Friday, September 28, 2012

Kentucky leads nation in drug-fraud prosecutions and settlements

Kentucky leads the U.S. in pursuing pharmaceutical fraud, according to a report by the Washington, D.C.-based consumer group, Public Citizen. Since 1991, the state has pursued the most claims against pharmaceutical companies and reached more than 30 settlements. It pursued 17 single-state settlements, the most of any state.

The most common violation was overcharging Medicaid programs for services, mostly for drugs, Beth Musgrave of the Lexington Herald-Leader reports. The violations that netted the biggest penalties were for improper promotion of drugs. Attorney General Jack Conway oversees the Office of Medicaid Fraud and Abuse Control; his spokeswoman, Shelley Catherine Johnson, told Musgrave the agency has recovered or been awarded more than $265 million since Conway took office in January 2008. (Read more)

Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

Health reform's exchange won't attract many new insurers to Ky. because it's a small, sickly state, former Medicaid boss says

Kentucky is unlikely to attract many new insurance companies when it starts its Health Benefits Exchange a year from now, a former state Medicaid commissioner told Dawn Marie Yankeelov for a story in The Lane Report.

“Kentucky is not a big attractor,” said Elizabeth Ann Johnson, a lawyer with Stites and Harbison in Lexington office. “We are a small state for insurers, and we have a sicker population statistically – we see high Medicaid use. I would be surprised to see new players flood into the state.”

The exchange, required by the federal health-reform law, will be a "web-based marketplace that includes information necessary so Kentuckians can compare price and quality as they shop for health insurance," Yankeelov notes. "It also will assist employers in facilitating enrollment of their employees into health plans, enable individuals to receive insurance-premium tax credits and subsidies, and qualify small businesses for tax credits. . . . The average employer and employee in Kentucky will be able to find information on the exchange through a planned Navigators program, an outreach and education program that will be staffed by employees trained and certified to discuss the exchange."

University of Kentucky researchers have estimated that as many as 2.4 million Kentuckians may use the exchange. "The high end of this estimate includes approximately 1.4 million individuals currently receiving employer-sponsored insurance through their large employers," Yankeelov notes. Her story has other good background information on the law, the exchange and the problem of the uninsured, who make up about 15 percent of Kentucky's population. Read it here.

At its first meeting yesterday, the Kentucky Health Benefit Exchange Advisory Board created committees: Behavioral Health, Dental/Vision, Education/Outreach, Navigator/Agent, Qualified Health Plans and Small Business, reports Jodi Mitchell of Kentucky Voices for Health. (Illustration from The Lane Report)

Exchange officials urged the Navigator, Qualified Health Plans and Small Business committees to meet immediately to provide feedback for the draft of the insurance application that must be filed with the federal government by Nov. 16. The Navigator Committee will meet Thursday, Oct. 4 at 1:30 at the exchange offices at 12 Mill Creek Park, off Millville Road near Frankfort.

Anyone interested in serving on the committees is asked to email Carrie.Banahan@ky.gov as soon as possible. Meetings of the committees will be posted on the Cabinet for Health and Family Services open-meetings site and will soon be available on a new exchange site. The next full meeting of the Advisory Board will be Oct. 25 at 1:30 p.m. at the exchange offices.

More information on state exchanges, which will serve as marketplaces for health insurance under the federal reform law, is available here.

Federal official and expert on integrating physical and behavioral health services will speak in Louisville Wednesday morning

The integration of physical health and behavioral health services, one of the hottest topics in health care, will be the topic of a Health Enterprises Network forum in Louisville Wednesday, Oct. 3.

The speaker will be Kathleen Reynolds, director of the federal Center for Integrated Health Solutions, vice president of health integration and wellness for the National Council for Community Behavioral Healthcare and author of Raising the Bar: Moving Toward the Integration of Healthcare. She will review the landscape of integration, discuss how it will affect Kentucky, and offer ideas on how health-care organizations can accomplish it.

