HIV and AIDS cases are on the rise in Kentucky; officials blame lack of education and increase of heroin use

Despite readily available information and awareness about practicing safe sex, and avoiding sharing needles, HIV and AIDS cases are on the rise in Kentucky. And the reason, say officials, is ignorance and an increase in heroin use, Mary Meehan reports for the Lexington Herald-Leader. Mark Royse, executive director of AVOL, which serves clients with HIV and AIDS in 72 Kentucky counties, said "his nonprofit routinely offers support services, including housing assistance, to about 400 families affected by HIV and AIDS."

Lauren Kirk, HIV and AIDS outreach specialist for the Lexington-Fayette County Health Department, "said a lot of the people they see are young and were born after the AIDS epidemic was at its lethal peak," Meehan writes. Another specialist, John Moses, told hr that the health department is seeing more young people with HIV. Part of that surge, he said, is from the use of shared needles as heroin use in Kentucky is on the rise." Heroin drug deaths in Kentucky increased by 550 percent in 2012, John Cheves reports for the Herald-Leader.

Another problem is that many people refuse to get tested, because discussion of HIV and AIDS includes talk of sexuality, homosexuality and drug abuse, Meehan writes. Royse told her, "It is a perfect storm of things we don't like to talk about." Royse said "a 'silence-is-better' policy is especially prevalent among Latinos and blacks, who account for the majority of new infections in Kentucky. He's concerned that if people stop talking about HIV and AIDS and become complacent, the infection will continue to spread." (Read more)

The state Cabinet for Health and Family Services, in its annual report from June, 2012, said 8,513 Kentuckians are diagnosed with HIV, with 7031 men and 1,482 women. Most of the cases are in urban areas, with 3,849 in Jefferson County and 1,099 in Fayette County. Of those cases, 4544 are classified as from men having sex with men (MSM), 917 as injection drug users (IDU) and 425 as people who reported to having engaged in both MSM and IDU.

The overall total of HIV and AIDS cases includes 21 boys under 13 years old, 107 between ages 13-19, and 1,269 between ages 20-29. For women, it includes 13 girls under 13 years old, 39 between ages 13-19, and 203 between ages 20-29. (Cabinet graphic: Newly diagnosed HIV cases in 2010 for Kentuckians ages 20-29 years old accounted for 32 percent of all new cases, even though that age group only makes up 13 percent of the total population)

Kentucky ranks 25th in HIV infections. In 2010, the state had 85 new HIV cases for people ages 13-24, accounting for 25 percent of all new cases in the state, which is higher than the national average for that age group of 21 percent. The average age of Kentuckians diagnosed with HIV went down from 37.1 years of age in 2006 to 35 years of age in 2010. To read the full report click here.

'Faces of Lung Cancer' photo exhibit at Markey Cancer Center is meant to spread awareness about disease and its prevention

Lung cancer survivor Juanita Meade

"Faces of Lung Cancer," a photo exhibit with portraits and inspirational messages from nine lung cancer survivors in Kentucky, is on display at the University of Kentucky Markey Cancer Center on the 1st floor atrium of the Combs Research Building, 800 Rose St., until Monday, Dec. 16.

This exhibit was coordinated by the Kentucky Cancer Program to spread awareness about lung cancer and prevention, according to a UK press release.

Lung cancer kills more Kentuckians every year than the next eight most common cancers combined, and Kentucky leads the nation in both lung cancer and deaths from it, and by some estimates also leads in smoking, the leading cause of lung cancer.

An estimated 25 to 28 percent of Kentuckians are smokers, compared to 18 or 19 percent nationally.

Kathy Sinclair, lung cancer survivor

And while tobacco use increases your risk, the UK release notes that anyone can develop the disease: "Lung cancer kills nearly twice as many women as breast cancer, and is the leading cause of cancer deaths for both men and women in the U.S."

Symptoms are generally not noticeable in the early stages of lung cancer, according to UK's Health Education through Extension Leadership newsletter.

Signs and symptoms of lung cancer include:
• Chronic cough
• Hoarseness
• Coughing up blood
• Weight loss
• Loss of appetite
• Shortness of breath
• Unexplained fever
• Wheezing
• Repeated bouts of bronchitis and/or pneumonia
• Chest pain

Life Lessons from Cancer encourages those with cancer to build a network of support

By Melissa Patrick
Kentucky Health News

The fight against cancer requires not only a personal commitment to mind, body and soul; it also requires the support and physical help of family and friends.

That's one of the key messages in Life Lessons from Cancer, a book written by cancer patient Keen Babbage and his sister-in-law and caretaker, Laura Babbage.

Keen, a teacher and native Lexingtonian who has written 17 books about education, said at the first promotional event for the book in October, that he hopes the lessons in this book will be an inspiration and guidance for other patients with cancer as well as a resource for health-care providers.

Kentucky has both the highest rate of new cancers as well as the highest death rate for all cancers in the U.S., according to a report from the Kentucky Cancer Consortium. With a 2013 census report saying 27 percent of Americans live in one-person households, many cancer patients are likely fighting this battle largely alone.

Keen was one of those.

Two days after he was diagnosed with a rare form of nasal cancer, in October 2010, he began an aggressive, three-month regime of radiation and chemotherapy at the University of Kentucky Markey Cancer Center.

His mother died of widespread abdominal cancer after his first round of chemotherapy. As she lay dying, Laura promised her that she would look after Keen.

Here's a video clip of the authors talking about the book at UK:
With great insight, Keen knew he couldn't battle cancer by himself and immediately set about building a network of people who could support him both physically and emotionally. He even enlisted the love and affection of Laura's family dog. "Cancer, we have learned, declares war," Keen said at the promotional event. "It's not a battle, it's a war."

