Ky. Rural Health Association seeks entries in reporting contest

The Kentucky Rural Health Association invites nominations for its annual rural health reporting awards, which aim to encourage more and better coverage of Kentucky’s rural health-related issues by the state’s newspapers.

The contest has daily and non-daily divisions, each with two categories: series and single story. Each of the four winners gets a plaque and a $100 prize at KRHA's summer conference. Articles must originally have been published during the preceding fiscal year. Entries will be accepted from staff writers, editors, freelance writers and others affiliated with a Kentucky-based newspaper, and from KRHA members and community members at large on the writers’ or newspapers’ behalf. Each entry should include three copies of the article as it originally appeared in the newspaper. The awards will be based on relevance to rural health, quality of reporting, impact on health care policy and new insights generated by the reporting.

For entry information, contact Ernie L. Scott of the Kentucky Office of Rural Health at 750 Morton Blvd., Hazard KY 41701, or 606.439.3557 ext. 83689, or ernie.scott@uky.edu.

Statewide smoking ban close to House vote, Stumbo says

For the second straight year, the state House Health and Welfare Committee has approved a bill that would ban smoking in enclosed public places or workplaces. It is still unlikely to become law, but might get farther in the legislative process.

"The proposal has never been voted on by the full House, and it would probably have a rough road in the Republican-controlled Senate," Beth Musgrave reports for the Lexington Herald-Leader. "Senate President Robert Stivers, R-Manchester, said that the government shouldn't tell businesses they cannot regulate smoking on their own property." (Stivers' hometown does just that; it is one of 22 Kentucky jurisdictions with smoking bans.)

House Speaker Greg Stumbo told Musgrave that he supports the measure, House Bill 190, and that sponsors are close to getting the votes it needs to pass the full House. The House has 100 members, but a bill can pass with as few as 40 votes as long as enough members abstain and it has a plurality.

The bill passed the committee Wednesday by a vote of 11-0, with four Republicans abstaining: Reps. Tim Moore of Elizabethtown, Robert Benvenuti of Lexington, Ben Waide of Madisonville and Addia Wuchner of Burlington.

Rep. Julie Adams of Louisville, the bill's Republican sponsor, told Musgrave that 29 states have statewide smoking bans, 24 with bans like the bill would impose. "This is a mainstream issue," she said. "The Kentucky General Assembly is way behind the general public." (Read more)

Basketball star Derek Anderson will join Smoke-Free Kentucky for its annual lobbying day in Frankfort Thursday, Feb. 14. He said in a press release, “Kentucky has so much to be proud of.   We are known for our hoops and horses.  Unfortunately, we are also number 1 in the number of deaths from lung cancer.  This is unacceptable to me. I want to be a part of the movement to change that.”  He added, “I am a businessman.  Smoke-free workplaces make good economic sense.” (Read more)

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

Physician assistants and some doctors urge lawmakers to pass bill that could ease provider shortage in rural Kentucky

Doctors and more than 150 physician-assistant students urged lawmakers Tuesday to pass a bill they stated involves dropping only one requirement in the law and could ease a physician shortage in Kentucky, reports Ryan Nick of cn|2's "Pure Politics."

Passage of Senate Bill 43 would repeal a law that allows physician assistants to treat patients only when a supervising physician is on site for the first 18 months after their certification. If passed, PAs would still be supervised but would be permitted to perform services in a location separate from the supervising physician, as long as that physician can be reached by phone at all times.

No other state requires PAs to have 18 months of on-site supervision. Colorado, the state with the next-longest mandate, requires supervision only for the first 1,000 hours after certification.

The bill's supporters say the burdensome supervision requirement has led to 55 out of Kentucky's 120 counties being medically underserved and has encouraged many PAs to practice in other states, reports Storm. They also say this rule needlessly complicates patient care, especially in rural areas where doctors are stretched thin, reports Melinda Beck of The Wall Street Journal.

