Autoimmune Disease Control

Autoimmune Attack:
What Goes Wrong When The Body Attacks Its Self?

Th1 and Th2: The Balancing Act:

Th1 (cell-mediated immunity) and Th2 (humoral immune response) are two areas of the human immune response. In a healthy body, there is balance between the Th1 (T-cell) and Th2 (B-cell) parts of our immune system.

Imagine a child’s teeter-totter with it balanced and both ends are the same height off of the ground.

Our immune system must discriminate between self-tissue and non-self tissue. Regulatory T-cells (Treg) are responsible for preventing immune system attacks against our own healthy tissue.

During times of infections or pregnancy, messengers known as Cytokines, down regulate Treg, which in turn allows our immune system warriors to launch an attack by shifting the system in either Th1 or Th2 dominance.

After the fighting is over and the threat is over Treg cells once again suppress these systems, allowing for the immune system to return to equilibrium.

When a person is Autoimmune, the Th1 or Th2 response has become dysregulated and is no longer under the control of the Treg cells. In effect the system has gone “Rogue”.

The system has shifted into perpetual dominance and it is running wild, unable to distinguish between healthy self-tissue and the non-self tissue, it begins to attack our own tissue.

Again, picture the child’s teeter-totter but now it has a big kid on one side and a small kid on the other side. The big kid weighs more and so the teeter-totter is now all the way to the ground on his side, he is the dominant side, the small child is way up in the air because he is much lighter so now he can not express himself with any movement of the teeter-totter back down to neutral.

Autoimmune conditions can be mediated!

Returning the two systems to equilibrium has given relief to many patients.

We have developed specific dietary protocols that modulate the immune response. This coupled with specific supplementation to enhance and optimize the immune system’s response, which allows for healthy regulation and returning of the system to a more balanced state.
One important thing we determine is what shift your immune system has done. What is its dominance?

If you are found to be Th1 dominant it is mandatory that you not ingest compounds that stimulate the Th1 system further, such as:

• Echinacea
• Garlic
• Vitamin C
• Immune stimulants
• Licorice root (Glycyrrhiza
• Astragalus
• Beta-glucan mushroom
• Maitake mushroom (Grifola frondosa)

If you are found to be Th2 dominant it is mandatory that you not ingest compounds that stimulate the Th2 system further, such as:

• Caffeine
• Green Tea
• Grape Seed Extract
• Herbal Barks
• Lycopene
• Resveratrol
• Pycnogenol
• Caffeine

If you or someone that you know has an Autoimmune Thyroid Condition, such as Hashimoto's Thyroiditis, call our office so that we can schedule a free, no obligation consultation to review your health goals and see what we can do to help.

Call 281-812-8101 and find out how we may help you.

Even if your Thyroid Condition is not autoimmune condition, give us a call, our approach to treating thyroid disease and along with many other chronic health conditions is both uniquer and highly successful in attaining our patients personal health goals.
Call 281-812-8101 and find out how we may help you.

Visit us on the web at http://FixMyThyroidNow.com

Yours in Health,

Dr. Walter K. Crooks
Chiropractic Clinical Neurologist
Autoimmune

Autoimmune Attack:
What Goes Wrong When The Body Attacks Its Self?

Th1 and Th2: The Balancing Act:

Th1 (cell-mediated immunity) and Th2 (humoral immune response) are two areas of the human immune response. In a healthy body, there is balance between the Th1 (T-cell) and Th2 (B-cell) parts of our immune system.

Imagine a child’s teeter-totter with it balanced and both ends are the same height off of the ground.

Our immune system must discriminate between self-tissue and non-self tissue. Regulatory T-cells (Treg) are responsible for preventing immune system attacks against our own healthy tissue.

During times of infections or pregnancy, messengers known as Cytokines, down regulate Treg, which in turn allows our immune system warriors to launch an attack by shifting the system in either Th1 or Th2 dominance.

After the fighting is over and the threat is over Treg cells once again suppress these systems, allowing for the immune system to return to equilibrium.

When a person is Autoimmune, the Th1 or Th2 response has become dysregulated and is no longer under the control of the Treg cells. In effect the system has gone “Rogue”.

The system has shifted into perpetual dominance and it is running wild, unable to distinguish between healthy self-tissue and the non-self tissue, it begins to attack our own tissue.

Again, picture the child’s teeter-totter but now it has a big kid on one side and a small kid on the other side. The big kid weighs more and so the teeter-totter is now all the way to the ground on his side, he is the dominant side, the small child is way up in the air because he is much lighter so now he can not express himself with any movement of the teeter-totter back down to neutral.

Autoimmune conditions can be mediated!

Returning the two systems to equilibrium has given relief to many patients.

We have developed specific dietary protocols that modulate the immune response. This coupled with specific supplementation to enhance and optimize the immune system’s response, which allows for healthy regulation and returning of the system to a more balanced state.
One important thing we determine is what shift your immune system has done. What is its dominance?

If you are found to be Th1 dominant it is mandatory that you not ingest compounds that stimulate the Th1 system further, such as:

• Echinacea
• Garlic
• Vitamin C
• Immune stimulants
• Licorice root (Glycyrrhiza
• Astragalus
• Beta-glucan mushroom
• Maitake mushroom (Grifola frondosa)

If you are found to be Th2 dominant it is mandatory that you not ingest compounds that stimulate the Th2 system further, such as:

• Caffeine
• Green Tea
• Grape Seed Extract
• Herbal Barks
• Lycopene
• Resveratrol
• Pycnogenol
• Caffeine

If you or someone that you know has an Autoimmune Thyroid Condition, such as Hashimoto's Thyroiditis, call our office so that we can schedule a free, no obligation consultation to review your health goals and see what we can do to help.

Call 281-812-8101 and find out how we may help you.

Even if your Thyroid Condition is not autoimmune condition, give us a call, our approach to treating thyroid disease and along with many other chronic health conditions is both uniquer and highly successful in attaining our patients personal health goals.
Call 281-812-8101 and find out how we may help you.

Visit us on the web at http://FixMyThyroidNow.com

Yours in Health,

Dr. Walter K. Crooks
Chiropractic Clinical Neurologist
Autoimmune

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Hopkinsville hospital's credit rating downgraded; part of national trend, but only Kentucky hospital nicked by rating agency lately

Following a national trend stemming from a slowly recovering economy, the hospital in Hopkinsville has had its credit rating downgraded, a possibility many Kentucky hospitals may be facing. "This means the hospital may have to pay a higher interest rate if it needs to borrow money in the near future," reports Nick Tabor, senior staff writer for theKentucky New Era.

Loss of business, a small revenue base and lots of debt were among the reasons Jennie Stuart Medical Center's rating dropped from BBB+ to BBB, Tabor reports. Fitch Ratings, one of the global agencies whose ratings guide investors, said uncertainty about the expansion of Kentucky's Medicaid system and how federal health reform will affect the hospital's finances were other reasons for the downgrade. The hospital has lost money in two of the last four years. Last year, it had a 1.9 percent loss.

Tabor explains there are eight ratings above the BBB level. If the facility's rating "were to slip two levels lower, to BB+, it would be on the level of 'junk bonds,' no longer considered investment grade," he reports.

There are three major rating companies in the U.S.: Fitch, Moody's and Standard and Poor's. Moody's expects downgrades of nonprofit hospitals to outnumber upgrades by the end of 2012, reports Jeffrey Young for The Huffington Post. Fitch expects the same will happen, said Senior Director Emily Wong. Smaller hospitals will especially feel the pinch since they "don't have as much ability to offset expense, inflation or reimbursement reductions," Wong said.

Since October 2011, Fitch has reviewed seven nonprofit hospitals in Kentucky. Five were affirmed, one was upgraded and Jennie Stuart was the lone downgrade. The other facilities reviewed were:
• Norton Healthcare, Louisville: affirmed at A-

• Owensboro Medicald Health System: affirmed at BBB+

• Appalachian Regional Healthcare: upgraded BB from BB-

• King's Daughters in Ashland: affirmed at A+

• Baptist Health Systems: affirmed at AA-

• St. Elizabeth Medical Center: affirmed at AA-

AA- and A-rated facilities are reviewed every two years. BBB and BBs are reviewed once a year, and B- and below-rated facilities are reviewed every six months. This type of story can be localized for any hospital. The easiest way to check ratings for hospitals in your area is to get an account at each of the three major rating companies. "These accounts are free and easy to set up," Tabor said. (Read more)

Following a national trend stemming from a slowly recovering economy, the hospital in Hopkinsville has had its credit rating downgraded, a possibility many Kentucky hospitals may be facing. "This means the hospital may have to pay a higher interest rate if it needs to borrow money in the near future," reports Nick Tabor, senior staff writer for theKentucky New Era.