The forum will be held from 8 to 9:15 a.m. Oct. 3 at the University of Louisville's Clinical and Translational Research Building, 505 S. Hancock Street. The registration fee for members of the Health Enterprises Network is $45; non-members $60; full-time students $10. For more information call 502.625.0179 or email Register@HealthEnterprisesNetwork.com.

Is carnitine effective for feline weight loss?

Center SA, Warner KL, Randolph JF, Sunvold GD and Vickers JR. Influence of dietary supplementation with l-carnitine on metabolic rate, fatty acid oxidation, body condition, and weight loss in overweight cats. Am J Vet Res. 2012; 73: 1002-15.

In the world of feline nutrition, L-carnitine is a conditionally essential nutrient that plays a pivotal role in fatty acid metabolism. The investigators in this study wanted to determine whether L-carnitine as a dietary supplement would facilitate weight loss in overweight cats fed a weight-reduction diet on an unrestricted or restricted basis. As well, they wanted to evaluate retention of lean body mass (LBM) during weight loss, and preferential treatment use of fat for energy expenditure. Thirty-two healthy adult colony cats were fattened by being fed an unrestricted, energy-dense diet for 6 months. The cats were randomly assigned to 4 groups and fed a weight reduction diet supplemented with O, 50, 100, or 150 µg of carnitine/g of diet (unrestricted for 1 month, then restricted). After weight loss, the cats were allowed unrestricted feeding of the energy-dense diet to study weight gain after feeding the test diet ceased.

Overall, the collective findings regarding absolute weight reduction do not suggest an obvious benefit of dietary carnitine supplementation in this respect. The results did indicate though that dietary L-carnitine supplementation appeared to have a metabolic effect in overweight cats undergoing rapid weight loss that facilitated fatty acid oxidation. This might explain why observations of supplementation with L-carnitine improved the probability of survival time in cats severely affected with hepatic lipidosis. A final phase of the study demonstrated the rapid rebound weight gain that may occur after substantial weight loss upon reinstitution of unrestricted feeding of an energy-dense diet. Some cats regained all weight lost during the study within 35 days after reinstitution of the energy-dense diet. [VT]

See also: Ibrahim W, Bailey N, Sunvold G and Bruckner G. Effects of carnitine and taurine on fatty acid metabolism and lipid accumulation in the liver of cats during weight gain and weight loss. Amer J Vet Res. 2003; 64: 1265-77.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

Dr. Stephanie Mayfield

Dr. Stephanie Mayfield has been appointed as the commissioner for the state Department for Public Health, making her the first woman and first African American to hold the position, which has typically been held by a physician. The appointment was made by Audrey Haynes, secretary of health and family services.

The department is the largest health-care provider in the state, with an annual budget this year of almost $400 million. It includes 59 county and district health departments, many of which are "financially struggling," notes Beth Musgrave of the Lexington Herald-Leader. "The health departments have seen their budgets cut in recent years, leading to some lay offs and furloughs." (Read more)

Mayfield has been director of Kentucky’s public health laboratory since 2005. According to the Cabinet for Health and Family Services, Mayfield and the state lab team have been instrumental in speeding up tuberculosis detection and in testing the state's newborns for a wide array of problems. In addition to overseeing the state lab, Mayfield has also served as a lecturer on rotation at the University of Kentucky School of Medicine’s Preventive and Occupational Medicine Residencies and the University of Louisville School of Medicine’s Department of Pathology.

Dr. Steve Davis, who as deputy commissioner has run the department for more than a year, tells Kentucky Health News that he will remain in the agency.

Dr. Stephanie Mayfield

Yikes! According to the Centers for Disease Control and Prevention, the "large" soda you order today is about six times as large as the one you ordered 60 years ago. "Food sizes have become larger over time," says Aradhna Krishna, a University of Michigan marketing professor who has been looking into portion size and perception. "So, that same hamburger has become bigger, the french fries have become bigger, and again this is leading to obesity."

