Princess Health and Forrest W. Calico, national leader in rural health care, dies at 75. Princessiccia

Princess Health and Forrest W. Calico, national leader in rural health care, dies at 75. Princessiccia

Appalachia books obituaries public health rural health rural hospitals

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Forrest W. Calico

Dr. Forrest W. Calico, a nationally recognized expert on rural health-care quality, died Monday at his home near Crab Orchard "after striving against multiple myeloma for several years," said his obituary in the Lexington Herald-Leader. He was 75.

A native of Garrard County, Calico received his medical degree from the University of Kentucky in 1966. He also held a master's degree in public health from Harvard University. In the U.S. Air Force, he was a flight surgeon at Area 51 in Nevada, a family physician, residency director and hospital administrator, earning the Bronze Star. He was president and CEO of Appalachian Regional Healthcare from 1993 to 1999, a health-systems adviser to the federal Office of Rural Health Policy and a senior quality adviser to the National Rural Health Association. In 2007 he was named a Rural Hero by the National Rural Assembly and in 2010 entered the UK College of Public Health Hall of Fame.

In retirement, Calico remained active at the state and local levels, serving on the boards of the Foundation for a Healthy Kentucky, the Friedell Committee for Health System Transformation and the Lincoln County Board of Health. In 2012 he published a memoir, Out of the Blue, with the subtitle "How open doors and unexpected paths set the course of my life."

Calico is survived by his wife Patricia Calico, their son Jefferson and wife Cari, daughter Tricia and husband Wes Cohron, his sister Helen Eden, a nephew and six grandchildren. A celebration of his life will be held Saturday, June 18, from 2 to 5 p.m., with a memorial service at 3 p.m., at The Church at Cedar Creek at 5787 US 150, east of Stanford. Memorial donations may go to The Friedell Committee, PO Box 910953, Lexington KY 40591, or the Dr. Patricia A. Calico Endowed Nursing Scholarship at UK, 315 College of Nursing Building, Lexington KY 40536.

Princess Health and Wellness coalition in Perry County, where life expectancy is state's lowest, gets funding from Foundation for a Healthy Ky.. Princessiccia

Princess Health and Wellness coalition in Perry County, where life expectancy is state's lowest, gets funding from Foundation for a Healthy Ky.. Princessiccia

Appalachia children children's health education farm to school farmers' markets food Foundation for a Healthy Kentucky foundations grants hospitals life expectancy nutrition philanthropy schools

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The Foundation for a Healthy Kentucky has funded the Perry County Wellness Coalition's three-year plan to encourage fitness and better nutrition in school-age children, "Kids on the Move!"

The wellness coalition will receive $144,450 from the foundation this year, matched by $124,944 from the community, to increase access to physical activity and provide healthier food options and nutrition education. Perry County has the lowest life expectancy in Kentucky.

"Our children are the most valuable resource we have," said Gerry Roll, executive director of the Foundation for Appalachian Kentucky, which is serving as fiscal agent for the coalition. "It's the best investment we can make as a community partner."

The health coalition will work with local schools to implement physical activity and nutrition-policy changes, collaborate with local farmers' markets for a strong farm-to-school component, and coordinate with other community agencies to create a lasting and collective impact.

The project also will implement best-practices nutrition and exercise programs in schools, support community gardens, summer feeding programs, and a "Farmacy" program to increase the purchase of healthier produce at farmers' markets and local grocery stores, among other changes to be coordinated by the agencies in the coalition.

The Appalachian Regional Healthcare hospital in Hazard will be the administrative hub for the coalition, providing leadership and sharing its expertise in promoting community health. "We have already begun these efforts by providing fitness fairs and health screenings to over 20 schools in our service area and reaching a little more than 2,500 middle school and high school age kids this year alone," said Hazard ARH Community CEO Dan Stone said.

The coalition is among seven Kentucky communities funded by the foundation's "Investing in Kentucky's Future" initiative, which is spending $3 million over five years to fund communities working to improve the health of their school-aged children. The other groups are in Breathitt, Clinton, Grant, Jefferson and McLean counties, and in Boyd and Greenup counties. Perry County was in the original announcement and recently completed its detailed plan. It shares with Breathitt and Wolfe counties the state's lowest life expectancy, 70 years.

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Appalachia doctors drug abuse drugs General Assembly legislature narcotics pain pain clinics physicians prescription drug abuse prescription drugs state government

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Kentucky is the only truly Appalachian state to have put a brake on fatal drug overdoses, report Rich Lord and Adam Smeltz of the Pittsburgh Post-Gazette as part of a series in the about the deadly epidemic of prescription painkillers in the region.

A chart with the series' story about Kentucky shows that fatal drug overdoses were less numerous in the state in 2013 than in 2012, when the General Assembly cracked down on "pill mills," and that while fatal overdoses rose in 2014, they were still not as numerous as in 2012. Official numbers for 2015 are expected soon, and may rise because of the spread of heroin.

The series also credited a crackdown by the Kentucky Board of Medical Licensure, which "took disciplinary action for prescribing irregularities against 135 of the state�s roughly 10,600 doctors" from 2011 to 2015. "The board also moved against 33 doctors during that time for abusing narcotics themselves."

"Getting tough on doctors works," Lord wrote in the series' main story. The state story reported, "Kentucky�s per-capita opioid consumption -- though still seventh in the nation -- dropped by a steepest-in-Appalachia 12.5 percent from 2012 to 2014, according to IMS Health Inc.," Lord and Smeltz report. "Kentucky is the only state, among the seven studied by the Pittsburgh Post-Gazette, in which fatal overdoses have plateaued. Elsewhere, they have climbed relentlessly."