This cancer-fighting network, according to Keen, must not only include family, but also friends and your faith community if you have one. "Put together a network and never let it go, " Keen said at the promotional event.

When building this network, Keen advises in his book that "this is the time to abolish, delete, overlook and eliminate any animosities or disagreements."

Cancer patients' needs are many. Physically, they need help with shopping and food preparation, caring for pets, laundry, cleaning, transportation, making appointments and keeping up with insurance to name a few. Emotionally, they need support that comes with companionship and encouragement.

There are times cancer patients can't leave home or the hospital for long periods; it is in these times that life must come to the patient, Keen writes.  It is only with the help and support of others that this can happen.

You must fight with every possible resource available to you, including prayer. "When someone is praying for you, it means you are not alone," Keen writes.

In response to a question about how to battle depression at the promotional event Keen said, "Small victories.  Hold onto what you believe, hold onto the people you love, eliminate every limit, find something to look forward to that can be done and then realize that it is done with a multitude of people. An individual might feel discouraged, depressed, regret. Surround yourself whenever possible with a lot of people."

Keen and Laura at Bluegrass
10,000 race, July 2011

Laura Babbage is a registered nurse who has worked as a health-care executive and is a chaplain for both UK HealthCare and St. Joseph Hospital.

Laura maintained a website on CaringBridge.com during Keen's treatment to keep family and friends informed of his condition, care and needs. The entries are included in the book and are both forthcoming and explicit. They also offer insight into the role of the caretaker.

"The caretaker needs care as well," Laura said at the promotional event. "Caretakers need to recognize their limits" and put systems in place to make sure the patient is being cared for while also taking care of themselves, she said.

Life Lessons from Cancer offers insight and encouragement to those battling cancer as well as the caregiver. It is full of lessons that not only apply to those who have cancer, but can also be applied to life.

One of the sayings for which Keen is known is his message to his students at Henry Clay High School: "Read. Read More. Keep Reading."

His motto while battling cancer came to him in a card from one of his students: "Fight. Fight more. Keep fighting."

First diabetes educator license is issued in Kentucky

Kim DeCoste (photo via AADE)

Kentucky is the first state to issue a diabetes educator license, according to a press release from the Kentucky Board of Licensed Diabetes Educators.

Kim DeCoste of Richmond, a registered nurse and chair of the Kentucky Diabetes Educators Licensure Board, is the licensee.

"I am proud to represent diabetes educators throughout Kentucky as the first person to receive a license,” DeCoste said. “Kentucky’s legislation assures that the qualifications of diabetes educators have been thoroughly reviewed and that individuals are appropriately credentialed. Improved consumer safety is vital as diabetes care becomes increasingly complex.”

The release said Kentucky passed laws in 2011 to require licensing of diabetes educators in an effort to improve the quality of health care in the state, which has a high rate of diabetes. Ten percent of Kentucky adults, or approximately 370,000, had been diagnosed with diabetes in 2010, according to the latest Kentucky Diabetes Report. An additional 233,000 Kentucky adults have been diagnosed with pre-diabetes, and research from the federal Centers for Disease Control and Prevention has indicated that approximately 27 percent of people with diabetes have not been tested or diagnosed.

Because diabetes is controllable if diagnosed early and managed well, diabetes educators play a vital role in working with people who have or are at risk of developing diabetes and developing a plan of care, the report says.

The American Association of Diabetes Educators define a diabetes educator as “health care professionals—registered nurses, registered dietitians and pharmacists, among others—who specialize in helping people with diabetes understand how to best manage their health.”

UK is first in U.S. to conduct clinical trial for new Parkinson's treatment that shows improvement in all five patients so far

A new treatment strategy for Parkinson's disease at the University of Kentucky could change the way the ailment is treated, manage symptoms better and halt or reverse the progressive degeneration of the brain that comes with the disease, the university announced Monday.

Dr. Craig van Horne demonstrated a deep-brain stimulation
remote control unit on Parkinson's patient Rodney Parsons.
(Lexington Herald-Leader photo by Charles Bertram)

Read more here: http://www.kentucky.com/2013/11/18/2939114/uk-researchers-making-progress.html#storylink=cpy

UK is the first U.S. university to conduct a clinical trial of the strategy, led by principal investigator Dr. Craig van Horne, associate professor of neurosurgery in the College of Medicine, according to a news release from the university.

Parkinson's, a progressive and degenerative disease, affects around 1 million Americans and 10 million people worldwide, according to the release. Symptoms include both motor and non-motor symptoms including tremor, rigidity, slow movement and unstable posture. No cure exists.

The first course of treatment is medication, but any medication loses its effectiveness over time.The second line of treatment is deep brain stimulation, a surgical procedure that works like a "brain pacemaker." Electrodes are surgically implanted into the malfunctioning part of the brain where cells have died to emit electrical impulses to regulate the brain's abnormal impulses, according to the release.

Deep brain stimulation has improved the quality of life for many people with Parkinson's, but while it manages symptoms, it does not change the course or outcome of the disease, according to the release. UK's clinical trial explores an additional treatment option, and possibly a way to alter the course of the disease.

"They are conducting an innovative clinical trial that builds upon the established deep brain stimulation procedure by supplementing it with a nerve graft of patients’ own peripheral nerves," the release says. "The nerves in the brain do not regenerate when they are damaged, but peripheral nerves—nerves outside of the brain and spinal cord—can regenerate." The trial will "aim to use the regenerative capacity of peripheral nerves to allow the brain to heal itself."