Thinking a lot about this, Krishna tried an experiment. She gave people cookies that were labeled either medium or large, and then measured how much they ate. "The catch? The cookies were identical in size, What happened? You guessed it," reports NPR's Helen Thompson and Shanikar Vedantam. "People ate more cookies when they were labeled 'medium.' Rather than trust what their stomachs were telling them, in other words, people went by the label." It gets worse: "(They) think they've not eaten as much," says Krishna.

The researcher said women have known all about this principle for awhile, because it's what's been happening with sizes of clothing. It's something called "vanity sizing." "What used to be a size 8 in the 1950s has become a size 4 in the 1970s and a zero in 2006," Krishna said. It makes you feel better about yourself and your body image. The real question, she asks, is how much do we want to be lied to or, indeed, how much do we lie to ourselves? (Read more)

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

A health-care study in Tennessee, which started with the premise that people in rural areas have less access to care than urban dwellers, ended with a rather surprising conclusion: They don't. Not if they have health insurance. "When it comes to commercially insured patients, there’s little disparity in access to health care between residents of rural communities and urban areas in Tennessee," said Dr. Steven L. Counter, president of the BlueCross BlueShield of Tennessee Health Institute.

How can this be? The study found that almost half of rural residents pass up the hospitals closest to their homes to go to larger urban hospitals, even if the same services are available locally, writes Getahn Ward of The Tenneseean. "The conclusion we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not," said Coulter.

Because the survey did not include consumers, it's only a guess about why they chose to take the time and trouble to go to the big town, but experts says it's a combination of services not being available or a perception that they aren't, even if they are. This raises, again, age-old questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services. However, Coulter told the Tennessean that "a recent increase in alliances between rural hospitals and larger hospitals and urban health systems raises hopes that non-urban hospitals may be able to expand their menus of services."

Such partnerships between non-profits and for-profit chains are becoming more common, reports Ward, and some say those efforts will change the perception of those in far-flung regions that great medicine is being practiced close-by. This could be especially important, said Wes Littrell, chief strategy officer and president of Nashville-based Saint Thomas Health, in the new world of health reform. “We expect that when you get more into population management that you need to take care of the patient closer to home in the lower-cost setting,” he said. (Read more)

Kentucky doctor honored for her work in bolstering health and preventing deaths of babies born a few weeks early

A Kentucky neonatalogist was honored this week for giving the state "a role in catalyzing a national movement around healthier babies." Ruth Ann Shepherd, M.D., division director for maternal and child health in the Kentucky Department for Public Health, was presented the Association of State and Territorial Health Officials Presidential Meritorious Service Award and recognized as "an early pioneer in recognizing the critical public health problem of preterm births in Kentucky, and that the troubling trend was common to most states in the country."

According to New Public Health, an online publication of the Robert Wood Johnson Foundation, Shepherd’s research "revealed that babies born at 37 or 38 weeks had far worse health outcomes than babies born at 39 or 40 weeks. With support from the leadership at the Kentucky Department of Health, and many other organizations who have since taken up the cause of helping to create conditions for healthier babies, many states are beginning to make strides in preventing early births."

Charles Kendall, chief of staff at the Kentucky Health Department, told the online magazine that the prematurity rate for infants in Kentucky was exceptionally high, averaging at about 36 weeks at the time of birth. "There was a corresponding infant death rate that was far exceeding the national average When she looked at the data, it occurred to her that many of those deaths could have been prevented.," he said. "Much of the prematurity rate had nothing to do with medical issues. The data were telling her that women who smoke are much more likely to deliver early and to have smaller babies. The size of the baby was really the predictor for the infant death rate."

