women and impotence in men are also complications that can arise from Type II diabetes.

Medicine Net notes that smoking, being overweight or obese, lack of exercise, consuming a diet that is high in processed meat, fat, sweets and red meats and high cholesterol increases a person's risk of Type II diabetes, as does women who had gestational diabetes in pregnancy and people with a family history of the disease.

In addition to working with a health care provider to create a healthy eating plan, it's also important for diabetics to exercise because this helps to lower blood glucose levels, and lowers the risk of heart disease and nerve damage, both common risks of diabetes.

The federal Centers for Disease Control and Prevention offers some tips for diabetics to "get moving and keep going," including:

• First, check with you doctor before starting a new or more difficult activity.
• Start slow and build up gradually; start with 10 minutes of walking and build up to 30.
• Results are often immediate. Check your blood sugar before and after the walk.
• Find an activity you enjoy.
• Walking and dancing cost nothing.
• Squeeze activity into the day; take the stairs, play with the kids, move during commercials.
• Make a plan; prepare for exercise the night before, put it on the calendar.
• Make a specific goal. For example, I am going to walk a mile every day for a month.
• Work out with a partner.
• Don't go more than two days in a row without being active.
• Do it for the T-shirt: Sign up for a 5K run/walk and train for it.

Study says only way to protect children from smoke exposure is to quit or not smoke in house; nicotine residue is everywhere

Children carry significant levels of nicotine on their hands even if their parents don't smoke around them, according to a recent study by Cincinnati Children's Hospital Medical Center and San Diego State University.

“Parents may think that not smoking around their child is enough, but this is not the case. These findings emphasize that the only safe way to protect children from smoke exposure is to quit smoking and ban smoking in the home," Dr. Melinda Mahabee-Gittens, co-investigator of the study, said in a Cincinnati Children's Hospital news release.

Kentucky has the highest smoking rate in the nation, 26 percent. And the federal Centers for Disease Control and Prevention says that between 2011-2012, two of every five children aged 3 to 11 in the United States were regularly exposed to secondhand smoke.

The pilot study, published in the journal Tobacco Control, involved 25 children who had visited an emergency room between April and September 2016 for illnesses that could be related to secondhand smoke exposure, like a runny nose or difficulty breathing. The average age of the children in the study was 5, and all their parents were smokers.

Researchers used specially designed hand wipes to extract nicotine from the children's hands and took saliva samples to check for cotinine, which is the product formed after nicotine enters the body.

"Researchers found that the presence of significant nicotine on the hands of children was associated with equally significant levels of the harmful tobacco metabolite cotinine in their saliva," the release says. Such exposure can cause respiratory and ear infections, and more frequent and more severe asthma attacks, and other ailments in children, the CDC says.

The release says previous studies have shown that secondhand smoke accumulates in dust, on home surfaces, on clothes and household objects, like toys. It also notes that young children touch everything and have a tendency to put their hands in their mouths.

This study will be followed up by a larger analysis of more than 700 additional children, with a further look at how much secondhand and thirdhand smoke contribute to tobacco exposure in children and how it affects their health. It will also explore ways to prevent such exposure.

Nonprofit grades hospitals on patient safety; Ky. improves slightly in national rank, but Louisville hospitals still get near-failing scores

University of Louisville Hospital reminds visitors
and workers to wash their hands to stop infections.

By Traci Thomas
Kentucky Health News

A nonprofit group that rates hospitals has released its latest patient-safety grades, giving most Kentucky hospitals a B or C. The scores are similar to grades released in October, but the overall score for Kentucky hospitals rose from 35th to 32nd among the states.

The Leapfrog Group, a nonprofit based in Washington, D.C., evaluated 2,639 hospitals nationwide, including 51 in Kentucky. Most of Kentucky's 129 hospitals were not rated because critical-access hospitals in rural areas don’t have to report their quality measures.

The grades are calculated using 30 publicly available safety-performance measures from the Centers for Medicare & Medicaid Services, the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association’s annual survey.

The calculations gave an A to 12 of Kentucky's hospitals, or 23.5 percent, lower than the national average of 31 percent. The majority of Kentucky hospitals got average scores, with 16, or 31.4 percent, earning a B, and 20, or 39.2 percent, earning a C. The remaining three hospitals got a D, one fewer than in the fall.

