Deadly, drug-resistant bacteria are becoming more common in Kentucky hospitals; key lawmaker wants to require public reporting

Nightmarish, drug-resistant bacteria that cause deadly infections are becoming more common in Kentucky hospitals, and a leading legislator on health issues says they should be required to report each case.

The state Department for Public Health and hospital officials are investigating the presence of carbapenem-resistant Enterobacteriaceae, or CRE, at Kindred Hospital Louisville, right, a long-term and transitional care facility.

“Since July, we have identified about 40 patients in whom we have cultured the organisms from one or more body fluids,” Dr. Sean Muldoon, chief medical officer for Kindred, told Laura Ungar of The Courier-Journal.

These superbugs kill about half of the patients who get infected. They have become resistant to nearly all the antibiotics available today, including drugs of last resort. CRE infections are caused by a family of germs that are a normal part of a person's healthy digestive system but can cause infections when they get into the bladder, blood or other areas where they don't belong, says the federal Centers for Disease Control. The presence of CRE in bodily fluids doesn’t mean someone is infected by the bacteria, because the patient could also be “colonized” by the bacteria without developing an infection, said Muldoon. CRE may be present in a patient before he or she is admitted to the hospital, or it can be transmitted from patient to patient at the hospital, Ungar notes.

Officials at several Louisville-area hospitals told The Courier-Journal last month that they have seen a growing number of CRE cases in recent years, reports Ungar. The CDC issued a warning report about the bacteria last month, but there has only been one "outbreak" of CRE listed for Kentucky. (Read more)

Given the threat of this bacteria, the CDC has called for quick action to stop these deadly infections, and the chairman of the House Health and Welfare Committee wants to tighten up CRE reporting requirements.

Rep. Tom Burch, D-Louisville, sent a letter to Gov. Steve Beshear proposing a new regulation that would mandate immediate reporting of CRE infection or colonization to the state. Burch said he plans to introduce a bill that would require such reporting by health-care facilities, and he is working with Dr. Kevin Kavanagh of the Somerset, Ky.-based watchdog group Health Watch USA, reports Ungar.

“If it gets in the community and spreads, we’re in trouble,” Kavanagh told Ungar. Burch emphasized this level of risk in his letter to the governor, saying that health-department involvement is crucial to preventing this deadly bacteria from "developing a foothold in Kentucky."

Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems

Some county health departments are trying, and others may try, to increase property-tax rates to make up for Medicaid shortfalls, program cuts and the rising costs of employee benefits so they can continue providing essential public health services for their communities.

Anderson County Health Department Director Tim Wright has proposed a 33 percent rate increase from 3 cents per $100 of assessed property value to 4 cents per $100. The increase would add an estimated $150,000, which Wright says he would use to end employee furloughs and make up for $200,000 that has not been paid by the Kentucky Spirit managed-care company, reports Editor Ben Carlson of The Anderson News.

Many departments have already cut positions and implemented furloughs to compensate for Medicaid shortfalls, state program cuts and employee benefit costs, said Scott Lockard, past president of the Kentucky Public Health Association and director of the Clark County Health Department. Most departments have done everything possible to increase efficiency of the departments' resources, he said.

A recent tax increase in Boyle County will make property owners pay a little more to help fund the county health department. The fiscal court recently voted to raise the county's health tax from 2.4 cents per $100 to 2.5 cents.

As funding streams have changed, departments need additional revenue sources, said Brent Blevins, director of the Boyle County Health Department. Blevins said without the rate increase, the already short-staffed department would have to cut services.

Declining property values during the recession have decreased tax revenue, said Marcia Hodge, director of the Garrard County Health Department. It proposed a tax rate increase from 4 cents to 4.25 cents in September that was estimated to bring in about $21,000, but the fiscal court did not approve it, she said.

Another problem that health departments face, Hodge said, is that they are required to participate in the state's insurance and retirement system. Over the 12 years she has been at the department, retirement contributions have increased from 4 percent to 25 percent, while costs of fringe benefits have more than doubled while salaries have only increased 10 percent, she said.

The Floyd County Health Department increased its tax rate last September for the first time in 20 years, primarily because of increased costs of employee benefits and department funding cuts, said Thursa Sloan, director of the department.