The bill's sponsor, Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects the Kentucky Medical Association to seek some changes in the bill, but also expects it to pass because Senate Republican leaders, hospitals and universities support it. "We're educating these PAs at a lot of state expense just to work in other states," he said. House Speaker Greg Stumbo, D-Prestonsburg, told Storm he sees no reason why the bill shouldn't pass. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, told KHN that she supports the bill.

PAs are expected to be in even greater demand when the health-care reform law brings hundreds of thousands of Kentuckians into the health-insurance system. Beck notes the state is expected to face a greater shortage of physicians, particularly in primary care and rural areas. Buford said, "We're going to provide all this health care for everybody, and there's nobody to go see." For more from cn|2, including video interviews, click here.

Kasich of Ohio is fifth Republican governor to accept Medicaid expansion; he and others cite need to protect rural hospitals, poor

Several Republican governors have decided to expand Medicaid under federal health-care reform, saying their conservative principles were outweighed by a need to protect their state's rural hospitals and low-income people. Yesterday, the governor of one of the biggest states got on the bandwagon.

John Kasich of Ohio joined Jan Brewer of Arizona, Brian Sandoval of Nevada, Susana Martinez of New Mexico and Jack Dalrymple of North Dakota in saying they will take heavy federal subsidies to expand the program to households with incomes up to 138 percent of the federal poverty threshold.

Democratic Gov. Steve Beshear of Kentucky has said he wants to expand Medicaid if Kentucky can afford it, and he expects to get cost estimates around the end of March.

While Kasich is not an "Obamacare" supporter, he said expanding Medicaid “makes great sense for Ohio” because it would save $235 million over the next two years and free about $100 million in local funds for mental-health and addiction services, reports The Columbus Dispatch.

Kasich said the decision could extend health coverage to as many as 578,000 uninsured Ohio residents, and could keep everyone else’s health insurance premiums down because there won’t be so many uninsured people going to emergency rooms for their medical care, reports David Nather of Politico.

Kasich emphasized that he would like to see the 2010 law repealed, but the federal money it would pump into the state — about $13 billion over the next seven years — was too much to pass up, reports Stateline. The federal government will pay the full cost of expansion through 2016; then  states will have to pitch in, rising to a limit of 10 percent by 2020.

Brewer likewise said it doesn't make sense for Arizona to pass up federal dollars, reports Howard Fischer of the Arizona Daily Sun. "We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured," Brewer said. She also said the expansion will create enormous economic benefit, inject $2 billion into the Arizona economy, save and create thousands of jobs and provide health care to hundreds of thousands of low-income individuals, reports Fischer.

Brewer said going along with expansion will save Arizona money because the costs of providing care to the uninsured are not simply absorbed by hospitals but passed along through increased insurance premiums. Supporters of the expansion hope the five Republicans' decisions will prompt more GOP governors to follow suit. Twenty governors from both political parties are still undecided. (Read more)

Report says veteran suicide rate is up from 2007

Almost every hour in this country, on average, a veteran commits suicide. The Department of Veterans Affairs reported that 22 veterans per day took their own lives in 2010, up four a day from the 2007 rate. Perhaps contrary to public perception, the report said most suicides occurred among veterans over 50. It recognized Vietnam-era veterans as a risk group, as well as female veterans.

Military service members come disproportionately from rural areas. Kentucky has two army posts, Fort Knox and Fort Campbell.

(Among active service members in 2012, more died from suicide than in combat, we reported here. The Army said Friday that 325 soldiers committed suicides last year; if the tentative number is confirmed, it would be a historical high. "If that bleak total remains at 325, the toll in 2012 would have risen by 15 percent over 2011 when the Army sustained 283 suicides," NBC News reported.)

Reactions to the VA report ranged from encouragement to outrage. The VA pointed out that the daily veteran suicide rate has "remained relatively stable over the past 12 years," but the percentage of the overall national suicide rate accounted for by veteran suicide has actually decreased.  Veteran suicides accounted for about one-fifth of American suicides in 2010, down from one-fourth of suicides in 1999.

