Princess Health and Small steps can prevent Kentucky's No. 1 killer, heart disease.Princessiccia

Princess Health and Small steps can prevent Kentucky's No. 1 killer, heart disease.Princessiccia

blood pressure cardiac care cardiovascular disease exercise heart disease sleep smoking

Gusty 21:00 Add Comment

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

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

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

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

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

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

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

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

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

children children's health doctors mental health school health state government

Gusty 19:30 Add Comment

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

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


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

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

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

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

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

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

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

Princess Health and Common beliefs about obesity and weight loss found to be myths.Princessiccia

Princess Health and Common beliefs about obesity and weight loss found to be myths.Princessiccia

breastfeeding child obesity diet exercise food nutrition obesity research weight loss

Gusty 17:25 Add Comment

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

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

Here are the seven myths:

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

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

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

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

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

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

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

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

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

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

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

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

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

children mothers neonatal care pregnancy research rural health

Gusty 12:15 Add Comment

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

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

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

Princess Health and Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program.Princessiccia

Princess Health and Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program.Princessiccia

Affordable Care Act federal government health care access health care costs health care law legislation Medicaid Patient Protection and Affordable Care Act poverty state government

Gusty 18:22 Add Comment

By Molly Burchett and Al Cross
Kentucky Health News

If Kentucky expands its Medicaid program, it will probably be able to reduce the cost by requiring patients whose incomes are above the federal poverty level to help pay for their care. That could make it more feasible for the state to expand the program to people with incomes up to 138 percent of the poverty line.

A proposed federal policy will let states charge co-payments and increased premiums for doctor visits and some prescription drugs and hospital care. Robert Pear of The New York Times reports that the policy is designed to encourage states to expand Medicaid under the federal health-care reform law, with generous federal help. By shifting costs to patients, the state and federal governments would pay less.

That adds a new perspective to the cost consideration in Kentucky's debate over expansion of Medicaid. It could influence the state's decision, Republican state Sen. Julie Denton of Louisville said Friday during a legislative panel at the Kentucky Press Association convention.

Denton cautioned that the state needs to fix its problems with Medicaid managed care before it expands the program. Democratic Gov. Steve Beshear has said he wants to expand Medicaid if the state can afford it, and since there is no deadline for deciding whether to participate in the expansion, the debate may carry over into 2014.

Some Republicans have said Kentucky can't afford the expansion. If the state expands Medicaid eligibility to 138 percent of poverty from its current threshold of 70 percent, the federal government would pay all the cost of the expansion until 2017, when the state would begin helping out, with its share reaching 10 percent in 2020. The federal share of the state's current program is 72 percent.

This proposed rule could have important implications not just for state finances, but for Medicaid patients. It means that a family of three with an annual income of $30,000 could be required to pay $1,500 in premiums and co-payments, Pear reports in the Times.

As published in the Federal Register last week, the rule proposes to "update and simplify Medicaid premium and cost sharing requirements, to promote the most effective use of services and to assist states in identifying cost-sharing flexibilities." It proposes "new options for states to establish higher cost sharing for nonpreferred drugs and to propose higher cost sharing for non-emergency use" of emergency rooms.

Barbara K. Tomar, director of federal affairs at the American College of Emergency Physicians, told Pear that the administration had not adequately defined the �nonemergency services� for which the poor might have to pay. "In many cases, she said, patients legitimately believe they need emergency care, but the final diagnosis does not bear that out," Pear writes.

The proposed rule has no limit on emergency department charges for "non-emergency use." It says the hospital will have responsibility to assess the individual clinically and ensure access to other sources of care before requiring payment, which could pose problems for hospitals.

The public has until Feb. 13 to comment on the proposed rule, which can be submitted at www.regulations.gov.

Princess Health and Prescription-painkiller epidemic is spurred by societal shift, experts say: People think every problem has a pill for an answer.Princessiccia

Princess Health and Prescription-painkiller epidemic is spurred by societal shift, experts say: People think every problem has a pill for an answer.Princessiccia

controlled substances drug abuse patients prescription drug abuse prescription drugs public health rural health substance abuse

Gusty 15:02 1 Comment

By Molly Burchett
Kentucky Health News

The prescription-painkiller epidemic stems partly from an evolution of society's views toward pain and how to deal with it, said experts at "The Different Faces of Substance Abuse" conference in Lexington Jan. 23-24.