Loss of business, a small revenue base and lots of debt were among the reasons Jennie Stuart Medical Center's rating dropped from BBB+ to BBB, Tabor reports. Fitch Ratings, one of the global agencies whose ratings guide investors, said uncertainty about the expansion of Kentucky's Medicaid system and how federal health reform will affect the hospital's finances were other reasons for the downgrade. The hospital has lost money in two of the last four years. Last year, it had a 1.9 percent loss.

Tabor explains there are eight ratings above the BBB level. If the facility's rating "were to slip two levels lower, to BB+, it would be on the level of 'junk bonds,' no longer considered investment grade," he reports.

There are three major rating companies in the U.S.: Fitch, Moody's and Standard and Poor's. Moody's expects downgrades of nonprofit hospitals to outnumber upgrades by the end of 2012, reports Jeffrey Young for The Huffington Post. Fitch expects the same will happen, said Senior Director Emily Wong. Smaller hospitals will especially feel the pinch since they "don't have as much ability to offset expense, inflation or reimbursement reductions," Wong said.

Since October 2011, Fitch has reviewed seven nonprofit hospitals in Kentucky. Five were affirmed, one was upgraded and Jennie Stuart was the lone downgrade. The other facilities reviewed were:
• Norton Healthcare, Louisville: affirmed at A-

• Owensboro Medicald Health System: affirmed at BBB+

• Appalachian Regional Healthcare: upgraded BB from BB-

• King's Daughters in Ashland: affirmed at A+

• Baptist Health Systems: affirmed at AA-

• St. Elizabeth Medical Center: affirmed at AA-

AA- and A-rated facilities are reviewed every two years. BBB and BBs are reviewed once a year, and B- and below-rated facilities are reviewed every six months. This type of story can be localized for any hospital. The easiest way to check ratings for hospitals in your area is to get an account at each of the three major rating companies. "These accounts are free and easy to set up," Tabor said. (Read more)

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Safety-net hospitals could get hit hardest in Oct. when patient ratings will influence Medicare and Medicaid payments

When hospitals start getting paid based on the perceived quality of care they provide to their Medicare and Medicaid patients, so-called "safety net" hospitals, a last resort for the poor, could be the losers in the equation. That's because a main way of measuring quality will be patient experience ratings, and safety-net hospitals tend to get poorer marks from patients, according ta new study published in the Archives of Internal Medicine.

Since hospitals have had to publicly report their patient experience ratings, the gap between how patients rated these facilities and the scores that other hospitals got widened. "We found that [safety-net hospitals] performed more poorly than other hospitals on nearly every measure of patient experience and that gaps in performance were sizeable and persistent over time," the authors write.

When the Centers for Medicare and Medicaid Services agency starts using the scores to hand out bonuses and penalties, safety-net hospitals could be at a disadvantage, especially since penalties could mean a 2 percent cut on regular Medicare payments. Starting in October, patient experience scores will determine 30 percent of a facility's bonus. "The hospitals that perform best will gain money, while those that lag in scores and improvement over time will end up with less," reports Jordan Rau for Kaiser Health News. (Read more)

When hospitals start getting paid based on the perceived quality of care they provide to their Medicare and Medicaid patients, so-called "safety net" hospitals, a last resort for the poor, could be the losers in the equation. That's because a main way of measuring quality will be patient experience ratings, and safety-net hospitals tend to get poorer marks from patients, according ta new study published in the Archives of Internal Medicine.

Since hospitals have had to publicly report their patient experience ratings, the gap between how patients rated these facilities and the scores that other hospitals got widened. "We found that [safety-net hospitals] performed more poorly than other hospitals on nearly every measure of patient experience and that gaps in performance were sizeable and persistent over time," the authors write.

When the Centers for Medicare and Medicaid Services agency starts using the scores to hand out bonuses and penalties, safety-net hospitals could be at a disadvantage, especially since penalties could mean a 2 percent cut on regular Medicare payments. Starting in October, patient experience scores will determine 30 percent of a facility's bonus. "The hospitals that perform best will gain money, while those that lag in scores and improvement over time will end up with less," reports Jordan Rau for Kaiser Health News. (Read more)

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Hospitals are not reporting cases of harm to patients; electronic health records may be key to solving the problem

By Tara Kaprowy
Kentucky Health News

Hospitals aren't reporting cases in which medical care harmed a patient, making it difficult for providers to identify problems and fix them, according to a report to be released by the U.S. Department of Health and Human Services.

The report indicates many hospitals are ignoring state regulations by not reporting preventable problems. In Kentucky, there are no mandatory public reporting requirements for hospitals. They must only inform the state Department of Public Health about infectious outbreaks, but the definition of an outbreak varies from facility to facility, based on the number of patients seen in a specific period of time.

Dr. Kevin Kavanaugh, a retired physician and chairman of Health Watch USA, said the report points to "the need for greater health care transparency and state government engagement."

The study's lead researcher, Lee Adler, is looking to electronic health records to set things right since "we may be able to prevent events, we may be able to ameliorate events, and (electronic records) may become your surveillance system," he said.

The software can be designed to "catch triggers for potential errors," Kelly Kennedy reports for USA Today. One example could involve a patient that is given an antidote after a medication overdose. The fact that the antidote was used would trigger an alert to a hospital quality control officer, who would them follow up in turn. (Read more)

About half of doctors are using EHRs nationwide, the latest survey from the Department of Health and Human Services shows. "That's a pretty high number, historically speaking," reports Sarah Kliff for The Washington Post. "As recently as 2005, just about a quarter of doctors' offices had gone digital."

In February, Health and Human Services Secretary Kathleen Sebelius said the percentage of hospitals using electronic health records has doubled in two years, Medical News Today reports. The shift at doctors' offices and hospitals stems from a provision in the federal health-care reform law, which gives financial incentives to facilities that switch over to EHRs.

In Kentucky, 723 eligible professionals and 15 hospitals have already been paid their incentives, which totaled more than $155 million as of May. In February, Sebelius said almost 2,000 hospitals and more than 41,000 doctors had received more than $3 billion in incentive payments to use health information technology. The proportion of hospitals that now use EHRs went up from 16 percent in 2009 to 35 percent in 2011. More than 80 percent of hospitals said they intend to advantage of the incentives by 2015.

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.

By Tara Kaprowy
Kentucky Health News

Hospitals aren't reporting cases in which medical care harmed a patient, making it difficult for providers to identify problems and fix them, according to a report to be released by the U.S. Department of Health and Human Services.

The report indicates many hospitals are ignoring state regulations by not reporting preventable problems. In Kentucky, there are no mandatory public reporting requirements for hospitals. They must only inform the state Department of Public Health about infectious outbreaks, but the definition of an outbreak varies from facility to facility, based on the number of patients seen in a specific period of time.

Dr. Kevin Kavanaugh, a retired physician and chairman of Health Watch USA, said the report points to "the need for greater health care transparency and state government engagement."

The study's lead researcher, Lee Adler, is looking to electronic health records to set things right since "we may be able to prevent events, we may be able to ameliorate events, and (electronic records) may become your surveillance system," he said.

The software can be designed to "catch triggers for potential errors," Kelly Kennedy reports for USA Today. One example could involve a patient that is given an antidote after a medication overdose. The fact that the antidote was used would trigger an alert to a hospital quality control officer, who would them follow up in turn. (Read more)

About half of doctors are using EHRs nationwide, the latest survey from the Department of Health and Human Services shows. "That's a pretty high number, historically speaking," reports Sarah Kliff for The Washington Post. "As recently as 2005, just about a quarter of doctors' offices had gone digital."

In February, Health and Human Services Secretary Kathleen Sebelius said the percentage of hospitals using electronic health records has doubled in two years, Medical News Today reports. The shift at doctors' offices and hospitals stems from a provision in the federal health-care reform law, which gives financial incentives to facilities that switch over to EHRs.

