Princess Health and Princess Health andFoundation for a Healthy Kentucky seeks nominations for its board and Community Advisory Committee by June 30.Princessiccia

Princess Health and Princess Health andFoundation for a Healthy Kentucky seeks nominations for its board and Community Advisory Committee by June 30.Princessiccia

Foundation for a Healthy Kentucky philanthropy

Gusty 03:54 Add Comment

The Foundation for a Healthy Kentucky is accepting nominations for qualified persons to join its board of directors and its Community Advisory Committee.

The 15-member board is responsible for preserving the foundation�s endowment and upholding its charitable mission of addressing the unmet health care needs of Kentuckians. It is advised by the 31-member advisory committee.

Nominations are being accepted for a directorship from Kentucky Supreme Court District 2, the counties of Barren, Breckinridge, Bullitt, Daviess, Grayson, Hancock, Hardin, Hart, Henderson, Larue, Meade, Ohio, Union and Warren.

The board expects to elect four new Community Advisory Committee members, who make recommendations to the board, serve as community liaisons, serve on foundation committees, take part in the foundation's annual policy forum and appoint or nominate candidates to the board.

Nominations for the advisory committee are sought from residents of five area development districts: Purchase, Barren River, Lincoln Trail, Buffalo Trace and Fivco. Members should bring diversity to the foundation and not be currently employed in the health sector.

You may nominate yourself or someone else via the online nomination form and attach a resume or bio by June 30. You may submit the nomination online, by mail or vuia email to: Mary Jo Shircliffe, chief operating officer; Foundation for a Healthy Kentucky; 1640 Lyndon Farm Court, Suite 100; Louisville, KY 40223. Her email is mshircliffe@healthy-ky.org. You will receive an email acknowledgement of the receipt of your submitted nomination. For more information call 502-326-2583 or (toll free) 877-326-2584. 

Princess Health and Princess Health andMcConnell presses Democratic foe Grimes to say how she feels about Obamacare, but won't bite on questions about Kynect.Princessiccia

Princess Health and Princess Health andMcConnell presses Democratic foe Grimes to say how she feels about Obamacare, but won't bite on questions about Kynect.Princessiccia

business elections health insurance health reform insurance exchange malpractice obamacare politics poll

Gusty 17:23 Add Comment

By Al Cross
Kentucky Health News

At his first press conference after winning the Republican nomination for a sixth term, U.S. Sen. Mitch McConnell pressed Democratic nominee Alison Lundergan Grimes to clarify her position on the federal health-care reform law but wouldn't say whether his plan to "start over" on the issue would include shutting down the state's successful health-insurance exchange.

"She's been dodging it for a year," McConnell said Friday. "She's been in this race for a year. It's time for her to answer the question, "How do you feel about it?" Grimes, Kentucky's secretary of state, twice refused Wednesday to say how she would have voted on the 2010 law if she had been a senator.

McConnell speaks at half-hour press conference.
(Associated Press photo by Timothy D. Easley)

The topic arose when McConnell was asked to reply to Democratic assertions that his pledge to "pull it out root and branch" would end the law's insurance coverage for 415,000 Kentuckians through the state exchange.

The senator didn't answer directly. "This is another good reason why the two of us ought to have a real debate," he said, recalling his post-primary proposal for three Lincoln-Douglas-style debates by the middle of September.

Asked if he would dismantle the state exchanges created under the law, McConnell said he would have created a national market -- "tear down the walls, the 50 separate silos in which health insurance is sold" -- passed medical-malpractice reform, and allowed small businesses to "band together in this international [sic] market."

Asked again, specifically, if he would shut down Kentucky's exchange, which is branded as Kynect, he said "I think that's unconnected to my comments about the overall question here."

While polls have shown the law to be unpopular in Kentucky, a small plurality of voters in a recent poll had a favorable opinion of Kynect. Last fall, the Kentucky Health Issues Poll found that people who weren't sure how the law would affect them and their families had an unfavorable opinion of it, while those who said they did know how it would affect them had a favorable opinion.

In his overall comments about the law, McConnell said a Congressional Budget Office study has predicted that full implementation of the law would still leave 30 million Americans uninsured, covering only 10 million. "What is the cost-benefit ratio of this kind of destruction, this kind of impact, on 16 percent of the economy?" he asked. "The people of this state are entitled to know the answer to the question, 'How do you feel about it?' and I think my opponent has tried to dodge that question."