But what Shepard also understood, said Kendall, was that a lot of these births were actually planned for convenience. "That was one of the more startling pieces of information from the data. In many cases it was not a medical issue but a lack of education or convenience. She also brought the science from her work that showed that the fetal brain is still in critical stages of development in those early weeks, and that it’s not at its full capacity until 39 or 40 weeks. That was very compelling. She also said this is not just a Kentucky issue. This is going on everywhere." ( Read more

September 29 is World Heart Day, and, according to the most recent edition of the United Health Foundation’s America’s Health Rankings, Kentucky has the third highest percentage of adults with cardiac disease. Arizona and West Virginia were the only states that ranked worse than Kentucky. It is the leading cause of death in the United States for both men and women.

According to the Heart Disease and Stroke Action Plan for the State report for 2011-2016, Kentucky women also have a higher heart disease age-adjusted death rate of 205 per 100,000 as compared to a national average of 176 per 100,000. Further, 41 percent of adult women in Kentucky have high cholesterol, a leading indicator for the disease. To read the state action plan, go here. For more on World Heart Day and the World Heart Federation, go here.

Fewer than 10 percent of Kentucky
parents report that their child has ever
walked or biked to school.

When asked, only about one in four Kentucky parents describe the meals served at their child's schools or day care centers as being nutritious. Fewer than 10 percent report that their child have ever walked or biked to school. And an overwhelming majority want information about sexually transmitted infections, human anatomy, abstinence education, birth control methods and condom use taught in Kentucky's high schools.

These are just a few of the surprising results from the first Kentucky Parent Survey conducted by the Foundation for a Health Kentucky, a random telephone survey of 1,006 parents of children under 18. The survey assessed the views of parents, step-parents, grandparents, foster parents and other legal guardians of children in Kentucky. The term "school" was used broadly in the survey as included (2 percent of total surveyed), as well those in pre-school and day care. The study took on nutrition, physical activity and health education.

Eighty-eight percent of parents reported that it was "very important" that meals at schools meet a minimum standard for nutritional value. Only about 1 in 4 parents currently thought their schools were meeting that standard. Only 11 percent are concerned that their younger children are getting too many "celebration-related" treats at their school.

While parents in the state reported that a little more than half (52 percent) of school-age children took physical education classes, that class was not a daily occurrence but met between one and four times a week. Only about 1 in 3 students took a daily course in P.E. That leaves 14 percent without a planned daily class during the school year.

On the topic of health education, parents reported that half of school-age children in the state took health classes, but again not daily. According to the FHK, "The Kentucky Parent Survey included a series of questions about dating relationships and sexual health to determine support for covering those topics...
At the middle school level, more than 8 in 10 parents would favor teaching communication skills (99 percent), human anatomy (91 percent), abstinence education (85 percent), and information about HIV and sexually transmitted infections (84 percent). At the high school level, more than 8 in 10 would favor teaching communication skills (99 percent), information about HIV and sexually transmitted infections (97 percent), human anatomy (97 percent), abstinence education (94 percent), birth control methods (87 percent), and condom use (84 percent)."

Future reports in the FHV series will address access to safe and effective health care for children, children's health behaviors and family routines and the places where parents turn for information on raising healthy kids.

Fewer than 10 percent of Kentucky
parents report that their child has ever
walked or biked to school.

Vitamin D: Possible cure for baldness?

Researchers investigating what causes hair follicles to go dormant are helping lead us toward a potential cure for baldness.

Current treatments for baldness prevent further hair loss but don’t actually increase hair growth. Several research teams are working to uncover ways to “wake up” existing dormant hair follicles. Scientists are finding that vitamin D and vitamin D receptors are crucial to continuing hair growth.

Typical hair growth follows a cycle. Hair follicles produce hair for two to six years before the hair falls out after which the follicles lie dormant for a short period. After a few weeks to a few months a new hair emerges. Sometimes the hair follicles permanently stay “asleep”, resulting in baldness.

Research so far has been encouraging. Dr Kotaro Yoshimura and colleagues at the University of Tokyo studied rats and found more stem cells became hair follicles when vitamin D was used in the final phase of growing the cells, when compared with those not treated with vitamin D. They also found that more of the follicles eventually produced hair, suggesting a potential role for vitamin D in hair transplants.