The three that got a D are in Louisville and owned or operated by KentuckyOne Health: Jewish Hospital, Sts. Mary and Elizabeth Hospital and University of Louisville Hospital. A state inspection of University Hospital last year found that shortcomings in nursing had endangered three patients, and nurses and doctors told inspectors that staff shortages put patients at risk. The hospital has since corrected those problems.

Despite the low grades, KentuckyOne Health told The Courier-Journal that it's "committed to delivering high quality, safe care for the people of Kentucky," Darla Carter reports for the Louisville newspaper. "After financial squabbling between the university and KentuckyOne, an executive committee of the U of L Board of Trustees approved an agreement in December to clear the way for KentuckyOne to no longer run the day-to-day operations of the hospital and the James Graham Brown Cancer Center as of July 1."

St. Joseph Hospital and St. Joseph East in Lexington, also owned by KentuckyOne, received Cs again after getting the same grade in October.

Pikeville Medical Center has received A grades from the start.

Among Leapfrog's top safety picks is Pikeville Medical Center, the only Kentucky hospital to get straight As since the rankings began in 2013. The two University of Kentucky hospitals once again earned Bs.

The grades include separate ratings for errors, injuries, accidents and infections. Click here for Kentucky's hospital safety scores.The Leapfrog Group says its analysis was developed under the guidance of the nation's leading patient-safety experts. The report is peer-reviewed and published in the Journal of Patient Safety.

“When we launched the Leapfrog Hospital Safety Grade in 2012, our goal was to alert consumers to the hazards involved in a hospital stay and help them choose the safest option. We also hoped to galvanize hospitals to make safety the first priority day in and day out,” Leah Binder, president and CEO of Leapfrog, said in a report. "So far, we’ve been pleased with the increase in public awareness and hospitals’ commitment to solving this terrible problem. But we need to accelerate the pace of change, because too many people are still getting harmed or killed.”

State health department offers services to fight opioid epidemic, including free antidote for overdoses and education about it

The state Department for Public Health is reminding communities of the services it offers to address the impact of opioid abuse, and to educate the public about an antidote to overdoses.

"We have an enormous challenge across Kentucky right now," Dr. Ardis Hoven, the department's consultant for infectious diseases, says in a video. "Drug abuse, particularly among those who inject heroin or other forms pf opioids has reached epidemic proportions. It has become clear to use that responding to this crisis means more than drug rehabilitation. We have to address all the outlying health issues attached to injection drug use and that means treating all the forms of harm associated with it."
The agency acted after "a recent report of a death in Louisville linked to the highly potent painkiller carfentanyl, which is a large animal tranquillizer never intended for human use," it said in a press release. "It can be hidden in heroin, cocaine and methamphetamine."

“This is a very serious public health issue tied to a number of overdoses, hospitalizations and deaths across the country,” said Dr. Hiram Polk Jr., commissioner of the department. “Heroin, particularly contaminated heroin mixed with carfentanyl, fentanyl and other toxic substances, is highly toxic and can lead to respiratory failure and death. As healthcare professionals and community leaders, we must be aware of the threat and take steps to address it.”

Polk said hospitals should stock up on naloxone, often known by its brand name Narcan), an antidote to heroin and other drug overdoses.

He also noted that his agency employs a mobile pharmacy unit and on-site testing for hepatitis C and HIV, which can spread through intravenous drug use. The mobile unit is staffed with pharmacists who visit at the request of local health departments to test for the diseases, provide communities with training in the use of naloxone, and distribute free naloxone to community members who request it.

“It can take as much as three times the amount of naloxone to reverse an overdose with these mixed drugs as it would normally,” Polk said. “Communities must be educated about the risks associated with these dangerous drugs.”

Friends and loved ones of those at risk from opioid abuse can get more information about naloxone at Kentucky Stop Overdoses, which also has a registry of pharmacies where the drug is available. The mobile harm reduction program, sponsored by the health department and the Kentucky Pharmacists Association, provides education and a free supply of naloxone to those who visit the mobile pharmacy when it’s in a community. It is visiting Garrard and Nelson counties in April.