The story quotes Kerry B. Harvey, U.S. attorney for the eastern half of Kentucky: �In much of Eastern Kentucky, the workforce is engaged in difficult, manual labor,� like mining, farming and logging, �so people would injure themselves and be prescribed these very potent narcotics, because the medical profession changed the way it looked at prescribing these kinds of narcotics for pain.� The drugs dulled the �sense of hopelessness� people had about the area�s economy, �and so for whatever reason, this sort of culture of addiction took hold.�

"Harvey said that as physicians have gone to jail, and others have faced board discipline, the painkiller business model has adapted. . . . Now the doctors take insurance, and bill the insurer or the government not just for the office visit, but for the MRI, urine screen and back brace they use to justify the addictive narcotic." Harvey said, �So instead of a cash business, in many cases now the taxpayers or the insurance companies pay. The result is the same. We end up with our communities flooded with these very potent prescription narcotics.�

Princess Health and At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions. Princessiccia

Princess Health and At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions. Princessiccia

Appalachia drug abuse drug treatment heroin mental health narcotics prescription drugs state government

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Image from Lauren Osborne, WYMT-TV Mountain News

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. � After a day of learning and talking about opioid prevention, treatment and mobilization, people at a forum in Corbin agreed on three things: Access to substance abuse and mental health services remains a huge barrier in southeastern Kentucky; more community education is needed; and drug-prevention programs should form coalitions to better use their limited resources.

Substance abuse affects almost every family in Kentucky, and four Kentuckians die every day from a drug overdose. That was part of the opening message from Dr. Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities.

"This is, in my opinion, one of the most pressing health-care issues facing our commonwealth today," Brenzel said. "If 1,000 people a year were dying from measles in the state of Kentucky, think about the public response that we would have. ... We would be on red-alert, we would have a complete, public-health, massive intervention to solve that problem."

Van Ingram, executive director at the Governor's Office of Drug Control Policy, said that next year's drug overdose report, which will be released in a few weeks, will show the problem is getting worse.

About 125 people, most of them health-care providers, attended the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Action" May 17 at the Corbin Technology Center. It was sponsored by The Kentucky Cabinet for Health and Family Services, the Hazelden Betty Ford Foundation, and Cumberland River Behavioral Health. Similar forums were held in Lexington May 16 and Louisville May 13.

John Tilley

John Tilley, secretary of the Kentucky Cabinet for Justice and Public Safety, said he hoped the forum would "light a fire under this community" to talk to their neighbors and friends, community leaders and legislators about the value of treatment over incarceration for substance abuse and mental health issues.

Tilley, who chaired the House Judiciary Committee when he was a state representative from Hopkinsville, acknowledged that some abusers should be in prison, but said society must distinguish between "who we are mad at and who we are afraid of. ... I promise you the way to get out of this mess is not to over-criminalize addiction and mental illness."

Tilley said "The solution is right before our eyes," using for treatment some of the billions of dollars now used to incarcerate drug users.

Tim Feeley, deputy secretary for the CHFS and a former legislator from Oldham County, agreed: "We are not going to incarcerate our way out of this." He said the state needs more treatment programs and said the cabinet was fully committed to addressing the state's addiction problems to the best of its abilities.

William Hacker

Kentucky has moved away from treating mental health and substance abuse issues criminally, said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. He said other successful anti-drug efforts include grassroots advocacy groups, the online prescription-drug tracking program, needle-exchange programs, a move toward medication assisted treatments for opioid addiction, and the SMARTS initiative, which provides addiction care for pregnant and parenting women for up to two years.

Hacker also mentioned Operation UNITE, a Kentucky non-profit created by U.S. Rep. Hal Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. UNITE has held a national drug abuse conferences for the past five years, with this year's summit in Atlanta including President Barack Obama. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.

A former pediatrician in Corbin, Hacker also noted that SOAR recently held a Substance Abuse Roundtable to discuss research and emerging opportunities associated with substance abuse and intravenous drug use in Appalachian Kentucky. He said SOAR works to create a network across the region to share best practices and money opportunities and to create community level empowerment.

"Substance abuse is not a failure of moral character, it is a disease," Hacker said. "Don't give up. Never give up."

At the end of the meeting, the attendees broke into groups that represented schools, community leaders, health-care professionals, parents and the faith community to discuss what actions they could take to address opioid abuse in their communities.

Most groups reported that lack of access to substance abuse and mental health treatment is a barrier in their communities. And while it was noted that some communities offer more services than others, several groups said they did not have enough counselors to support medication-assisted therapies or enough doctors willing to prescribe it. Lack of transportation was also mentioned as a barrier toward getting treatment in several groups.

Also, most groups said community members often aren't aware of the resources, so more community education is needed. They listed schools, churches and county Extension offices as possible sources of education, and noted that a community resource website would be helpful. They also said parents would benefit from a class to learn how to talk to their children about drugs.

The groups agreed that all sectors of the community were needed to combat substance abuse and suggested that drug prevention programs in each community should form coalitions to better use resources and information.

Princess Health and Study says intravenous drug users in almost half of Kentucky's counties are at high risk of getting hepatitis C or HIV. Princessiccia

Princess Health and Study says intravenous drug users in almost half of Kentucky's counties are at high risk of getting hepatitis C or HIV. Princessiccia

Appalachia drug abuse drug use hepatitis c HIV

Gusty 14:44 Add Comment

By Melissa Patrick
Kentucky Health News

A preliminary report by the federal Centers for Disease Control and Prevention has identified 220 counties in the United States as being most vulnerable to outbreaks of HIV and hepatitis C among those who inject drugs in those communities, and 54 of those counties are in Kentucky.

Most are in Appalachia, but the list includes the non-Appalachian counties of Hickman, Breckinridge, Grayson, Allen, Taylor, Boyle, Mercer, Carroll, Gallatin Grant and Campbell.

Counties deemed most vulnerable to outbreaks are green; top 25 of 220 in U.S. are numbered on map.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

�Both HIV and hepatitis C can be transmitted when people who inject drugs share their needles," Doug Hogan, acting communications director for the Cabinet for Health and Family Services, said in an e-mail to Kentucky Health News. "Many of Kentucky�s HCV cases are among rural youth, ages 12-29, who have been sharing needles."

Clark County Health Director Scott Lockard called the CDC report a "wake-up call."

"We are potentially on the leading edge of one of the biggest public-health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," north of Louisville.

Lockard made these comments in April after attending a Shaping Our Appalachian Region roundtable that focused on substance abuse and intravenous drug use in the region. More than half (56 percent) of the 220 counties identified as most vulnerable for HIV or hepatitis C were located in the Appalachian regions of Kentucky, Tennessee and West Virginia.

"About 25 percent of our state�s population lives in these 54 counties," Hogan said.