In Kentucky, 723 eligible professionals and 15 hospitals have already been paid their incentives, which totaled more than $155 million as of May. In February, Sebelius said almost 2,000 hospitals and more than 41,000 doctors had received more than $3 billion in incentive payments to use health information technology. The proportion of hospitals that now use EHRs went up from 16 percent in 2009 to 35 percent in 2011. More than 80 percent of hospitals said they intend to advantage of the incentives by 2015.

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.

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More breakthroughs lately in fight against HIV/AIDS

It has been an inspiring season of breakthroughs in the fight to prevent the spread of HIV and AIDS. Earlier this week, the Food and Drug Administration approved the pill Truvada, "a preventive measure for healthy people who are at high risk of acquiring HIV through sexual activity, such as those who have HIV-infected partners," reports Matthew Perrone for The Associated Press.

Just two weeks ago, the agency also approved the first over-the-counter HIV test that can be used at home. "I think the combination of self-testing and a medicine that you can take at home to prevent infection could mean a whole new approach to HIV prevention that is a bit more realistic," said Dr. Demetre Daskalakis of New York University's Langone Medical Center.

In the meantime, a research team at the University of Nebraska Medical Center is making progress to develop a weekly or twice-monthly injection that would help manage patients with HIV. The long-acting injection "would be a substantive improvement over daily and sometimes more complex regimen of pills," lead investigator Dr. Howard Gendelman told research-reporting service Newswise.

"We actually followed the process exactly as we would with a person — and it worked," he said. "This is all very exciting. Although there are clear pitfalls ahead and the medicines are not yet ready for human use, the progress is undeniable." (Read more)

It has been an inspiring season of breakthroughs in the fight to prevent the spread of HIV and AIDS. Earlier this week, the Food and Drug Administration approved the pill Truvada, "a preventive measure for healthy people who are at high risk of acquiring HIV through sexual activity, such as those who have HIV-infected partners," reports Matthew Perrone for The Associated Press.

Just two weeks ago, the agency also approved the first over-the-counter HIV test that can be used at home. "I think the combination of self-testing and a medicine that you can take at home to prevent infection could mean a whole new approach to HIV prevention that is a bit more realistic," said Dr. Demetre Daskalakis of New York University's Langone Medical Center.

In the meantime, a research team at the University of Nebraska Medical Center is making progress to develop a weekly or twice-monthly injection that would help manage patients with HIV. The long-acting injection "would be a substantive improvement over daily and sometimes more complex regimen of pills," lead investigator Dr. Howard Gendelman told research-reporting service Newswise.

"We actually followed the process exactly as we would with a person — and it worked," he said. "This is all very exciting. Although there are clear pitfalls ahead and the medicines are not yet ready for human use, the progress is undeniable." (Read more)

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Chest deformities in Bengal kittens

Charlesworth TM, Sturgess CP. Increased incidence of thoracic wall deformities in related Bengal kittens. J Feline Med Surg 2012;14:365-368.



There are several thoracic wall deformities described in kittens, including pectus excavatum (PE), flat-chest defect, scoliosis, lordosis, kyphosis, pectus carinatum, and missing or extra ribs or thoracic vertebrae. In this study, clinical records made during examinations for routine vaccinations were evaluated in populations of domestic shorthair (DSH) kittens and Bengal kittens. The records for 244 Bengal kittens were reviewed and compared to those of 1748 DSH kittens. No thoracic wall abnormalities were recorded in the DSH kittens compared with 12 cases in the Bengal kittens. Among the 12 cases in Bengal kittens, the deformities detected were pectus excavatum (5), unilateral thoracic wall concavity (6), and scoliosis (1). There was a high degree of common ancestry found in analyzing five-generation pedigrees and this indicates a familial cause is likely. The data presented supports the hypothesis that these deformities are more common within the study’s examined population of Bengal kittens than a DSH population. Data also suggests that thoracic wall deformities may be a relatively common familial defect in Bengal kittens. Bengal kittens should have their thoracic wall carefully evaluated during routine clinical evaluation. [VT]

See also: Yoon H, Mann F, Jeong S. Surgical correction of pectus excavatum in two cats. J Vet Sci 2008;9:335-337. [free, full text article]

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Charlesworth TM, Sturgess CP. Increased incidence of thoracic wall deformities in related Bengal kittens. J Feline Med Surg 2012;14:365-368.



There are several thoracic wall deformities described in kittens, including pectus excavatum (PE), flat-chest defect, scoliosis, lordosis, kyphosis, pectus carinatum, and missing or extra ribs or thoracic vertebrae. In this study, clinical records made during examinations for routine vaccinations were evaluated in populations of domestic shorthair (DSH) kittens and Bengal kittens. The records for 244 Bengal kittens were reviewed and compared to those of 1748 DSH kittens. No thoracic wall abnormalities were recorded in the DSH kittens compared with 12 cases in the Bengal kittens. Among the 12 cases in Bengal kittens, the deformities detected were pectus excavatum (5), unilateral thoracic wall concavity (6), and scoliosis (1). There was a high degree of common ancestry found in analyzing five-generation pedigrees and this indicates a familial cause is likely. The data presented supports the hypothesis that these deformities are more common within the study’s examined population of Bengal kittens than a DSH population. Data also suggests that thoracic wall deformities may be a relatively common familial defect in Bengal kittens. Bengal kittens should have their thoracic wall carefully evaluated during routine clinical evaluation. [VT]

See also: Yoon H, Mann F, Jeong S. Surgical correction of pectus excavatum in two cats. J Vet Sci 2008;9:335-337. [free, full text article]

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Read the Cat Health News Weekly
Join us on Google+

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Forums set to explain state insurance exchange and its new opportunities for coverage, little known to most who will be eligible

By Tara Kaprowy
Kentucky Health News

Now that Gov. Steve Beshear has issued the order to create a state health insurance exchange, the state is scheduling public forums to explain it. Rachel Klein, the executive director of Enroll America, said 78 percent of uninsured Americans "have no idea that there is new health coverage coming." 

Klein's nonprofit organization, based in Washington, D.C., is working with local and state groups like the Kentucky Voices for Health coalition to help spread the word that many will be eligible for health care under the exchange, part of national health reform.

Under the exchange, people who earn up to 400 percent of the federal poverty level will be able to buy private health insurance, and most will have their premiums partly paid for through federal subsidies. They will be able to get information about various policies and enroll online.

Officials from the state Department of Insurance and Cabinet for Health and Family Services will hold six educational forums in the coming days to talk about the exchange the federal health-care reform law. Here is the schedule:

• Erlanger: 1-3:30 p.m. July 25, Northern Kentucky University, The METS Center
• Louisville: 1-3:30 p.m., July 26, University of Louisville Shelby Campus
• Prestonsburg: 1-3:30 p.m., July 27, Big Sandy Community and Technical College
• Somerset: 1-3:30 p.m., Aug. 1, Somerset Community College
• Paducah: 1-3:30 p.m., Aug. 16, West Kentucky Community and Technical College
• Owensboro: 8:30-11 a.m., Aug. 17, Owensboro Community and Technical College

Once the exchange is set up, Klein said it will be important for the sign-up process to be easy. States should make the application itself easy to read and be sure there is a lot of help available to those enrolling, she said. "It's hard to underestimate the incredible need for assistance," Klein said. Another key piece is to make sure the exchange's technology "coordinates well with other systems that are already in existence," she said.

The exchange will include the federal-state Medicaid program. Kentucky has the option of expanding its program up to 133 percent of the federal poverty level (with a sort of fudge factor up to 138 percent). Right now, only those earning up to 59 percent qualify. Expansion would cover almost 300,000 more Kentuckians, Democratic U.S. Rep. John Yarmuth of Louisville said last week. The  has not yet released an exact number of how many would be affected.

As of last Friday, Kentucky was the 16th state to commit to an exchange. States have until Nov. 1 to inform the federal government if they intend to set up an exchange, and have until Jan. 1, 2014 to get them up and running.

KVH said it will also help educate the public. Executive Director Jodi Mitchell said she is staying connected with the state to keep abreast of the status of the exchange. "The cabinet is going to do it the way the cabinet is going to do it," she said. "The challenge is for us to keep involved and hold them accountable as they 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.

By Tara Kaprowy
Kentucky Health News

Now that Gov. Steve Beshear has issued the order to create a state health insurance exchange, the state is scheduling public forums to explain it. Rachel Klein, the executive director of Enroll America, said 78 percent of uninsured Americans "have no idea that there is new health coverage coming." 

