UK president sees the need for 'irrational optimism' and working as a community to improve Kentucky's health

The health and economic issues facing Appalachian Kentucky are daunting, but still worthy of "irrational optimism," as espoused by the head of the federal Centers for Disease Control and Prevention, University of Kentucky President Eli Capilouto says in his most recent short essay.

Dr. Thomas Frieden of the CDC, who toured Eastern Kentucky with Capilouto and U.S. Rep. Hal Rogers last week, had a daily motto for his staff while working in India, a place with even greater challenges: "Irrational optimism is a pre-requisite for sucess," Capilouto writes. He says he saw the power of that in a day-long symposium on health issues sponsored by the Shaping Our Appalachian Region initiative started by Rogers and Gov. Steve Beshear.

"Where so many see problems, Kentuckians see potential," Capilouto writes. "Where others place limits and barriers, Kentuckians see the promise of a brighter tomorrow," especially when they can work together. To illustrate that, he tells the story of a Denver minister he heard on a radio show.

"She was discussing the idea of what it means to be human; what it means to be part of a community," Capilouto writes. "The minister said she disagreed with the notion that God will never give you more than you can handle. 'God,' she said, 'will never give you more than your community can bear or you as a member of a community.' The idea, of course, is that we all need each other. And we all have responsibilities to each other. That’s what it means to be part of — and partners with — community." (Read more)

Women Leading Ky. Health: Exchange Director Carrie Banahan says getting people health insurance is highlight of her career

This is the first in a series, Women Leading Kentucky Health, of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick

Kentucky Health News

Energy exudes from Carrie Banahan when she talks about her work with others to bring affordable health care to more than half a million Kentuckians.

Banahan discussed Kynect with a man in Pikeville last
 summer. (Wall Street Journal photo by Ian Bates)

“I worked all my life to see this happen, that we can provide affordable health insurance to people, and it has actually happened,” she said. “I am thrilled that we are actually helping people in Kentucky. It is the highlight of my career.”

Banahan is executive director of the Kentucky Health Benefits Exchange, which the state has branded as Kynect, partly to avoid identification with the pejorative nickname Obamacare. She shares the credit for its success.

“One thing that I am proud to say I am part of is our team in general,” she said in an interview. “Everybody is very dedicated to this project and wants it to succeed and believes, as we all do, that we are going to make a huge difference in people’s lives.  We are going to improve the health status of Kentuckians.”

She attributes the success of Kynect to early planning, collaboration and teamwork.  Outside state government, she credits the support of community groups and a pent-up demand in Kentucky for access to affordable health insurance.

Banahan was executive director of the state Office of Health Policy when the Patient Protection and Affordable Care Act passed in 2010. Gov. Steve Beshear immediately gave her the task of investigating whether Kentucky should establish its own health-insurance exchange.

Beshear decided to do that, but they had to wait until the U.S. Supreme Court ruled on the law. On June 28, 2012, the court voted 5-4 to uphold it, except the part that would have denied Medicaid funds to states that did not expand the program.

Beshear created the exchange and named Banahan its director. With its successful rollout little more than a year later, Kentucky has become the national model for how to start and run a successful state exchange.

Banahan knew the landscape of Kentucky health care and insurance because of her work in the key departments involved: Insurance, Medicaid and Community Based Services, formerly Social Services.

“I think it has been beneficial that I am a veteran,” she said.  “They all know me. They all trust me. I have good working relationships with all of them.  So I think that has helped to sell this.”

She said much credit should go to others. “We have just tremendous support from the business community, the Kentucky Chamber of Commerce . . . all of the medical related associations, advocacy groups, insurers, agents.”

But Banahan was key to making it happen, said her boss, Audrey Haynes, secretary of the Cabinet for Health and Family Services.

“There was not another person that was in this state as suited for that job at this time as Carrie Banahan,” she said. “And when I recommended her to the governor, he was also convinced that there was no one else.”

So far, more than 521,000 Kentuckians have enrolled for health-care coverage through Kynect, three fourths of them through Medicaid.

