Tuesday, 3 April 2012

Princess Health and 2012 county health rankings released; meant to spur local change.Princessiccia

By Tara Kaprowy
Kentucky Health News

Meant to be a conversation starter to fuel change for better health, the third-annual County Health Rankings were released today, a health-evaluation tool that assesses the country's counties on everything from their smoking to early mortality rates. Kentucky's rankings did not change significantly from last year, with Oldham and Boone counties at the top and Owsley, Magoffin and Wolfe counties at the bottom of the list.

Kentuckians who are the least healthy live in the Appalachian swath of the state, the rankings show. Fulton County in Kentucky's southwestern tip ranks low, though is not surrounded by other low-ranked areas. Counties that hug urban centers � Louisville, Lexington and Cincinnati � have the highest rankings. The data are compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation.

Kentucky's breakdown is not unusual, but part of a nationwide pattern in which the least healthy counties are often in rural, sparsely populated areas, said Dr. Patrick Remington, lead researcher and associate dean for public health at UW's School of Medicine and Public Health. "At the other end, you see urban centers as having similar problems and often ranking at the bottom of the list," he said. "Another pattern is some of the suburban communities, ring communities, are some of the healthiest communities."

Counties are ranked in two ways: health outcomes (such as premature death rates, low birthweight, how good or bad people feel physically and mentally) and health factors (such as smoking, obesity and binge-drinking rates). In health outcomes, graphic above, Oldham, Boone and Calloway ranked first, second and third respectively. Owsley County was ranked last, preceded by Martin and Wolfe counties.

In health factors, left, Woodford County ranked first, followed by Oldham and Boone. Clay County (labeled CY) was in last place, preceded by Magoffin and Wolfe counties (MG and WO).

Though Kentucky's counties are ranked from 1 to 120, because of the small sample sizes in many of them, the rankings do not "represent statistically significant differences from county to county," the rankings website reads. Sources for the data also change, so direct comparisons from year to year are also inexact, Remington said. This year, researchers tracked the number of fast-food restaurants in a county and levels of physical inactivity. They also used premature death rate trends over 10 years, a hard number that alone can indicate progress, Remington said.

Though Remington said he would "be naive to say the competitive element doesn't pique interest in the rankings," they are "not really intended to be a race to the top." Instead, rankings should be used as a "Polaroid snapshot of community health," Remington said. The data should be used by officials to pinpoint problem areas, drill down and make policy changes in turn, he said.

That's what Chip Johnson, mayor of Hernando, Miss., did. Participating in a teleconference about the rankings, Johnson talked about how policies aimed at improving health have changed his city. Officials have required sidewalks in all new and re-developments, he said. All new streets should be biking and pedestrian accessible. The city has partnered with schools so people can use their gyms to work out. And Johnson encouraged a local bank to donate land for a 37-acre park. "Banks are sitting on land they've repossessed and don't know what to do with it," he said. "We're naming the park after the bank."

The goal is to create infrastructure that will make it easier for people to make healthy decisions, he said, pointing out, "You can't exercise your personal responsible for good health if your city or county does not give you that atmosphere or opportunity." Johnson said he responded to this reality by strategically placing the city's only farmers' market, community garden and community center in its lowest-income area.

As indicated by the data assessed and Johnson's efforts, "Much of what influences our health happens outside of the doctor's office," foundation President Risa Lavizzo-Mourey said, and factors like education rates, income levels and access to healthy food all play a part, researchers found. Data also show where someone lives can influence health. Excessive drinking, for example, is highest in Northern states. Rates of teen births, sexually transmitted infections and children living in poverty are highest in Southern states.

The rankings are based on several sources of data, from vital statistics to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the world's largest, on-going telephone health survey. "We found even though the data are available nationally, it requires a lot of time and effort," Remington said. "This is one-stop shopping, not just for death and disease rates but for all of the factors that lead to a healthy community. Combining them allows people to start the conversation pretty easily."

Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, applauded the effort. "Local health data can spur communities to action to create better health outcomes for all Kentuckians," she said.