Sloan said she anticipates a big change in the services that health departments provide over the next 10 years.  Primary care will take a much more preventive approach, she said, and health departments will have to pull back in such services and go back to the basics.

New website for after-school programs promotes 'Drink Right, Move More and Snack Smart' to fight childhood obesity

To combat the country's childhood obesity epidemic, ChildObesity180, a new initiative from Tufts University, has launched Healthy Kids Hub, a website with resources for out-of-school-time programs, encouraging kids to develop and adopt three universal nutrition and physical activity principles: "Drink Right, Move More and Snack Smart."

The Hub offers free activity, nutrition and equipment support to volunteers, coaches and leaders in out-of-school-time programs, which serve tens of millions of children and have been identified as a promising area for obesity prevention efforts, the site says.

In Kentucky, almost 18 percent of middle-school-age children and 16 percent of elementary-age kids are obese, says a recent report from the University of Kentucky's College of Public Health.

Research shows that foods and beverages, as well as opportunities for physical activity, vary greatly in out-of-school programs, so the Hub promotes greater consistency in such programs and provides resources to help children follow healthy habits while out of school.

The website was launched at the National Afterschool Association convention in Indianapolis last week, according to a release. Visitors to the website can complete a brief survey to get resources tailored to their specific needs. Click here for the website.

U of L dean says $50 billion in annual health costs could be saved if Americans just walked more

Small changes in health behavior can have a huge impact on the public's overall health and well-being, and during National Public Health Week discussions last week, Dr. Craig Blakely, the new dean of the University of Louisville School of Public Health and Information Sciences, talked about the important role played by public health in promoting healthy behavior, preventing disease and saving both lives and money.

Blakely pointed to obesity as an example of an emerging health-related crisis, which can be addressed with behavioral changes that make a significant difference like adding more physical activity to your day, according to a U of L release.

“If we all took exercise seriously by just walking, we could save $50 billion in cardiovascular disease-related costs,” Blakely said. “A 10 percent weight loss equals a $5,000 savings in health-related complications. A typical desk worker could lose a pound a month by standing two hours a day.”

Blakely also addressed smoking bans, which are becoming popular in Kentucky, even though the state has the highest share of smokers (29 percent) of any state, leads the nation in high-school smokers (24 percent) and spends only a minuscule portion of its tobacco revenues to fight tobacco use, according to the Centers for Disease Control and Prevention.

If every state adopted comprehensive smoke-free policies, said Blakely, $2 billion would be saved in smoking-related deaths, lung cancer treatments and care for related health complications over the course of several years, says the release.

Blakely highlighted several other examples of public health’s potential return on investment. For example, says the release, every dollar spent on childhood immunizations saves $18 on vaccine-preventable disease-related costs, every dollar spent in prenatal care translates to $6 in health care cost savings and for every dollar spent on fluoridated water saves $20 in dental care.

Public health research will continue to find effective ways to generate these cost savings, such as finding researching how to modify environments to encourage exercise or how to send strong messages that promote regular physical activity (Read more)

It's Autism Awareness Month; do you know the warning signs?

The University of Kentucky hosted the state's first Light It Up Blue event by illuminating Memorial Hall with blue lights on April 2nd, and this event is a unique global initiative that kicks-off Autism Awareness Month and helps raise awareness about autism.

This is the sixth year for Light It Up Blue, but the Autism Society has been celebrating National Autism Awareness Month since the 1970's in order to highlight the need for awareness about autism. Autism is increasing in prevalence, and according to a recent report by the Centers for Disease Control and Prevention, 1 in 50 school-age children in the United States has autism; that number increased from 1 in 88 in 2012.

Autism is defined by a certain set of behaviors and is a spectrum disorder that affects individuals differently. Typically, autism appears during the first three years of life and affects a person’s ability to communicate and interact with others, says the CDC. While there is no known single cause of autism, it is treatable, and studies show that early diagnosis and intervention lead to significantly improved outcomes for families.

With individualized interventions, says the CDC, parents can minimize challenges their child faces. From birth to 5 years, children should reach certain milestones in how he or she plays, learns, speaks and acts, and delays in any of these areas could be a sign of a developmental problem. Therefore, it is important to talk to a doctor as soon as possible children display some of the warning signs below.