That was more than expected; when Banahan was interviewed this spring, her staff was celebrating with a cake for only 275,000 signups.

Banahan said her biggest surprise was “the overwhelming response, people applying. People out there on our website.  That has been the biggest surprise for everybody, how successful the rollout was, the support we have had.  It was a wonderful surprise.”

She added, “That just demonstrates that there was certainly pent-up demand from folks who needed affordable health insurance coverage. . . . There are people who couldn’t afford to get treatment and now they can seek services.”

Looking to the future, she said, “It will be hard to top next year.”

Banahan’s “next year” is closer than it sounds. She and her team are planning for the next open enrollments, which will run from Nov. 15, 2014, through Jan. 15, 2015.

She said her primary focus of the next enrollment period will be informing individuals about the subsidy component of Kynect, even those with private health insurance.  A family of four making as much as $94,000 a year qualifies for a subsidy.

Kynect will also work on improving its Small Business Health Options Program (SHOP), which allows employers with fewer than 50 workers to enroll them for health coverage through Kynect; increasing outreach and education for those age 18-29, known as the “young invincibles;” and making sure people understand that the eligibility for Medicaid has expanded, and that many who qualify haven’t applied for it, Banahan said.

“I am always energized and very optimistic,” she said.  “I am ready for the next open enrollment to see if we can reach more people.”

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

Health issues facing Appalachia, focus of CDC director's tour, could be a forewarning of where the country is heading

The chronic health issues of Appalachia, the focus of a recent tour by the head of the federal Centers for Disease Control and Prevention, are really no different than the chronic health issues the entire country faces; they are simply more concentrated in one area, Laura Ungar writes for The Courier-Journal and USA Today.

"It's about proportion and intensity rather than something unique that's happening there," Jesse Roman, chairman of the Department of Medicine at the University of Louisville, told Ungar. "The problem is larger and more visible there, but they're not alone."

Ungar describes the health challenges of one couple in Appalachia, 48-year-old Alisha Blankenbeckler and her husband, Tony. Alisha has diabetes, bowel and bladder problems and is on oxygen. Her condition makes it hard to take care of her husband who has heart disease and hip problems since being struck by lightening in 2010. He takes 11 pills a day; she takes 30.

"Dying is something I think about every day," Alisha told Ungar.

This story, Ungar reports, is common in the Appalachian region, which is considered one of the nation's unhealthiest regions.

Heart disease prevalence is 84 percent higher in the region than the national average, diabetes is 47 percent higher, and lung cancer kills at a rate 83 percent higher. The region has the highest-in-the-nation smoking rates, with nearly a third of adults smoking cigarettes, and Kentucky has the highest number of deaths caused by cancer.

"We're in the stroke belt, the diabetes belt, the coronary valley. We get all those labels," Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health at Hazard, told Ungar. "We're in a sad state here."

Some experts say Appalachia "may be a harbinger of where the country is headed if we don't rein in epidemics like obesity," Ungar writes. Obesity spawns "diabetes, heart disease and many cancers and spanning all socioeconomic levels/."

CDC Director Tom Frieden recently toured Eastern Kentucky to "find out more about the underlying causes of the region's ills and how to treat them -- and in the process gain traction against the rising burden of chronic disease that ails the nation," Ungar reports.

"The Appalachian region is just like the rest of the U.S. — only more," Frieden said on the tour. "We want to help an entire community and a whole nation."

Ungar writes, "Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty."

Alisha Blankenbeckler told Ungar that at times she has had to stretch her insulin by taking less than the prescribed amount and once needed to go to the hospital but didn't because she had no insurance or money to pay the bill. She recently got insurance through the state's Medicaid expansion, and her husband is on Medicare, but that doesn't guarantee access to all the care they need because of required Medicare co-payments, medical equipment that is not covered, and gas to get to the doctor. The couple gets disability benefits of $1,427 a month.