Klein's nonprofit organization, based in Washington, D.C., is working with local and state groups like the Kentucky Voices for Health coalition to help spread the word that many will be eligible for health care under the exchange, part of national health reform.

Under the exchange, people who earn up to 400 percent of the federal poverty level will be able to buy private health insurance, and most will have their premiums partly paid for through federal subsidies. They will be able to get information about various policies and enroll online.

Officials from the state Department of Insurance and Cabinet for Health and Family Services will hold six educational forums in the coming days to talk about the exchange the federal health-care reform law. Here is the schedule:

• Erlanger: 1-3:30 p.m. July 25, Northern Kentucky University, The METS Center
• Louisville: 1-3:30 p.m., July 26, University of Louisville Shelby Campus
• Prestonsburg: 1-3:30 p.m., July 27, Big Sandy Community and Technical College
• Somerset: 1-3:30 p.m., Aug. 1, Somerset Community College
• Paducah: 1-3:30 p.m., Aug. 16, West Kentucky Community and Technical College
• Owensboro: 8:30-11 a.m., Aug. 17, Owensboro Community and Technical College

Once the exchange is set up, Klein said it will be important for the sign-up process to be easy. States should make the application itself easy to read and be sure there is a lot of help available to those enrolling, she said. "It's hard to underestimate the incredible need for assistance," Klein said. Another key piece is to make sure the exchange's technology "coordinates well with other systems that are already in existence," she said.

The exchange will include the federal-state Medicaid program. Kentucky has the option of expanding its program up to 133 percent of the federal poverty level (with a sort of fudge factor up to 138 percent). Right now, only those earning up to 59 percent qualify. Expansion would cover almost 300,000 more Kentuckians, Democratic U.S. Rep. John Yarmuth of Louisville said last week. The  has not yet released an exact number of how many would be affected.

As of last Friday, Kentucky was the 16th state to commit to an exchange. States have until Nov. 1 to inform the federal government if they intend to set up an exchange, and have until Jan. 1, 2014 to get them up and running.

KVH said it will also help educate the public. Executive Director Jodi Mitchell said she is staying connected with the state to keep abreast of the status of the exchange. "The cabinet is going to do it the way the cabinet is going to do it," she said. "The challenge is for us to keep involved and hold them accountable as they 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.

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Being sedentary is just as deadly as smoking, series finds

Getty Images photo by George Doyle

Physical inactivity is such a problem worldwide it has become as deadly as smoking, a series of studies has found. Lack of exercise causes about one in 10 premature deaths worldwide, in large part because it contributes to heart disease, Type 2 diabetes, breast cancer and colon cancer.

"If physical inactivity could be reduced by just 10 percent, it could avert some 533,000 deaths a year; if reduced by 25 percent, 1.3 million deaths could be prevented," reports Alice Park for Time Healthland.

In a study published in the journal Lancet, researchers "calculated something called a population attributable fraction (PAF), a measure of the contribution of risk factors like physical inactivity to diseases such as heart disease or diabetes, and even risk of death," Park reports. That calculation indicated how many incidences of disease could have been prevented if people started exercising like they should. PAFs were calculated for 123 countries and showed overall that physical inactivity is responsible for 6 percent of heart disease, 7 percent of Type 2 diabetes and 10 percent of breast and colon cancers.

The numbers also showed people living in the Americas have the most physically inactive populations — 43 percent of people don't get enough exercise — while people who live in Southeast Asia are the most active. The Americas' reliance on cars and other vehicles is considered a major factor in their sedentary lifestyles, with just 4 percent of people in the U.S. walking to work and fewer than 2 percent using a bicycle to commute.

Experts say sufficient physical activity is the equivalent of 150 minutes of moderate exercise a week, which could mean 30 minutes of fast walking five times a week.

Another paper in the series pointed to steps people and communities can take to be more active: using signs to suggest taking the stairs rather than the elevator, or free exercise classes at public parks, for example. Maintaining streets and improving lighting can raise activity levels by 50 percent, some studies show. Researchers also discussed an effort in Bogotá, Colombia, where some city streets are closed to cars and vehicles on Sunday mornings and public holidays. Each week, about 1 million people show up to exercise. The effort has spread to Kentucky and been dubbed Second Sunday Kentucky.

Some experts took issue with the comparison with smoking, since "even if smoking and inactivity kill the same number of people, far fewer people smoke than are sedentary, making tobacco more risky to the individual," Park reports. (Read more)

Getty Images photo by George Doyle

Physical inactivity is such a problem worldwide it has become as deadly as smoking, a series of studies has found. Lack of exercise causes about one in 10 premature deaths worldwide, in large part because it contributes to heart disease, Type 2 diabetes, breast cancer and colon cancer.

"If physical inactivity could be reduced by just 10 percent, it could avert some 533,000 deaths a year; if reduced by 25 percent, 1.3 million deaths could be prevented," reports Alice Park for Time Healthland.

In a study published in the journal Lancet, researchers "calculated something called a population attributable fraction (PAF), a measure of the contribution of risk factors like physical inactivity to diseases such as heart disease or diabetes, and even risk of death," Park reports. That calculation indicated how many incidences of disease could have been prevented if people started exercising like they should. PAFs were calculated for 123 countries and showed overall that physical inactivity is responsible for 6 percent of heart disease, 7 percent of Type 2 diabetes and 10 percent of breast and colon cancers.

The numbers also showed people living in the Americas have the most physically inactive populations — 43 percent of people don't get enough exercise — while people who live in Southeast Asia are the most active. The Americas' reliance on cars and other vehicles is considered a major factor in their sedentary lifestyles, with just 4 percent of people in the U.S. walking to work and fewer than 2 percent using a bicycle to commute.

Experts say sufficient physical activity is the equivalent of 150 minutes of moderate exercise a week, which could mean 30 minutes of fast walking five times a week.

Another paper in the series pointed to steps people and communities can take to be more active: using signs to suggest taking the stairs rather than the elevator, or free exercise classes at public parks, for example. Maintaining streets and improving lighting can raise activity levels by 50 percent, some studies show. Researchers also discussed an effort in Bogotá, Colombia, where some city streets are closed to cars and vehicles on Sunday mornings and public holidays. Each week, about 1 million people show up to exercise. The effort has spread to Kentucky and been dubbed Second Sunday Kentucky.

Some experts took issue with the comparison with smoking, since "even if smoking and inactivity kill the same number of people, far fewer people smoke than are sedentary, making tobacco more risky to the individual," Park reports. (Read more)

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Infant mortality, pre-term birth, teenage pregnancy, children living in smokers' homes all drop even as as child poverty goes up

Nationwide, the rates of infants who die, babies who are born prematurely, teens who are having babies, and the percentage of young children who live in a home where someone smokes have all decreased in the last five years. But the percentage of kids who live in poverty has gone up.

These findings are some highlights of the report "America's Children in Brief: Key National Indicators of Well-Being, 2012," compiled by the Federal Interagency Forum on Child and Family Statistics. The report, which does not break down data by state, looks at children's demographic backgrounds, family and social environments, economic circumstances, health care, physical environment and safety, behavior, education and health.

"This year's report contains good news about newborns," said Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. "Fewer infants were born pre-term and fewer died in the first year of life."

Among other findings: In the last five years there has been a five-fold increase in the percentage of teens who have received the vaccine that prevents the most dangerous form of meningitis. Other key findings show:
• A drop in the percentage of children who live in homes that are classified as food insecure.
• A drop in the percentage of teens ages 16 to 19 who don't work and are not enrolled in high school or college.
• A rise in the percentage of children from birth to age 17 who live in counties in which one or more air pollutants were above allowable levels.
• An increase of one statistical point in the average math scores for 4th and 8th graders from 2009 to 2011. For a quick glance at the findings, click here. (Read more)

Nationwide, the rates of infants who die, babies who are born prematurely, teens who are having babies, and the percentage of young children who live in a home where someone smokes have all decreased in the last five years. But the percentage of kids who live in poverty has gone up.

These findings are some highlights of the report "America's Children in Brief: Key National Indicators of Well-Being, 2012," compiled by the Federal Interagency Forum on Child and Family Statistics. The report, which does not break down data by state, looks at children's demographic backgrounds, family and social environments, economic circumstances, health care, physical environment and safety, behavior, education and health.

"This year's report contains good news about newborns," said Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. "Fewer infants were born pre-term and fewer died in the first year of life."

