March 24 is World Tuberculosis Day; 71 Kentuckians got the airborne disease last year

March 24 is World Tuberculosis Day, an observance meant to spread awareness about the disease, which is the second leading cause of death worldwide after HIV/AIDS. The Centers for Disease Control and Prevention estimate about 2 million people die each year from TB.

"Many people assume that TB is no longer a concern in this country, but we continue to see cases each year — in Kentucky and around the U.S.," said Steve Davis, acting commissioner of the state Department of Public Health. "While public health has made great strides in preventing the spread of the disease, our work continues."

In 2011, 71 active TB cases were diagnosed in Kentucky, though the state falls below the national average of 3.6 cases per 100,000 people.

TB is an airborne disease, transmitted when an infectious person coughs, shouts, sneezes, speaks or sings. It generally attacks the lungs, but can affect any part of the body, including the kidneys, spine and brain. If left untreated, the disease can be fatal.

People exposed to TB can also get a latent TB infection, which has no symptoms but can still be spread to others. That infection can progress into full-blown TB. Symptoms include coughing up blood, loss of appetite, chest pain and fatigue. (Read more)

Number of teens and young adults who smoke, use smokeless tobacco is on the rise

A "shocking" number of American teenagers smoke cigarettes and/or use smokeless tobacco, the first U.S. surgeon general's report on youth tobacco since 1994 has found. (Photo by Karen Bleier, AFP/Getty Images)

"The numbers are really shocking," Surgeon General Regina Benjamin said, noting the data show 1 in 4 high school seniors and 1 in 3 young adults under age 26 smoke. "It's a problem we have to solve."

Though there was dramatic progress in reducing youth smoking rates from 1997 to 2003, the 899-page report shows the decline has flattened. "Smokeless tobacco is up among white high school-age boys, and cigar smoking appears to be rising among black high school girls," reports David Brown for The Washington Post.

Data from the 2010 Kentucky Youth Tobacco Survey show that almost 25 percent of the state's high-school students are smokers. Although the prevalence of smoking among youth has declined in the past few years, the smoking prevalence among teenagers and young adults is higher than among other adult populations.

"Two people start smoking for every one who dies from the habit each year," Benjamin said. "Almost 90 percent of those 'replacement smokers' first try tobacco before they are 18."

The findings showed smoking can damage lung function at a very young age. One study of "nearly 700 children from East Boston found that those who started to smoke at age 15 exhaled 8 percent less air in one second — a key measure of lung function — than non-smoking teenagers. The growth of lung capacity stopped a year earlier in smokers — at 17 in girls and 19 in boys — than in non-smokers," Brown reports.

Another study showed how smoking affects the cardiovascular system. Researchers looked at autopsy results of white men ages 25 to 34 who were killed either by trauma or homicide. Smokers were two times as likely to have advanced damage of the abdominal aorta as non-smokers. "They also had somewhat greater damage to the blood vessel most often implicated in acute heart attacks," Brown reports.

Danny McGoldrick of the Campaign for Tobacco-Free Kids told USA Today's Wendy Koch tobacco marketing "is a big cause of the problem." He pointed to his organization's report revealing the tobacco industry's relationship with convenience stores to blatantly advertise and display tobacco products.

The industry's success in fighting increases in tobacco-related taxes is considered to be another factor. But industry officials like Ken Garcia of Altria Group, parent company of Philip Morris USA, said "there's already quite a (tax) burden on adult smokers." (Read more)

Expect more hospital mergers across the country, some with unlikely partners, Moody's Investors Service report predicts

Reflecting several hospital mergers that have already taken place in Kentucky, a new report from Moody's Investors Service predicts hospitals will continue to band together across the country as they respond to changes in health care.

"The difficult business environment and the changes expected in how hospitals will be paid for delivering care are driving many smaller, stand-alone hospital groups into the arms of larger and better-financed organizations," reports Reed Abelson for The New York Times.

Hospitals have long looked for partners to become larger in order to have more negotiating power to ask for higher payments from insurers. But now they are looking at ways to become more efficient too as they expect lower reimbursements from Medicare because of federal health-care reform. That means more consolidation, Moody's says.

While there are traditional mergers in play, there are also more atypical alliances forming. One of the nation's largest nonprofit hospital groups, North Shore-LIJ Health System, will join with Hackensack University Health Network in New Jersey, for example. There are instances of for-profit hospital groups joining with private equity firms. Health insurance companies could even become buyers, and hospitals and doctors could join forces "so they can be more of a one-stop shop," Abelson reports.

As a result, patients will ultimately have fewer hospitals from which to choose, but some small, stand-alone hospitals, especially in rural areas, will still exist. "We're not going to predict the small independent hospitals will all shutter and close," said Lisa Goldstein, one of the authors of the report. (Read more)

Storm victims need to be vigilant about avoiding tetanus and mold, and protecting food safety

As storm and and flood cleanup continues, Kentuckians need to be vigilant about tetanus, mold and food safety, the state Department for Public Health warns.

Regarding tetanus, the DPH recommends avoiding contact with flood waters, which can be a risk for contracting the disease for people who have open wounds.

