Women who smoke triple their risk of dying early, but quitting early enough might just wipe out that risk

A new study of more than a million women found that smokers have more than triple the risk of early death than nonsmokers, and that quitting can virtually eliminate the increased risk. Smoking is still the most preventable cause of death in the United States and the United Kingdom.

The University of Oxford study, published this week in the British medical journal The Lancet, included 1.3 million women between the ages of 50 and 65, making it one of the largest ever conducted on smoking. At the start of the study, in 1996, 20 percent of the women were smokers, 28 percent were former smokers and 52 percent had never smoked. "Each of the women was registered in the U.K.’s national health system, so their deaths and cause of death were recorded," explains Alexandra Sifferlin of Time magazine. "By 2011, 66,000 had passed away." Researchers found that even smokers who smoked as few as nine cigarettes a day had twice the mortality rate of nonsmokers.

"More encouraging, however," writes Sifferlin, "was the positive effect that quitting seemed to have on the women’s life span. Those who quit smoking before they reached 40 avoided more than 90 percent of the increased risk of premature death from cigarettes, while women who stopped even earlier -- before age 30 -- avoided 97 percent of the added risk." (Read more)

Here are the seven factors driving health care cost increases

Escalating health care costs are everybody's problem and no one entity's fault. Julie Appleby at Kaiser Health News reports that the United States spends about18 percent of its gross domestic product -- or about $2.6 trillion a year -- on health care costs. So what's making that figure rise? A Bipartisan Policy Center study took on the task of finding out and came up with it believes are seven major factors:

1. Paying our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient. Even insurers like Medicare pay on a fee-for-service system. New efforts in the federal health law look to change that.
2. Growing older, sicker and fatter as a nation. Medicare is set to grow by an average of 1.6 million people annually. With two-thirds of adults are either overweight or obese, lots of additional medical spending looms.
3. Wanting the latest drugs, technologies, services and procedures. Prices for newer treatments are often higher than for the products they replace.
4. Employers and employees get tax breaks on health insurance, and it costs employees little to seek care. Appleby writes, "The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care."
5. Not having enough information to make decisions on which medical care is best for us.
6. Hospitals increasingly gain market share through consolidation and demand higher prices.
7. Legal issues complicate efforts to slow spending. Doctors sometimes prescribe tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing is another concern. The report notes that laws sometimes limit the ability of medical professionals to do work for which they are trained but that more highly paid doctors must do. (Read more)

To read the entire Bipartisan Policy Center report here.

Kentucky to get $811,000 from drug company as settlement of federal suit alleging unfounded promotion of three medications

Attorney General Jack Conway has confirmed that the state will receive almost $811,000 for its share of recoveries in a settlement reached in a lawsuit filed by the federal government against Boehringer Ingelheim Pharmaceuticals Inc. In all, the drug company has agreed to pay $95 million to settle allegations that it promoted three drugs for uses in Kentucky and other states that were not medically accepted.  The Associated Press reports that the stroke-prevention drug Aggrenox, the chronic obstructive pulmonary disease drug Combivent, and the high-blood-pressure drug Micardis are the drugs named in the suit. The Justice Department said the company also promoted the use of the heart drug Atrovent at doses exceeding those covered by federal health programs. (Read more)

Anthem funds program to fight childhood obesity in Louisville area

A $35,000 Anthem Foundation grant to the American Academy of Pediatrics will allow a program that fights childhood obesity in Louisville and northern Kentucky counties to continue, reports Darla Carter of the The Courier-Journal. The grant provides free YMCA memberships and fitness and nutritional guidance to families of 9- to 17-year-olds with weight issues who have been referred by member physicians. The foundation is a philanthropic arm of Anthem Blue Cross and Blue Shield in Kentucky. 

Democratic ads accuse Republicans of supporting pill mills by voting against bill that all agree needs work

A bipartisan group of Kentucky lawmakers are looking ahead to fixing the much complained about "unintended consequences" of last spring's hastily passed bill aimed at curbing prescription drug abuse. Still, the House Democratic Caucus Committee has paid for political ads criticizing at least three Republican House members for not supporting the measure though they may have raised concerns about the very issues that now need legislative surgery.