UPDATE: Joe Sonka of LEO Weekly writes, "According to the CBO, by 2024 the number of uninsured will, in fact, be 31 million people, but without the ACA there would have been 56 million people uninsured. This number takes into account the undocumented immigrants who can�t get insurance because of the lack of immigration reform, and the people who can�t get Medicaid in states that opted out of the Medicaid expansion. That means that when the ACA 'kicks in fully' . . . 26 million will have gained access to health-care coverage because of it."

Asked if repealing the law would be his top priority as majority leader if Republicans take control of the Senate, he said he wasn't ready to say because he's not in the majority yet, "but I think it's reasonable to assume that would be a high priority for us." He noted that Obama will be president until January 2017, an implicit acknowledgement that Obama would veto any repeal and two-thirds votes of the House and Senate would be required to override him.

Jason Millman of The Washington Post writes that the issue could be pivotal in the race. "Kentucky is about as big of an Obamacare paradox that you could find: the state's exchange is working well, but Obamacare remains unpopular in the state," he writes. "It�s also home to one of the more successful Obamacare health insurance exchanges." He concludes, "Grimes may want to have a better answer the next time she's asked whether she would have voted for the health-care law." She has refused to say.

Princess Health and Princess Health andSummer and water recreation offer fun and risk at the same time; prevention is the key to decrease the risk.Princessiccia

Princess Health and Princess Health andSummer and water recreation offer fun and risk at the same time; prevention is the key to decrease the risk.Princessiccia

swimming water safety

Gusty 09:35 Add Comment

One of the best parts of summer is splashing in a pool, playing in the back yard sprinkler or swimming in a lake or stream, but recreational water activity always comes with a risk of drowning.

It's important not to lose sight of this risk as you strive to keep your children and adolescents safe, writes Susan Pollack, director of the Pediatric and Adolescent Injury Prevention Program at the Kentucky Injury Prevention and Research Center at the University of Kentucky.

"Every year in Kentucky, an average of 14 children die by drowning. About half the drowning deaths occur among children ages 1 to 4," Pollack writes in the Lexington Herald-Leader. "From 2009-11, 80 percent of childhood drowning deaths occurred at the child�s residence or someone else�s home. A quarter of drowning deaths occurred among adolescents, mostly while swimming, boating or fishing on lakes and rivers."

Prevention requires constant supervision of toddlers and children around all types of water. This not only includes the obvious such as pools, swift-flowing creeks and large bodies of water, but also bath-tubs, car-washing buckets and ornamental ponds, Pollack says. Toddlers can fall in and drown even in just a few inches of standing water in a bucket. It is also important to empty baby pools immediately after use.

Drowning can happen "swiftly and silently," Pollack writes. This requires a responsible adult to supervise children at all times, even if lifeguards are present. And if a child can't swim, this adult should be within arms-reach. Supervision is needed even if the child is wearing an appropriately sized Coast Guard-approved life vest. Floaties and water-wings are not sufficient life-saving devices.

It is also important to create barriers to water sources. This can be accomplished by putting a four-sided, 4-foot-high fence with a self-closing gate around backyard pools or removing the ladder from above-ground pools that are not fenced.

While teaching children to swim does not replace supervision, it is an important life-saving skill children should learn, Pollack writes. The YMCA, Red Cross and university swim programs all offer lessons.

Adolescents should be reminded to never swim without a buddy and that alcohol and boating never mix, Pollack says. They should also be reminded of the dangers of swimming while fatigued and the importance of wearing a U.S. Coast Guard-approved life jacket when boating. (Read more)

Princess Health and Princess Health andMost Kentucky Medicaid members are allowed to switch managed-care organizations until June 18.Princessiccia

Princess Health and Princess Health andMost Kentucky Medicaid members are allowed to switch managed-care organizations until June 18.Princessiccia

health care managed care Medicaid

Gusty 09:00 Add Comment

Kentucky citizens with traditional Medicaid coverage may switch to a different managed-care organization (MCO) until June 18, Kentucky Voices for Health Board Chair Sheila Schuster notes in a press release.

The option is open to traditional Medicaid members enrolled with Coventry/MH Net or WellCare, except those in Region 3 (Jefferson and 15 area counties). Switching is voluntary. If members take advantage of the option, coverage with any new MCO will start July 1.

Until June 18 eligible Medicaid members can switch to Humana-CareSource, Passport Health Plan, Anthem Health Plans, CoventryCares/MH Net or WellCare. To learn details about each of the MCOs call 1-855-446-1245 or click here or here.