Though more than half a million Kentuckians have enrolled in health insurance through the Affordable Care Act, "access to health care is difficult in Appalachia," Roman told Ungar.  "And there seems to be something about culture — a sense of fatalism, that whatever happens, happens."

Ungar writes that Friden and Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health "say improving the health of Appalachia and like communities will not be easy, because it depends on changing seemingly intractable socioeconomic disparities and personal health habits."

Frieden said that while outreach and health education is crucial, he will "listen and take cues from local communities about how best to attack their particular health problems. If he finds an effective program, he said, he will replicate it and fit it to other communities."

State gives 5 health departments money for mobile dental-hygiene teams that will examine children at schools; 5 more next year

Using new money in the state budget, the state Department for Public Health has given five local health departments grants to launch mobile dental hygiene programs.

The one-year awards of $160,000 will pay for a full-time dental hygienist and assistant; portable dental equipment to set up two treatment areas; a transport vehicle and transportation costs; and dental supplies.

“Hundreds of thousands of children in this state don’t see a dentist regularly and many not at all,” Gov. Steve Beshear said. “The vast majority of both childhood and adult dental problems could be avoided through routine dental care and other preventive efforts.”

The hygienists and assistants will visit schools for "assessments, age-appropriate cleaning services, fluoride varnishes and dental sealants on permanent teeth for children at the beginning of the school year," says a release from the Kentucky Press News Service. "They can also serve local day care centers and Head Start programs. Hygienists will work with parents to facilitate any needed follow-up care with a local dentist."

The grants went to the Lincoln Trail District Health Department, which serves Hardin, LaRue, Marion, Meade, Nelson and Washington counties; the Purchase District Health Department, which serves Ballard, Carlisle, Fulton, Hickman and McCracken counties; the Pike County Health Department and the departments in Jessamine County, which will also serve Mercer County; and Lawrence County, which will also serve Martin County.

Three health departments – Madison County, the Barren River district, and the Northern Kentucky district – already have dental hygiene programs in place. Five more health departments are to get grants next year two for similar programs.

The legislature appropriated $1.2 million in the current fiscal year and $2.1 million in fiscal 2016 for the grants and other enhancements to the state oral health program, overseen by state dental director Julie W. McKee.

“Placing public health dental hygienists in the community where they can provide front-line support and services to our young people is a great leap forward in terms of not only being able to assess problems, but provide on-site cleanings and dental care,” McKee said.

Improving the oral health of Kentuckians is one of the goals of kyhealthnow, Beshear's plan to improve Kentuckians' health. It aims to reduce the percentage of children with untreated dental decay by 25 percent and increase adult dental visits by 10 percent.

Beshear has been more active on oral health than other recent governors. He launched an effort in 2009 to enroll all eligible children in state health insurance through the Kentucky Children's Health Insurance Program and Medicaid; authorized the "Healthy Smiles Kentucky" initiative, which includes training for general dentists on how to care for young patients; community oral health coalitions; and started the "Smiling Schools" program, which provided free protective tooth varnishes to school children in first through fifth grades in 16 Appalachian counties.

UK professor develops nasal spray to deliver standard antidote to painkiller overdose; fast-tracked, in final clinical trials

A new lifesaving product to treat painkiller overdoses is in its final round of clinical trials at the University of Kentucky and is being fast-tracked by the U.S. Food and Drug Administration.

The product is a nasal-spray application of the anti-opoid drug naloxone, developed by Daniel Wermeling, professor in the UK College of Pharmacy, through his startup company AntiOp Inc.

Opioids are the class of pain-killing drugs that are related to morphine, including prescription drugs such as hydrocodone and oxycodone as well as illegal drugs such as heroin. Naloxone is the the standard treatment for suspected opioid overdose, according to a UK news release.

Naloxone is now administered by injection. The spray eliminates the need for needles, with a ready-to-use, single-use delivery device inserted into the nose of an overdose victim. The product delivers a consistent dose, absorbed across the nasal membranes even if the patient is not breathing.