About half of Kentucky adults support syringe exchanges, meant to decrease the risk of outbreaks of HIV and hepatitis C

By Melissa Patrick
Kentucky Health News

More Kentucky adults favor syringe exchanges than oppose them, and the more they know about them, the more likely they are to support them, according to the latest Kentucky Health Issues Poll.

Kentucky's legislature approved syringe exchanges in 2015 to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require local approval and funding and are often called needle exchanges; a needle is part of the syringe.

In the Sept. 11-Oct. 19 survey, 56 percent of Kentucky adults polled said they were familiar with needle-exchange programs, while 44 percent weren't familiar with them; and 49 percent favored the programs, 43 percent opposed them and 8 percent said they weren't sure.

Those who were familiar with syringe exchanges were more likely to favor them. Of the 56 percent who said they were familiar, 59 percent said they favored the programs, while 37 percent opposed them. Among the 44 percent who were not familiar, 37 percent said they favored the programs, 50 percent opposed them and 13 percent were not sure.

Last year, the Centers for Disease Control and Prevention said 54 of Kentucky's 120 counties were  among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among those who inject drugs. Sixteen of the state's counties ranked in the nation's top 25.

But the decision to support syringe exchanges hasn't come easy for many counties, often because of beliefs that they condone drug use, concerns about safety and concerns about the costs to taxpayers, not to mention a general lack of knowledge about what they do.

"Research tells us that needle-exchange programs can help cut down on the spread of HIV and hepatitis C," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Research also indicates that these programs do not increase drug use."

A great example of how local news coverage can play a role in educating its readers about needle exchanges is found in Brad Bowman's in-depth article about Franklin County's exchange in The State Journal. This story not only explains why needle exchanges are important and describes how they work, but also paints a picture of who uses them: "The clients come from all walks of life, from suit-and-tie professionals to people who are unemployed," Bowman writes.

As of March 29, according to the state Cabinet for Health and Family Services, 31 counties had approved syringe-exchange programs, with 21 of them operational. Eleven are in counties the CDC has deemed most vulnerable to HIV and hepatitis C outbreaks. Click here for more information on specific locations and hours.

Income levels didn't affect opinions about needle exchanges, but age and education did: only 42 percent of adults 65 and older approved of them, while around 50 percent of those 18 to 64 did. Support also increased as education levels increased.

Randy Gooch, director of the Jessamine County Health Department, said in a foundation news release that while the ultimate goal of the program is to reduce HIV and hepatitis C infections, they also measure success in the number of clients who get counseling and treatment services because of the interactions they have with them.

"Our greatest success to date has been realized with our first participant, a 34-year-old female who came seven weeks straight to our program and returned on the eighth week to turn in her syringes and inform us she was checking into rehab. After four weeks of rehab, she was placed on medication-assisted treatment and often comes by to visit and say she is doing well," Gooch said.

Gooch said Jessamine County's exchange, which opened in April 2016, has served 114 clients in 347 encounters, has tested 20 percent of the clients and found that 30 percent of those tested are positive for hepatitis C. They have given out 11,361 syringes and have had 8,083 returned.

"The drug epidemic will only be controlled through a multi-prong approach of education, legislation, prevention, intervention, treatment, faith and other community components," Gooch said. "I'm extremely proud of our community for being proactive in these areas as a 'Safe Community'."

The poll was conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the foundation and Interact for Health. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones and has an error margin of plus or minus 2.5 percentage points.

Studies: 21% of people with serious conditions are misdiagnosed; most in U.S. will get an incorrect or late diagnosis at some time

More than one in five patients who sought a second opinion at the Mayo Clinic had been misdiagnosed by their primary-care doctors, a study concluded.

The results, published in the Journal of Evaluation in Clinical Practice, "are generally similar to other research on diagnostic error, but provide additional evidence for advocates who say such findings show that the health-care system still has room for improvement," Lenny Bernstein reports for The Washington Post.

Researchers at Mayo, in Rochester, Minn., looked back at 286 patients their primary-care doctors and nurse practitioners saw in 2009 and 2010. Nearly two-thirds were under 65, and most were female. The researchers reported that in 62 cases (21 percent), the second diagnosis was "distinctly different" from the first. In 188 cases, the diagnoses were at least partly correct but were “better defined” by the second opinion, the study said. In 36 cases, the diagnoses were the same.