From the CDC's Learn the Signs, Act Early campaign

Kentucky is one of 12 states with existing autism care insurance requirements, meaning that private insurance must cover autism treatment. Fortunately, there are many treatment options for autism in Kentucky that can generally be divided into four categories: behavioral and communication approaches, dietary approaches, medication and alternative medicine approaches. Click here for a full list of treatment resources or here for more Autism signs and symptoms.

In addition to when a parent is concerned, the American Academy of Pediatrics recommends that children be screened for general development using standardized, validated tools at 9, 18, and 24 or 30 months and for autism at 18 and 24 months. While autism spectrum disorders occur in all racial, ethnic and socioeconomic groups, they are almost five times more common among boys than girls, says the CDC.

In order to make sure your child reaches his or her full potential, it is very important to get help as soon as possible if your child shows concerning symptoms, according to the CDC's Learn the Signs, Act Early campaign.

Kentuckians tell pollsters they are concerned about air quality, but don't seem to put their concern into action

A recent poll shows that more than half of Kentucky adults, especially women, are concerned about air quality in their community, but only 48 percent say they change their behavior when an air quality alert is issued.

Perhaps they have never heard of an air quality alert, which is issued by a local or state air-pollution authority to protect the public's health from air pollution. The U.S. Environmental Protection Agency monitors air quality and uses an Air Quality Index to warn the public when the amount of particle pollution or ozone in the air may harm their health.

When pollution gets to a level of concern, alerts or action days are issued in participating areas, which in Kentucky are Louisville, Lexington and the Mammoth Cave area (primarily Edmonson County). This could explain why almost 30 percent of poll respondents from Louisville said they were very concerned about air quality in their community, and only 13 percent of respondents from Appalachia indicated this level of concern.

Almost 60 percent of Appalachians said they are not concerned at all about the air quality in their community, compared to 26 percent of Louisville respondents that aren't at all concerned. Few Eastern Kentucky counties are part of an air-quality monitoring program. In addition to the areas monitoring for alerts or action days, 37 Kentucky counties (colored in the map) participate in the monitoring program. Click here to compare counties.

Counties covered by an air-quality monitoring program are colored.

The poll indicated that just 20 percent of Kentucky adults said they change or limit their activities a lot when air quality alerts are issued, and about 30 percent said they change their behavior a little.  Respondents from the Louisville region were most likely to change or limit their activities, while those in the Lexington area were the most likely to not change or limit their behavior at all. 

When air quality is at an unhealthy level, people can protect themselves by limiting outdoor activities or avoiding heavy exertion.  These protective measures are even more important for those sensitive to air pollution, such as people with heart or lung disease, the elderly and children.

“The quality of our air impacts all of us, but is particularly important for sensitive groups, such as children with asthma. When an air quality alert is issued, we can protect ourselves and our families by avoiding heavy exertion and limiting outdoor activities,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “We can also do our part to limit emissions and protect our neighbors by turning off our car’s engine while we are waiting.” 

Almost 30 percent of Kentucky adults and 40 percent of Western Kentucky adults said they never turn their car’s engine off when waiting in their car and not moving, as in a traffic jam, train crossing or drive-through. Including those who never turn off their cars, more 60 percent said they wait at least four minutes before turning off their car’s engine when waiting in the car and not moving. Experts recommend turning off a waiting car’s engine after just ten seconds in order to save gas and limit emissions.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati and was conducted last year from Sept. 20 to Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones and the poll has a margin of error of plus or minus 2.5 percentage points.

Public Health Week theme: It's a good investment, saving lives and money

April 1-7 is National Public Health Week, and the Kentucky Department for Public Health is working to raise awareness and help people live longer, healthier lives by promoting the 2013 week's theme: the return on investment of public-health services.

Everyone likes sound, stable and high-return investments, and research shows that investing just $10 per person each year in proven, community-based public health efforts can save the nation more than $16 billion within five years. That’s a $5.60 return for every $1 invested.

“Our nation and community simply cannot sustain the current trajectory of health care spending and chronic disease Dr. Stephanie Mayfield, the state health commissioner, said in a Cabinet for Health and Family Services release. “Fortunately, we know that investing in prevention and public health can make an enormous difference and it’s the right direction for Kentucky to move in to address poor health outcomes.”