Princess Health and This week is National Public Health Week; this year's focus is on prevention and wellness.Princessiccia

Princess Health and This week is National Public Health Week; this year's focus is on prevention and wellness.Princessiccia

With a focus on prevention and wellness this year, the Kentucky Department of Public Health is promoting national Public Health Week, which kicked off yesterday and will be observed until Sunday. The prevention theme was chosen to underscore the impact of chronic disease on the American population.

Americans miss 2.5 billion days of work because of diseases like heart disease, cancer and diabetes, which costs the country $1 trillion. Unintentional injuries, such as those stemming from motor vehicle accidents, poisonings and burns, rank within the top 10 causes of death for people 44 and younger, according to a DPH press release.

"Often, these horrible diseases and injuries could have been prevented with more attention to lifestyle choices like physical activity and nutrition or preventive safety measures," said Dr. Steve Davis, acting DPH commissioner. "The health care community � as well as the individual � must work to understand the risk for developing chronic disease and avoiding injury so that we can prevent complications. This is key to improving the health of our state."

Public health is also crucial in emergency response, as witnessed with recent tornadoes that struck the state. "The contribution of public health is tremendous � both on a day-to-day basis and in times of crisis," Davis said. "I encourage everyone to go online to read more about our public health programs; talk to your health care provider about chronic disease and injury prevention; or, better yet, visit your local health department to learn more about how public health can � and does � improve your life." (Read more)
Princess Health and 'One Text or Call Could Wreck It All' traffic safety campaign being promoted this month.Princessiccia

Princess Health and 'One Text or Call Could Wreck It All' traffic safety campaign being promoted this month.Princessiccia

A new traffic campaign with the slogan of "One Text or Call Could Wreck It All" is being sponsored by the National Highway Traffic Safety Administration this month.

April has been designated Distract Driving Awareness Month, with Kentucky law-enforcement agencies committed to spreading the word. In 2009, nearly 5,500 people were killed and another half a million people were hurt in accidents caused by distracted driving, according to national safety administration figures.

The national effort "focuses on ways to change the behavior of drivers through legislation, enforcement, public awareness and education � the same activities that have curbed drunken driving and increased seat belt use," The Courier-Journal reports.

Officials said they want to reach teen drivers especially with the effort, since that group has the highest proportion of distracted drivers who were involved in fatal crashes. (Read more)


Monday, 2 April 2012

Princess Health and Bill amendment could make dental, vision care more expensive.Princessiccia

Princess Health and Bill amendment could make dental, vision care more expensive.Princessiccia

A last-minute amendment to a bill intended to limit when insurance companies could terminate policies may end up costing Kentuckians more out-of-pocket dental and vision expenses, Courier-Journal political writer Joseph Gerth writes in his weekly column.

The implications of House Bill 497 changed when Sen. Tom Buford, R-Nicholasville, "filed a one-paragraph amendment that was brought to him at the last minute by a lobbyist for the Kentucky Dental Association," Gerth writes. "That amendment said that if you have vision or vision insurance, your insurance provider can't require your health care provider to give you discounted rates on services that aren't paid for by the insurance plan."

That could mean that low-cost plans that only cover a few procedures but offer "added benefit by making sure you're not paying inflated prices for other services" may no longer be available, Gerth reports. Opponents say insurance companies will stop offering such plans because people won't buy them without the discounts. And people who can't afford more expensive plans will sacrifice dental and vision insurance.

On Tuesday, the Senate adopted the amendment and passed the bill. The bill cleared the House the next day. Gov. Steve Beshear has not indicated if he will sign or veto it.

Advocates say the bill will save in dental and vision care costs. Opponents say people will have difficulty having access to case. As for who's right, Gerth writes: "Bill advocates have presented no evidence to suggest that, and there have been no full-fledged hearings for the dentists behind the bill to make their case or to answer the questions that need to be asked." (Read more)

Princess Health and Three of four UK's research professorships fund work in health.Princessiccia

Three of the four University of Kentucky research professorships awarded for the 2012-13 school year will fund health-related work. Each award is worth $40,000.