The procedure will implant a small piece of a patient's peripheral nerve from just above an ankle. This can be done at the same time as deep brain stimulation, so the patient will get the benefit from both procedures, the release says. The effect of the implant will be tested by simply turning off the deep brain stimulator. The hope is that the peripheral nerve will "stimulate regeneration in the parts of the brain that have been damaged by Parkinson's disease."

So far, five Parkinson’s patients have undergone the combined procedure. The trial calls for six. All five have shown consistent improvement in symptoms and "were able to entirely go off the medication one month later, relying on the deep brain stimulation device to manage their symptoms," the release says. Normally, deep-brain stimulation patients are able to reduce their medication but not eliminate it.

"The patients can have more consistent 'on' times—fewer ups and downs with their symptoms," Van Horne said. "They’re not fluctuating due to meds if they’re just using the stimulation."

The trial has progressed quickly because it uses the patient's own tissue, with no risk of rejection or need for immuno-suppressant drugs, and takes only 30 minutes longer than standard deep brain stimulation.  If successful, this procedure could significantly change the treatment of Parkinson’s disease, the release says, and could have an impact on other neuro-degenerative disorders. To learn more click here.

New guidelines for cholesterol management spark controversy; faulty risk calculator could lead to over-prescribing statins

The American College of Cardiology and the American Heart Association released new guidelines for cholesterol management, a new formula to assess heart attack and stroke risk, and guidelines for lifestyle modifications and weight management to reduce heart attack and stroke risk.

“These guidelines will be helpful to all physicians and their patients, but they will be particularly relevant in Kentucky, where nearly 70 percent of Kentuckians are overweight or obese, we are the third highest state in rates of high blood pressure, five Kentucky counties are among the least active in the U.S. and the incidence of diabetes is above the national average,” Dr. Susan Smyth, director of the Gill Heart Institute at the University of Kentucky, said in an e-mail.

However, some experts have questioned the new guidelines, and the new formula for calculating cardiovascular risk appears to overstate the risk value used to determine who should receive cholesterol-lowering statin drugs.

"There may be no single perfect score that we can use to give statins the 'thumbs up' or 'thumbs down' for our patients without established cardiovascular disease," Smyth said. "Ultimately, physicians have many different tools at their disposal to evaluate CV risk in their patients, and they will review all of the available evidence to make a determination about who may be likely to benefit from statin therapy."

The new guidelines also change how statins should be prescribed. The drugs have been given to lower cholesterol to a specific numerical value, but now it is suggested that moderate to high doses of statins be given to patients who fall within four identified groups of patients who have been determined to get the most benefit from the drug:

• already diagnosed with heart disease or stroke
• with an LDL {"bad" cholesterol) of 190 mg/dL or higher, who may have genetic risk
• aged between 40 and 75, with Type 2 diabetes and high LDL levels, but without heart disease or stroke
• with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75, without heart disease or stroke, but with high LDL levels.  

Instead of focusing strictly on patients' LDL and total cholesterol, the new guidelines suggest physicians treat patients based on their overall risk of heart disease or stroke, of which cholesterol levels are just one part, according to the report.

The guidelines in the report also call for lifestyle modification, including adhering to a heart-healthy diet, which includes vegetables, fruits, whole grains, low-fat dairy, poultry, fish, beans and healthy oils and nuts; 30 to 40 minutes of exercise three to four times a week; avoidance of tobacco products, and maintenance of healthy weight.

The guidelines use a cardiovascular risk calculator that considers age, race, sex, diabetes, smoking habits, blood pressure and low HDL, or "good" cholesterol levels, among other considerations.

But a problem has been identified with the risk calculator, so worrisome that a past president of the College of Cardiology called for a halt to the implementation of the new guidelines, reports Gina Kolata of The New York Times. The calculator appears to overestimate the risk group so greatly, Kolata reports, that it could mistakenly suggest that millions more people should be candidates for statin drugs.

"It's stunning," the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine of the Cleveland Clinic, told Kolata. "We need a pause to further evaluate this approach before it is implemented on a widespread basis."

After an emergency, closed-door meeting on Saturday night, the two organizations that published the guidelines said "that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator," Kolata reports.

Dr Sidney Smith, the executive chairman of the guideline committee, told Kolata that "the association would examine the flaws found in the calculator and determine if changes were needed."

Two Harvard Medical School professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the calculator was not working among the populations it was tested on by the guideline makers a year earlier, during an independent review for the National Institutes of Health's National Heart, Lung, and Blood Institute, which originally developed the guidelines, Kolata reports.

Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University, told Kolata that "the committee thought the researchers had been given these results."

Ridker and Cook evaluated the calculator again after they saw the guidelines and found that it over- predicted risk by 75 to 150 percent, depending on the population, Kolata reports. They wrote in The Lancet, a British medical journal, that the miscalibration be "reconciled and addressed" before implementation, saying: "If real, such systematic overestimation of risk will lead to considerable over-prescription."

Some doctors are concerned that because many people are already "leery of statins, the public would lose its trust in the guidelines or the heart associations," Kolata reports. Currently, it is only obvious that those in the highest risk groups, such as those who have heart attacks, strokes or have diabetes, should take statins, she reports.

Great American Smokeout is Thursday, Nov. 21, featuring supportive characters to share on social media and a Twitter chat

The American Cancer Society's annual Great American Smokeout will be held Thursday, Nov. 21. The event encourages smokers to quit smoking, or make a plan to quit smoking, that day.

Quitting, even for one day, according to the Cancer Society, is an important step toward a healthier life, one that can lead to reducing cancer risk.

In Kentucky, according to the Centers for Disease Control and Prevention, 25.2 percent of adults are cigarette smokers, second highest in the nation. The Kentucky Tobacco and Cessation Program reports that each year more than 8,000 Kentuckians die of illnesses caused by tobacco use.