Ryan Alessi of cn|2's "Pure Politics" reports that Rep. Mike Harmon of Boyle County and Rep. David Floyd of Bardstown are being targeted for not supporting the expansion of the use of the prescription monitoring system, KASPER, and requiring pain clinics to be run by physicians. Rep. Kim King of Harrodsburg has also been targeted; there may be othesr. Here is the ad:

Republican Floor Jeff Hoover of Jamestown, a supporter of HB 1, told Alessi that that need for changes in the bill now "vindicates lawmakers like Floyd and Harmon, who raised questions about whether the law would be overly restrictive for law abiding Kentuckians." (Read more, see more videos)

Health care is strong second to economy among concerns of Ky. registered voters; candidates compared on handling of issues

Health care ranks high among the concerns of Kentucky voters, according to the latest Kentucky Health Issues Poll taken for the Foundation for a Healthy Kentucky.

The poll, taken Sept. 20 through Oct. 14, asked registered voters to name the two most important issues in the Nov. 6 presidential election. The economy was mentioned by 65 percent; health care was second, with 42 percent. Foreign policy was a distant third, at 21 percent. The error margin on the sample of 1,160 voters is plus or minus 2.88 percentage points.

The poll did not ask voters whom they favored for president, but did ask which candidate they trusted to do a better job on certain issues. Romney, who is considered certain to win Kentucky, had a clear advantage on two issue areas, listed first:

• Dealing with the federal budget deficit: Romney 49%; Obama 36%

• Dealing with the economy and jobs: Romney 48%; Obama 36%

• Dealing with the future of the health reform law: Romney 45%; Obama 40%

• Addressing terrorism: Romney 43%; Obama 42%

• Dealing with the situation in Afghanistan: Romney 42%; Obama 40%

• Improving education: Obama 45%; Romney 40%

• Looking out for the best interests of women: Obama 42%; Romney 40%

• Making decisions about women's reproductive health choices and services: Obama 41%; Romney 38%

"This poll gives us a reliable snapshot of the issues most important to Kentucky voters as they decide who they will vote for on Nov. 6," said Dr. Susan Zepeda, president/CEO of the foundation. "Regardless of the outcomes of the election, our foundation believes it is essential for our elected officials to know what Kentuckians think about these issues." To download the full report by the Institute for Policy Research at the University of Cincinnati, click here.

Statewide trauma system established; called 'most significant advancement in health of Kentuckians for the last 20 years'

Dr. Andrew Bernard, chair,
State Trauma Advisory Committee

Ten Kentucky hospitals have been recognized as part of the state's first official statewide trauma system. The announcement came during the 2012 Statewide Trauma and Emergency Medicine Symposium Friday in Lexington. Dr. Andrew Bernard, a University of Kentucky trauma surgeon and chair of the State Trauma Advisory Committee, called this "the most significant advancement in the health of Kentuckians in the last 20 years and lives will be saved because of it."

More than half of the states have such systems.  "The goal of the state trauma system is getting the right patient to the right place at the right time," said Bernard, explaining that the system provides education so that proper assessment can be made of severely injured patients, so that they are taken to the most appropriate facility as quickly as possible.

Trauma centers are graded I through IV, with Level I hospitals able to treat the most severely injured and most at risk.  Level I trauma centers are UK Chandler Hospital (Lexington), Kentucky Children's Hospital (Lexington), Kosair Children's Hospital (Louisville), and University of Louisville Hospital.  Level III  are Ephraim McDowell Regional Medical Center (Danville) and Taylor Regional Medical Center (Campbellsville). Level IV are Ephraim McDowell Fort Logan Hospital (Stanford), James B. Haggin Memorial Hospital (Harrodsburg), Livingston Hospital (Salem) and Marcum & Wallace Hospital (Irvine).

More child-welfare indicators added to Kids Count data site

Kentucky Youth Advocates has added four new child welfare indicators to the agency's Kids Count Data Center. These four new indicators provide Kentuckians and those who report on them with more information on vulnerable children and families in the state.