Supporting public health approaches to better health outcomes does reap life-saving returns, said Mayfield. For example, research shows that each 10 percent increase in local public health spending contributes to a nearly 7 percent decrease in infant deaths, a 3.2 percent decrease in cardiovascular deaths and a 1.4 percent decrease in diabetes-related deaths.

“In some way, public health touches everyone, every day in Kentucky. We are dedicated to making our infrastructure even stronger, including ongoing work to become nationally accredited in 2014, finding opportunities for improvement within our programs, and focusing on overall prevention for the health and well-being of Kentuckians,” said Mayfield.

Since 1995, communities nationwide have celebrated National Public Health Week each April to draw attention to the need to help protect and improve the nation’s health and to educate the public, policymakers and practitioners.

“We hope this week will serve as an opportunity for the public to learn more about the vital role of public health in Kentucky,” said Mayfield. (Click to learn more about the Kentucky Department for Public Health or National Public Health Week)

State Health Department gets diabetes prevention funding; will focus on prediabetes detection and lifestyle changes

The state Department for Public Health has been awarded a $134,380 federal grant to help reduce high rates of prediabetes and Type 2 diabetes in Kentucky.

“Diabetes is a tremendous public health concern that is both horrific for the individual, if unmanaged, and costly in terms of medications, various complications and long-term hospitalizations that are so often associated with the disease,” Audrey Haynes, secretary of the Cabinet for Health and Family Services, said in a press release.

In 2009, Kentucky's rate for diagnosed diabetes was the fourth highest in the nation at 11.4 percent of the population, compared to a national median of 8.3 percent. The rate means an estimated 366,000 adults in Kentucky have diabetes. An additional 266,000 Kentuckians are estimated to have prediabetes, according to the CFHS website.

Prediabetes often leads to Type 2 diabetes, the most common type, within a few years, but lifestyle changes promoted by the federal Diabetes Prevention Program can decrease the risk of developing diabetes by almost 60 percent, according to a recent study published in the Journal of Preventive Medicine.

“We must act now to begin reversing the devastating impact of diabetes on our state,” Haynes said. “We are excited to continue our work with the Diabetes Prevention Program to help more Kentuckians start making healthier lifestyle choices so they can avoid developing diabetes and lead longer, healthier lives.”

The DPP specifically targets individuals with prediabetes and works with them to reduce their risk of developing Type 2 diabetes. The risk factors for both are: being older than 45, being overweight or obese, physical inactivity, having a family history of diabetes, ever having gestational diabetes, high blood pressure, abnormal cholesterol, having a history of cardiovascular disease and being African-American, Hispanic/Latino, Native American, Asian American or Pacific Islander. Click here to take the diabetes risk test.

The federal Centers for Disease Control estimates that national efforts to prevent Type 2 diabetes could save $5.7 billion in health care costs by preventing 885,000 cases in the next 25 years. Kentucky will focus on three diabetes prevention strategies that involve raising awareness among health care providers to improve detection and treatment of prediabetes and encouraging both state/local government and business to add lifestyle change programs to the list of covered services under health plans, says the news release. (Read more about diabetes and prevention in Kentucky).

Health departments in N. Ky. and Franklin County are among the first 11 in the nation to be accredited, a milestone in public health

Three Kentucky departments are among the first 11 in the nation to receive accreditation from the national Public Health Accreditation Board, which announced the achievements Thursday.

The Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties received five-year accreditation.

"I am proud of the departments achieving this public health milestone of national accreditation," said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health. "Before now, there has not been a national system for health departments to demonstrate accountability and quality to their community."

Scutchfield said accreditation means a department is providing a "high quality of public health service, leadership and accountability to its constituents," and is a clear indication of the departments' "passion and dedication to improving and protecting the health" of the community.

The board, funded by the federal Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, has received 128 total applications for accreditation: 112 from local health departments, 15 from state departments; and one tribal department.

In addition to the three Kentucky departments that have received accreditation, other Kentucky departments have applied and are awaiting site visits. Those are the Lexington-Fayette County, Barren River District, Madison County and Christian County health departments, said Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services.

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year. (Click here to learn more about accreditation)

Make sure your first aid serves its purpose!