Among other findings: In the last five years there has been a five-fold increase in the percentage of teens who have received the vaccine that prevents the most dangerous form of meningitis. Other key findings show:
• A drop in the percentage of children who live in homes that are classified as food insecure.
• A drop in the percentage of teens ages 16 to 19 who don't work and are not enrolled in high school or college.
• A rise in the percentage of children from birth to age 17 who live in counties in which one or more air pollutants were above allowable levels.
• An increase of one statistical point in the average math scores for 4th and 8th graders from 2009 to 2011. For a quick glance at the findings, click here. (Read more)

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Beshear says he will expand Medicaid if state can afford it, says 'If we've got a healthier Kentucky, we're all better off'

By Al Cross
Kentucky Health News

Gov. Steve Beshear said today that he would expand Kentucky's Medicaid program under the federal health-reform law if the state can afford the cost.

"If there is a way that we can afford that will get more coverage for more Kentuckians, I'm for it, because if we've got a healthier Kentucky, we're all better off. Our economy's better off, and of course the individuals are better off," Beshear told Jack Pattie of WVLK Radio in an interview on Pattie's mid-morning show. (KET image)

That may have been Beshear's first public statement from his own mouth on the issue. State House Republican Leader Jeff Hoover has said Beshear should not expand Medicaid because it would cost the state hundreds of millions of dollars once it has to start paying part of the cost of covering the new patients, beginning in 2017 and rising to 10 percent in 2020.

The first caller to the show asked the Democratic governor, "How much is this going to cost us?"

Beshear did not reply with a number. He said, "We're gonna analyze that part of the law to see how much it will cost us, how many people we're talking about. I do know the profile of the people we're talking about; they're working adults, they're working families that just can't afford health care because they don't make enough money to be able to pay premiums" for health insurance.

Beshear said he would make "a reasoned and fiscally responsible decision, and there is "no timetable on making it at this point." Republicans are expected to make it an issue in the fall elections, raising the prospect of reduced state services or higher taxes.

Pattie asked the governor, "Is it possible to do all this without a tax increase?" Beshear answered, "I've got to look out into the future, see how our revenues are growing, see how our economy is doing, to make sure we don't put a burden on ourselves that we can't afford."

The 2010 law specified that if states did not expand Medicaid to cover those with incomes up to 133 percent of the federal poverty level, they could lose all their federal Medicaid funds, which in Kentucky covers 70 percent of the program's current cost. The U.S. Supreme Court ruled that threat was unconstitutional, giving the states the option.

Several Republican governors have said they would not expand Medicaid, while Democrats are generally in favor of it, but governors of both parties have said they are undecided. It is possible that federal officials would allow the program to be adjusted in ways that would reduce the cost of the expansion.

Beshear also defended his decision to create a state exchange for health insurance, saying the state's business interests, hospitals, insurance companies and other interests wanted the state to run its own exchange rather than let federal officials do it. "We know better about Kentuckians than the federal government does," he said. He told the first caller that the exchange "would not cost us anything," and explained later that insurance companies would pay the cost.

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.

By Al Cross
Kentucky Health News

Gov. Steve Beshear said today that he would expand Kentucky's Medicaid program under the federal health-reform law if the state can afford the cost.

"If there is a way that we can afford that will get more coverage for more Kentuckians, I'm for it, because if we've got a healthier Kentucky, we're all better off. Our economy's better off, and of course the individuals are better off," Beshear told Jack Pattie of WVLK Radio in an interview on Pattie's mid-morning show. (KET image)

That may have been Beshear's first public statement from his own mouth on the issue. State House Republican Leader Jeff Hoover has said Beshear should not expand Medicaid because it would cost the state hundreds of millions of dollars once it has to start paying part of the cost of covering the new patients, beginning in 2017 and rising to 10 percent in 2020.

The first caller to the show asked the Democratic governor, "How much is this going to cost us?"

Beshear did not reply with a number. He said, "We're gonna analyze that part of the law to see how much it will cost us, how many people we're talking about. I do know the profile of the people we're talking about; they're working adults, they're working families that just can't afford health care because they don't make enough money to be able to pay premiums" for health insurance.

Beshear said he would make "a reasoned and fiscally responsible decision, and there is "no timetable on making it at this point." Republicans are expected to make it an issue in the fall elections, raising the prospect of reduced state services or higher taxes.

Pattie asked the governor, "Is it possible to do all this without a tax increase?" Beshear answered, "I've got to look out into the future, see how our revenues are growing, see how our economy is doing, to make sure we don't put a burden on ourselves that we can't afford."

The 2010 law specified that if states did not expand Medicaid to cover those with incomes up to 133 percent of the federal poverty level, they could lose all their federal Medicaid funds, which in Kentucky covers 70 percent of the program's current cost. The U.S. Supreme Court ruled that threat was unconstitutional, giving the states the option.

Several Republican governors have said they would not expand Medicaid, while Democrats are generally in favor of it, but governors of both parties have said they are undecided. It is possible that federal officials would allow the program to be adjusted in ways that would reduce the cost of the expansion.

Beshear also defended his decision to create a state exchange for health insurance, saying the state's business interests, hospitals, insurance companies and other interests wanted the state to run its own exchange rather than let federal officials do it. "We know better about Kentuckians than the federal government does," he said. He told the first caller that the exchange "would not cost us anything," and explained later that insurance companies would pay the cost.

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.

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Are fallacies about health reform becoming accepted wisdom? Former New York Times editor Bill Keller says he fears so

"A number of fallacies seem to be congealing into accepted wisdom" about the Patient Protection and Affordable Care Act, former New York Times editor Bill Keller writes for the paper. The myths, he says, are that (1) the law is killing jobs, (2) it's a federal takeover of the health system, (3) the free market would be better, (4) states can fix the problems with health insurance, and (5) the law is a political loser. Here's a capsule of Keller's counterpoints:

(1) Jobs: While some workers "no longer so dependent on employers for their health-care safety net may choose to retire earlier or work part-time," Keller writes, their jobs will be open for others, and he cites FactCheck.org's latest debunking of the job-killer claim.

(2) Takeover: "The main thing the law does is deliver 30 million new customers to the private insurance industry," Keller writes, with emphasis. "Insurance will be governed by new regulations, and supported by new subsidies . . . but the share of health-care spending that comes from the federal government is expected to rise only modestly."

(3) Marketplace: "To the extent there is a profound difference of principle anywhere in this debate, it lies here," Keller writes. He says giving people tax credits to buy their own insurance and care could reduce wasteful spending, but quotes Karen Davis, president of The Commonwealth Fund: Ten percent of the population accounts for 60 percent of the health outlays. They are the very sick, and they are not really in a position to make cost-conscious choices.”

(4) States: "Some states are too poor to adopt worthwhile reforms. Some are intransigent, or held captive by lobbies," Keller writes, noting that the law "underwrites pilot programs to reduce costs, and gives states freedom — some would argue too much freedom — in designing insurance-buying exchanges."

(5) Politics: Because most of the law won't take effect until 2014, "so there are not yet testimonials from enthusiastic, family-next-door beneficiaries. This helps explain why the bill has not won more popular affection. It also explains why the Republicans are so desperate to kill it now, before Americans feel the abundant rewards," Keller writes, calling on Democrats to "mount a full-throated defense." (Read more)

"A number of fallacies seem to be congealing into accepted wisdom" about the Patient Protection and Affordable Care Act, former New York Times editor Bill Keller writes for the paper. The myths, he says, are that (1) the law is killing jobs, (2) it's a federal takeover of the health system, (3) the free market would be better, (4) states can fix the problems with health insurance, and (5) the law is a political loser. Here's a capsule of Keller's counterpoints:

(1) Jobs: While some workers "no longer so dependent on employers for their health-care safety net may choose to retire earlier or work part-time," Keller writes, their jobs will be open for others, and he cites FactCheck.org's latest debunking of the job-killer claim.

(2) Takeover: "The main thing the law does is deliver 30 million new customers to the private insurance industry," Keller writes, with emphasis. "Insurance will be governed by new regulations, and supported by new subsidies . . . but the share of health-care spending that comes from the federal government is expected to rise only modestly."

(3) Marketplace: "To the extent there is a profound difference of principle anywhere in this debate, it lies here," Keller writes. He says giving people tax credits to buy their own insurance and care could reduce wasteful spending, but quotes Karen Davis, president of The Commonwealth Fund: Ten percent of the population accounts for 60 percent of the health outlays. They are the very sick, and they are not really in a position to make cost-conscious choices.”