One new indicator shows the prevalence of certain risk factors -- substance abuse, mental health issues, and income -- in cases where child abuse or neglect was found to have occurred after an investigation was done. Another new indicator include the numbers of children community members bring to the attention of the state Department for Community Based Services due to suspicions of child abuse or neglect. (Read more)

Kids Count provides information across states and for Kentucky counties and school districts on many measures of child well-being, including economic well-being, education, health, and safety. To find the data center, go here.

Rural states with declining immunization rates have increasing incidence of whooping cough

In the state that once had the highest immunization rate, Vermont's medical community is not so proud of anymore. Fewer people are vaccinating their children in the nation’s most rural state, reports Dr. Wendy Mahoney, a private practioner in the state. But Vermont isn't alone. Stories about declining immunization have come in from across rural America, Mahoney writes in the Daily Yonder, and they "come in the midst of a pertussis outbreak the likes of which Vermont has not seen in years, if ever." Pertussis is whooping cough.

Mahoney says she can find one reason for the recent outbreak: a new law in her state, like some in other rural states, that allows parents to exempt their children from required vaccinations "because of a personal, moral, or other belief." Mahoney says many rural residents use the exemption, which she finds hard to fathom in the face of scientific advances that prove that vaccination has ended smallpox, wiped out polio in most of the world, and controlled measles, rubella, tetanus, diphtheria, influenza type b and other infectious diseases.

The top map shows the estimated percentage of children enrolled in kindergarten who have been exempted from receiving one or more vaccines in the 2011–12 school year. Comparison with the other map shows that states with large numbers of exemptions are those where whooping cough is making a comeback. (Centers for Disease Control maps)

A comparison between states with low vaccination coverage rates and those reporting higher numbers of whooping cough cases shows some, though not consistent, overlap. (Read more)

Association of Health Care Journalists' reporting fellowship application deadline is Nov. 9

The Association of Health Care Journalists is offering fellowships for reporting on health care performance to journalists who wish to pursue a significant year-long reporting project related to the U.S. health care system. It can be local or national in scope -- or a little of both, according to materials included with the announcement, which suggests a topic could be "an aspect of the Patient Protection and Affordable Care Act playing out in your community or subject specialty, or the impact of particular evidence-based treatments on health outcomes, or an analysis of a health care organization’s performance, using public data sets."

Newsrooms for which the fellows work need to commit to publish or air their work. Freelancers will also need to have that commitment from a news source. Guidance is provided by AHCJ fellowship leaders through seminars on health care systems, conference calls and email consultations. The fellowship covers the cost of attending the seminars and conferences, and a project allowance is available. Application deadline: Nov. 9, 2012. (Read more)

Here are some examples of the work done by those awarded fellowships in 2012:

• The New Goliaths: The 2010 health law was designed to lower costs. Yet hospitals merging seems  to have upped the price of care.
  
• Nothing to Smile About: The number of dentists is shrinking. 
  
• In Praise of Price-Fixing:  Maryland may have found an answers to health care inflation. 
  

CaldWELL County group campaigns for smoking ban

A committee dedicated to the wellness of Caldwell County, which makes the most of the county's name, is pushing for a smoking ban. The CaldWELL Committee's internal acronym stands for Wellness Education through Local Leadership, and members did some of that Tuesday when the group asked the county Fiscal Court for an ordinance banning cigarette smoking indoors in public buildings. The group was joined by representatives from the local health department, housing authority, Extension office, law enforcement, education, emergency services, mental health, senior services and other public and private agencies, reports Jared Nelson of The Times Leader.

The committee has been collecting survey data from residents about their health perceptions and needs. Their request to the fiscal court is a direct result of that data, said Allison Beshear, health educator and public information officer with the Pennyrile District Health Department. In Caldwell County, about 27 percent of adults are identified as smokers. That number is down from 34 percent reported in the results of a 2008-10 survey. The Times-Leader is behind a paywall. To credit an account, go here.

Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.