"The goal is to make the medication available to patients at high risk of opioid overdose and to caregivers, including family members, who may lack specialized medical training," Wermeling said. "The treatment could be given in anticipation of EMS arrival, advancing the continuum of care and ultimately saving lives."

Nationwide, deaths from opioid overdose are on the rise, according to the federal Centers for Disease Control and Prevention. Kentucky, with a long history of opoid abuse, ranks third in the nation for drug overdoses, with more than 1,000 dying each year. Heroin abuse is on the rise, with 230 deaths, or 31.9 percent, of autopsied overdose deaths attributed to heroin in 2013.  This is a 60 percent increase from the previous year, according to the Kentucky Office of Drug Control Policy.

Congratulating Wermeling on his success, UK President Eli Capilouto said, "The epidemic of opioid abuse in our state presents an enormous and urgent challenge, not only for health care providers and law enforcement but also for us here at the University of Kentucky. Dr. Wermeling's project is putting a powerful new tool into the hands of those on the front line of the fight against heroin, both here in Kentucky and beyond."

Wermeling's research was supported by a three-year, $3 million grant from the National Institutes of Health through the National Institute on Drug Abuse with additional funding from the Kentucky Science and Technology Corporation. His company partnered with Reckitt Benckiser Pharmaceuticals in May to accelerate the production and worldwide marketing of the product.

Ky. neck-and-neck with Ark. for largest drop in percentage of uninsured; Kynect and Medicaid expansion make the difference

By Melissa Patrick
Kentucky Health News

Kentucky is finally near the top of a good list about health. It's neck-and-neck with Arkansas for the greatest drop in the percentage of uninsured adults since the federal health-care reform law's requirement to have insurance took effect in January, according to a recent Gallup-Healthways Well-Being Index poll.

Kentucky decreased its estimated share of uninsured by 8.5 percentage points between 2013 and midyear 2014, going from 20.4 percent in 2013 to 11.9 percent now. That was a 42 percent drop in the percentage of the state population that is uninsured. Arkansas' percentage-point drop was larger, but the results were within the polls' error margins.

Ky. error margins: 2013, plus/minus 1.8 percentage pts.; 2014, +/- 2.1 pts. Ark.: +/- 2.2 and +/- 2.4.

The poll found that states that expanded Medicaid and established a state-based marketplace or a state-federal partnerships showed the largest drop in the uninsured. Kentucky has participated in both of these measures with Kynect, its statewide health insurance marketplace, and its expansion of Medicaid to households with annual incomes up to 138 percent of the federal poverty level.

County-by-county estimates on Kynect Medicaid and private insurance through Kynect are at http://governor.ky.gov/healthierky/Documents/kynect/20140410_kynectEnrollmentData.pdf.

The gap between states that implemented these measures and those that did not nearly doubled between 2013 and midyear 2014, with the uninsured rate declining an average of 4 points in the 21 states that have implemented both measures, compared with a 2.2-point drop in the 29 states that have implemented one or neither.

The latest state figures show that 512,000 Kentuckians are newly enrolled in health coverage, with nearly three out of four of them under the Medicaid expansion.

Medicaid Commissioner Lawrence Kissner illustrated the dramatic impact of the expansion in Kentucky at a recent legislative committee meeting with county-by-county maps that show the estimated percentage of uninsured in each county in 2012 and this year.

The national poll results are based on both cellular and land-line telephone interviews of a random sample of 178,000 adults living in all 50 U.S. states during 2013, and 88,678 respondents between Jan. 2 and June 30, 2014.

UK, CDC announce two new health initiatives for Appalachia

University of Kentucky President Eli Capilouto, joined by U.S. Rep. Hal Rogers and Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, announced during Frieden's visit to the region Tuesday two new UK initiatives toward improving the health of Appalachian Kentucky.

The Appalachian Cancer Patient Navigation Project will allow UK and its partners to establish an infrastructure to train patient navigators over the next five years in five Appalachian states, a UK press release said. The navigators will serve as advocates for patients and help them connect with the services they need.