The VA said that showed its programs are working, but promised to take "immediate actions." NBC reported that "the top strategy" on the VA's agenda was an already-established task force that could help suicide screening identify warning signs earlier.

Some groups were dismayed by the VA report and demanded more action. Iraq and Afghanistan Veterans of America called for more research and collaboration. "The country should be outraged that we are allowing this tragedy to continue," IAVA found and CEO Paul Rieckhoff told NBC.

On Feb. 13, the U.S. House Committee on Veterans' Affairs will hold a hearing on veterans and mental health care. The Veterans Crisis Line -- 800-273-TALK -- is available for veterans who are concerned about their mental health. (Read more)

Big papers' Page 1 stories spotlight recovery center for pill addicts, lack of state program for problem gamblers

Gripping stories from recovering addicts, on the front pages of Kentucky's two largest newspapers this morning, highlight Kentuckians' fights against all types of addiction, from gambling to drugs.

Hope of recovery emerges from Laura Ungar's story in The Courier-Journal that focuses on the Isaiah House recovery center in Willisburg. A gymnasium at the site has been transformed into a factory of sorts, where a pill addict who has been clean three weeks polishes car parts, while a morphine addict with 103 days’ sobriety hammers nails into wood to make pallets, Ungar reports.

Work is an essential part of recovery at the Isaiah House, giving structure to chaotic lives, teaching job skills and building confidence. “It gives them a sense of purpose, of accomplishment,” Executive Director Mark LaPalme told Ungar. “They get their dignity back — that’s what work does.”

LaPalme, a Connecticut native and recovering cocaine addict, said he started Isaiah House in his basement in 1999, after a spiritual experience moved him to set aside seven bedrooms for other addicts. Today, the house helps to rebuild the lives of drug and alcohol addicts, while promoting worth ethic and responsibility throughout the recovery process (Read more).

Jack Brammer of the Lexington Herald-Leader writes about Kentucky's lack of a state program to treat problem gamblers. It is one of 13 states without such a program.

Billy Stephens, 66, Hawesville Mayor Rita Stephens' husband, said he lived a "a life of lies" with his gambling addiction, but with professional treatment, has not gambled since 2010. When he finally sought treatment, he could find no affordable treatment in Kentucky. The family had to borrow money to pay for his $6,000 treatment in a 36-day program in Louisiana, which is free to residents of the Bayou State.

"My addiction almost destroyed me," he told Brammer. "My insurance in Kentucky would have helped with my treatment if it were alcohol. But it was gambling." (Read more)

Invisible health panel could help Ky., if it had money and met

A panel charged with helping devise solutions to the nation’s health-care workforce crisis, which includes ensuring rural areas have enough health-care providers, is having a workforce crisis of its own: It hasn’t been funded, and it’s never met, writes Kyle Cheney of Politico. 

The National Health Care Workforce Commission was created by Congress nearly three years ago under the Affordable Care Act, the panelists were appointed, but that’s about it. The lack of action was noted at a hearing Tuesday of a subcommittee of the Senate Special Committee on Aging, convened by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging.

Sanders issued a report estimating that 57 million Americans lack ready access to primary care. Since  millions are expected to gain coverage when the reform law goes into full effect next year, there is a looming concern over whether there are enough doctors, physicians' assistants, nurse practitioners, nurses and so on. Most of the worry relates to the lack of primary-care providers in underserved areas, which could be a huge problem for Kentucky.

In addition to exploring the health workforce needs in rural and “medically underserved” settings, the commission was supposed to address the capacity of the nursing workforce, graduate medical education policies, education and loan programs for health-care professionals and the “mental and behavioral health care workforce capacity,” writes Cheney.

Since the 15-member panel was appointed in September 2010 by the U.S. comptroller general, 10 members’ terms have expired, and they’ve been reappointed for another three years each, Cheney reports. No funding has been approved, although both Senate Democrats and President Barack Obama have proposed $3 million funding packages.