(4) States: "Some states are too poor to adopt worthwhile reforms. Some are intransigent, or held captive by lobbies," Keller writes, noting that the law "underwrites pilot programs to reduce costs, and gives states freedom — some would argue too much freedom — in designing insurance-buying exchanges."

(5) Politics: Because most of the law won't take effect until 2014, "so there are not yet testimonials from enthusiastic, family-next-door beneficiaries. This helps explain why the bill has not won more popular affection. It also explains why the Republicans are so desperate to kill it now, before Americans feel the abundant rewards," Keller writes, calling on Democrats to "mount a full-throated defense." (Read more)

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Beshear issues order to create insurance exchange as GOP legislators carry symbolic vote against lease to house it

As Gov. Steve Beshear issued an executive order to establish a state insurance exchange this afternoon, lawmakers voted along party lines against a lease that would have housed employees of the exchange, once again illustrating the divisive nature of the controversial Affordable Care Act.

Members of the Capital Projects and Bond Oversight Committee voted 4-3 against the nearly $300,00-per-year lease, with Sen. Tom Buford of Nicholasville, Sen. Jared Carpenter of Berea, Rep. Steven Rudy of Paducah— all Republicans — voting no, along with Independent Sen. Bob Leeper of Paducah. Leeper caucuses with Senate Republicans.

Rep. Jim Wayne, Sen. Julian Carroll of Frankfort and and Rep. Jim Glenn of Owensboro, all Democrats, voted yes. Discussion focused on the uncertainty of the cost of implementing provisions in the Affordable Care Act and the state budget.

The committee does not have the power to block the lease permanently, but Beshear will have to go through some additional procedural steps.

The exchange is considered one of the cornerstones of the federal health-care reform law aimed at containing costs by spurring competition among private insurers. It will be a marketplace to shop for different packages of state-approved health insurance and will be available to people who earn up to 400 percent of the federal poverty level. To offset the cost of their premiums, those participating in the exchange will receive subsidies in the form of tax credits. The Medicaid program will also fall under the exchange's umbrella. 

Small businesses with fewer than 100 employees can also qualify for the exchange, a move that is meant to boost their purchasing power.

 
Beshear said, "We will work closely with insurers, providers and consumers and other groups to develop a robust, responsive, and user-friendly portal that will help Kentuckians find the coverage that best suits their needs."

He said the exchange will be in operation starting Jan. 1, 2014 as the federal law requires. The state has already received more than $66 million to plan for the exchange. States had the option to run the exchange themselves or have the federal government do so for them. But Audrey Tayse Haynes, secretary for the Cabinet for Health and Family Services, said Kentucky is better geared to running its own program since it "is more in tune with the unique regional and economic needs of our citizens, as well as the health insurance needs of individuals, Kentucky small businesses and nonprofits." (Read more)

As Gov. Steve Beshear issued an executive order to establish a state insurance exchange this afternoon, lawmakers voted along party lines against a lease that would have housed employees of the exchange, once again illustrating the divisive nature of the controversial Affordable Care Act.

Members of the Capital Projects and Bond Oversight Committee voted 4-3 against the nearly $300,00-per-year lease, with Sen. Tom Buford of Nicholasville, Sen. Jared Carpenter of Berea, Rep. Steven Rudy of Paducah— all Republicans — voting no, along with Independent Sen. Bob Leeper of Paducah. Leeper caucuses with Senate Republicans.

Rep. Jim Wayne, Sen. Julian Carroll of Frankfort and and Rep. Jim Glenn of Owensboro, all Democrats, voted yes. Discussion focused on the uncertainty of the cost of implementing provisions in the Affordable Care Act and the state budget.

The committee does not have the power to block the lease permanently, but Beshear will have to go through some additional procedural steps.

The exchange is considered one of the cornerstones of the federal health-care reform law aimed at containing costs by spurring competition among private insurers. It will be a marketplace to shop for different packages of state-approved health insurance and will be available to people who earn up to 400 percent of the federal poverty level. To offset the cost of their premiums, those participating in the exchange will receive subsidies in the form of tax credits. The Medicaid program will also fall under the exchange's umbrella. 

Small businesses with fewer than 100 employees can also qualify for the exchange, a move that is meant to boost their purchasing power.

 
Beshear said, "We will work closely with insurers, providers and consumers and other groups to develop a robust, responsive, and user-friendly portal that will help Kentuckians find the coverage that best suits their needs."

He said the exchange will be in operation starting Jan. 1, 2014 as the federal law requires. The state has already received more than $66 million to plan for the exchange. States had the option to run the exchange themselves or have the federal government do so for them. But Audrey Tayse Haynes, secretary for the Cabinet for Health and Family Services, said Kentucky is better geared to running its own program since it "is more in tune with the unique regional and economic needs of our citizens, as well as the health insurance needs of individuals, Kentucky small businesses and nonprofits." (Read more)

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Beshear to have outside panel review cases of children killed or life-threatened by abuse

An independent panel of experts will review cases of children who have been killed or severely hurt by child abuse or neglect, Gov. Steve Beshear announced Monday. The panel will have 17 members and be based in the Justice and Public Safety Cabinet. Its aim will be to assess if the state's child-protection workers did all they could to protect children who died as a result of abuse. It will also determine causes of death.

The Cabinet for Health and Family Services "released thousands of pages of documents Monday that detail the state's involvement with dozens of children who were killed or nearly killed as a result of abuse of neglect," reports Beth Musgrave for the Lexington Herald-Leader. "Still, the cabinet continues to withhold some case files and has redacted large portions of others."

The release is the result of a lengthy court battle between the cabinet and the state's two largest newspapers, the Herald-Leader and The Courier-Journal. The newspapers argued documents pertaining to these cases were subject to open record laws and Franklin Circuit Court Judge Phillip Shepherd agreed. The cabinet released 76 of about 140 files, but with key information omitted. In February, Shepherd ruled the cabinet had 90 days to hand over remaining case files, fined the cabinet $16,000 for withholding the records and ordered it to pay $57,000 in attorney fees for the newspapers.

The cabinet appealed the ruling in the Court of Appeals, but on July 9, the court sided with the newspapers, refusing to allow the documents from being withheld. More than 40 similarily-redacted cases were released yesterday but the cabinet filed an appeal with the Kentucky Supreme Court. "We disagree on how much personal information about the children and private individuals included in caseworker files should be made public," Cabinet Secretary Audrey Haynes said.

Also yesterday, Beshear issued an order to create the panel, which will meet four times a year and will issue an annual report that details issues it finds. "When a child dies or is critically injured because of abuse or neglect, we must carefully review the practices of all government entitites involved to make sure that our system performed as it was supposed to — and if not, that review allows us to take disciplinary action," Beshear said.

Panel members will include law enforcement, prosecutors and medical experts, Musgrave reports. While the meetings will be open to the public, the records consulted during them will not be subject to open records laws. (Read more)

An independent panel of experts will review cases of children who have been killed or severely hurt by child abuse or neglect, Gov. Steve Beshear announced Monday. The panel will have 17 members and be based in the Justice and Public Safety Cabinet. Its aim will be to assess if the state's child-protection workers did all they could to protect children who died as a result of abuse. It will also determine causes of death.

The Cabinet for Health and Family Services "released thousands of pages of documents Monday that detail the state's involvement with dozens of children who were killed or nearly killed as a result of abuse of neglect," reports Beth Musgrave for the Lexington Herald-Leader. "Still, the cabinet continues to withhold some case files and has redacted large portions of others."

The release is the result of a lengthy court battle between the cabinet and the state's two largest newspapers, the Herald-Leader and The Courier-Journal. The newspapers argued documents pertaining to these cases were subject to open record laws and Franklin Circuit Court Judge Phillip Shepherd agreed. The cabinet released 76 of about 140 files, but with key information omitted. In February, Shepherd ruled the cabinet had 90 days to hand over remaining case files, fined the cabinet $16,000 for withholding the records and ordered it to pay $57,000 in attorney fees for the newspapers.

The cabinet appealed the ruling in the Court of Appeals, but on July 9, the court sided with the newspapers, refusing to allow the documents from being withheld. More than 40 similarily-redacted cases were released yesterday but the cabinet filed an appeal with the Kentucky Supreme Court. "We disagree on how much personal information about the children and private individuals included in caseworker files should be made public," Cabinet Secretary Audrey Haynes said.