This $1.5 million project, funded by the CDC and the Appalachian Regional Commission, will also address cancer and other chronic diseases by promoting screening and prevention in the region. The program is part of a new multi-year partnership with the CDC's Division of Cancer Prevention and Control.

“Patient navigators can help Kentuckians get screened for cancer—finding it early can save your life,” Frieden said in the release. “By training more patient navigators where they are most needed, this CDC grant can help people in Appalachian areas live longer, healthier, cancer-free lives.”

The second initiative announced was the launch of the Community Leadership Institute of Kentucky, "a three-week intensive leadership development program designed to enhance research and capacity-building competencies in community leaders who play a key role in using data and decision-making related to health and health care," Powell writes.

Training for this program is competitive and will begin in October and November. Selected participant organizations will receive a $1,500 grant for completion of their proposed project over a 12-month period. Applications are currently being accepted through Aug. 29 for the first class of eight to 10.

"Our commonwealth is only strong if every community is strong," Capilouto said in the UK release. "And every community will only be strong when every community is healthy."

“We owe a great debt of gratitude to the University of Kentucky,” Rogers said in the release. “UK has helped transform the availability of health care in the mountains—improving access to specialists, spending thousands of dollars on cancer research and screening projects, and training students who want to come home to practice medicine.”

The announcements came during a symposium at Hazard Community and Technical College, the second Shaping Our Appalachian Region "Health Impact Series" event with Frieden. “I am thrilled to have such an impressive group of experts in health care here this week to focus on our health issues,” Rogers said. “We’re laying out our problems on the table.”

Tuesday’s symposium, sponsored by Appalachian Regional Healthcare, also featured presentations by Stephanie Mayfield, commissioner of the Kentucky Cabinet for Public Health, CDC Deputy Director Dr. Judith Monroe and a panel discussion of health care experts moderated by Dr. Nikki Stone, associate professor of the UK College of Dentistry/Medicine and chair of the SOAR Health Work Group.

Common themes in the discussions included "wellness, healthy foods, the smoke-free initiative, a focus on children and coordinated school health, oral health, diabetes/obesity, seniors, the need for mental health assessments and services beginning in early childhood and the drug epidemic," the UK release says.

Compared to the national averages, the prevalence of heart disease is 84 percent higher in the region. Diabetes is 47 percent higher, obesity is 26 percent higher and the state's lung cancer mortality rates are among the highest—at 67 percent above average—according to the Kentucky Department for Public Health. Kentucky as a whole has the nation's third highest rate of deaths from drug overdoses.

Rogers presented "Health Impact Awards" at the meeting to celebrate the "great work" of these organizations in awareness and prevention efforts, Powell writes. The awards went to Appalachian Regional Healthcare, the UK Gill Heart Institute-Appalachian Heart Center, the Hazard Police Department, the Knott County Drug Abuse Council and Kentucky Homeplace.

'Superbug' considered the worst one yet is still not widespread in Kentucky hospitals, but officials predict it is coming

A new deadly superbug that is almost totally resistant to antibiotics and kills about half who get bloodstream infections has found its way to community hospitals in the Southeastern United States, Laura Ungar reports for The Courier-Journal.

 "We haven't seen much here, but I'm sure it's coming," Forest Arnold, an epidemiologist at University of Louisville Hospital and an associate professor of infectious diseases at the university, told Ungar.

CRE, short for carbapenem-resistant Enterobacteriaceae, are a family of bacteria that have, over time, become resistant to antibiotics called carbapenems, which are considered drugs of last resort for this type of infection. It can cause a range of illnesses depending on where it infects the body, ranging from gastrointestinal illness to pneumonia to bloodstream infections.

A recent study in the journal Infection Control and Hospital Epidemiology indicates CRE increased "fivefold" at community hospitals in several southeastern states from 2008 to 2012, Ungar reports. Kentucky was not part of the study, but researchers say the rates "reflect a growing problem across the region and throughout the country." 

"People need to be aware," Arnold told Ungar. "It will eventually get here."