The CDC began this study after an unprecedented outbreak of HIV infections occurred in Scott County, Indiana, in 2014 among its intravenous drug users to see what other counties might be vulnerable to such an outbreak.

Researchers looked at all 3,143 U.S. counties and based their rankings on six variables, including: the number of overdose deaths, per-capita-income data, unemployment data, population studies, prescription opioid sales, and prescription sales for opioid treatments such as buprenorphine.

The report points out that this does not mean that HIV or hepatitis C outbreaks are inevitable in these counties, or that there is a current problem with intravenous drug users in these counties, but says that intravenous drug users in these counties are at a higher risk.

One way to slow down the spread of HIV and hepatitis C is through needle exchanges, where intravenous drug users trade dirty needles for clean ones. Needle exchanges were authorized in Kentucky under a 2015 anti-heroin law but also require local approval.

So far, only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Kenton, Knox, Pendleton and Pike are either operating or have approved such programs. Of the 54 high-risk counties, only Boyd, Carter, Clark, Knox and Pike counties have operating needle exchanges.

Hogan said, "The Kentucky Department for Public Health is working closely with (the) CDC and at-risk communities to increase HIV and hepatitis C testing, and is assisting counties in their processes of establishing syringe exchange programs."

Here's a list of Kentucky counties and their national rankings for vulnerability to the rapid spread of HIV and hepatitis C among people who inject drugs: Wolfe, 1st; Breathitt, 3rd; Perry, 4th; Clay, 5th; Bell, 6th; Leslie, 8th; Knox, 9th; Floyd, 10th: Clinton, 11th; Owsley, 12th; Whitley, 14th; Powell, 15th; Knott, 17th; Pike, 21st; Magoffin, 23rd; Estill, 25th; Lee, 30th; Menifee, 31st; Martin, 34th; Boyle, 35th; Lawrence, 39th; Rockcastle, 40th; Harlan, 45th; McCreary, 48th; Letcher, 50th; Johnson, 53rd; Russell, 54th; Elliott, 56th; Laurel, 65th; Carroll, 67th; Taylor, 75th; Grant, 77th; Adair, 93rd; Lincoln, 97th; Wayne, 99th; Cumberland, 101st; Gallatin, 108th; Bath, 125th; Grayson, 126th; Greenup, 129th; Green, 132d; Casey, 153d; Carter, 154th; Monroe, 163d; Garrard, 167th; Robertson, 175th; Lewis, 178th; Edmonson, 179th; Allen, 180th; Boyd, 187th; Hickman, 191st; Breckinridge, 202d; Campbell, 212th; and Mercer, 214th.

Princess Health and More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region. Princessiccia

Princess Health and More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region. Princessiccia

Appalachia drug abuse drug prevention heroin needle exchanges substance abuse

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By Melissa Patrick
Kentucky Health News

More than 100 people attended the Shaping Our Appalachian Region Substance Abuse Roundtable April 7 to learn about current research and emerging opportunities associated with substance abuse and intravenous drug use in region, according to a SOAR news release.

SOAR is a bipartisan effort to revitalize and diversify the economy in Kentucky's 54 Appalachian counties. It has advisory councils for each of its 10 areas of focus, one of which is community health and wellness.

That council's chair, former state health commissioner Dr. William Hacker, facilitated the roundtable at Natural Bridge State Resort Park.

As part of the solutions-driven discussion, Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, told the attendees that it is important to ask the right questions when gathering information about drug abuse to accurately depict what is going on in the region.

�When you ask people if they have a problem with prescription drugs they, of course, say no,� Zepeda said. �When you ask them if they know someone, like a family member or friend, that answer is very different.�

The group also discussed the importance of getting accurate data about substance abuse and overdose into the right hands to make progress on these issues.

�We want to get data into the hands of legislators and those who can do something about prescription-drug overdose,� said Dana Quesinberry, public-health-policy and program evaluator for the Kentucky Injury Prevention and Research Center at the University of Kentucky. �Sitting in a repository, it doesn�t do anything for anyone.�

The roundtable members also discussed needle-exchange programs, authorized under the state's 2015 anti-heroin law. The program is meant to slow the spread of HIV and hepatis C, which are commonly spread by sharing of needles among intravenous drug users.

�We�ve seen a switch from using pills as an opioid to using intravenous methods,� said Greg Lee, the HIV/AIDS continuing-education program director for the state Cabinet for Health and Family Services.

Clark County Health Director Scott Lockard said the federal Centers for Disease Control and Prevention issued a "wake-up call" with its report identifying 54 Kentucky counties as being among the 220 most vulnerable in the nation for the rapid spread of HIV and hepatitis C infection among intravenous drug users. Most of the counties, and eight of the top 10, were Appalachian.

"We are potentially on the leading edge of one of the biggest public health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," just north of Louisville.

Although many Kentucky county officials are talking about needle-exchange programs, so far only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Knox, Pendleton and Pike are either operating or have approved such programs. Of these, Boyd, Carter, Clark, Elliott, Knox and Pike are part of SOAR.

The news release noted that participants left the discussion with a commitment to continue the conversation and to build a strategic plan to address substance abuse issues in the region, with a focus on clinical practices, health systems, drug screenings and other best practices.

Princess Health and Rural drug-overdose rates, high in Kentucky, blamed partly on limits on treatment medication and mental-health services. Princessiccia

Princess Health and Rural drug-overdose rates, high in Kentucky, blamed partly on limits on treatment medication and mental-health services. Princessiccia

Appalachia behavioral health Congress drug abuse drugs health rankings mental health

Gusty 10:55 Add Comment

"People in rural areas of Appalachia are more likely to die early deaths than in other parts of the country," and a big reason is that they "die from drug overdoses at greater rates than the rest of the country," writes Kery Murakami, the Washington, D.C., reporter for Community Newspaper Holdings Inc.'s CNHI News Service.

Murakami notes that in Leslie County, Kentucky, 7.9 of every 10,000 residents overdosed each year in 2012-14. "That�s six times the national rate," and third in the nation, he writes, citing the annual County Health Rankings done for the Robert Wood Johnson Foundation by the University of Wisconsin Population Health Institute. Several other Appalachian counties in Kentucky and West Virginia rank high.