Eligible members can change MCOs by calling 1-855-446-1245 between 8 a.m. and 5 p.m. EDT and speaking with a Medicaid member representative. They should be prepared to give the birthdate and Social Security number of each person listed on their letter from Kentucky Medicaid. (Read more)

Princess Health and Princess Health andPsychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve.Princessiccia

Princess Health and Princess Health andPsychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve.Princessiccia

emergency medical service emergency rooms hospitals Medicaid mental health Patient Protection and Affordable Care Act psychiatrists psychiatry

Gusty 11:23 Add Comment

Psychiatric patients' demand for emergency-room care has been a concern in hospitals, and it's going to get worse. Even though ERs are not properly equipped to help psychiatric patients, people still often go there with psychiatric concerns. Most ERs simply lack room to deal with such situations. According to a survey, 84 percent of emergency physicians say they have psychiatric patients "boarded" in their emergency departments awaiting transfer to a mental-health facility, Adrianna McIntyre writes for Vox.

"People having a mental-health crisis seek care in emergency departments because other parts of the health care system have failed them," said Alex Rosenau, president of the American College of Emergency Physicians.

A psychiatric patient who shows up to the emergency room may require immediate care at the hospital, and sometimes there isn't an open bed in the right department. Those shortages often necessitate psychiatric patients to wait in the emergency room, or board, until space elsewhere opens for them. Both the closure of psychiatric facilities and diminished state funding have contributed to the issue. "Between 1955 and 1997, total state spending on mental health fell 30 percent, a period during which most health spending grew rapidly," McIntyre writes.

If hospitals don't figure out how to deal with the problem, it's going to get worse. In fact, experts say the implementation of the Patient Protection and Affordable Care Act will only exacerbate the problem. Some studies reveal that insured patients are more inclined to go to the emergency room�even for non-urgent issues�because the cost usually isn't as high. Lower-income people are even more likely to do that, and this population will comprise many of the newly insured citizens.

Though hospitals want people to use the health system properly, they also want to make sure patients do visit the ER when it really is necessary. "We don't want to impose any barriers on people going to the emergency room," said Hans House, a clinical professor at the Iowa University Carver College of Medicine. "We don't want people to be afraid to go to the ER."

The Affordable Care Act has provided more funding for reimbursement of emergency psychiatric care in Medicaid, a service the public program doesn't generally cover. However, this doesn't address the lack of space in emergency departments. "We know that a lack of psychiatrists available and staffing patient beds is a barrier," House said. "That's a personnel issue." (Read more)

Princess Health and Princess Health andUK College of Medicine graduate Ashley Loan makes commitment to practice emergency medicine in rural Kentucky .Princessiccia

Princess Health and Princess Health andUK College of Medicine graduate Ashley Loan makes commitment to practice emergency medicine in rural Kentucky .Princessiccia

COPD rural medicine

Gusty 09:11 Add Comment

Ashley Loan

Ashley Loan graduated from the University of Kentucky College of Medicine on May 17 and plans to practice emergency care medicine in rural Kentucky, Elizabeth Adams reports in a UK press release.

Loan began working toward her goal four years ago as one of 10 graduating students who participated in UK's Rural Physician Leadership Program, where she believes her roots in Greenup County prepared her for a future responding to medical emergencies in rural Kentucky, Adams reports.

Loan told Adams that her earliest experiences in emergency medicine were watching her mother, Elizabeth Loan, respond to accidents in the farming community because she had an associate's degree in nursing and was the most educated health care provider within a 10-mile radius of the Loan farm.

Her daughter recalled that when the neighbor's son went into a diabetic coma, her mother rushed to their house to administer sugar. Another time, her mother administered CPR to a farmer who was pinned under a tractor until the emergency responders arrived.

"There have been a lot of instances when my mom was the sole health care provider," Loan said.

Loan told Adams that she understands cultural characteristics that influence health in rural populations, such as an attitude of self-reliance that results in attempts to self-medicate or postpone visits to the doctor. It's often difficult for doctors from urban environments to appreciate those cultural variances.

"I get why people don't go to the doctor�rural people are raised to take care of themselves," Loan said. "Before they come to the doctor, they've tried a few things."

Loan told Adams she also understands first-hand some of the health challenges found in rural communities. Her father, a longtime tobacco farmer and user, suffers from chronic obstructive pulmonary disease.