Mark Graber, a senior fellow at the research institute RTI International and founder of the Society to Improve Diagnosis in Medicine, told Bernstein, “Diagnosis is extremely hard. There are 10,000 diseases and only 200 to 300 symptoms.”

Graber, who was not involved in the Mayo research, "estimates that the rate of misdiagnosis, although difficult to determine, occurs in 10 percent to 20 percent of cases," Bernstein reports. The new study cites previous research that found diagnostic errors "contribute to approximately 10 percent of patient deaths" and "account for 6 to 17 percent of adverse events in hospitals."

"In 2015, the National Academy of Medicine reported that most people will receive an incorrect or late diagnosis at least once in their lives, sometimes with serious consequences," Bernstein writes. "It cited one estimate that 12 million people — about 5 percent of adults who seek outpatient care — are misdiagnosed annually. The report also noted that diagnostic error is a relatively under-measured and understudied aspect of patient safety."

James Naessens, a policy researcher at Mayo, said in a press release: "Effective and efficient treatment depends on the right diagnosis. Knowing that more than one out of every five referral patients may be completely [and] incorrectly diagnosed is troubling — not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all."

Researchers call for better tracking of antibiotic-resistant infections to determine best way to fight them; big issue in Ky.

By Melissa Patrick
Kentucky Health News

If the United States really wants to figure out the best way to fight infections that are resistant to antibiotics, a big problem in Kentucky, researchers say it first needs to create a better system for tracking the infections.

The study, published on BioMed Central, looked at the incidence rate of Methicillin-resistant Staphylococcus aureus (MRSA) by analyzing data from five different reports and determined the data varied so widely between them that any sort of real comparison would be difficult.

Report notes that this MRSA infection
might not be reported, depending on
the data-reporting guidelines. (CDC)

The variances included the types of populations studied (general population, military facilities, medical centers, pediatric patients and different geographic areas); the types of infections measured (total MRSA infections versus bloodstream infections only) as well as variances in how baseline data was gathered. In addition, it said the terminology used to describe the results also varied.

Taking all this into account, the researchers said they did not find any "definitive evidence" that MRSA rates had decreased significantly in health-care facilities or in communities since 2010-2011, and found they had increased between 2014 and 2015. However, the U.S. Veterans Health Administration had over an 80 percent reduction in MRSA.

Dr. Kevin Kavanagh

Why does this matter?

The U.S. Department of Health and Human Services has set a goal of reducing MRSA infections by half by 2020, but lead researcher Dr. Kevin Kavanagh of Somerset, an infection-control activist who leads Health Watch USA, said in a separate opinion piece about the study that the nation "is nowhere near on track to meet this target."

The researchers note that health-care facilities use two main strategies to fight these infections, and one seems to have better results than the other, but they say that until all of the tracking measures are equal, a "best practice" cannot conclusively be determined.

The strategy used by VA hospitals is based on identification and isolation, along with strict hand-washing rules. The other, used by more than 60 percent of U.S. hospitals, is based on the "Reduce MRSA" study and involves a protocol of daily bathing with chlorhexidine along with intranasal mupirocin, an antibiotic.

Many health experts have concerns about the "Reduce MRSA" study because Sage Products, the maker of the chlorhexidine wipes, provided "funding and millions of dollars in wipes for studies" to Rush University Medical Center in Chicago to test the efficacy of the product, and that Rush has since "published 11 articles on six trials that endorse daily washing of patients with Sage's patented wipes, which is an 'off label' use," the Reuters news service reports in an in-depth investigative story. The U.S. Food and Drug Administration has only approved the wipes for cleaning patients before surgery.

"The industry money funding chlorhexidine research muddies the message of the results, in the view of many health experts," Deborah J. Nelson and Ryan McNeill report for Reuters.

They also report that experts have voiced concerns about routine use of such a "potent biocide," and the FDA recently issued warnings about increased "reports of allergic reactions, including a couple of deaths, and other adverse events linked to the chemical." In addition, Sage has also recalled the product twice because the chlorhexidine cloths have been "tied, ironically, to dozens of infections by Burkholderia cepacia, a pathogen that wreaks havoc on hospital patients," they write.