The rates are high partly because "addicts in some parts of the country get turned away by doctors and are not given a drug called buprenorphine that is used to kick opioid addictions," Murakami reports, citing addiction experts. "Buprenorphine causes less euphoria and physical dependence and can ease withdrawal and cravings."

However, "Federal law caps the number of patients to whom a doctor is allowed to prescribe the drug, out of concern of creating places where large numbers of addicts receive opioid-based medication. Such treatment hubs, much like methadone clinics, bring unwanted community opposition, said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. That limits treatment choices in rural areas, where one doctor might be the only one licensed to prescribe buprenorphine for hundreds of miles."

The Department of Health and Human Services is moving to ease the limits, and Sens. Ed Markey, D-Mass., and Rand Paul, R-Ky., want to go even further. "But some addiction experts are concerned that raising the caps on buprenorphine will nudge the country toward treating addiction with medication rather than counseling, Murakami reports. The department�s proposed rules would require mental-health care, which is often hard to get in rural areas. The senators� bill would not.

�Turning people away from the most evidence-based treatment we have for a chronic, life-threatening disease is heart wrenching for a doctor,� Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine, told CNHI. �Rural areas have been hit hardest by this round in overdoses, which is the worst round of overdose deaths in our country.� She said medication is especially important in rural areas because opioid use spreads among families. �In rural areas, you�re treating the person, their parents and grandparents,� she said. �Entire families are addicted. It�s not like saying, �Stay away from certain friends,� if they�re shooting up with their sister and their mother.�

Princess Health and UK research project will create strategies to improve respiratory health for those living in Appalachian Kentucky.Princessiccia

Princess Health and UK research project will create strategies to improve respiratory health for those living in Appalachian Kentucky.Princessiccia

air pollution Appalachia asthma chronic disease environment public health research respiratory illness University of Kentucky

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Public health researchers at the University of Kentucky will undertake a five-year long research project called "Community-Engaged Research and Action to Reduce Respiratory Disease in Appalachia," Sarah Noble writes in a UK press release.

Funded by the National Institutes of Health's National Institute of Environmental Health Sciences, the project will involve creating strategies to improve respiratory and environmental public health. Kentuckians living in Appalachian counties have the state's highest rates of serious respiratory illness.

"Adults in Appalachian Kentucky are 50 percent more likely to develop asthma or chronic obstructive pulmonary disease than the overall U.S. population," Noble writes. "As many as one in five adults in the region have received a diagnosis of asthma, and rates of COPD are nearly two-and-a-half fold the incidence of the disease in other parts of the country.

Although studies show associations between respiratory health problems and environmental contaminants, data doesn't yet include individual-level assessments or behavioral risk factors common in the area�such as smoking, poor diet and insufficient physical activity. The "Community Response to Environmental Exposures in Eastern Kentucky" project will fill those gaps.

The CREEEK project will include three steps. A community-based assessment will "identify the relationships between indoor air pollutants, behavioral and social determinants and the effects these factors have on risk of respiratory disease," Noble writes. That information "will be shared with local stakeholders in an effort to increase understanding of the environmental exposures present in the region," then the project will put in place "an environmental public health action strategy and will evaluate that strategy's ability to impact short-and long-term outcomes for respiratory health."

Princess Health and Newspapers' data analysis finds that Kentucky's seniors on Medicare are among the sickest in U.S.; local data available.Princessiccia

Princess Health and Newspapers' data analysis finds that Kentucky's seniors on Medicare are among the sickest in U.S.; local data available.Princessiccia

Appalachia chronic disease county health data elderly Medicare seniors

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Red counties are over 21%. For map with data, click here.

The top 10 Kentucky counties with the highest percentage of seniors on Medicare who have six or more chronic conditions are also in the nation's top 50 for sick seniors, according to government data analyzed by USA Today and The Courier-Journal. Nine of the top 10 counties are in Appalachia.

"That's not surprising," Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, told The C-J's Laura Ungar. "And when you're having breathing problems, high blood pressure problems and other problems, to me it seems like you're waging a daily battle against the chronic diseases. It's hard to fight the battle ... and as you get older, it's harder."

The top 10 Kentucky counties ranked by percentage of the 65-and-older Medicare population with six or more chronic conditions are Clay, 27.1 percent; Breathitt, 26.3 percent; Johnson, 26.2 percent; Knott, 25.1 percent; Perry, 24.6 percent; Letcher, 24.2 percent; Bell, 24 percent; Floyd, 23.8 percent; Wolfe, 23.7 percent; and Taylor, 23.6 percent. Taylor County (Campbellsville) is not in Appalachia but borders three non-coal Appalachian counties.

Beve Cotton (C-J photo by Mark Mahan)

Beve Cotton, 81 and with a long list of chronic diseases, is one of those seniors. He lives in Manchester, the seat of Clay County, which ranks 12th among more than 3,100 counties nationally for the percentage of seniors on Medicare with six or more chronic conditions, Ungar reports.

"I'm a mess," said Cotton, who gets around in a power chair and wears a full set of dentures after losing all his teeth. "I'm not able to do things. I'm an accomplished cook, but I can't do that anymore ... I can't drive. My legs don't cooperate. ... It's very hard."

Ungar reports that Clay County, population 21,147, has many of the factors that combine to cause poor health.: "Nearly 38 percent of residents live below the poverty level, compared with a state average of 19 percent, according to the Census Bureau. Median household income is about $22,000 a year, about half the state average.Access to health care, especially specialists, is limited, and there are few well-stocked grocery stores or safe places to exercise. Smoking and obesity rates are sky-high."

Carmen Webb, who directs the senior center in Manchester, told Ungar that many seniors struggle with being able to afford staples, let alone healthy food and also the high cost of transportation, making it difficult to get to doctors appointments to manage their illnesses.

Cotton, who grew up in Manchester, told Ungar that he depends on others for rides, frequently to doctors' appointments, including many at the Veterans Affairs Medical Center in Lexington, about 100 miles away. Webb noted that public transportation in the area costs $1.50 per mile.

Feltner added that many seniors in the area don't know how to prevent chronic disease, some have fatalistic attitudes and because many of them are on multiple medications, they face the dangers of drug interactions and side effects, Ungar reports.