Also yesterday, Beshear issued an order to create the panel, which will meet four times a year and will issue an annual report that details issues it finds. "When a child dies or is critically injured because of abuse or neglect, we must carefully review the practices of all government entitites involved to make sure that our system performed as it was supposed to — and if not, that review allows us to take disciplinary action," Beshear said.

Panel members will include law enforcement, prosecutors and medical experts, Musgrave reports. While the meetings will be open to the public, the records consulted during them will not be subject to open records laws. (Read more)

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Cats and canine parvovirus

Clegg SR, Coyne KP, Dawson S, et al. Canine parvovirus in asymptomatic feline carriers. Vet Microbiol 2012;157:78-85.
 
Parvoviruses are important pathogens of dogs and cats, and have a high mutation rate. The canine strains that have emerged in recent years have the ability to infect and cause disease in cats as well as dogs. These investigators looked at the numbers of healthy cats in rescue shelters that harbor canine parvovirus in their feces. In fact, CPV was found in one-third of cats in a cat-only rescue shelter and a mixed rescue shelter. Interestingly, no feline parvovirus was found in these cats. Also interesting was the fact that none of the cats were clinically ill. This indicates that normal cats could potentially be shedding canine parvovirus and may be a potential source for dogs in the same environment. [MK]

See also: Battilani M, Balboni A, Ustulin M, et al. Genetic complexity and multiple infections with more Parvovirus species in naturally infected cats. Vet Res 2011;42:43. [free, full text article] 


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Clegg SR, Coyne KP, Dawson S, et al. Canine parvovirus in asymptomatic feline carriers. Vet Microbiol 2012;157:78-85.
 
Parvoviruses are important pathogens of dogs and cats, and have a high mutation rate. The canine strains that have emerged in recent years have the ability to infect and cause disease in cats as well as dogs. These investigators looked at the numbers of healthy cats in rescue shelters that harbor canine parvovirus in their feces. In fact, CPV was found in one-third of cats in a cat-only rescue shelter and a mixed rescue shelter. Interestingly, no feline parvovirus was found in these cats. Also interesting was the fact that none of the cats were clinically ill. This indicates that normal cats could potentially be shedding canine parvovirus and may be a potential source for dogs in the same environment. [MK]

See also: Battilani M, Balboni A, Ustulin M, et al. Genetic complexity and multiple infections with more Parvovirus species in naturally infected cats. Vet Res 2011;42:43. [free, full text article] 


More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Read the Cat Health News Weekly
Join us on Google+

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Cabinet for Health and Family Services held in contempt over Medicaid services for Eastern Kentuckians

Hazard Appalachian Regional Medical Center, one of
eight ARH hospitals. Courier-Journal photo, copyright 2000

For taking "practically no steps to a comply" to a request to help thousands of patients transfer their Medicaid services, the Cabinet for Health and Family Services was held in contempt of court Monday.

U.S. Senior Judge Karl Forester said the Cabinet's refused to "process requests by patients to transfer away from Coventry Cares, a managed-care organization, in light of Coventry's impending termination of its provider contract with Appalachian Regional Healthcare," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

ARH and Coventry, part of Coventry Health and Life Insurance Co., battled it out in court earlier this year when Coventry wanted to terminate its contract in May — six months before its contract was set to expire — with the hospital chain, which covers 25,000 patients. In turn, ARH filed a lawsuit asking for a preliminary injunction to avoid the termination, which was ultimately granted. The injunction states Coventry must continue to pay ARH for services until Nov. 1. But the cabinet was supposed to help facilitate the transfer of patients from Coventry to Wellcare, the only other company that has a contract with ARH, in the meantime. Forester said in his order about 6,000 transfer requests "were being held by the Cabinet," Spears reports.

Mike Wynn of The Courier-Journal reports that 8,400 patients have sought to switch to Wellcare from Coventry since May.

Though Forester said he will decide whether to impose sanctions on the cabinet at a later date, but did not require "the cabinet to process transfer requests with the start of open enrollment only five weeks away," Wynn reports. The open enrollment window is between Aug. 20 and Oct. 19, Spears reports.

Cabinet attorney argued processing transfers was unnecessary since Coventry had been forced to pay for services through the open enrollment period. ARH argued stopping the requests creates confusion.

In response to the ruling, the cabinet praised Forester for acknowledging "the need to allow the Medicaid program to proceed with open enrollment so as not to cause a gap in service or confusion for members."

"Member support is extremely important and the cabinet remains committed to listening to concerns from Medicaid members about their managed-care company as well as medical providers," the statement continued.

Hazard Appalachian Regional Medical Center, one of
eight ARH hospitals. Courier-Journal photo, copyright 2000

For taking "practically no steps to a comply" to a request to help thousands of patients transfer their Medicaid services, the Cabinet for Health and Family Services was held in contempt of court Monday.

U.S. Senior Judge Karl Forester said the Cabinet's refused to "process requests by patients to transfer away from Coventry Cares, a managed-care organization, in light of Coventry's impending termination of its provider contract with Appalachian Regional Healthcare," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

ARH and Coventry, part of Coventry Health and Life Insurance Co., battled it out in court earlier this year when Coventry wanted to terminate its contract in May — six months before its contract was set to expire — with the hospital chain, which covers 25,000 patients. In turn, ARH filed a lawsuit asking for a preliminary injunction to avoid the termination, which was ultimately granted. The injunction states Coventry must continue to pay ARH for services until Nov. 1. But the cabinet was supposed to help facilitate the transfer of patients from Coventry to Wellcare, the only other company that has a contract with ARH, in the meantime. Forester said in his order about 6,000 transfer requests "were being held by the Cabinet," Spears reports.

Mike Wynn of The Courier-Journal reports that 8,400 patients have sought to switch to Wellcare from Coventry since May.

Though Forester said he will decide whether to impose sanctions on the cabinet at a later date, but did not require "the cabinet to process transfer requests with the start of open enrollment only five weeks away," Wynn reports. The open enrollment window is between Aug. 20 and Oct. 19, Spears reports.

Cabinet attorney argued processing transfers was unnecessary since Coventry had been forced to pay for services through the open enrollment period. ARH argued stopping the requests creates confusion.

In response to the ruling, the cabinet praised Forester for acknowledging "the need to allow the Medicaid program to proceed with open enrollment so as not to cause a gap in service or confusion for members."

"Member support is extremely important and the cabinet remains committed to listening to concerns from Medicaid members about their managed-care company as well as medical providers," the statement continued.

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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)

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)

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Book on Appalachian health gets good review from doctor

A new book discusses the health disparities that affect rural and urban Appalachians and has won the praise of a Kentucky physician, who calls its impact "profound."

Appalachian Health and Well-Being was reviewed by Dr. Kevin Kavanagh, a retired physician from Somerset, for The Courier-Journal.

Each chapter stands alone so readers can choose topics according to their interests. One chapter focuses on obesity and discusses issues like "food deserts" and lifestyle choices. The authors "suggest policy changes for childhood obesity of health school lunches, elimination of junk food and drinks from school vending machines, and an increase in physical activity," Kavanagh writes.

The book also sets the facts straight on myths such as the high incidence of consanguinity and the use of home remedies and faith-based healing in rural Appalachian communities. The authors find Appalachian communities are no different than other rural regions in these regards.

The book, edited by University of Cincinnati scholars Robert L. Ludke and Phillip J. Obermiller, also discusses the methamphetamine epidemic. It notes that in Eastern Kentucky 377 meth labs were found in 2005, while in 2011, nearly 200 labs were found just in Laurel County alone. "For those who wish to understand the health and well-being in Eastern Kentucky, this is an insightful book which will give us all an appreciation of the herculean task that has been placed upon the Kentucky Cabinet for Health and Family Services," Kavanagh concludes. (Read more)

A new book discusses the health disparities that affect rural and urban Appalachians and has won the praise of a Kentucky physician, who calls its impact "profound."

Appalachian Health and Well-Being was reviewed by Dr. Kevin Kavanagh, a retired physician from Somerset, for The Courier-Journal.

Each chapter stands alone so readers can choose topics according to their interests. One chapter focuses on obesity and discusses issues like "food deserts" and lifestyle choices. The authors "suggest policy changes for childhood obesity of health school lunches, elimination of junk food and drinks from school vending machines, and an increase in physical activity," Kavanagh writes.