Dr. Robert A. Weinstein, an infectious-disease specialist at Rush and senior researcher on the chlorhexidine wipe studies, told Reuters that the maker funding his research has not influenced his findings. He has published one negative report on the product.

Reuters, in another investigative story, also found that infections and deaths from antibiotic-resistant infections are not reported or tracked routinely, saying that the federal Centers for Disease Control and Prevention estimate that 23,000 Americans die each year from an antibiotic-resistant infection is "mostly guesswork" and that the real number is likely much higher.

In its analysis, Reuters looked at health-department records and compared them to death certificates during the same time period and found that while health departments reported about 3,300 deaths from antibiotic-resistant infections in 2003-2014, death certificates reported 180,000 such deaths. In the same time frame, Kentucky's health departments reported nine such deaths, but the Reuters investigation found 3,027.

With pushes from Obama administration, Kentucky schools focused more on health; example: less junk food is available

Lexington Herald-Leader file photo

Sugary drinks, fatty snacks and chocolate candy are becoming harder to buy in Kentucky schools, which are paying more attention to health issues, according to the latest survey by the federal Centers for Disease Control and Prevention.

The CDC's latest biennial School Health Profiles for 2014 found big declines in the availability of junk food since 2014. Here are the specifics:

• Chocolate candy: 7.8 percent in 2016, down from 22.6 percent in 2014
• Salty snacks that are not low in fat: 13.7 percent in 2016, down from 26.1 percent.
• Cookies, crackers or other baked goods that are not low in fat: 12.0 percent in 2016, down from 24.1 percent.
• Soda or fruit drinks that are not 100 percent juice: 15.7 percent in 2016, down from 33.1 percent in 2014.

There was also a big increase last year in the number of Kentucky schools that banned less nutritious foods and beverages from being sold in fundraising, up to 36 percent from 23 percent in 2014, a news release from the state Department of Education said.

Schools are systematically paying more attention to health issues. The survey found that 66 percent have used the CDC’s School Health Index or another self-assessment tool to evaluate them in the areas of physical activity (66 percent in 2016, 56 percent in 2014), nutrition (62 percent in 2016, 53 percent in 2014) and asthma (35 percent in 2016, 21 percent in 2014).

More schools are offering opportunities for students to participate in physical activity before the school day through organized activities or access to facilities or equipment: 29.4 percent in 2016, up from 19.3 percent in 2014.

"Nearly three-fourths of schools have one or more groups such as a school health council, committee or team that offers guidance on the development of policies or coordinates activities on health topics," the release said. "There were such groups in 74.7 percent of schools in 2016, up from 63.8 percent in 2014."

The department and the Kentucky School Nutrition Association attributed the improvements to the Healthy, Hunger-Free Kids Act that Congress passed 2010, the U.S. Department of Agriculture’s "Smart Snacks in School" regulation of 2014 and a review of the state education department’s Practical Living Career Studies program.

Janet Tietyen Mullins, a University of Kentucky extension professor of food and nutrition, said the improvements are encouraging, "because they can help Kentucky students reduce their risk of developing diabetes and other chronic diseases," Valarie Honeycutt Spears writes for the Lexington Herald-Leader.

Mullins told Spears, “These changes in the school food environment are a positive way to help students choose more nutritious foods. Everyone benefits from an environment where healthy foods are readily available, and the changes could also benefit school staff and guests.”

Read more here: http://www.kentucky.com/news/local/education/article143288254.html#storylink=cpy

Some hospitals in Kentucky can't find enough nurses

Editor's note: A longer version of this story was published April 4.

Highlands Regional Medical Center nursing interns

By Melissa Patrick
Kentucky Health News

Studies show Kentucky will have a surplus of registered nurses in the next decade, but many of the state's hospitals are struggling to hire enough nurses to care for patients.

"We are feeling it in our facilities," Susan Ellis, the vice president of patient care services at Highlands Regional Medical Center in Prestonsburg. "You really can't run your facility without your registered nurses; they are at the patients' bedsides."