Experts report that overuse of antibiotics is one of the main reasons for these superbugs, Ungar writes. And Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, told Ungar that  Kentucky has one of the nation's highest rates of antibiotic use, sometimes prescribed unnecessarily.

"CRE is very dangerous," Kavanagh said. "It is almost totally resistant to antibiotics."

Ungar reports that local hospitals have seen growing numbers of CRE, citing examples of University Hospital with a case last year in which the patient died, and Norton Healthcare, with three cases in the first three months of last year and 10 others between 2010 and 2013.

Last year, the federal Centers for Disease Control and Prevention warned that CRE had spread from one medical facility in 2001 to numerous facilities in 46 states in 2013, Ungar notes. CDC Director Tom Frieden has labeled  CRE "nightmare bacteria," calling them the worst of the growing list of antibiotic resistant germs that "take hold in health care settings."

 One in 25 hospitalized patients has at least one health care-associated infection on any given day, according to the U.S. Centers for Disease Control and Prevention, with C. difficile, which causes 14,000 American deaths per year and MRSA, which one study shows kills 18,000 Americans a year, being  two of the most common, Ungar reports.

Doctors say they hope to control CRE before it becomes as common as MRSA, which has spread to communities, Ungar reports.

 "So far, CRE are just in the health care setting," Kavanagh told Ungar. " 'If it continues to grow and escape into the community, it will be an even bigger problem' and the medicines doctors count on to cure bacterial infections will no longer work against them."

Kavanagh told Ungar that "antibiotics should be used only when they are absolutely necessary, and hospitals must remain vigilant about ensuring health care workers wash their hands often, keep rooms and medical equipment clean, wear gowns and gloves when appropriate and separate infected patients from others."

"If the emergence and spread of superbugs aren't prevented,'we'll be in a post-antibiotic era'," Kavanagh told Ungar. "And the danger is not going to go away unless we change the course of how we do things."

University of Louisville gets $14.7 million federal grant to develop tobacco protein for HIV and AIDS prevention

Researchers from the University of Louisville are leading an international effort to develop a gel from tobacco plants that will contain a specific protein to prevent the transmission of HIV.

The project is being funded by a five-year, $14.7 million grant from the National Institutes of Health, according to a press release from the university.

The plan is to develop a gel containing a protein called griffithsin, which has been shown to prevent HIV in the lab. The gel will be meant for use during sexual intercourse by people at risk for HIV transmission, according to the release.

They will develop this microbicide by injecting a synthetic copy of the protein into a tobacco mosaic virus and then this virus will carry the protein into the tobacco leaves. After 12 days, the researchers harvest the leaves and extract the mass-produced protein for development into the vaccine, the release says.

Kenneth Palmer (University of Louisville)

“Our goal is to optimize the delivery system of the protective agent, which in this case is a gel, and determine its safety and estimates of its efficacy, leading to a first-in-humans clinical trial,” said research leader Kenneth Palmer, professor of pharmacology and toxicology and director of the Owensboro Cancer Research Program of U of L’s James Graham Brown Cancer Center.

“People may question why a cancer program is conducting research into HIV prevention,” center Director Donald Miller said in the release. “In fact, cancer can be a result of every major disease that we know about, and HIV infection is no exception.”

David L. Dunn, the university's executive vice president for health affairs, said: “Approximately seven years ago, U of L and Owensboro Health created a joint venture to develop a world-class plant pharmaceutical program that would have an impact globally. Today’s announcement, coupled with the announcement we made in May about the Helmsley Charitable Trust providing funding to our research into two other cancer vaccines utilizing tobacco plants, demonstrates that the vision is becoming a reality.”

U of L President James Ramsey said, "The development of a low-cost method to prevent transmission of HIV certainly is something that is desperately needed and the use of tobacco plants as a method of carrying the vaccine appears to be key in the process."

The grant provides for three steps. The first involves the manufacturing of the microbicide active ingredient, the second ensures that the vaccine is safe and actually provides protection from infection, and the third involves conducting a clinical trial, as well as conducting the first-in-humans testing.