Experts say that such high levels of illness hurts communities, "hastening a downward economic spiral locally and requiring huge portions of Medicare budgets," Ungar writes. It also overtaxes the medical communities in rural counties even thinner.

"These patients need to be seen frequently by doctors, and they need much longer visits. ... These folks need intense care," Dr. Michael Karpf, executive vice president for health affairs at UK, told Ungar. "Given the shortage of primary care in Appalachia, this kind of patient just exacerbates that shortage."

"The real issue is prevention � weight control, exercise, food habits," Karpf said. "But it's hard. Fast food is cheaper than wholesome, healthy food, and (the way people eat) is partly cultural. Those things are hard to change. It's a generational process."

Princess Health and Hepatitis C is on the rise in Appalachian Kentucky, and dirty needles are to blame; officials predict surge of HIV to follow.Princessiccia

Princess Health and Hepatitis C is on the rise in Appalachian Kentucky, and dirty needles are to blame; officials predict surge of HIV to follow.Princessiccia

Appalachia drug abuse hepatitis HIV needle exchanges

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Kentucky has the highest rate of acute hepatitis C in the nation and public officials predict it could get much worse, Claire Galofaro and Dylan Lovan report for the Kentucky bureau of The Associated Press.

Dirty needles shared by drug users is the primary cause of this upsurge in hepatitis C, a contagious liver disease that destroys the liver, often leads to cancer or cirrhosis, and is the leading cause of liver transplants. It is spread primarily through contact with the blood of an infected person.

Patton Couch talks about his troubles.
(AP photo by David Stephenson)

Patton Couch, 25 and one month sober, is one of thousands of young Appalachian drug users recently diagnosed with hepatitis C. Galofaro tells the story of how one night four years ago, Couch said �he plucked a dirty needle from a pile at a flophouse and jabbed it into his scarred arm� even though he knew most of the addicts in the room probably had hepatitis C.

"All I cared about was how soon and how fast I could get it in," he says. "I hated myself, it was misery. But when you're in the grips of it, the only way I thought I could escape it was one more time."

Public-health officials are also concerned that Kentucky or part of it will become the next Scott County, Indiana, which is dealing with one of the worst American HIV outbreaks among injection drug users in decades, Galofaro notes. She says Scottsburg is much like many Appalachian towns � which have poor and/or few treatment options, and have long been seized by an epidemic of prescription drug abuse.

"One person could be Typhoid Mary of HIV," said Dr. Jennifer Havens, an epidemiologist at the University of Kentucky's Center on Drug and Alcohol Research, who has studied Perry County drug users for years as the hepatitis rate spiraled through small-town drug circles there. Of the 503 drug users she has tracked since 2008, 70 percent have hepatitis C.

�An explosion of hepatitis C, transmitted through injection drug use and unprotected sex, can foreshadow a wave of HIV cases,� Galofaro writes.

In Scott County, 160 people have tested positive for HIV in five months, compared to just 49 drug users testing positive in New York City in all of 2013, Greg Millett, director of public policy for the Foundation for AIDS Research, told Golofaro. �This is a canary in the coal mine for other places with high rates of hepatitis C,� he said.

In a study released last month, the federal Centers for Disease Control and Prevention found that hepatitis C cases across four Appalachian states � Kentucky, Tennessee, West Virginia and Virginia � more than tripled between 2006 and 2012.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

Officials in Appalachian are �scrambling to figure out how to stop it, whether through needle exchange programs, drug treatment or jail,� Galofaro writes.

Kentucky passed a law in March allowing local health departments to create needle-exchange programs. The guidelines have been set, but it is up to the counties to decide whether they want one.

Louisville and Lexington plan to launch needle exchange programs this summer, but �few rural communities have expressed interest,� possibly letting the larger cities work out the details first, Van Ingram, executive director for the Kentucky Office of Drug Control Policy, told Galofaro.

Even with the law in place, the debate about the needle-exchange programs persist. Proponents maintain that �we have to change the way we think� about treatment and that doing nothing is not an option, others told her that in small communities, the �fear of being exposed as a drug user may keep users away,� and others objected on a moral ground, �claiming they facilitate drug use rather than prevent it,� Galofaro reports.

Princess Health andCDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored.Princessiccia

Princess Health andCDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored.Princessiccia

Appalachia Centers for Disease Control and Prevention health

Gusty 06:20 Add Comment

By Melissa Patrick
Kentucky Health News

Shaping Our Appalachian Region, the bipartisan effort to revitalize and diversify Eastern Kentucky's economy, will focus its health efforts on substance abuse, obesity and diabetes, SOAR Executive Director Jared Arnett told Kentucky Health News.

"We believe they have the greatest impact on our ability to create jobs and build a world class workforce," Arnett said in an email. He said David Roberts of the federal Centers for Disease Control and Prevention, determined the priorities after spending three months at the SOAR office in Pikeville.

The priorities differ from those put forth by SOAR's Health Working Group, which made two major recommendations after a series of public forums: a coordinated health program in schools, and a study of the health effects of large-scale surface mining. However, when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. No recommendations appear on the health group's webpage.

At the health session of SOAR's "Strategy Summit" May 11, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the CDC, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it, Al Cross reported for the Appalachian Kentucky page of The Rural Blog.  

"That dismayed me," Cross writes. Later, upon raising his hand and being recognized by Seymour, he told her and the audience that it was "disconcerting and almost unbelievable" that she was unaware of the recommendation about mountaintop mining. Seymour replied that she had, in fact, heard about it.

Cross wrote, "Noting that the Pike County Fiscal Court Room was nearly full, I told Seymour that a lot of people had attended meetings and made their concerns known, and that even though this issue was "a hot potato," because of the coal industry's role, she needed to "go back to the powers that be, and tell them there's a room full of people who want answers."

Cross wrote that he was not for or against a study on the health effects of mountaintop mining, and " Unless they're writing opinion pieces, journalists aren't supposed to take sides," he wrote. "But they do need to speak up when issues of broad community concern aren't being addressed, especially when those concerns have been solicited."