“In order for the promise of expanded coverage passed into law by ACA to become a reality, the provisions designed to reach those goals must be fully funded and implemented,” Sanders said. “We need to make sure that our health care system has the infrastructure in place to provide the care necessary to prevent diseases and improve the health of all Americans.” (Read more)

Small steps can prevent Kentucky's No. 1 killer, heart disease

It is now February, which is American Heart Month and a perfect time to remind people that small steps can reduce their risk of heart disease, Kentucky's No. 1 killer.

You may be surprised to hear that almost 80 percent of heart disease is preventable and there are daily things that can be done to keep hearts healthy, according Dr. Martha Grogan, medical editor-in-chief of Mayo Clinic Healthy Heart for Life.

For example, try to move 10 extra minutes each day, Recent research shows a sedentary lifestyle may increase your risk of heart attack almost as much as smoking, said Grogan.

Each day, make an effort to get up from your desk to go talk to a colleague instead of sending an email, or walk around the house as you are talking on the phone, she recommends: “Moving even 10 minutes a day for someone who’s been sedentary may reduce the risk for heart disease by 50 percent.”

Hearts are also hurt when you deprive yourself of sleep, which is a necessity like food and water, said Virend Somers, a Mayo cardiologist and sleep expert. Chronic sleep deprivation can increase the risk of obesity, high blood pressure, heart attack, diabetes and depression.

Healthy habits can reduce a majority of risks for heart attack. "A 53-year-old male smoker with high blood pressure has a 20 percent chance of having a heart attack over the next 10 years. If he stops smoking, his risk drops to 10 percent; if he takes high blood pressure medicine, it falls to 5 percent," says preventive cardiologist Randal Thomas, M.D.

These healthy habits and changes like quitting smoking and taking blood pressure medicine can make a difference in life and death. For more from the Mayo Clinic, click here; for a American Heart Month information from the federal Centers for Disease Control and Prevention, go here.

Improving Kentucky's mental health calls for the action of schools and doctors to identify children's mental health needs early

Many people may think that addressing mental health needs in Kentucky relies mostly on more funding, but its effectiveness hinges more on the ability to identify children who need help and make sure they get it early, two experts said on cn|2's "Pure Politics" Tuesday.

About half of mental illnesses begin to appear before a person turns 14, reports cn|2's Ryan Alessi. Mental-health experts say it’s often more effective and efficient to treat children, and it’s easier for parents to make sure their children get help than it is for someone to convince or coerce an adult exhibiting symptoms that he needs treatment, said Dr. Allen Brenzel, a child psychiatrist.


Encouraging school officials and doctors to identify children with these needs can be a challenge, Brenzel said, because it is difficult for a teacher to have tough conversations with parents about this topic. Also, while doctors may be most important in this process, obstacles exist because our current "system of care doesn't promote the amount of time and effort and importance on these issues," he said.

When a primary-care doctor's offices are jammed with sick patients and a parent comes in to discuss problems their child is having in school, "That’s a challenging environment in primary care,” Brenzel said. “But people trust their primary care providers very often, and that is where they go. So some of what we need to look at is co-location of services.”

Brenzel said we need a system with a single point of access, where a family can be greeted, there is a period of engagement and a reimbursement structure that supports the time and efforts required by behavioral health.

"We need to integrate behavioral health into the overall health care system," he said. "We have a very fragmented and inefficient system that leads to confusion when a family identifies that their child needs help and this isn't going to be fixed by a medical model.  We now know that the kinds of services need to be much more comprehensive and supportive. A system that allows a comprehensive mental and behavioral health assessment of needs will allow us to triage many kids out of the juvenile justice system."

Benzel said this is a societal issue and for every $1 that we spend in supportive services, we can avoid spend $5 later on adult incarcerations and adult prison. On average, it was more than $2,000 cheaper per person to treat a child than an adult. It amounted to $4,328 per child compared to more than $6,500 for each adult treated, Alessi reports.

Families may be fearful of the cost of mental-health services, but there are resources for people without mental-health insurance coverage at the 14 mental health centers in Kentucky, said Steve Shannon, executive director of the Kentucky Association of Mental Health/Mental Retardation Programs.