"Tobacco use remains the single largest preventable cause of disease and premature death in the U.S., yet nearly one in every five adults smoke," the Cancer Society says. It also notes that there are 13.2 million cigar smokers in the U.S. and 2.2 million who smoke tobacco in pipes, which are also dangerous and addictive forms of tobacco.

To celebrate quitters and their supporters, the American Cancer Society has designed a series of characters available to share on social networks. (See characters.)

They are also hosting, with Sharecare, a Great American Smokeout Twitter Chat on Wed., Nov. 20. This event allows you to post questions on Twitter to  @Sharecarenow  about how to quit smoking, smoking legislation or anything on your mind related to smoking.  You can also submit questions on Sharecare’s Facebook page.  The answers from the Cancer Society and other experts will roll out on Twitter at #quitforgood on Thurs., Nov. 21, between 11 a.m. and 4 p.m.

The health benefits of quitting are greater if you quit when you are young, but quitting at any age is beneficial. The Cancer Society lists the benefits chronologically:

• In 20 minutes: your heart rate and blood pressure drop
• In 12 hours: the carbon monoxide level in your blood drops to normal
• 2 weeks to 3 months: your circulation improves and your lung function increases
• 1-9 months: coughing and shortness of breath decrease
• 1 year: your risk of coronary heart disease is cut to half that of a continuing smoker
• 5 years: risk of certain cancers is cut in half, and stroke risk can fall to that of a non-smoker
• 10 years: the risk of dying from lung cancer is about half that of a person who still smokes and other cancer risk decrease
• 15 years: the risk of coronary heart disease is that of a non-smoker

The American Cancer Society is available to offer steps to quit smoking and to provide quit-smoking programs. To learn about the available tools, call 1-800-227-2345.

National Rural Health Day to be held Nov. 21, including webinars on current topics

The third annual National Rural Health Day, which brings awareness to rural health issues and current efforts in addressing these issues, will be observed with events nationwide and special presentations in Sterling Heights, Mich., Nov. 21.

The National Organization of State Offices of Rural Health and all 50 state offices of rural health said in a news release that health concerns of the 60 million rural Americans include: a lack of health care providers; accessibility issues, particularly transportation and technology; and affordability, as the result of higher out-of-pocket costs and other factors.

"Meanwhile, rural hospitals and health systems face declining reimbursement rates and disproportionate funding levels that make it challenging to meet the physical, social and economic needs of their communities," organizers say.

The observance also focuses attention on state rural-health offices, which foster relationships, disseminate information and provide technical assistance that improves access to quality health care for rural citizens, according to the news release.

National Rural Health Day events include several free webinars. Topics, times, and speakers are:

• AgriSafe: Protecting the People Who Feed America (Noon EST) – Natalie Roy, executive director and Carolyn Sheridan, clinical director, AgriSafe Network(Registration: https://www3.gotomeeting.com/register/491563334)
• Rural 101: The Basics of Rural Health (1 p.m. EST) – Kristine Sande, program director, Rural Assistance Center(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=660990830) 
• Population Based Health and Health Promotion in Rural (2 p.m. EST) – Lynda Bergsma, program director, Arizona Center of Rural Health; Caroline Ford, former director, Nevada State Office of Rural Health(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666479151)
• The Affordable Care Act in Rural America (3 p.m. EST) – Tom Morris, associate administrator; Deepti Loharikar, public health analyst, and Aaron Fischbach, public health analyst, federal Office of Rural Health Policy(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=666426441)
• Resources for Recruitment, Networking, and Telehealth (4 p.m. EST) – Mike Shimmens, executive director, National Rural Recruitment and Retention Network; Rebecca Davis, executive director, National Cooperative of Health Networks Association; Kathy Hsu Wibberly, director, Mid-Atlantic Telehealth Resource Center(Registration: https://nosorh.webex.com/nosorh/onstage/g.php?t=a&d=664434416)

The rural health offices' national organization will have a National Rural Health Day press conference and celebration at the National Press Club in Washington at 10 a.m. EST Nov. 21. To learn more about the observance, visit http://celebratepowerofrural.org. Contacts: Bill Hessert at 814-360-1964, billh@nosorh.org; Teryl Eisinger at 586-850-5257, teryle@nosorh.org.

Prescriptions for better health care and health: empowering patients, increasing health education and collaboration

By Melissa Patrick
University of Kentucky School of Journalism and Telecommunications

The importance of empowering patients, increasing health education and collaboration were a few of the topics discussed at the Health Watch USA 2013 Conference in Lexington Nov. 1.

"Patients must be empowered with knowledge" was the primary message of Dr. Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas School of Medical Science and former surgeon general under President Clinton.

“You can’t keep ignorant people healthy,” Elders said. “We must educate our patients or we will continue to have major problems.”

Elders called for doctors to fight for comprehensive health education, everyone must be involved – the schools, the Internet, social media – and said that as a country we need to embrace comprehensive health education instead of being afraid that all discussions will lead to sex.

Patients have a responsibility to ask questions about their health care, Elders said, and if people are better educated in health care they will have a better idea of what to ask.

Karen Meyers, who works with catastrophic-injury victims and health-care providers, shared the story about her elderly mother who was critically injured during a fall; the doctor said she was terminal. Meyer persuaded the physicians to try to save her critically injured mother eight years ago, and that spurred her passion for the importance of patient and family-centered care. She attributes her mom’s recovery to doctors who listened to her and excellent nursing care.

 “Patient and family centered care,” Meyers said, “is based in dignity, respect, information sharing, participation and collaboration. We must teach doctors collaboration and that the patient and family are part of the team. We are not a threat. We are not ignorant. We should not be dismissed.”