The SOAR working groups concluded their meetings last summer and submitted their final reports. Since then, the SOAR executive board has decided to launch a SOAR Advisory Council and hold annual roundtables, or more as needed. They have made a request for a community health representative to be appointed to serve on this council, and Arnett said he expects this person to be appointed by June 1 or so. 

In addition, a follow-up CDC representative will be assigned to the SOAR office for one year beginning in late summer to help put together a strategic plan to address the three areas of focus recommended by the CDC at the summit. This person will also lead a Community Health Action Team for SOAR to work on building a blueprint for improved public health in the region, Arnett said.

"We are focused on working with our corporate partners and the Community Health roundtable to address these issues identified by the CDC on what can have the broadest reach and the greatest impact," Arnett said. A full report of all of the CDCs recommendations is expected in the near future, he said.

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Appalachia diseases drug abuse drug use drugs health hepatitis c prescription drug abuse rural health rural-urban disparities

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By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths�a majority of which are from prescription drugs�in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."

Princess Health andBaptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort.Princessiccia

Princess Health andBaptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort.Princessiccia

Appalachia Central Baptist Hospital economy governor health care

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Baptist Health has become the first stand-alone health-care provider to sign on as a founding partner in Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Baptist will work with SOAR to develop and implement health and education initiatives for residents of Appalachian Kentucky and has committed $150,000 to the initiative over the next three years, the organizations said in a press release.

�Baptist Health understands Eastern Kentucky because we have a proven and time-honored commitment to the health and well-being of our people,� Stephen C. Hanson, chief executive officer of Baptist Health, said in the press release. �Our participation in SOAR reflects this pledge. Besides Richmond, we�ve also got hospitals in Corbin and Lexington, along with outpatient facilities, doctors� offices and other services all over Eastern Kentucky, the rest of the commonwealth and indeed throughout the region."

The University of Kentucky was the first founding sponsor of SOAR, pledging $300,000 over the next three years and winning the right to use the UK HealthCare brand on SOAR materials as well as the university's general logo.

Gov. Steve Beshear and Congressman Hal Rogers formed SOAR in the fall of 2013 to create strategic plans to improve Eastern Kentucky's economy and quality of life.

�Our primary objective is creating and maintaining jobs across eastern Kentucky, and in order to do that, we need a healthy and well-educated workforce,� Beshear said in the release. �I�m pleased that Baptist Health understands the key connections among our efforts and the critical role that health will play in the future of this region."

Princess Health andProposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate.Princessiccia

Princess Health andProposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate.Princessiccia

Appalachia county health Foundation for a Healthy Kentucky health health rankings health status overall health status research

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A three-year research project to determine factors that can support a culture of health in Appalachia and whether that knowledge can be translated into actions that address the region's health disparities has released its Request for Proposal to invite proposals from qualified research teams and consultants who would like to work on this project.

The project,�Creating a Culture of Health in Appalachia: Disparities and Bright Spots,� is sponsored by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky and will run through the end of 2017.

The research for this project will identify Appalachian �bright spots,� where health outcomes are better than would be expected based on unemployment and poverty rates and other community factors, and try to figure out why. Researchesr will also try to determine why health outcomes in some communities are not as good as would be expected.

The request for proposals offers detailed guidelines for submissions, which are due June 8. Applicants are encouraged to register for a webinar, detailed on the RFP, to be held May 7 at 10 a.m. EDT. Click here for more information.

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Princess Health andStudy of poor but healthy Appalachian counties aims to find community-based approaches to improving the region's health .Princessiccia

Appalachia county health economy health status poverty research

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Though some people equate Appalachian areas with poverty, David Krol seeks to "shine a light" on a different picture�one that reflects "how health can flourish across Appalachia," despite data that confirms economic hardship, Krol writes for the Robert Wood Johnson Foundation.

While Krol was reviewing the Appalachian Regional Commission's county-based economic data, which compares economic indicators like poverty and unemployment rates with national averages and then ranks each county, it occurred to him to overlay this county index with the annual County Health Rankings.

For the most part, Krol said he found what he expected, "that the most economically distressed counties in Appalachia would also be in the lowest quartiles of health outcomes and factors for their state." But some counties that were economically distressed ranked in the top quarter of their state in health factors and outcomes.

"What was it about Wirt County, West Virginia; Pickett County, Tennessee; and Oktibbeha County, Mississippi, that helped them overcome significant economic challenges towards better health outcomes when similarly distressed counties in the same state did not?" he wrote.

The need to know why these "unexpected outliers" occurred has prompted Krol, with the help of the ARC and the Foundation for a Healthy Kentucky, to study how these counties have accomplished this and to look at whether this could be re-created in similar communities.

"This approach is rooted in the belief that communities have the best solutions to the problems they face�as opposed to solutions driven by outside experts," he wrote.

It�s an opportunity to �go beyond the data.. to community conversations about what�s important,� Susan Zepeda, CEO of the foundation, told Krol.

Krol wrote, "Quantitative data can get only get us so far�it�s up to us to ask those critical questions of �Why? How? What can be done? It�s up to us to turn data into action."

Princess Health and Princess Health andMorehead State, UK and Morehead hospital sign agreement to form Appalachian Health and Research Center.Princessiccia

Princess Health and Princess Health andMorehead State, UK and Morehead hospital sign agreement to form Appalachian Health and Research Center.Princessiccia

Appalachia hospitals medical education research rural health University of Kentucky

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Morehead State University, St. Claire Regional Medical Center and the University of Kentucky's Institute for Rural Health Policy signed a memorandum of understanding April 30 to form the Appalachian Health and Research Center.