Until you really really need it, you often don't even think about having a first aid kit. Having the right first aid kit can save the day in a home or office situation. Apart from that, as a responsible workplace manager you should take care of the welfare of your workers by having first aid at the ready. By adding and subtracting just a few items from your kit you

• If travel or spend a lot of time in the car you should definitely invest in a car kit
• If you are out and about doing fieldwork or outdoor activities, a bumbag might be the best kind of kit for you
• Specialised hiking kits are also available
• Your kit should comprise of a series of basic items like gauze, adhesive tape, eyewash, sterile wipes and gloves as well as a selection of specialised items like burn treatments, depending on the kind of work you do
• You should update your kit every two to three years
• consider buying a separate first aid kit for your kitchen and then one for the rest of the house, as the kitchen is one of the main danger areas in the home
• Make sure you include these items in your kit, these are often forgotten; emergency phone numbers and contact numbers, medical consent forms, the medical history of any family members, sunscreen, a flashlight and candles, a syringe, a medical cup and spoon, an epi pen, and diarrhoea medication.

For more information on first aid, visit First Aid Management.

Foundation for a Healthy Kentucky gives UK $1 million for endowed co-chairs in rural health policy

Tyrone "Ty" Borders in the University of Kentucky College of Public Health's Department of Health Services Management, and Brady Reynolds in the UK College of Medicine's Department of Behavioral Science, have been named the Foundation for a Healthy Kentucky endowed co-chairs in rural health policy.

A $1 million gift from the foundation to the College of Medicine was matched by the state Research Challenge Trust Fund, better known as "Bucks for Brains." The gift has the goal of enriching Kentucky's research capabilities in regards to rural health issues and rural health policy.

Reynolds earned doctoral and master's degrees in life-span developmental psychology from West Virginia University. He also holds a master's degree in general/experimental psychology and a bachelor's degree (magna cum laude and with distinction) from James Madison University. His research has focused on nicotine use by adolescents, drug use, gambling and other addictive behaviors. In recent years Reynolds has begun research to promote smoking cessation among pregnant smokers in rural Appalachia.

Borders earned doctoral and master's degrees in health administration, as well as a master's degree in epidemiology from the University of Iowa, and a bachelor's degree in psychology from the University of Kansas. His research focuses on the conduct and analysis of population-based studies to identify subgroups of persons at risk for poor health and problems obtaining health services, with an emphasis on rural populations.

“Drs. Reynolds and Borders have skills in intervention research and rural health policy expertise that can help the University remain at the forefront of rural health policy work in today’s rapidly changing healthcare environment,” said Susan Zepeda, president and CEO of the foundation.

The mission of the foundation is to addresses the unmet health care needs of Kentuckians. Mission objectives are advanced through two initiative areas: promoting responsive health policy and a new children’s initiative named “Investing in Kentucky’s Future.” Foundation work aims to improve access to health care, reduce risks and disparities, promote health equity and healthy lifestyles. Since 2001, over $22 million has been invested in health policy research and demonstration grant projects across Kentucky

Update on Obesity

Sarah Fudin currently works in community relations for the George Washington University's online MPH degree, which provides prospective students the ability to earn an online Masters degree in Public Health. Outside of work Sarah enjoys running, reading and all things education.

Americans have been increasingly concerned about weight gain in recent years, and with good reason. According to the Center for Disease Control and Prevention, one in three Americans is obese, making it common to speak of obesity as an epidemic a widespread problem that affects the society as a whole rather than an affliction of individuals who make poor eating decisions.

Who is Obese?

The obesity rate has fallen slightly in recent years and appears to have stabilized among children, but obesity does not affect all portions of the population equally. Obesity disproportionately affects those who with less money and education, as well as women. And obesity affects earning power and other forms of opportunity in turn: The obese earn as much as 18 percent less than those of "normal weight," according to a recent Organisation for Economic Co-operation and Development report. In light of these considerations, taxing unhealthy food an approach adopted by Denmark, Hungary, France and Finland is problematic because it puts the economic burden of obesity on those most directly disadvantaged by it.

Healthy Eating Begins in Childhood

According to Margo Wootan of the Center for Science in the Public Interest, the trick to reducing obesity is to change the way that children eat. Wootan says that by serving healthier lunches in schools and removing vending machines, we can habituate children to healthier eating. She also suggests that part of the problem is that 80 percent of food marketing aimed at children advertises unhealthy food an argument that recalls the controversy around cigarettes being marketed to children. Children who learn to eat healthfully are likely to remain healthy throughout their lives, while those who don't will face an uphill battle.