In terms of resources, Kentucky spent nearly a half billion dollars on mental health for people under 21 in the 2010-11 fiscal year. For adults, the state spent more than $730 million, according to figures from the Cabinet for Health and Family Services. (Read more)

Common beliefs about obesity and weight loss found to be myths

Think going to gym class drives weight loss, or that breastfeeding protects a child from obesity? Think again, because these are among seven popular myths about obesity myths, according to an international team of researchers.

The seven popular but largely inaccurate beliefs, which lead to poor policy decisions, inaccurate public-health recommendations and wasted resources, were identified by the team led by David Allison, associate dean for science in the School of Public Health at the University of Alabama at Birmingham.

Here are the seven myths:

• Myth 1: Small, sustained changes in how many calories we take in or burn will accumulate to produce large weight changes over the long term.
Fact: Small changes in calorie intake or expenditure do not accumulate indefinitely. Changes in body mass eventually cancel out the change in calorie intake or burning.

• Myth 2: Setting realistic goals in obesity treatment is important. Otherwise, patients become frustrated and lose less weight.
Fact: Some data suggest that people do better with more ambitious goals.

• Myth 3: Gradually losing weight is better than quickly losing pounds. Quick weight losses are more likely to be regained.
Fact: People who lose more weight rapidly are more likely to weigh less, even after several years.

• Myth 4: Patients who feel “ready” to lose weight are more likely to make the required lifestyle changes, do health-care professionals need to measure each patient’s diet readiness.
Fact: Among those who seek weight-loss treatment, evidence suggests that assessing readiness neither predicts weight loss nor helps to make it happen.

• Myth 5: Physical-education classes, in their current form, play an important role in reducing and preventing childhood obesity.
Fact: Physical education, as typically provided, does not appear to counter obesity.

• Myth 6: Breastfeeding protects children against future obesity.
Fact: Breastfeeding has many benefits for mother and child, but the data do not show that it protects against obesity.

• Myth 7: One episode of sex can burn up to 300 Kcals per person.
Fact: It may be closer to one-twentieth of that on average, and not much more than sitting on the couch.

The research team also defined six “presumptions" that are generally held to be true even though more studies are needed before conclusions can be drawn, such as the idea that regularly eating versus skipping breakfast contributes to weight loss. Studies show it has no effect.

The same goes for the idea that eating vegetables by itself brings about weight loss, or that snacking packs on the pounds. According to Allison and colleagues, these hypotheses have not been shown to be true, and some data suggest they may be false.

The researchers also identified nine research-proven facts about weight loss. For example, weight-loss programs for overweight children that involve parents and the child’s home achieve better results than programs that take place solely in schools or other settings.

Also, many studies show that while genetic factors play a large role in obesity, “Heritability is not destiny.” Realistic changes to lifestyle and environment can, on average, bring about as much weight loss as treatment with the most effective weight-loss drugs on the market. (Read more)

Poor, rural mothers-to-be have high levels of stress, and few resources to help them handle it, small-scale study concludes

Low-income pregnant women in rural areas experience high levels of stress, but lack the appropriate means to manage their emotional well-being, according to a small-scale study at the University of Missouri. The authors suggest that rural doctors should link these women with resources to help manage stress, Medical Xpress reports.

"Many people think of rural life as being idyllic and peaceful, but in truth, there are a lot of health disparities for residents of rural communities," Mizzou nursing professor Tina Bloom told Medical Xpress. "Chronic, long-term stress is hard on pregnant women's health and on their babies' health. Stress is associated with increased risks for adverse health outcomes, such as low birth weights or pre-terms deliveries, and those outcomes can kill babies."

Researchers studied about 25 rural pregnant women. Through interviews, researchers discovered that financial problems were one of the biggest stressers for them. Financial stress was exacerbated by the women's lack of employment, reliable transportation and affordable housing. The women also said that small-town gossip, isolation and interdependence of their lives with extended family members also increased stress. Almost two out of three women showed symptoms of depression, and one in four displayed symptoms of post-traumatic stress disorder. (Read more)