Leaders in health care and education meet on child obesity and what can be done about it, and not just in the schools

By Al Cross

Kentucky Health News

Children who are physically active are likely to be better learners, but not enough Kentucky schools seem to put that knowledge into practice, speakers suggested at last week's Kentucky Summit on Childhood Obesity and Physical Activity at the University of Kentucky.

Kentucky ranks eighth in child obesity, and nationally, adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

"Many of the adults who will be obese in 2030 are the children in Kentucky schools today," said Dr. Mary Lynne Capilouto, the wife of UK President Eli Caiplouto. The couple hosted an opening brunch for the conference, and at one small-group session.

The conference was an unusual gathering of people from education and health care, who don't discuss common interests enough, said Terry Brooks, executive director of Kentucky Youth Advocates, which staffed the conference. "Our intent is to put together a guiding coalition . . . and make something happen in 2015-16."

That would probably include legislation, but "We can't legislate ourselves out of this problem," educator Leon Mooneyhan told the group. "We need to change the mindset of our society," with multifaceted solutions. Mooneyhan, a former superintendent in Shelby County, is CEO of the Ohio Valley Educational Cooperative, which assists school districts.

He said each district needs a strong "wellness committee" to focus on health, nutrition and physical activity and promote such measures as integrating physical activity into the classroom and not using denial of recess as punishment for misbehavior. "We really need to focus at the elementary schools," he said. "That's where it starts."

The biggest obstacle may be the educational system itself.

An example of classroom-based physical activity,
from Dr. Heather Erwin's PowerPoint presentation

Some schools are reluctant to carve out time for physical activity because of pressure to spend time preparing students for annual achievement tests, but research shows that more physical-activity time "does not appear to to adversely impact academic performance," said Heather Erwin, Ph.D., a UK specialist in kinesiology, the study of human movement.

Erwin said some schools have started intensive math instruction lasting 90 minutes, and students could benefit from two of three physical-activity breaks in such a long classroom session. She said, "So many teachers will say after implementing physical activity, why haven't we been doing this all along?"

"If your butt is numb, your brain is, too," said Jamie Sparks, director of the School Health and Physical Education Network for the state Department of Education.

Sparks said it's unfortunate that some schools are using recess as extra study time before achievement tests. Stu Silberman, executive director of the Prichard Committee for Academic Excellence, said research has shown that students do better on achievement tests on days that they have physical activity.

"There is an achievement gap related to obesity," but many teachers don't see the connection, Silberman said. When students take part practical, in-class programs like those Erwin mentioned, "it becomes a habit for the rest of their lives. . . . Frankfort's not the answer on this.

Tom Shelton, who succeeded Silberman as superintendent in Fayette County, said asking teachers "to do one more thing is almost criminal," they are so busy, but nations such as India and China emphasize physical activity, and "It's amazing to me that we're going the other way. . . . We know for a fact that healthy students are better learners."

Shelton said "Poverty is the number-one barrier to student achievement," and part of that is "lack of good food options."

The face of poverty has changed to one of obesity, said David Jones Jr., a member of the Jefferson County school board and a Louisville venture capitalist. Poor people often eat poor food and don't get enough exercise. "The problem is, we don't know how to eat. We don't know how to deal with calorie-rich environments," Jones said.

Jones was among those who said the solution to child obesity lies in the community at large, not just in its schools.

"It has to be parents and schools and the community and legislators," said Susan Zepeda, president of the Foundation for a Healthy Kentucky, which funded the conference. "This challenge is about nutrition policies, physical-activity policies and building our environment with health in mind."

Saint Joseph Hospital Foundation and Verizon team up to help certain patients with chronic diseases monitor their health

Verizon and the Saint Joseph Hospital Foundation have teamed up to help select patients who have a chronic disease manage their condition from home, according to a press release from KentuckyOne Health, St. Joseph's parent organization.