Preventing the development of obesity in children has been a common goal of many anti-obesity strategies. While such strategies may not produce the quick results that many of us would like to see, they could produce much healthier generations of adults in the years to come.

A Strategy for Prevention

The Institute of Medicine recently released a new strategy for preventing obesity in the United States. The strategy addresses the obesity epidemic from multiple angles, including restrictions on marketing unhealthy food to children, increasing the amount of physical exercise mandated in schools, making healthier food available to children in restaurants and using doctors to disseminate information and advice about healthy eating.

While obesity is a deep-rooted problem that isn't likely to disappear overnight, we can take steps to prevent it from spreading and to eventually reverse the trend. It seems clear that no easy answer or single strategy will solve the problem of obesity in our society, just as drastic dietary changes tend to produce temporary results for individuals. But approaching the problem from several different angles at once does seem more likely to produce results.

Three Kentucky health departments in first group up for national accreditation; requires local health assessment, improvement plan

By Molly Burchett
Kentucky Health News

Three Kentucky health departments are among the first in the nation to be considered for national accreditation, a process that could help improve patient care and put the agencies in closer touch with their communities' needs.

The national Public Health Accreditation Board will make its first accreditation decisions next week. Among the first group being considered are the Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties.

The decision will be a historic one, and this is an exciting time for the board and Kentucky, said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health.

The accreditation program was launched in September 2011 after a seven-year development process aimed at advancing quality and performance and value in the departments, and their accountability to stakeholders, Scutchfield said.

Departments are assessed by rigorous standards tested in 30 diverse health departments across the country to ensure essential public health services are provided in the community, according to the board's website. Two of the 12 "domains" of the standards deal with administration and governance. In Kentucky, state law makes county health boards responsible for the health of the county. Counties served by district health departments still have county boards.

Accreditation can help a board and department identify opportunities to improve performance and management, and to improve relationships with the community, since the process requires a community health assessment, a community improvement plan and a strategic plan to address the need of the community, said Scutchfield.

The process, often called "Mobilizing for Action through Planning and Partnerships," can help boards and departments be better prepared to proactively respond to emerging and re-emerging health challenges. For a PDF of Franklin County's MAPP document, click here.

The accrediting board has received 108 applications from health departments around the nation: 13 state health departments, 94 local health departments and one tribal agency. In addition to the three Kentucky agencies being considered in the first group, the other Kentucky departments that have applied for accreditation and are awaiting site visits are Lexington-Fayette County, Barren River District, Madison County and Christian County, Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services, said in an email.

The accreditation process encourages departments to move away from the "silo" model to collaborate with community programs. In Christian County, it has changed the way department employees view their jobs, because they have to continuously reflect on their methods and brainstorm for ways to improve, Health Department Director Mark Pyle told Nick Tabor of the Kentucky New Era.

"Accreditation will likely open new revenue streams," Tabor writes. "But in a way, the process matters more than the status designation."

Midkiff said, "In addition to benefiting from the process itself, our federal and state resources in public health are increasingly shrinking, we are being asked to do more with less. And there is a need for transparency within agencies."

Midkiff said accreditation "may make the agency more competitive for grants in the future. We are actually seeing quality improvement and performance management requirements being written in many federal grants now, so it is being expected at the national level."

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year.

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

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

By Molly Burchett
Kentucky Health News

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

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

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

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

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

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

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

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

New U of L public-health dean has rural health background

Craig H. Blakely, dean at the School of Rural Public Health at Texas A&M University, has been named dean of the University of Louisville School of Public Health and Information Sciences. U of L has a role in rural health in Western Kentucky, overseeing the Area Health Education Centers in the region.

Blakely, who has a Ph.D. and a master's in public health, has researched and published extensively regarding access to care and rural health. His research has focused on under-served expectant mothers and juvenile delinquents, and includes substance-abuse prevention and community-based change. Blakely has also evaluated major initiatives such as a school-based prevention program targeting at-risk youth.

Blakely’s expertise will be invaluable in tackling issues like obesity, access to care, disease management and much more, said Dr. David L. Dunn, U of L's executive vice president for health affairs. Blakely’s appointment is effective April 1 and is subject to approval by the U of L Board of Trustees. He replaces Richard Clover, who has led the school for 10 years.