�The primary mission of the AHRC is to increase the capacity for innovative, collaborative research based out of Morehead, which directly addresses health issues faced by residents of Appalachian Kentucky and beyond,� said Dr. Michael Henson, Morehead State's associate vice president for research and graduate-school dean. �AHRC will seek to improve local educational opportunities related to health research and to facilitate the translation of research findings into local health policy.�

From left: Reynolds, Andrews and hospital CEO Mark Neff

Dr. Brady Reynolds, UK's Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy and co-director of the Institute for Rural Health Policy, said, �This partnership stands to greatly increase capacity for health-related research in the Morehead area and northeastern Kentucky, with the ultimate aim of improving health and health policy in the region. Through this partnership we will be able to accomplish research and community health goals that may not otherwise be possible.�

Morehead President Wayne Andrews said the agreement will �allow us to focus on some areas of research that will help us improve the lives of the citizens in East Kentucky.� The specific AHRC goals are to:

• Create new and productive research partnerships with regional colleagues at the two universities and the hospital in the areas of health and wellness;
• Increase infrastructure for health research in Morehead and the surrounding area;
• Enhance opportunities for faculty, students, and medical residents to participate in cutting-edge biomedical research;
• Streamline the required review process for collaborative projects and increase the number of behavioral and clinical trials into which local residents and patients may be enrolled;
• Promote dialogue with the public about health, wellness and biomedical research; and
• Actively work to identify and translate specific research findings to local health policy to improve health in the region.

The research center will be housed in Morehead State's Center for Health, Education and Research, which was created in 2010 as the first such partnership involving a regional public university, a land-grant research university and a nonprofit hospital corporation. The $30 million, 90,000-square-foot facility is the largest construction project in the history of Morehead State, according to a university press release. 

Princess Health and Princess Health andEar, nose and throat doctor at UK aims to reduce state's high rate of hearing loss among children.Princessiccia

Princess Health and Princess Health andEar, nose and throat doctor at UK aims to reduce state's high rate of hearing loss among children.Princessiccia

Appalachia hearing otolaryngology rural health rural-urban disparities telemedicine

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Dr. Matthew Bush, an otolaryngologist at the University of Kentucky, is working to reduce the state's high rate of hearing loss, especially in Appalachia and among children. He was born in Charleston, W.Va., and attended medical school at Marshall University in Huntington. "In the course of his extensive training, Bush 'fell in love' with hearing health care, ear surgery and technologies like cochlear implants that offer revolutionary opportunities for people who are deaf or hard of hearing to rejoin or enter the hearing world," Mallory Powell writes for UK. 

"It was the clinic setting that informed and fueled my efforts and interests because the patients that we see have some tear-jerking stories," Bush said. "They didn't have access to services, or they were totally unaware that there were options to help their hearing impaired child. So they show up at the clinic very delayed, well past the optimal age for intervention, and the child has already lost a lot of language development potential."

About 1 in 1,000 children experience pediatric hearing loss, and Bush said the rate is much higher in Kentucky, 1.7 out of 1,000 in Kentucky. Though hearing loss isn't life-threatening, it can greatly impact the quality of life, influencing speech, language and cognitive development in children. Early detection is important for successful treatment. "The consequences of delaying care in the first few years of life are amplified dramatically," Bush said.

Rural residents deal with many health disparities, and "delays in pediatric hearing health care are unfortunately common," Powell writes. "Children with hearing loss in rural areas are diagnosed later than children in urban areas and subsequently receive interventions like hearing aids and cochlear implants at a later age."

This rural hearing-health disparity results from factors such as distance from health-care facilities and inadequate knowledge of the importance of timely care for pediatric hearing loss. Bush says he hopes to employ telemedicine to reduce the effects of distance from facilities, with "diagnostic testing, patient counseling and hearing loss rehabilitation with hearing aids and implants. These services have not been offered before in Appalachia."

Bush is also working to increase parental knowledge about pediatric hearing loss and educate rural primary-care physicians in diagnosing and treating pediatric hearing loss. "This is not something that they're seeing on a daily basis, so provider knowledge about next steps and resources is limited," Bush said. He and his colleagues have created online educational modules that will be circulated to providers.

"In an ideal world . . . there would be a seamless transition from the birthing hospital to resources for hearing testing and treatment, whether face-to-face or via telemedicine. We'd like the quality of care and access to care to be the same for all children. That's really what our passion is," Bush said. (Read more)

Princess Health and Princess Health andKentucky ranks 49th in well-being survey, and Eastern Kentucky's congressional district ranks last in the nation.Princessiccia

Princess Health and Princess Health andKentucky ranks 49th in well-being survey, and Eastern Kentucky's congressional district ranks last in the nation.Princessiccia

Appalachia economy poll public health rural health rural-urban disparities state government survey wellness

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Kentucky ranked 49th in the nation in a survey that measures perception of well-being, ranking higher than West Virginia and lower than Mississippi, and its 5th Congressional District ranked dead last in the nation.

"The survey assessed people's emotional and physical health; behavior that affects health, such as smoking or exercising; job satisfaction and access to basic needs, including food and housing; and their outlook on life," Bill Estep reports for the Lexington Herald-Leader. The Gallup Organization and Healthways, a Tennessee-based company that provides services to improve well-being, administered the survey.

Kentucky has ranked 49th each year except for 2008, the year the index began, when it ranked 48th. Factors contributing to this result include high poverty, top smoking rates, many uninsured people, high depression rates, drug abuse, obesity and other health issues. "Our health status is dismal in Kentucky," state Health Commissioner Stephanie Mayfield told Estep.

Louise Howell, a consultant for Kentucky River Community Care, said Eastern Kentucky has "profound health disparities." Harlan County lost 13,054 years of individual lives due to premature death, according to the survey. In Breathitt County, only 25.1 percent of people have access to satisfactory exercise opportunities. In Martin County, 37.4 people smoked.

Shaping Our Appalachian Region, a program Gov. Steve Beshear and 5th District Rep. Hal Rogers began last year, is forming strategic plans to improve the region's economy through expansion and diversification. This summer the public meeting will take place to brainstorm ideas and promote involvement. "I think this is the toughest most difficult region we've worked in, ever," said Charles W. Fluharty, who heads the Rural Policy Research Institute and is interim executive director of SOAR. However, he said the region will benefit from people's awareness that the coal-depend region has to try to a new strategy, Estep writes.