Mark Filmore, right, who teaches in UK's Department of Psychology, will research the role that cognitive processes have in promoting risk-taking behavior. It will have an emphasis on recreational drug use, including alcohol abuse and dependence.

Douglas Andres, left, professor and vice chair of the Department of Molecular and Cellular Biochemistry,  "had begun to define the molecular pathways that control adult neurogenesis, and have shown that Rit, a Ras family G-protein, plays a critical role in the survival of newborn adult neurons following traumatic brain injury," a press release reads. If that is the case, strategies that target Rit activation may be effective in helping recover or repair the injury.

In the Department of Internal Medicine, Mark Dignan, right, leads a program that focuses on cancer prevention and control in community settings using community-based participatory methods. Using the funds of his professorship, he plans to expand his training, "allowing him to conduct translational research with teams that include basic and clinical scientists as they continue their work to reduce cancer health disparities," the press release reads.

Christopher Pool, professor in the Department of Anthropology, is the fourth professorship recipient. (Read more)
Princess Health and Need for painkillers and social support, shortage of treatment programs, feeds prescription drug abuse in Appalachian Ky..Princessiccia

Princess Health and Need for painkillers and social support, shortage of treatment programs, feeds prescription drug abuse in Appalachian Ky..Princessiccia

By Ivy Brashear
Kentucky Health News

Taking opioids is still the best way to treat patients with pain, but the drugs are addictive because they do more than just alleviate physical suffering � they cause patients to feel good too. That's causing big problems in Kentucky, the state with the highest rate of opioid use and overdose.

In Perry County, for example, prescription medicines are the drugs of choice, second only to marijuana, and users may get more of them from relatives than from doctors. And their drug use appears to be part of a social support system.

Those were the findings of three separate studies presented at the second annual Appalachian Health Summit in Lexington last week.

Prescription-drug abuse is "an epidemic" that "seems to have started in rural Appalachia," Jennifer Havens, an associate professor in the University of Kentucky Department of Behavioral Science, said in presenting a study showing how disease spreads through the region.

Havens� study of Hazard and Perry County found that prescription drug abuse in the county is second to marijuana use, and that painkiller abuse among high school seniors is at the same rate as in adults.

Though it�s not clear why prescription drug abuse is so rampant in the region, Havens speculated that lack of availability of other �hard� drugs, like heroin and cocaine, has led Appalachian drug users to turn to prescription medicine to get high. There are few drug-treatment options for users in the region, and many hospitals aren�t �financially viable� to care for drug abusers, she said.

An earlier study in which Havens was involved revealed that rural adults use more �alternate� methods to take drugs, including snorting and injecting. The study compared drug users in Perry County to those in Louisville and found that more than 40 percent of adults in the Hazard area were injecting prescription drugs to get high, and youth there were 25 percent more likely than those in Louisville to abuse such drugs.

The study found high rates of sharing drug-taking instruments, which increases risk for diseases such as hepatitis and HIV, Havens said. Almost 90 percent of participants said they shared snorting straws, and almost 1 in 3 said they shared syringes. No cases of HIV were found among the participants, but almost 43.7 percent of the 500 interviewed had hepatitis-C, and 11.5 percent had herpes-2.

Eighty percent were lifetime users, and about half first abused Oxycontin through injection. Havens said 28 percent of users had overdosed, and 58 percent had witnessed an overdose.

The study also found that a person�s likelihood of continuing drug use correlated with higher levels of social support, which Havens said contradicts long-held assumptions that drug users continue to abuse prescription pills because of low social support.

�Most people in the study depended on people also using drugs for social support,� Havens said. �As you can imagine, that�s not a good idea.�

No good alternative to prescribing painkillers

Despite widespread opioid abuse in Appalachia, such drugs are �still the best pain therapy,� UK physiology professor Karin Westlund High reported.

The purpose of her study was to determine what effect a high-fat and alcohol diet would have on �visceral pain� in the pancreas, and then what effect opioid gene therapy would have on the organ.