Health agencies in Rockcastle, Jackson, Clay, Harlan to lose 14 employees, some environmental and food-safety inspections

In the latest example of Medicaid changes' impact on local health departments, environmental and food-safety inspections will be reduced by layoffs in four counties served by the Cumberland Valley District Health Department, Nola Sizemore of the Harlan Daily Enterprise reports. Health departments in Harlan, Rockcastle, Clay and Jackson counties will lose a total of 14 employees later this month. (Enterprise photo: Harlan County Health Department)

Health Department Interim Director Lynett Renner told Sizemore said the layoffs, along with furlough days, are a result of decreased funding and the "advent of managed care organizations" in November 2011. The agency has almost $1 million in outstanding accounts because payments from those organizations have been slow to come in. "Also, one of the things that affected the health departments tremendously is we’re the only provider in the state required to pay a Medicaid match, which means for every service we provide for a client who has Medicaid, we have to pay the state back 20 percent and that recently increased to 28 percent," Renner said.

Renner told Sizemore that environmental services and restaurant health inspections would be most affected, adding that public health is often taken for granted by the local community. "So much is done behind the scenes to ensure the health and safety of every citizens," she told Sizemore. "My fear is they're reducing the ability of the public health infrastructure to be able to maintain that level of service that provides protection." (Read more)

Asthma Relief at Home

When it comes to asthma inhalators are a must have for anyone suffering its effects, however there are ways to avoid some of what this condition deals to the human body. While asthma care centers exist and they are very good at what they do the bulk part of the asthma relief is usually done in domestic conditions since our lives need to go on as seamlessly as possible. You will need to find ways to avoid stress as well as knowing how to deal with the onset and asthma triggers which lead to attacks since this is a condition which so far requires a lot of care. We have prepared some tips with which we hope to alleviate your situation:

1. Peak Flow Meters

When it comes to asthma these are cheap and useful devices used to measure the exhaled air through your lungs. It is a simple construction which allows you to measure the peak expiratory flow also known as PEF. This small device allows you to have a relatively accurate understanding of the condition of your asthma and whether its worsening or getting better by measuring and monitoring your PEF.

2. Developing a plan

When it comes to asthma you should be aware that special care is needed which will help you prevent and manage your asthma attacks. You should speak to your doctor or health care provider regardless of what country you live in for ways your condition can be alleviated. You will need to provide them with as much personal information as you can to allow your doctors a better chance to understand what is causing your asthma attacks.

3. Keep track

There is a reason for that since it will allow you understand and keep a record of when the attacks occur. You should record the initial time when the attack starts and you should measure your PEF as well as other details which will allow you to collect this data for an accurate understanding and information which your doctor will be able to use to deduce ways to find solutions.

4. Controlling possible asthma triggers

This is a crucial step when it comes to attacks since knowing what onsets the attack will help you prevent it in the future. Most often it is stress and this can help, though sometimes the reasons for an attack are certain allergens of which you will need to be aware so you can treat the problem effectively.

5. Air filtration

This can be very useful in cases of allergens being the prime reason for asthma attacks. They are relatively cheap and they offer a good way of keeping most of these out of the air around your home. There are multiple technologies out there currently being used for air filtration from small, stationary units to larger ones which offer better quality of air. You should consider those if you know the reason for your asthma attacks are airborne allergens such as pollen and other substances.

This guest post has been written on behalf of: www.handymoves.co.uk

Kentucky's week-long brand of flu now called 'widespread'

What started out early is now full-blown. The Kentucky Department for Public Health informed federal health authorities this week that data it has received from local health departments, hospitals, clinics and private doctors indicates that flu is now "widespread" in the state.

Darla Carter of The Courier-Journal reports that Louisville officials have confirmed nine cases and 127 positive rapid tests since the first week of November. For the status to be "widespread," the state explained it had received numerous reports from throughout the commonwealth. What is being reported is not a 24-hour bug, but a 7-10 day virus.  Health officials are vigorously encouraging flu vaccinations. (Read more)

Court of Appeals panel rules 2-1 that county boards of health can pass smoking bans; appeal in Bullitt County case seems likely

By Al Cross
Kentucky Health News

In Kentucky's first appellate-court ruling on the issue, the state Court of Appeals today upheld the Bullitt County Board of Health's smoking ban, which is virtually the same as others enacted by several other county health boards. However, the panel's 2-1 vote and the strength of the dissent suggests that the ruling will be appealed to the state Supreme Court.