Meyers went on to say that “The home care agency of the future is the patient, the family and the support systems. We have to have a support system that works and we have to include them.”

Elders also talked about collaboration between physicians. She said they need to provide integrated, comprehensive and transparent care because when a patient is seen on the same day by a team of specialist, they receive better care and experience better outcomes.

Martha Deed, a retired psychologist and a member of the Consumers Union Safe Patient Project's patient safety advocates network, was a seasoned patient advocate for her daughter, Millie Niss. who had Behcet's disease, a chronic disorder of the blood vessels.  Millie was hospitalized with a severe case of swine flu in 2009, coding within one hour of arrival at the hospital, and died less than a month later.

While in the hospital, Deed and Niss documented everything.  They voiced their concerns, followed the proper channels of communication, documented faulty medical equipment, found inaccuracies in nursing and doctor reports and requested test.  Despite this high level of advocacy, Millie died.

Millie's autopsy revealed a missed diagnosis that might have saved her if it had been discovered and treated, Deed said. She has since applied her research skill to investigate both the specific medical as well as hospital culture/system causes of her daughter's death. Her goal is to prevent future premature deaths in the hospital. "Patients and families very much need to be listened to," Deed said.

Elders offered advice on how to be an empowered, health literate patient:
• Take a trusted person with you when you go to the doctor
• Ask questions, write them down before you go to the doctor
• Bring all of your medications with you to each doctor visit
• Ask the doctor to write down suggested actions and medications
• Let your doctor know if you have vision and/or hearing problems
• Ask your doctor about the results of your test and what they mean

“Our health care system is presently physician centered, but patients need to be involved,” Elders said. “The largest health care work force that we are going to have is our own patients. We need to push for education.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

KET offers program about diabetes prevention and control

KET's "Connections with Renee Shaw" is offering a program about diabetes prevention and control on KET2 Friday, Nov. 8 at 5 p.m. and KET Sunday, Nov. 10 at 1:30 p.m.

This programming could not be more timely, since Kentucky, along with parts of Appalachia and the Deep South, is part of the nation's Diabetes Belt. Diabetes rates are 11 percent or higher in many counties, and as much as 25 percent of Kentucky's Medicaid budget goes towards treating the complications of type 2 diabetes, according to the program guide.

Experts will discuss statewide education and prevention methods and the changes individuals can make to avoid diabetes.

This show will explain the difference between type 1 and type 2 diabetes, the function of the pancreas and insulin, and the role that diet and exercise play to help control diabetes complications and even prevent the onset of diabetes.  It will offer personal stories of people who are living with diabetes, explain the concept of pre-diabetes and how to prevent it, and discuss specific ways we can help resolve this growing problem.

Program guests include Dr. Raymond Reynolds, professor of internal medicine, endocrinology fellowship program director, and director of the Barnstable Brown Diabetes and Obesity Center at the University of Kentucky; Theresa Renn, coordinator of the Kentucky Diabetes Prevention and Control Program; Tami Ross, a registered dietitian, certified diabetes educator, and nationally recognized speaker and health and nutrition writer; Stewart Perry, a Lexington insurance broker who has been living with Type 2 diabetes for more than 20 years and is a policy advocate on the state and national level for the Kentucky Diabetes Prevention and Control Program and the American Diabetes Association.

Information session on state health insurance exchange to be offered at Paducah Thursday, Nov, 7

The Kentucky Health Benefit Exchange will present an information session and allow time for questions about Kentucky's online health insurance exchange, KYnect, Nov. 7 at the West Kentucky Community and Technical College in Paducah from 11 a.m. to 1 p.m.

This event is geared toward health-care providers, administrators, directors, community agencies, coalitions, Kynect navigators, mid-level managers, front-line staff and other health-care workers.

Bill Nold, deputy director of the exchange, will present this program, sponsored by the University of Kentucky Center of Excellence in Rural Health, the Kentucky Office of Rural Health, the Purchase Area Health Education Center and the Western Kentucky Rural Health Network.

The event is free, but pre-registration is required because seating is limited. Contact Alice Combs, Kentucky Office of Rural Health, alice.combs@uky.edu, or call 606-439-3557, ext. 83703.

Anthem gift will let Kentucky Homeplace expand diabetes self-management and education project to counties in Western Ky.

Kentucky Homeplace has been awarded a second gift of $150,000 from the Anthem Foundation to continue its diabetes self-management education project in Appalachian Kentucky counties that have high rates of diabetes but lack providers to help address it.

With this gift, Kentucky Homeplace community health workers can continue work to improve diabetes outcomes in Appalachia through a Diabetes Self-Management and Education program, which are designed to help people better manage their diabetes through improved self-testing and lifestyle changes, says a release from the University of Kentucky Center of Excellence in Rural Health.

DIABETES BELT (CDC map)

Sixty-eight of Kentucky's 120 counties are included in the “Diabetes Belt” of the rural Southeast, counties in which 11 percent or more of adults have been diagnosed with having diabetes, compared to the national average of 8.5.

In these areas, about a third of the excess risk of becoming diabetic is associated with risk factors that can be modified, such as sedentary lifestyle and obesity, says the Centers for Disease Control and Prevention.  In Kentucky, the number of certified diabetes educators in these counties is much lower than in other areas of the state, the UK release says.

The first study, in Eastern Kentucky, showed more glucose testing by patients and lower measures of hemoglobin A1c, the key indicator of diabetes. The new grant will let Kentucky Homeplace expand to include parts of Western Kentucky and enroll more than 300 additional participants.

Kentucky Homeplace was originally developed in 1994 by the UK Center for Excellence in Rural Health as a demonstration project. It now gets state funding and has worked for two decades to provide tens of thousands of rural Kentuckians with medical, social and environmental services they might not have had otherwise, says the release.