There are clusters of Appalachian counties at high risk for pancreatitis, which can lead to pancreatic cancer. Severe abdominal pain is associated with both, and morphine is typically used to treat it. However, High said, patients usually develop a tolerance to the drug over time.

She and other researchers used rats to test an opioid gene therapy involving herpes simplex-1, which 90 percent of Americans already have, to see if it would reduce pancreatitis pain without building tolerance in the rats. After 10 weeks of treatment, there was no tolerance present and the therapy seemed to be reversing damaged sections of the pancreas caused by the disease.

While opioids are effective in alleviating pain, "There are lots of different kinds of pain, but most opioids act as if they treat the same pain,� said Michelle Lofwall, a UK psychiatry and behavioral science assistant professor. Lofwall set out to discover how pain affects prescription drug abuse, since that is the main reason such drugs are prescribed or first used.

Her study participants, who were all drug users, placed one arm in a cooler of ice to elicit pain, and then were asked about pain levels. The test was repeated after a dose of painkiller.  Researchers were attempting to give the drug to treat patients� pain only, and not to have the patient feel a high when the drug was in their system, but that failed.

�Unfortunately, in my patients I wanted to say, �Yes, let�s treat your pain and you won�t feel any good effects�,� Lofwall said. �I wasn�t able to say that to them.� She said they are now trying to help doctors better prescribe pain medication so that habits aren�t formed.

One of the biggest habit-forming painkillers is Oxycontin, which was introduced in 1996 but wasn�t abused on a large scale until doctors had to start documenting pain in 1999, Lofwall said. Sales of, treatment for, and death from prescription drug abuse have increased since then. She noted that Kentucky has the highest rates of opioid use and overdose.

The makers of Oxycontin have reformulated the drug to make it harder to crush, mix with water and snort, but a new drug has risen to take its place: Opana. Lofwall said researchers have been trying to study Opana use, but can�t get a study supply because it is in such high demand. She said she has seen more of a rise in heroin use by her patients because even heroin is easier to get than Opana.

Though legislators are grappling to curb the proliferation of "pill mills" in the state, Lofwall said "doctor shopping" may not be the problem it's been billed to be. According to the National Household Survey on Drug Use and Health, 56 percent of users get their supply from a relative, of whom 85 percent have a prescription from one doctor. The drug abuser may get the drug from the relative as a gift, by paying for it or by stealing it.

Asked about the Kentucky All Schedule Prescription Electronic Reporting system, which allows doctors to search a database for �doctor shoppers� before prescribing pain pills, Lofwall said KASPER is limited because it only covers Kentucky, but �I think the state�s ready to make it better.�

Kentucky Health News is a 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.

Princess Health and Serious shortage of primary-care physicians expected in Louisville.Princessiccia

An aging population, a high number of doctors getting ready to retire, and medical students opting to specialize for better pay and hours are all factors contributing to an expected shortage in primary-care doctors in Louisville.

"By 2020, Jefferson County will need 455 new primary-care doctors � almost as many as the number that work in local medical practices now," reports Patrick Howington for The Courier-Journal. (C-J photo by Matt Stone)

"We see a real workforce crisis in the future � in the immediate future," said Bill Wagner, executive director of Family Health Centers, a group of community clinics that serve low-income residents.

One survey of local physicians found about a third of doctors are 56 or older and are planning to retire within 10 years. Couple that statistic with the fact that the number of American medical-school seniors who entered family-medicine residencies fell from 17 percent in 1997 to 8 percent last year, Association of American Medical Colleges figures show. Part of the reason for the drop is the comparatively low salaries primary care physicians make. On average, they are paid as little as half as much as specialists, such as radiologists and invasive cardiologists.

Though doctor shortages have typically been seen as a rural problem, that's not so anymore. "No matter where you're talking about, we clearly have an aging primary care workforce," because primary care has been "so unpopular," said Dan Varga, chief medical officer of Kentucky's St. Joseph hospitals and a former Louisville internist. (Read more)