UPDATE, Dec. 19: The county Fiscal Court voted Dec. 18 to appeal, Tom O'Neill of The Courier-Journal reports.

Health boards in Clark, Hopkins, Madison and Woodford counties have enacted smoking bans. The Hopkins County ban was upheld by the local circuit judge, whose ruling was not appealed. (Courier-Journal video story on smoking in Bullitt County bars)


In Bullitt County, the fiscal court and eight towns sued to stop the ban four days before it was to take effect last year. Bullitt Circuit Judge Rodney Burress ruled that the board lacked authority to ban smoking in public places, but the appeals court said the General Assembly had clearly given county health boards the power to impose regulations protecting public health, that secondhand smoke is a public-health issue, and that the board's regulation is reasonable, because it is virtually the same as an ordinance upheld in Lexington.

The majority cited regulations that the Jefferson County Board of Health had enacted in the 1970s to prevent lead poisoning, and cited other court decisions saying that courts should construe public-health laws liberally. The local governments argued that the Bullitt health board has usurped legislative  power held only by them, but the 2-1 majority said the state legislature had granted the board that authority in public-health matters.

Judge Jeff Taylor of Owensboro dissented, writing that the law cited by the majority and the board was passed 58 years ago. "I harbor grave doubt that the General Assembly intended to empower health departments at that time with the authority to regulate smoking as a threat to public health," he wrote. "In 1954, second-hand smoke was not a known public health issue." He said the legislature had specifically authorized the Jefferson County lead program, and the Lexington ban was passed by the local council, not the Fayette County Board of Health.

Taylor noted that the Bullitt board had relied on "national and international studies on the effects of secondhand smoke," with no local studies showing "smoking presents a threat to the health of the citizens of Bullitt County." And even if the board had such studies, he wrote, other state laws "reserve to cities and counties the authority to regulate smoking and secondhand smoke in their respective jurisdictions." The laws he cited do not appear to do that, but he argued that allowing health boards to enact smoking bans, he said, would give them "limitless" power to regulate guns, alcohol, sales of large-size soft drinks or "the number of cheeseburgers sold by fast-food restaurants."

Taylor wrote, "To the extent the cities and county, and their elected officials have failed to address a perceived serious public health issue, the citizens of Bullitt County have an easy method to remedy the problem – the ballot box," Taylor wrote. "Or, in the alternative, the Kentucky General Assembly can expressly authorize health boards to regulate smoking in each county." To read the seven-page majority opinion and the eight-page dissent, click here.

Two Kentucky moms participate in Duke study that found potentially toxic and unnecessary chemicals in most couches

Two Central Kentucky mothers participated in a Duke University-led study published today that shows that a vast majority of U.S. couches contain potentially toxic flame retardants that pose risks to humans. Wendy Koch of USA Today reports that the risks occur when the chemicals migrate from furniture foam into house dust.

The closely watched study revealed that more than 40 percent of the foam in the 102 couches tested contained the carcinogen chlorinated Tris, a substance that was ordered removed from children's pajamas 35 years ago. Another 17 percent of the couches contained pentaBDE, a globally banned substance. More than 85 percent were treated with a potentially toxic flame retardant, which researchers and experts say amounted to more than a pound of chemicals per couch. Flame retardants have been linked to hormone disruption, cancer and neurological toxicity in hundreds of animal and human studies. A fire specialist told Koch that the chemicals are not effective in suppressing fires.

The two Kentuckians, both women concerned about their family's health, sent samples from their couches to be analyzed and both expressed horror at the findings. Dr. David A. Atwood, a chemist at the University of Kentucky, said a systematic shift in chemical regulation is necessary to protect public health. “We have made an enormous mistake assuming that a chemical should be used freely until it is determined to have adverse health effects, rather than taking the position that all chemicals should be avoided unless it is absolutely certain that the chemical is safe." In New York, legislation is already in motion that would ban chlorinated Tris. According to the Kentucky Environmental Foundation, efforts will begin next year to restrict the toxic chemical. (Read more)