The key is the vitamin D receptor, not vitamin D alone. The receptor activates hair growth, so the next step will be to focus on activating the vitamin D receptor to possibly initiate hair growth.

Dr Yoshimura and colleagues are currently planning a clinical trial which will investigate new hair transplantation techniques involving their recent vitamin D research.

To read the full story click here.

Source:

The Wall Street Journal. The search for a baldness cure. September 2012.

About Dr Kevin Lau

Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.

About Dr Kevin Lau

Walmart, Humana to give discount on healthier grocery choices like veggies, fruit, lean meat, skim milk, certain packaged goods

Starting Oct. 15, more than 1 million members of Humana Inc.'s Healthy Rewards program will start getting a 5 percent credit on about 1,300 healthy food items at all U.S. Walmart stores. The credit can be used against future purchases at Walmart, which is the largest U.S. food retailer.

Walmart has taken note that "one of the biggest barriers to healthy nutrition is cost," Dr. John Agwunobi, president of health and wellness at Walmart, told Reuters. His company, he said, is trying an overall approach to improve the nutritional value of the food it sells. And because food accounts for more than half of Walmart's annual sales, and since it has tremendous clout in the U.S. market, the hope is that changes at its stores can influence other supermarket chains to do more about healthy eating.

Walmart products eligible for the credit include fresh fruits, vegetables, lean cuts of meat, skim milk, brown rice and packaged goods, the company told Reuters. The program works with a HumanaVitality card provided to members of Humana's rewards unit who receive points for meeting health goals. (Read more)

Eighteen Kentucky hospitals have been included on the annual list of hospitals that have excelled at adhering to basic procedures for surgery and other treatment of common illnesses such as heart attacks, heart failure and pneumonia. The Joint Commission, the nation’s major hospital accreditation board, has released this year's list of 620 hospitals considered to be “top performers” for following recommended protocols at least 95 percent of the time. The top 18 percent of accredited hospitals make the list.

Among the Kentucky hospitals that qualified on all four measurements were Greenview Hospital in Bowling Green, Ephraim McDowell Regional Medical Center in Danville, St. Elizabeth Medical Center in both Florence and Fort Thomas, Central Baptist Hospital in Lexington.

Those qualifying in three categories were the Robley Rex Veterans Affairs Medical Center in Louisville (not in surgery) and the Appalachian Regional Hospitals in Harlan and Middlesboro (not in heart attack).

Qualifying in two categories were Twin Lakes Regional Medical Center in Leitchfield, Frankfort Regional Medical Center, the Hospital of Louisa and Jackson Hospital Corp., all for pneumonia and surgical care.

Recognized for pneumonia care were Parkway Regional Hospital in Fulton, Paul B. Hall Regional Medical Center in Paintsville, Logan Memorial Hospital in Russellville and the KentuckyOne Health Hospital in Martin.

Among behavioral-health hospitals, ranked on their in-patient psychiatric care, the Kentucky facilities on the list were the Universal Health Services facility in Bowling Green, the new Cumberland Hall Hospital in Hopkinsville.

According to Kaiser Health News, the Leapfrog Group, a nonprofit organization devoted to patient safety, aided in the rankings process, as did Consumer Reports. The Commission has its own metrics. It's worth noting that next month, Medicare will start using hospital quality rankings on its Hospital Compare website to set reimbursements. (Read more)

Tom Eblen

Tom Eblen, the Lexington Herald-Leader's local columnist and former editor, spent two days shadowing doctors last week and lived to tell about it. Part of the Lexington Medical Society's Mini-Internship Program, Eblen was given a close-up look at the working lives of physicians and the world in which they, well, operate. He found himself alongside an orthopedic surgeon replacing shoulders, doing fascinating retinal work with an caring opthalmologist, in an emergency room on a slow day and with a busy internal medicine specialist. He learned more than confirming he had probably made the correct career choice, he writes.