Study shows talking with college students about binge drinking makes them think about it

College students who hear warnings about binge drinking from family or friends are more likely to be concerned about their own alcohol use, compared to those who don't hear this advice, a new study indicates.

The study found that students who were not distressed about their binge drinking had not heard concern expressed to them about their alcohol consumption.

“On the other hand, when a friend or family member expressed concerns to a student about her or his excessive drinking, it can help the student reflect on their alcohol consumption and begin to take steps to reduce it,” said lead researcher Jeffrey Hayes, professor of counseling psychology in Penn State's College of Education, in a news release.

Despite the negative consequences of binge drinking, about 80 percent of college students drink alcohol, and about half of those who drink engage in binge drinking, says the National Institute on Alcohol Abuse and Alcoholism. Hayes said more than half of college students who sought counseling reported drinking alcohol at a level considered to be “hazardous” by the World Health Organization.

As a psychologist, Hayes often hears about the negative effects of binge drinking on students' academic performance and emotional and physical well-being. "I am aware of and concerned about the ingrained culture of binge drinking among adolescents," he said in the release.

Results of this study can help inform professionals who work with college students to encourage student engagement through outreach programs, and it also raises awareness for family and friends of those who may abuse alcohol, said Hayes. (Read more)

Community-based solutions to childhood obesity show signs of progress elsewhere; will Kentucky pick up on them?

By Molly Burchett
Kentucky Health News

For decades, researchers reported with alarm the increasing trend of overweight children in America, with one in three kids on the way to developing Type 2 diabetes. Across the country, action has been taken to address this problematic trend, and now some preliminary, scattered results indicate that obesity rates have plateaued or dropped in some areas. Is Kentucky part of this success, and if not, will it learn from it?

The first set of positive signs came last year, with falling child obesity rates in New York City and Philadelphia, reports Lydia DePillis of The Washington Post. And, a recent Robert Wood Johnson Foundation brief shows similar progress in states with a large rural population as well:

• Mississippi posted a decrease from 43.9 percent of kids being overweight and obese in 2005 to 40.9 percent in 2011, three years after passage of the Mississippi Healthy Students Act. 
• In North Carolina, Vance and Granville counties saw significant declines after implementing healthy living programs based on the Centers for Disease Control’s community guide.
• Kids in Kearney, Neb., in grades one through five saw a 13.5 percent decline in obesity rates between 2005 and 2011.
• West Virginia fifth graders posted a 8.6 reduction in obesity rates over a six-year period.

Overall, progress was made through community-based solutions, including changes to make healthy foods available in schools while eliminating fried foods and working to integrate physical activity into people's daily lives while educating them about the importance of doing that, says the brief.

Kentucky, which suffers from one of the highest childhood obesity rates in the country, could learn from these successful programs. The state ties Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent) and has the third highest percentage of children ages 10 to 17 who are obese (21 percent), compared to 16.4 percent nationally, says a report by Kentucky's Task Force on Childhood Obesity.

The Kentucky General Assembly has not enacted legislation regarding healthy eating and physical activity like many other states, notes a National Conference of State Legislatures report, but established a task force that made various recommendations to the legislature in September for strategies that address the problem of childhood obesity and that encourage better nutrition and increased physical activity among Kentucky children.

Some of the task force's recommendations include: requiring schools to improve nutritional content of school food, including promoting the use of school gardens, adopting a statewide standard for physical activity initiatives and nutrition education in schools and encouraging physical activity through a coordinated school health program. To view that report, click here.

Kentucky has no requirements for physical activity in schools. About 65 percent of Kentucky's youth did not attend physical-education classes in 2010, and 80 percent did not attend such classes five days per week, says a 2011 Center for Disease Control and Prevention survey.

However, the state does have several programs to promote physical activity or healthy eating. They includes the Farm to School program, which has been adopted by 1,243 schools and 174 school districts and is a collaborative effort between federal and state agencies to bring local agricultural products to schools and to educate students about local food production, says the report.

Using the success of other state programs and existing Kentucky programs as a guide, Kentuckians and "the members of the Task Force on Childhood Obesity are encouraged to continue their advocacy efforts to address Kentucky’s health crisis in ways that have the greatest likelihood of preventing and reversing chronic diseases associated with childhood obesity," says the report.

Ky. Rural Health Association seeks nominations by Aug. 20 for annual award honoring health service to rural Kentuckians

The Kentucky Rural Health Association is seeking nominations for this year's recipient of the Dan Martin Award, an annual honor for an individual who has provided many years of service to rural Kentuckians through direct patient care, health professions education, health administration, health promotion or public advocacy.

This award is named for its first recipient, in 2003, Dr. Dan Martin of the Trover Foundation in Madisonville. Susan Starling, CEO of Marcum and Wallace Memorial Hospital in Irvine, received the award last year, honoring her dedication and compassionate work for rural health in Kentucky.

Nominations will be received until Aug. 20. The award will be presented at the KRHA Annual Conference Sept. 26-27 in Bowling Green. To nominate someone, please complete this form and e-mail to lmashe2@uky.edu.

Employers welcome delay in coverage mandate, but individual mandate remains and many uninsured people are unaware of it

By Molly Burchett

Kentucky Health News

The Obama administration's decision to delay, for a year, the health-reform law's mandate that employers of more than 50 workers offer them coverage could jeopardize the success of the law -- which already faced several challenges.

The linchpin holding the wheels of "Obamacare" together is an individual mandate, which remains in effect. Millions of people must sign up for insurance coverage -- especially those who are healthy. About 50 million, including 640,000 Kentuckians, who haven't bought or been able to buy health insurance will have to do so or pay a tax penalty, unless they qualify for the expanded Medicaid program.