Kentucky has the nation's highest rate of COPD, 9.3 percent of the population, according to the federal Centers for Disease Control and Prevention. Tobacco use is the primary cause, but air pollution and genetics can also play a role.

Loan told Adams that growing up in a rural area isolated from hospitals fueled her desire to deliver more efficient emergency medical care to rural communities. She said she "enjoys the challenge of being the first doctor on the trauma scene and 'Macgyver-ing' her way through emergencies with limited resources."

"I love the fact that patients who come to the emergency department are the sickest patients you are going to see," Loan said. "You lay your eyes on them; you have no previous notes�you are the person who has an hour before the patient crashes to figure out what's going on."

Loan's experience in the Rural Physician Leadership Program allowed her to gain more hands-on experience with patients because of the hospital's smaller medical staff and fewer residents in the program, Adams reports. She has delivered more than 10 babies, assisted attending physicians with bowel surgery and helped stabilize a coding patient in the emergency department.

During her stint, Loan participated in a clerkship and lectures at St. Claire Regional Hospital in Morehead. Dr. Phillip Overall, the emergency clerkship director at the hospital, told Adams that Loan has already demonstrated the calm and decisive qualities needed in an emergency-room doctor.

"She is able to think very quickly on her feet and subsequently provide excellent patient care," Overall told Adams. "We take care of critical patients on a daily basis, and she is absolutely able to step back and assess the entire situation calmly and come up with a plan to take care of the patient."

The assistant dean who recruited Loan to the Rural Physician Leadership Program, Dr. Anthony Weaver, said that rural practices and hospitals need physicians who are committed to living and working in small towns. Loan's closeness to her family and ability to "have conversations with anyone about just about anything" made her an ideal candidate for the program, he told Adams.

"Ashley Loan has the intelligence and drive to succeed as a physician, but more importantly, she cares about her family and her neighbors," Weaver said. "Improvements in the health of rural Kentucky will come from people like Ashley."

Loan also received a certificate in health systems leadership upon graduation from medical school and will work toward a master's in business administration during her medical residency, which she is also completing at UK. Loan aspires to serve as the director of a rural emergency department.

Loan was once a high-school girl who wanted to escape rural Kentucky. Now, she not only has committed to practicing medicine in rural Kentucky, but she and her fianc� Ryan Brown have bought an 87-acre farm in Greenup County and built a house there. She plans to raise beef cattle when not practicing emergency medicine in a nearby hospital or responding to emergencies, Adams writes.

"I'm definitely a small-town person," Loan told Adams. "I feel an obligation to come back and serve the people who have really believed in me for so long. It makes my day when someone says, 'You are coming back here?' I'm Ashley�I'm the girl who sold corn with her dad on the side of the road�they trust me, and I like that." (Read more)

Princess Health and A New Understanding of an Old "Obesity Gene". Princessiccia

Princess Health and A New Understanding of an Old "Obesity Gene". Princessiccia

genetics overweight

Gusty 17:13 Add Comment

As you know if you've been following this blog for a while, obesity risk has a strong genetic component. Genome-wide association studies (GWAS) attempt to identify the specific locations of genetic differences (single-nucleotide polymorphisms or SNPs) that are associated with a particular trait. In the case of obesity, GWAS studies have had limited success in identifying obesity-associated genes. However, one cluster of SNPs consistently show up at the top of the list in these studies: those that are near the gene FTO.

As with many of the genes in our genome, different people carry different versions of FTO. People with two copies of the "fat" version of the FTO SNPs average about 7 pounds (3 kg) heavier than people with two copies of the "thin" version, and they also tend to eat more calories (1, 2).

Despite being the most consistent hit in these genetic studies, FTO has remained a mystery. As with most obesity-associated genes, it's expressed in the brain and it seems to respond somewhat to nutritional status. Yet its function is difficult to reconcile with a role in weight regulation:

• It's an enzyme that removes methyl groups from RNA, which doesn't immediately suggest a weight-specific function.
• It's not primarily expressed in the brain or in body fat, but in all tissues.
• Most importantly, as far as we know, the different versions of the gene do not result in different tissue levels of FTO, or different activity of the FTO enzyme, so it's hard to understand how they would impact anything at all.

An important thing to keep in mind is that GWAS studies don't usually pinpoint specific genes. Typically, they tell us that obesity risk is associated with variability in a particular region of the genome. If the region corresponds to the location of a single gene, it's a pretty good guess that the gene is the culprit. However, that's not always the case...

Read more �