The book also sets the facts straight on myths such as the high incidence of consanguinity and the use of home remedies and faith-based healing in rural Appalachian communities. The authors find Appalachian communities are no different than other rural regions in these regards.

The book, edited by University of Cincinnati scholars Robert L. Ludke and Phillip J. Obermiller, also discusses the methamphetamine epidemic. It notes that in Eastern Kentucky 377 meth labs were found in 2005, while in 2011, nearly 200 labs were found just in Laurel County alone. "For those who wish to understand the health and well-being in Eastern Kentucky, this is an insightful book which will give us all an appreciation of the herculean task that has been placed upon the Kentucky Cabinet for Health and Family Services," Kavanagh concludes. (Read more)

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Biggest problem with health-care reform law is advocates' poor sales job to the American public, Rep. John Yarmuth tells C-J

By Tara Kaprowy
Kentucky Health News

The biggest problem with the federal health-care reform law is not the law itself, but the fact that "We've never done as good a job as we could have" in explaining what it is about, Democratic U.S. Rep. John Yarmuth of Louisville told the editorial board of The Courier-Journal Friday.

In his lengthy interview, Yarmuth said the problem started at the law's inception when President Obama outlined his parameters but  let Congress decide what the bill should be. "The challenge was explaining what the bill even was because we didn't know what it was going to be," he said.

The issue was compounded by the fact that, unlike energy legislation where its "impact is relatively uniform," with health care "everyone wants to know how it will affect you and your family ... and it's all different," Yarmuth said. "It's hard to market something individually to 300 million people."

Also contributing to the problem is the complexity of the subject itself, which Yarmuth likened to "the biggest Rubik's cube that ever existed," since "Every time you move one piece, 100 pieces move."

That has resulted in deeply-seated misconceptions about the law that are difficult to undo. The biggest, he said, is "that it is some form of government takeover." Those with that view note that the law's individual mandate in the law will force people to buy insurance or pay a fine, and the law will impose new rules on health-insurance companies and put many other controls on the system.

But Yarmuth argues the law uses "free enterprise and competition" to "provide more affordable care for individuals." Indeed, state insurance exchanges will feature different benefits packages from private companies from which people who qualify for the exchange can choose. People who qualify for the exchange — those who earn up to 400 percent of the federal poverty level — will be given subsidies in the form of tax breaks to help pay for their premiums. "The reason why the Republicans don't have an alternative is Obamacare was their alternative," Yarmuth said. "This was their plan: creating competition among insurers and letting them compete for individual business."

Another misconception is that people who don't have health insurance are "deadbeats," Yarmuth said. But he said 37 percent of Americans who are uninsured make over $50,000 a year and almost 20 percent make over $75,000 a year (those percentages are confirmed here). "No, these are solid citizens," he said. He pointed out that all families pay the cost of those who are uninsured, adding that an estimated $1,000 of every health insurance policy goes toward paying for uncompensated care.

Yarmuth said in Kentucky nearly $600 million is spent on uncompensated care each year. (A Kentucky Hospital Association report estimated it is far higher: $1.67 billion in 2010.) Regardless of the figure, Yarmuth said losses could be offset by expanding Medicaid, a claim supported by a report by the Urban Institute. Expansion would cover almost 300,000 Kentuckians and would cost the state $515 million through 2019, he said. "It will bring in $12 billion of federal money," he said. "Is that a good trade-off?"

Asked how provisions in the law would be paid for, Yarmuth acknowledged "If you're adding 30 million more people, it's going to add cost to the system." Ultimately, costs will continue to go up but "less than they otherwise would," he said. He referred to pre-law estimates by the Congressional Budget Office that the cost of employer-based insurance would double to $25,000 a year for a family of four, but the law seems to have slowed that trend. Yarmuth referred to an article published in the journal Health Affairs that indicated that between 2010 and 2011, overall national health-care expenditures increased by 3.9 percent. "That's the lowest rate of growth in the last 50 years," he said. "It is having an effect." The CBO estimated the law will reduce the deficit over the next 10 years by $130 billion, with an estimated $1.2 trillion saved in the second 10, Yarmuth noted. "We all knew we were on an unsustainable path."

But most still don't know that, and on Saturday, a day after the Yarmuth interview, the C-J editorial board criticized Democrats for not doing a better job getting their message out about the new law: "The problem is partially that the law is complex and 2,000 pages long. It's partially that the Republicans have successfully put the Democrats on the defensive, forcing them to defend the law to people who have already had the GOP message driving into their heads. But it's also that the Democrats don't trust that the American people will be willing or able to understand them when they defend the health-care law."

By Tara Kaprowy
Kentucky Health News

The biggest problem with the federal health-care reform law is not the law itself, but the fact that "We've never done as good a job as we could have" in explaining what it is about, Democratic U.S. Rep. John Yarmuth of Louisville told the editorial board of The Courier-Journal Friday.

In his lengthy interview, Yarmuth said the problem started at the law's inception when President Obama outlined his parameters but  let Congress decide what the bill should be. "The challenge was explaining what the bill even was because we didn't know what it was going to be," he said.

The issue was compounded by the fact that, unlike energy legislation where its "impact is relatively uniform," with health care "everyone wants to know how it will affect you and your family ... and it's all different," Yarmuth said. "It's hard to market something individually to 300 million people."

Also contributing to the problem is the complexity of the subject itself, which Yarmuth likened to "the biggest Rubik's cube that ever existed," since "Every time you move one piece, 100 pieces move."

That has resulted in deeply-seated misconceptions about the law that are difficult to undo. The biggest, he said, is "that it is some form of government takeover." Those with that view note that the law's individual mandate in the law will force people to buy insurance or pay a fine, and the law will impose new rules on health-insurance companies and put many other controls on the system.

But Yarmuth argues the law uses "free enterprise and competition" to "provide more affordable care for individuals." Indeed, state insurance exchanges will feature different benefits packages from private companies from which people who qualify for the exchange can choose. People who qualify for the exchange — those who earn up to 400 percent of the federal poverty level — will be given subsidies in the form of tax breaks to help pay for their premiums. "The reason why the Republicans don't have an alternative is Obamacare was their alternative," Yarmuth said. "This was their plan: creating competition among insurers and letting them compete for individual business."

Another misconception is that people who don't have health insurance are "deadbeats," Yarmuth said. But he said 37 percent of Americans who are uninsured make over $50,000 a year and almost 20 percent make over $75,000 a year (those percentages are confirmed here). "No, these are solid citizens," he said. He pointed out that all families pay the cost of those who are uninsured, adding that an estimated $1,000 of every health insurance policy goes toward paying for uncompensated care.

Yarmuth said in Kentucky nearly $600 million is spent on uncompensated care each year. (A Kentucky Hospital Association report estimated it is far higher: $1.67 billion in 2010.) Regardless of the figure, Yarmuth said losses could be offset by expanding Medicaid, a claim supported by a report by the Urban Institute. Expansion would cover almost 300,000 Kentuckians and would cost the state $515 million through 2019, he said. "It will bring in $12 billion of federal money," he said. "Is that a good trade-off?"

Asked how provisions in the law would be paid for, Yarmuth acknowledged "If you're adding 30 million more people, it's going to add cost to the system." Ultimately, costs will continue to go up but "less than they otherwise would," he said. He referred to pre-law estimates by the Congressional Budget Office that the cost of employer-based insurance would double to $25,000 a year for a family of four, but the law seems to have slowed that trend. Yarmuth referred to an article published in the journal Health Affairs that indicated that between 2010 and 2011, overall national health-care expenditures increased by 3.9 percent. "That's the lowest rate of growth in the last 50 years," he said. "It is having an effect." The CBO estimated the law will reduce the deficit over the next 10 years by $130 billion, with an estimated $1.2 trillion saved in the second 10, Yarmuth noted. "We all knew we were on an unsustainable path."

But most still don't know that, and on Saturday, a day after the Yarmuth interview, the C-J editorial board criticized Democrats for not doing a better job getting their message out about the new law: "The problem is partially that the law is complex and 2,000 pages long. It's partially that the Republicans have successfully put the Democrats on the defensive, forcing them to defend the law to people who have already had the GOP message driving into their heads. But it's also that the Democrats don't trust that the American people will be willing or able to understand them when they defend the health-care law."

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