The delay in the employer mandate could reduce the number of uninsured people who will use state-based insurance exchanges to shop for insurance coverage starting Oct. 1, said Sara Rosenbaum, a professor of health law and policy at George Washington University and an advocate of the law. A White House spokeswoman disputed that, but Obama and his allies face four other broad challenges in implementing the law, as outlined in a recent Politico story by Jason Millman and Joanne Kenen:

1. Uninsured don't know they must get health coverage or pay a tax penalty

Many people know about Obamacare, but a large percentage of the uninsured do not know that they will soon be required to buy coverage, according to the most recent Gallup poll:

2. Middle-class and low-income Americans don't know about subsidies

Another part of the Obamacare message that hasn't yet gotten through to millions of Americans, at least those who need to know, is that the law offers subsidies for coverage, based on income. The challenge is that this message must get to a hard-to-reach population without inflating the law's benefits, Millman and Kenan write. And, many of those who qualify for Medicaid or subsidized coverage are low-income, may not speak English well, or may know little about health insurance.

On top of these obstacles, there can't be a consistent, nationwide message because the coverage criteria is different for states like Kentucky that aren't using a federal health insurance exchange. Kentuckians can visit the exchange website, Kynect, to see if they qualify for special discounts or tax credits to help cover the costs of coverage. For example, the website indicates that a family of four making $48,000 a year will get an estimated $252-per-month tax credit for buying insurance. For a PDF fact sheet about payment assistance, click here.

3. Appealing to young invincibles and businesses

For the new system to work, it is critical that young, healthy people buy insurance to cover the cost of care for older and sicker individuals and keep overall premium costs down. Many young people don't know what an insurance premium or co-payment is, and many don't think they need health coverage. Still, Obama administration officials have said they’re hoping 7 million people sign up for private insurance through exchanges in the first year, including 2.7 million young adults.

The delay in the employer mandate came as a relief to many employers who say it will put their businesses at the brink of survival. But the requirement has only been delayed to 2015, not repealed. Before the delay, some companies with payrolls slightly above or below the 50-employee threshold said they would cut or keep their number of full-time workers below that figure to avoid providing coverage.

Many businesses with 50 or fewer employees don't know they won't be penalized for not offering health coverage and that they can get tax credits for providing it. Kentucky businesses can use Kynect to buy coverage if they have 50 or fewer employees. Significant tax credits may be available through the site for businesses that have fewer than 25 employees with an average annual salary under $50,000; the employer must pay at least 50 percent of the premium for each employee. See the chart below or click here for more details.

4. Threats to public messaging campaigns from the opposition

While the success of Obamacare may depend upon public awareness and outreach efforts, the efforts of those opposing it create additional challenges for supporters. Many Republicans used the delay announcement to advance the cause of overall repeal or delay of the individual mandate. House Speaker John Boehner said, “I hope the administration recognizes the need to release American families from the mandates of this law as well. This is a clear acknowledgment that the law is unworkable.”

Senate Republican Leader Mitch McConnell of Kentucky said, “The White House seems to slowly be admitting what Americans already know, and what I hear consistently in my travels around Kentucky regarding the regulatory burden on employers.”

On the other hand, former White House health policy adviser Ezekiel Emanuel said on MSNBC’s "Morning Joe" that the delay of the employer mandate will affect a relatively small number of companies and is no big deal. The provision only applies to about 200,000 employers who have 50 or more employees working full-time (which the law defines as 30 hours or more a week), he said, and “94 percent already offer health insurance.”

Free HIV testing available from health departments and community-based health groups in June; key to AIDS prevention

In honor of National HIV Testing Day on June 27, community-based organizations and local health departments are hosting free HIV testing throughout the month of June. HIV is an infection that can lead to AIDS, and early screening and detection of HIV are critical to fighting the disease, avoiding further health complications and ensuring it isn't unknowingly transmitted to others.

“Routine testing ensures HIV-positive individuals are made aware of their status early before the disease progresses to AIDS,” said Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, which is promoting the HIV testing and awareness events through mini-grants. “Testing remains one of the most critical and effective strategies for preventing transmission, ensuring good health outcomes, keeping service costs low and keeping infected individuals healthy.”

About 20 percent of people with HIV don't even know they are infected, which is very problematic because these individuals are believed to transmit HIV to more than half of the people who become newly infected each year, and one-third of the people is diagnosed so late that they develop AIDS within one year, says the federal Centers for Disease Control and Prevention.

In 2010, 32 percent of Kentucky's 7,751 HIV cases led to an AIDS diagnosis within 30 days of the initial infection, says a Cabinet for Health and Family Services release. This highlights the importance of routine testing, which the CDC recommends for everyone, regardless of risk factors, especially for all people age 13 to 64.

"A delay in diagnosing HIV is a life and death issue, with many individuals receiving a concurrent diagnosis of HIV/AIDS upon initial testing. Early intervention and linkage to care is critical to enhance the quality of life and reduce costs for treatment,” said Gayle Yocum, HIV/AIDS prevention section supervisor, in the CHFS release.

In Kentucky, HIV disproportionately affects racial minorities, particularly the African-American and Hispanic populations. Although African-Americans represent 7 percent of the state’s population, they account for 34 percent (2,884) of new HIV infections. Individuals who are at a higher risk for infection should be tested at least annually, including those with multiple sex partners, injection drug-users and their sex partners, people who exchange sex for money or drugs, men who have sex with men and sex partners of someone with HIV, says the CDC.