Most of the state's critical-access hospitals, which usually have fewer than 20 patients at a time, haven't been hit by the shortage. But at any given time larger Kentucky hospitals may have between a 10 percent and 40 percent vacancy rate, Ellis said.

Highlands is a 184-bed facility that needs about 120 registered nurses in its clinical area and is about 24 short, or 20 percent.

Chandler Medical Center, University of Kentucky (UKHealthCare)

The University of Kentucky, which operates a 569-bed hospital, also struggles with the shortage. UK HealthCare is in a "rapid growth" phase and has hired around 600 new nurses a year for several years.

"I think most of the folks in Lexington who are trying to hire registered nurses would share a similar perspective," said Colleen Swartz, the chief nurse executive at UK HealthCare. "For example, as recently as three years ago, which would put us in th3at 2013-14 time-frame, we would post a registered nurse position and get 20 applications for it, but right now we have positions that we have posted and re-posted and had no applicants."

Kentucky has about 45,500 full-time employed RNs, whose average annual salary is about $60,000, according to the federal Bureau of Labor Statistics. The Kentucky Board of Nursing website reports 69,337 active RN licenses in the state.

The latest Kentucky Occupational Outlook to 2024 report says the state will need an additional 16,047 full-time registered nurses between 2014 and 2024, mostly because of an aging population.

Peter Buerhaus, a health-care workforce expert at Montana State University, said a retiring workforce, health reform and the primary-care shortage will also drive the need for more nurses.

UK College of Nursing students practice (photo provided)

Research on the nursing shortage is mixed. Buerhaus's research found that Kentucky is expected to have "substantial growth" in the future, which is supported by another report that says the nation and Kentucky will have a future surplus of nurses; but another report projects a future national shortage.

Whatever forecast is correct, that doesn't affect today's nursing shortage in Kentucky, which is searching for innovative ways to fill those vacancies.

Staffing solutions and challenges

Both Highlands and UK HealthCare have returned to using agency nurses, who typically sign on for three months at a time.

Ellis, at Highlands, said it had been five to seven years since they had last used agency nurses, noting they can cost twice as much. UK's Swartz said it had been "more than a decade" since they had used them, but they now do, mostly in specialty areas.

Highlands Regional Medical Center (website photo)

Highlands also offers a sign-on bonus, has a nurse-intern program and has an incentive program for employee's who successfully refer an RN. It also plans to hire four internationally trained nurses, but Ellis said they too are expensive as the hospital pays their recruiting cost, which can be upward of $15,000 per RN.

Appalachian Regional Healthcare, an 11-hospital system that serves Eastern Kentucky and West Virginia, is reported to have severe nursing shortages, with around 177 RN job openings listed on its website, as well as many for licensed practical nurses. ARH offers a $5,000 signing bonus and a $2,000 employee referral incentive. ARH Hazard has also partnered with Galen College of Nursing to bring more RNs into the region. ARH opted to not answer questions on the subject.

More challenges

Nursing schools in Kentucky and the nation often turn qualified applicants away, and are struggling to expand because of aging faculty, who must be doctoral-prepared, and non-competitive pay, not to mention limited clinical access for training and student/faculty ratios that are mandated by the state.

Another challenge is that many nurses come out of nursing school with their sights set on the next job, such as nurse-midwife or nurse practitioner.

There is also a push for nurses with associate degrees, who make up 60 percent of Kentucky's registered nurses, to get baccalaureate degrees.

UK College of Nursing graduates (photo provided)

Pat Burkhart, professor and associate dean of undergraduate faculty affairs at UK's nursing college, said faculty are working on innovative ways to further develop the nursing workforce, with a focus on second-degree students and second-career military medics.

UK Nursing Dean Janie Heath stresses the importance of helping nurses become more resilient and the need for better work environments.

"Science is there," Heath said, "that if we are not taking good care of ourselves, we can't take good care of our patients, our families, our communities."

Burkhart added that students are looking for work-life balance, noting the industry isn't adjusting "fast enough" to this changing attitude.

This article was produced as part of the Health Care Workforce Media Fellowship of the Center for Health, Media & Policy, New York, N.Y.  The fellowship is supported by a grant from the Johnson & Johnson Foundation. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.