Dee Davis, president of the Center for Rural Strategies in Whitesburg, told Estep: "People realize if we've got any chance at all we've got to seize the reins; we've got to diversify the economy." (Read more)

Princess Health and Princess Health andRepublicans wait for elections and chance to roll back Medicaid expansion; few Kentucky Democrats defend Obamacare.Princessiccia

Princess Health and Princess Health andRepublicans wait for elections and chance to roll back Medicaid expansion; few Kentucky Democrats defend Obamacare.Princessiccia

Affordable Care Act Appalachia elections General Assembly governor health insurance health reform legislature Medicaid obamacare Patient Protection and Affordable Care Act politics poverty

Gusty 17:38 Add Comment

Though thousands of their constituents have benefited from it, Republican state legislators say they are planning to roll back Democratic Gov. Steve Beshear's expansion of Medicaid under the Patient Protection and Affordable Care Act if they take control of the state House this fall or win the governorship next year.

In other words, the "wildly successful" rollout of the health-reform law in Kentucky has not changed the politics of it in the state, reports Louisville native Perry Bacon Jr., political writer for Yahoo! News.

Stivers and Beshear

Bacon starts his story by focusing on the home county of state Senate President Robert Stivers, a Republican from Manchester: "In one of the poorest areas of Appalachia, about 2,500 people have signed up to get health insurance over the last six months � a number that represents more than a tenth of Clay County�s residents. One hundred and twenty miles way, the county�s state senator, Robert Stivers, is laying out his plans to gradually gut the Affordable Care Act in Kentucky, which provided his constituents with insurance."

Stivers acknowledged that the Medicaid expansion has benefited his neighbors, but told Bacon that it is �unsustainable� in the long run. For the first three years, the federal government is paying the entire cost of the expansion, but starting in 2017, the state will have to pay 5 percent, rising in steps to a cap of 10 percent in 2020.

Beshear cites a study showing that the expansion will pay for itself, largely by creating jobs in health care, and Health Secretary Audrey Haynes told Kentucky Health News that the expansion brought $45 million to health-care providers in the state in January, the first month it was in effect.

Republican Rep. Robert Benvenuti of Lexington, a former state health official, doesn't buy the Democratic sales pitches. �I think it�s immoral to give you something you know we can�t pay for,� he told Bacon. �Why are you creating dependency you know you can�t afford?�

Stivers suggested that Republicans could gradually reduce the income limit for Medicaid eligibility, now 138 percent of the federal poverty level, to reduce costs, but "The Obama administration has long said it would not support such a partial expansion of Medicaid," Bacon reports.

Also, "Some Republicans privately concede it will be difficult to roll back expansion of health insurance to so many," Bacon reports, quoting a "top GOP operative" as saying, "Three hundred thousand people are on this now. It's going to be hard to take this away from people." And since that anonymous person spoke, the number is close to 400,000.

House Republicans tried to force a floor vote on Obamacare in the current legislative session, but Democrats foiled that through a parliamentary maneuver.

"Steve Robertson, chairman of the Kentucky Republican Party, said the GOP statehouse candidates would run this fall on the mantle of repealing the health care law, looking to gain five seats and the House majority," Bacon reports. "And a Republican could replace Beshear," who can't seek re-election in 2015. Robertson said, �It�s a question of when, not if, when Kentucky will become just truly a red state.�

Bacon writes, "Democrats acknowledge the political challenge in defending the law. They say the policy success has done little to shift the politics because anything associated with Obama is unpopular in Kentucky. . . . The stories of the newly insured are drowned out, politicians in both parties here say, by the enduring unpopularity of Obamacare and the man it is named after, concerns (often unfounded) that the law has caused premiums to increase for people who previously had insurance and general confusion about the law, particularly the individual mandate" to buy insurance.

"Other than Beshear, many of the state's leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of 'Obamacare'," Bacon reports.

Princess Health and Princess Health andTelemedicine can help delay Alzheimer's, especially in rural areas, where it starts sooner, Appalachian health conference is told.Princessiccia

Princess Health and Princess Health andTelemedicine can help delay Alzheimer's, especially in rural areas, where it starts sooner, Appalachian health conference is told.Princessiccia

Alzheimer's disease Appalachia dementia rural health rural-urban disparities telemedicine University of Kentucky

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By Melissa Landon
Kentucky Health News

Telemedicine is a strategy that can be used to help prevent and treat Alzheimer's disease, especially in rural areas, where the disease comes sooner in life, Dr. Gregory Jicha, clinical-core director of the University of Kentucky's Disease Center, said today at the fourth annual Appalachian Translational Research Network Summit in Lexington.

Dr. Gregory Jicha

While mortality rates for prostate cancer, breast cancer, heart disease and HIV are going down, the rates for Alzheimer's are going up, and by 2020, it is estimated that 5.6 million Americans could be affected by it. Rural areas have higher incidents of the condition, and the onset of dementia averages four years younger in rural areas than in urban areas, Jicha said.

The university's Telemedicine Cognition Clinic offers appointments that involve video interaction with patients and caregivers in remote areas. In rural areas in general, telemedicine can be particularly helpful for patients who live great distances from the nearest specialist. "I cannot drive to Paducah and fill an entire clinic every week," Jicha said. But he explained that he can "travel" to a different city every hour and provide care to patients. "Telemedicine really is the wave of the future," he said. 

During telemedicine appointments, medical experts can talk about the patients' history, administer cognitive tests, and even observe patients walking or performing tasks to diagnose them. The goal of the program is to provide high level care and cognitive evaluations in rural areas by partnering with primary care physicians and clinics in rural areas, Jicha said.

Another important aspect of the growing program is education, both for patients and for physicians. Alzheimer's disease has no sure, but some risk factors associated with it�such as hypertension, alcohol use and depression�are treatable. If rural residents had better access to specialists who can detect the early symptoms of the disease, its onset could be delayed.

The conference was a forum for hundreds of research efforts. Among the topics discussed during the conference were the connection between physical fitness and academic performance in children, and environmental enrichment to promote healthy aging brains.

Todd Gress, a professor at Marshall University in Huntington, W.Va., presented a study about a pilot test of a text-message reminder system to advance diabetes awareness, compliance, and education�particularly in remote areas where cell phone service might be unreliable.

The advancing telemedicine strategy and these other research agendas should serve as a reminder that gifted researchers are searching for ways to improve rural health.

Such conferences "represent the best of what's happening out there in the world of universities and the world of communities," UK Provost Christine Rirodan told one session. She said the Appalachian gathering "represents the passion of people who are dedicated to solving these problems" in the region, "which require a great deal of collaboration to solve. . . . They're not small problems."