Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

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

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)

Norton Healthcare implements a mobile application that allows doctors to monitor patients, especially expectant mothers

 

Norton Healthcare is the first health-care provider in Kentucky to implement a patient monitoring system that allows obstetricians to monitor expectant mothers while they're in labor via the physician's smart phone or tablet. The real-time application uses wave-form technology and works with iPhones, Androids, BlackBerrys and a variety of Windows Mobile devices. Its use has been cleared by the U.S. Food and Drug Administration.

The implications are vast for doctors in busy urban settings as well as for those in rural areas where doctor shortages may limit a physician's personal attention to individual patients. According to Norton Healthcare press materials and their obstetrician spokesperson, Dr. Reed Netter, the application allows the doctor to view "the same patient information that he or she would see at the patient’s bedside, looking at the monitor for heartbeat, contraction patterns, or signs of distress." This could save valuable time when a fetus is in trouble or if nurses see something that worries them.

The applications of the technology are evident for use in ambulances, in intensive care units, operating and emergency rooms, said Steve Heilman, Norton's system vice president and chief medical information officer for Norton Healthcare. (Read more)

UK medical center is fifth in the nation to be recognized for out-of-body respirator help for babies, children and adults

Because they use extracorporeal (out-of-body) membrane oxygenation, or ECMO, to support patients, the University of Kentucky's Albert B. Chandler Hospital and Kentucky Children's Hospital have been awarded a triple designation from the Extracorporeal Life Support Organization. UK is just the fifth medical center to receive the triple-designation honor, reports UK's Allison Perry. (UK photo)

ECMO uses an artificial lung device that gives "cardiac and respiratory support to patients whose heart and lungs are so severely damaged that they can no longer function," Perry reports. "It can also serve as a bridge to transplantation, allowing patients to not only survive, but to become stronger and healthy enough to undergo the transplant surgery." The technique is used on neonatal, pediatric and adult patients, hence the triple designation.

"This designation is another example of the expertise and advanced technology available for neonatal to adult patients who require complex care that can only be provided at top academic medical institutions," said Dr. Michael Karpf, UK's vice president for health affairs. (Read more)

Comprehensive series looks at new angle of prescription pain pill epidemic: addicted newborns

The Courier-Journal's health reporter, Laura Ungar, is again delving into the prescription pain-pill epidemic in Kentucky, this time focusing on babies who are born addicted. For any reporter interested in writing stories about prescription pill addiction and the scope of the problem — stories that could be localized in every county in the state — Ungar's award-winning work is the place to start researching.

In a four-page piece, Ungar looks at:
• the limited options available to addicted moms
• the lack of funding available to fix the problem
• what to do for loved ones with a prescription drug problem
• the causes, symptoms and treatment for newborn addicts

There are also links to more recent stories pertaining to the issue here.

Ungar found hospitalizations for addicted newborns increased from 29 in 2000 to 730 last year, when there was a big jump. "It's a silent epidemic that's going on out there," said Audrey Tayse Haynes, secretary of the state Cabinet for Health and Family Services. "You need to say: 'Stop the madness. This is too much.'"

Nurse Tonya Anderson, an infant development/touch therapist at Kosair Children's Hospital, said she's seen as many as 14 of 26 babies in the special-care nursery where she works suffer from symptoms of withdrawal. "They are just agitated," she said. "They are screaming. They have tremors. Their faces — you have to grimace. They're in pain."

Those close to the problem say there is not enough treatment for addicts who are pregnant. But it's an investment worth making, Ungar suggests. One study showed the health-care costs for addicted newborns was $720 million in 2009, up from $190 million in 2000. Babies with addictions stay about 16.4 days in the hospital, which costs an average of $53,300 per infant. In 80 percent of those cases, Medicaid pays the bill.

Researchers estimate that more than 13,5000 babies were born addicted in 2009. "We knew that it was common, but we would not expect this problem would have tripled in the last decade," said Dr. Matthew Davis, an associate professor at the University of Michigan and one of the study's authors. "There are not many medical problems that have tripled in a decade — not obesity, not heart disease, not diabetes." (Read more)

Mothers should try to go to full term in their pregnancies, but many are unaware of the risks of early delivery, UK study finds

Illustration by Michelle Kumata via KRT

Babies who are born before the full term of 40 weeks may have health problems later in life, since important brain development takes place in the very last stages of pregnancy. As such, mothers should try to avoid being induced early or having elective C-sections.

A study conducted at the University of Kentucky College of Communication and Information found women often don't realize the important development that takes place at the end of pregnancy, write UK doctoral student Sarah Vos and H. Dan O'Hair, dean of the college, for the Lexington Herald-Leader.

Evidence shows that early, elective births are expensive. One study found reducing the number of elective births before 39 weeks of gestation to less than 2 percent of all U.S. births would save $1 billion each year.

But many women are uncomfortable at the end of their pregnancy, are anxious to know their children are healthy, and may even ask for early induction of labor because employers aren't flexible about time off. Sometimes doctors and other providers induce women early for their convenience.

Encouraging women to go full term and telling them the disadvantages of early labor — problems feeding and a higher incidence of Sudden Infant Death Syndrome — can influence their decision. As Vos and O'Hair conclude, "Babies are worth the wait." (Read more)