Mold can develop in homes that have been flooded, but air conditioners or dehumidifiers can help prevent mold growth, the DPH advises. When cleaning affected areas, wear safety goggles, rubber boots and waterproof gloves. In areas of heavy mold growth, a respirator or suitable mask is advised.

The DPH recommends removing all items that have been wet for more than 48 hours and cannot be dried or cleaned. Mold can be removed from hard surfaces using cleaners, soap and water or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Severe cases should be cleaned by experts.

When it comes to food safety, a full freezer will keep its temperature for 48 hours. A freezer that is half full will maintain its temperature for 24 hours. Refrigerated foods are safe as long as the power is not out for more than four hours. Any perishable food that has been above 40 degree for more than two hours should be discarded.

Freezer and refrigerators should be cleaned with a solution of 2 tablespoons baking soda dissolved in 1 quart of warm water. (Read more)

What's the status of a health insurance exchange in Kentucky?

By Tara Kaprowy
Kentucky Health News

At the end of February, Kentucky received $57.8 million in federal funds to help set up a health insurance exchange or marketplace under federal health-care reform. Officials say all the money will be used to plan for a potential exchange, even though lawmakers have made no move to introduce legislation to create one.

Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services, said Kentucky has hired a planning vendor "to develop a list of detailed requirements and a potential operating model that is specific to Kentucky's information systems environment."

The exchange is meant to act as a marketplace in which individuals and employees of small businesses can shop and compare several plans that have coverage packages pre-approved by the state and federal governments. Medicaid recipients will also be able to get their insurance from the exchange. Right now, it has not been decided what plans will be offered, Midkiff said. It's also unknown if the plans in the system will be available to everyone or if there will be some plans only available to Medicaid recipients and some only for individuals who qualify.

Who would qualify? People with an income of up to 133 percent above the federal poverty level — now $14,404 for individuals and $29,326 for a family of four — will qualify for Medicaid starting in 2014. Also, the federal government will give subsidies to help Americans whose income is up to 400 percent above the poverty level. With them, they must buy private coverage through the exchanges.

Kentucky has until Jan. 1, 2013 to create a state-based exchange. If lawmakers do not introduce and pass legislation that will create an exchange, the state has two options. It can allow the federal government to operate the exchange or Gov. Steve Beshear can issue an executive order to create one. Beshear "has taken a wait and see approach to exchange planning, neither explicitly endorsing nor refusing to implement a state-run exchange," reads a state-exchange profile put together by the Henry J. Kaiser Foundation.

Kentucky started planning for an exchange in September 2010 and received a total of $8.6 million to do so prior to receiving the $57.8 million grant. Midkiff pointed out most of the activities for this latest grant "must be completed regardless of whether the state or federal government operates the exchange."

Last September, state officials said the delay in setting up an exchange was largely because the federal government had not decided what benefits needed to be offered in the exchange. In December, the Obama administration put the onus on states to come up with their own regulations pertaining to what benefits insurance companies have to offer. When asked if the change has allowed Kentucky to move forward, Midkiff said the Cabinet for Health and Family Services is working with the Department of Insurance to review the new dictate.

While the state does not have an estimate of how many people will use the exchange, Julia Costich, chair of the Department of Health Services Management at the University of Kentucky, said her research shows about 400,000 Kentuckians will be eligible for federal subsidies. After coverage expands, she estimates about 1.1 million Kentuckians will be eligible for Medicaid.

So far, 30 states and the District of Columbia have received grants to set up exchanges. Of those, only 13 and D.C. have adopted a plan for how to proceed.

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

More young kids going under anesthesia to fix bad dental problems

Preschoolers are increasingly having to undergo extensive surgery to get fix the cavities they've gotten from lack of brushing, get root canals or have teeth extracted.

Five years ago, the Centers for Disease Control and Prevention found the number of preschoolers with cavities had increased — the first time that had happened in 40 years. "Dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more," reports Catherine Saint Louis for The New York Times. "The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake." (Times photo by Stuart Isett)

"We have had a huge increase in kids going to the operating room," said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. "We're treating more kids more aggressively earlier."

Causes for the increase can be linked to lots of snacking and juice or other sugary drinks before bedtime; kids drinking bottled water rather than tap water; a lack of knowledge that infants should go to the dentist by age 1 to be assessed for cavity risk.

Parents can sometimes confused dental decay with teething and don't realize there is a problem until teeth break or the pain becomes so bad the child cannot sleep. (Read more)

Bill passed that would require fingerprint background checks at nursing homes

The state House has approved a bill requiring long-term care facilities to run background checks using fingerprinting technology, a move that would be mostly funded by a $3 million federal grant. The state will kick in $1 million.

The House approved the measure 62-36, though many lawmakers are worried about who is going to pay for the effort when the grant runs out in three years. Background checks cost between $60 and $80.

Now, long-term care facilities must "do a name-based background check," reports Beth Musgrave for the Lexington Herald-Leader. "However, those background checks only look at state records. A fingerprint check can search nationally for criminal records."

Rep. Carl Rollins, D-Midway, said he was unsure if House Bill 250 will pass in the Republican-controlled Senate. (Read more)