In the emergency room: "A middle-aged man with a history of heart trouble came in with chest pains. An elderly man came in suffering from dizziness. A young man came in with an infection from a mouth full of rotten teeth. Like more than one-quarter of all Kentuckians, the young man and several other people Wooster saw that day had no health insurance. What people forget when they debate the cost of universal coverage is that society already pays for treating uninsured people, often at high-cost emergency rooms. . . .

"As I shadowed these physicians, I kept thinking how much of their patients' pain and suffering could have been avoided if they had taken better care of themselves — if they had eaten better, gotten more exercise, and avoided cigarettes and substance abuse. I wondered how we will continue to manage not only our health care system, but our rising expectations. As people live longer and get sicker, we may need to focus more on quality of life rather than simply extending it at all costs." (Read more)

Tom Eblen

White children exposed to high levels of bisphenol A, better known as BPA, are five times more likely to be obese than children with low levels, according to a study published last week in the Journal of the American Medical Association. The study by the New York University School of Medicine is the first to link the chemical to obesity in children, which is especially prevalent in Kentucky.

Environment Health News reporter Brien Bienkowski reports that scientists found traces of BPA, which are used in some canned food and beverages, paper receipts and dental sealants, "are found in virtually every U.S. adult and child. In the study of body mass and BPA data from 2,838 youths aged 6 to 19, only white children were found to have significant increases in obesity prevalence as their BPA levels increased. Those with the highest concentrations in their urine were five times more likely to be obese than children with the lowest levels. Black children with higher BPA levels were 1.25 times more likely to be obese than those with lower levels, which the scientists said is not statistically significant. Hispanic children had the same rates of obesity at the highest and lowest levels."

Bienkowski reports that "representatives from the chemical industry said the study had too many weaknesses to prove any connection. Steven Hentges, from the American Chemistry Council's Polycarbonate/BPA Global Group, said that attempts 'to link our national obesity problem to minute exposures to chemicals found in common, everyday products are a distraction from the real efforts underway to address this important national health issue.' "

One study of preschoolers in North Carolina and Ohio found that 99 percent of BPA exposure was through food. But since the chemical is in many plastics and other products, this is difficult for scientists to pin down. “People are always told if you just stop eating or exercise more, you will lose weight. But there may be more to it … and I think there is,” said Retha Newbold, a visiting scientist at the National Institute of Environmental Health Sciences, who specializes in BPA and other endocrine-disrupting chemicals. (Read more)

James Bruggers, environmental writer for The Courier-Journal, noted the report here.

Margaret Levi, a lawyer with the Lexington firm of Wyatt, Tarrant & Combs, has authored a new publication, The Impact of Health Care Reform on Kentucky Employers. The 68-page booklet, published by the Kentucky Chamber of Commerce, is a readable summary of The Patient Protection and Affordable Care Act, writes Greg Kocher of the Lexington Herald-Leader.

The law that started taking effect in March 2010 has had more more interpretations and critics than it has pages -- that's 2,555, if you don't count the legal citation references that require reading included within it. "There's a lot of criticism of it from people who haven't read it, and I think you have to know it before you can criticize it," said Levi, a Danville native and resident, said of the law. "I'm not taking a political position one way or another. I am neutral and I tried very hard to remain neutral."

The most common misconception about the law "is that all health care is going to be free and people can get all the care they want," Levi told Kocher. 'So there are some unrealistic expectations on behalf of consumers."

Levi also noted some confusion about how different-sized businesses qualify for different exemptions under different provisions of the law. She said that some employers are weighing the "pay or play" mandate that takes effect in 2014. Under that provision, writes Kocher, "employers with 50 or more employees must provide 'minimum essential' health plan coverage to their eligible employees or pay a penalty if an eligible employee obtains coverage through a state-sponsored health insurance exchange and qualifies for benefits subsidized by the government. An employer who offers no health coverage will be subject to a penalty equal to $2,000 a year per employee after the first 30 employees. "I think some employers are doing the math as to whether they pay the penalty or provide insurance for their employees," Levis said. "I saw a report that said 88 percent of employers are still going to provide the coverage."