"The entire society's viewpoint of pain and the management of pain has completed shifted," said Dr. Ryan Stanton, an emergency physician and conference panelist.

Pain is considered the fifth vital sign, after temperature, pulse, blood pressure and respiratory rate, but it is the only sign that is subjective, which complicates the problem, said Stanton, because patient satisfaction is associated with the amount of drugs the provider prescribes. If an emergency-room doctor suggests exercise to combat back pain, he said the patient's reaction might be, "You might as well ask a man to deliver a baby."

The substance-abuse problem shouldn't be laid at the feet of prescribers because patients think there is a pill out there for every problem when sometimes the answer is non-prescription ibubrofen and an ice pack, said Van Ingram, executive director of the state Office of Drug Control Policy.

"This is a complicated issue," Ingram said. "It's easy to be against heroin, and it's easy to be against cocaine. But prescription opioids are things that many people need to live and need to improve their quality of life at the end of life."

Patients need to understand how much a doctor can or should do, said Dr. Helen Davis, conference panelist and chair of the Gov. Steve Beshear's KASPER Advisory Council. "Patients come in to the doctor's office expecting a silver bullet . . . but when looking at pain, the goal isn't to make the patient pain-free," she said. "The goal is to reduce the pain enough that they can have systematic and functional relief to go about their daily living."

Davis said doctors and nurses must change their culture to become more collaborative with the patient to address the non-pharmacological management of pain. There are some things that are the responsibility of the provider and there are some things that are the patients', families' and communities' responsibility, she said, adding that all professionals must look at their interdisciplinary responsibility to the people of the state.

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

Princess Health and Experts explain changes to state prescription-tracking system.Princessiccia

Princess Health and Experts explain changes to state prescription-tracking system.Princessiccia

controlled substances General Assembly legislation legislature prescription drug abuse prescription drugs state government substance abuse

Gusty 14:38 Add Comment

By Molly Burchett
Kentucky Health News

The Kentucky All-Schedule Prescription Electronic Reporting system, the key to fighting doctor-shopping for painkillers in the state, has undergone several changes since the legislature passed House Bill 1 last year to crack down on so-called pill mills. An expert panel at "The Different Faces of Substance Abuse"conference last week in Lexington addressed the more recent changes to KASPER.

�The new legislation has brought prescription drug use into the medical arena when it had not been before,� said Dr. Michelle Lofwall, member of the KASPER Advisory Council, created last year by Gov. Steve Beshear.

Very soon Kentucky will be sharing KASPER data with all seven border states, which will be provided automatically in reports, and all agreements to enable this exchange have already been signed, said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

One important but little-reported change is that KASPER reports can now be included in patients� medical records. Prior to the passage of HB1, this was a felony and created workflow problems for physicians.

Attorney General Jack Conway has steered money from a mortgage settlement to enable the necessary system upgrades to KASPER that will bring about additional changes, said Ingram. Starting in July, dispensers of drugs will be required to report data every 24 hours instead of the current weekly timeframe, improving the timeliness of the data.

Changes are also coming to the regulations associated with HB1, since medical licensure boards have �gotten an earful� and have revisited the regulations to make them more straightforward and common sense, KASPER program manager Dave Hopkins said.

Ingram said, �With any big policy change, there are going to be unintended consequences. . . . The legislature will take a look at the unintended consequences. If you want to make drastic changes, it�s going to be chaos for a while.�

�In a lot of things with government, great ideas are complicated by reality,� said Dr. Ryan Stanton, UK Good Samaritan Hospital emergency-room physician and medical director, as he painted a more realistic picture of KASPER from when he first created an account with the system in 2005.

Stanton said recent changes have included timelier and more accurate reports that make the system easier to use. He said more such improvements are critical to catch those who "abuse in spurts," and are also important because physicians have minimal time and need to spend more time with patients instead of in front of a computer.

The use of KASPER has increased significantly since the passage of HB 1, with the number of reports requested increasing from 811,000 in 2011 to 2.69 million in 2012.

Medications containing the painkiller hydrocodone, including Lortab, Lorcet and Vicodin, remain the most-prescribed type of controlled substance in Kentucky, 41.5 percent of the total.

Click here for more information about KASPER.

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