Kentucky testing sites

The Department of Public Health's statewide network of HIV testing sites provide risk reduction counseling and helps individuals develop a behavior-change plan to reduce the risk of getting or spreading HIV. Here's a list of the statewide events providing free HIV rapid testing in the next two weeks:

◾ June 17, free testing and education, 10:30 a.m. to 2 p.m., Salvation Army of Bowling Green, 400 W. Main Ave., Bowling Green.
◾ June 20, afternoon gospel fest, noon to 5 p.m., New Beginnings Church, 4127 Flintlock Drive, Louisville.
◾ June 22, church health fair, 10 a.m. to 5 p.m., Faith Fellowship, 727 S. 15th Street, Louisville.
◾ June 25, free testing, 11 a.m. to 3 p.m., 2106 St. Louis Ave., Louisville.
◾ June 28, free testing and education, 10 a.m. to 3 p.m., Housing Authority of Bowling Green, 247 Double Springs Road, Bowling Green.
◾ June 28, neighborhood test fest, 10 a.m. to 4 p.m., Nia Center, 2900 W. Broadway, Louisville.
◾ June 29, free testing, 11 a.m. to 1 p.m., Walgreens, 110 Town Center Dr., Lexington.
◾ June 29, free testing, 11 a.m. to 1 p.m., Crossings, 117 N. Limestone, Lexington.
◾ July 3, free testing, 8 p.m. to midnight, The Bar Complex, 224 E. Main Street, Lexington.

Click here for more information about HIV and AIDS, about the National HIV Testing Day/Month Campaign or other programs and services.

Covington schools show 'Fitness Rocks' by lowering body mass, lifting the bars of nutrition, wellness and academic achievement

Sparks are flying in Covington Independent Schools. The schools' Fitness Rocks program, which combines fitness and wellness activities in an after-school program four or five days a week to create a healthier community for students, is the reported cause of fire.

The district's after-school student activities are based on the SPARK (Sports, Play and Active Recreation for Kids) curriculum for out-of-school-time, and the district reports great success since the program launched three years ago.

Since then, students' body mass has shrunk 4 percent, and there has been a 6 percent increase in the number of students who engage in at least an hour of daily physical activity and the number of students eating fruits two or more times a day, and vegetables three or more times a day, reports Julie Wohlleb of the Kentucky School Boards Association.

Students in Fitness Rocks also saw a greater increase in their math and science MAP (Measure of Academic Progress) scores than students not participating. “It’s been demonstrated how students who are active 60 minutes or more a day have increased academic success,” Haggard told Wohlleb.  

The program is also being used for professional development for physical education teachers, and "The SPARK curriculum has been really helpful in giving our fitness coaches and PE teachers ways to get all kids engaged no matter their skill level,” Haggard told Wohlleb.

The district started Fitness Rocks three years ago at each of its seven schools through a Carol M. White Physical Education grant from the U. S. Department of Education. The program encourages a range of activities to keep students active, from playing flag football to video games, and so far, 55 percent of elementary students and 19 percent of high school students across the district have participated in the program this year.

In addition to after-school activities, Fitness Rocks provides healthy snacks and sponsors family nights at every school that focus on fitness, wellness and nutrition, and program coordinators are witnessing changes in health behaviors across the district. “We’ve been really working hard, especially this year, at finding a sustainability model because it has been so impactful for the community and parents and students alike; they just love it,” Haggard said. (Read more)

UK HealthCare hosts 'Women, It's About You' conference June 1

On June 1 UK HealthCare will present its fifth annual "Women, It’s About You" conference, which is designed to educate women with the most up-to-date information about health topics ranging from mammograms to nutrition to financial abuse.

This year's conference will feature 15 presentations on the following women's health topics:

Menopause, presented by Dr. Kathy Dillon 

Memory and aging, presented by Dr. Gregory Jicha 

Women's heart health, presented by Dr. Susan Smyth 

Eye health, presented by Dr. Eric Higgins 

Physical fitness, presented by Richard Watson 

Gynecologic cancer, presented by Dr. Lauren Baldwin 

Financial abuse of women, presented by Susan Lawrence 

Weight loss, presented by Dr. Stephanie Rose 

Skin care and cosmetic procedures, presented by Dr. Amit Patel 

Stroke, presented by Lisa Bellamy 

Diabetes, presented by Sheri Legg and Beth Holden 

Nutrition, presented by Rachel Miller 

Mammography, presented by Dr. Margaret Szabunio

Pelvic Prolapse, presented by Drs. Rudy Tovar and Mark Hoffman.

Participants will have the opportunity to participate in a variety of health screenings, including blood pressure and stroke-risk assessment, says a UK HealthCare press release. The event, which will take place at the Embassy Suites hotel on Newtown Pike in north Lexington, costs $10 and also includes a continental breakfast, a luncheon with entertainment, giveaways and an exhibitor fair. Click here for more information or to register by the Friday, May 17 deadline.

CaldWELL County group campaigns for smoking ban

A committee dedicated to the wellness of Caldwell County, which makes the most of the county's name, is pushing for a smoking ban. The CaldWELL Committee's internal acronym stands for Wellness Education through Local Leadership, and members did some of that Tuesday when the group asked the county Fiscal Court for an ordinance banning cigarette smoking indoors in public buildings. The group was joined by representatives from the local health department, housing authority, Extension office, law enforcement, education, emergency services, mental health, senior services and other public and private agencies, reports Jared Nelson of The Times Leader.

The committee has been collecting survey data from residents about their health perceptions and needs. Their request to the fiscal court is a direct result of that data, said Allison Beshear, health educator and public information officer with the Pennyrile District Health Department. In Caldwell County, about 27 percent of adults are identified as smokers. That number is down from 34 percent reported in the results of a 2008-10 survey. The Times-Leader is behind a paywall. To credit an account, go here.