The program will help patients age 50 and older monitor and manage their health with new technologies after being discharged from Saint Joseph Hospital and Saint Joseph East in Lexington, and Saint Joseph Mount Sterling.  It will also be available to some patients who have certain health issues by referral from their primary care provider or patients can enroll in the program if they have been treated for congestive heart failure, acute myocardial infarction, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft surgery, diabetes, hypertension, hyperlipidemia as well as some other concerns.

The goal is to enroll 300 patients in the first year of the program, according to the release.

Funding to create this program came from a $125,000 grant from the Verizon Foundation and in-kind donations of technologies, which includes 4G LTE powered smartphones and tablets, from Verizon Wireless. Grant funds will purchase biometric devices to better self-manage the participants conditions and share that information with their team of health care providers. 

Patients will use the smartphones and tablets for six months to access pre-loaded health apps, such as Glucose Buddy and Fooducate, according to the release. The grant will also provide items such as digital weight scales, blood pressure monitors, FitBit activity trackers, CalorieKing Calorie, Fat and Carbohydrate Counter book and digital food scales/nutritional calculators.  Some will get glucose test strips. Individualized health-coaching will also be available.

"Verizon is also supplying all of the technology protective gear for the devices, the data plans to allow that technology to work, plus funding for a part-time dietitian and research assistant for the program," the release says.

Prevention and preparation is the key to a productive year at school for kids with asthma (and that's 1 in 10 students)

By Melissa Patrick
Kentucky Health News

As the beginning of a new school year approaches, parents of children with asthma and allergies need to make sure that not only does their child recognize what triggers their symptoms and how to treat a flare-up, but also that their school knows what to do.

One of every 10 school-aged children in Kentucky has asthma, and these students miss an average of four school days each year, according to the Cabinet for Health and Family Services. Kentucky has one of the highest rates of asthma in the United States.

Nationally, more than 10 million kids under age 18 have asthma, 11 percent have respiratory allergies and about six percent have food allergies, according to according to the American College of Allergy, Asthma and Immunology. And on any given day, more than 10,000 kids miss school due to asthma.

Preventative care and avoiding triggers will help children miss fewer days in the classroom and will also allow them to be more productive in all of their activities, the college said in a news release.

“Parents need to be advocates for their kids, to help ensure they’re breathing well with clear minds and able to navigate the triggers that sometimes stand in their way,” Michael Foggs, president of the college. “If kids are having difficulty breathing, are sneezing, have runny noses and itchy eyes, and haven’t slept well the night before, they won’t perform at their best.”

Here are some tips to help with symptom-free days in the classroom and outdoors:

• Create an action plan with your allergist specific to your child's needs. Include medications, doses, triggers, early symptoms of flare-up and what to do if there is a flare up.&

• Share your child’s action plan with your child's teacher and whoever else might come into contact with your child every day. Discuss how independently your child is able to deal with their asthma, give them contact numbers for you and your child's doctor and be sure your child and school staff knows how to work the peak flow meter and how to administer medications, especially if your child needs assistance.

• Assess any triggers for your child at school: mold, dust mites, cockroaches, chalk dust, perfumes, cleaning products or other chemicals, animal dander, saliva or urine. Work on a plan to minimize these triggers.

• Discuss how to handle emergencies. Children who are at risk for a life-threatening allergic reaction (anaphylaxis) also should have epinephrine to use. Be sure your child and school staff know how to use emergency medications.

• If your child has food allergies, send a bagged lunch to school every day and instruct your child to not share foods, napkins or utensils.

• Make sure you have a plan for recess and sports activities. The American College of Allergy, Asthma, Asthma and Immunology says in the release that "asthma symptoms during exercise may indicate poorly-controlled medications."

• Pay attention to the pollen counts if your child is allergic to pollen; it is suggested to start medications two weeks prior to when the levels are at their worst.

Proper asthma control helps kids sleep better at night, spend more time in the classroom, experience less anxiety about their condition and fully participate in all school activities, according to kidshealth.org.