Jim Ford, vice president of business education for the Kentucky Chamber, told Kocher that the booklet "basically says here are the rules, here's what it means, here's what implementation means. We're leaving politics at the door. Here's what you need to know." (Read more) For information on buying the booklet, go here.

New approaches to treatment of feline diabetes mellitus

Final report, Winn grant W09-015
The incretin effect: A potential role for GLP-1 analogues in the treatment of feline diabetes?
Investigators: Chen Gilor, Thomas Graves; University of Illinois at Urbana-Champaign

A compelling animal model for diabetes is the cat because cats develop a spontaneous form of diabetes that closely resembles human type 2 diabetes. Incretin hormones are secreted from the intestines in response to specific nutrients. They potentiate insulin secretion and offer beneficial effects of glucose homeostasis. Two incretin hormones, glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide 1 (GLP-1), account for the incretin effect in humans. One goal of this study was to determine whether the incretin effect occurs in cats by comparing the effect of oral glucose, lipids, or amino acids on serum concentrations of insulin, GIP, and GLP-1 in 10 healthy cats. The results indicated that the incretin effect does exist in cats but the effect on glucose-dependent insulin secretion is not as substantial as it is in people. They also noted that this potentiated effect is mediated by GLP-1 but not GLP. This lack of GIP response and a weak incretin effect could make the cat relatively glucose intolerant and might lead to inappropriate glycemic control in cats fed a diet high in carbohydrates.

Exenatide is a GLP-1 mimetic drug that has a glucose-dependent insulinotropic effect. In people with type 2 diabetes, exenatide is effective in controlling blood glucose with minimal side effects. The other goal of this study was to evaluate the effect of exenatide on insulin secretion during euglycemia and hyperglycemia in 9 young, healthy cats. The results indicate that exenatide in cats does stimulate glucose-dependent insulin secretion that is similar to the effect of exenatide in people. Further evaluation of the results did not show improved glucose tolerance with exenatide because its duration of effect was too short. The investigators feel that GLP-1-based medications have potential in treatment of diabetes in cats. Though exenatide will most likely not be clinically useful in cats, other drugs with a similar mechanism of action but longer duration of effect may be helpful. Such drugs would likely promote insulin secretion but may be safer than insulin injections because of the reduced likelihood of hypoglycemia. [VT]

Gilor, C., T. K. Graves, et al. (2011). The GLP-1 mimetic exenatide potentiates insulin secretion in healthy cats. Domest Anim Endocrinol 41(1): 42-49.

Gilor, C., T. K. Graves, et al. (2011). The incretin effect in cats: comparison between oral glucose, lipids, and amino acids. Domest Anim Endocrinol 40(4): 205-212.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

Health News

Pages

Friday, September 28, 2012

Kentucky leads nation in drug-fraud prosecutions and settlements

Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

Health reform's exchange won't attract many new insurers to Ky. because it's a small, sickly state, former Medicaid boss says

Health Benefit Exchange advisory board forms panels to help draft application Kentuckians will use to obtain health insurance

Federal official and expert on integrating physical and behavioral health services will speak in Louisville Wednesday morning

Thursday, September 27, 2012

Is carnitine effective for feline weight loss?

Mayfield named state's top doctor, as head of health department

Obesity alert study: Portion size labels can be deliberately confusing and consumers are easily, even willingly, fooled

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

Wednesday, September 26, 2012

Kentucky doctor honored for her work in bolstering health and preventing deaths of babies born a few weeks early

Kentucky has the nation's third highest rate of cardiac disease. Learn more, Sept. 29 is World Heart Day

Kentucky Parent Survey: We could do a lot better on school meals, we're very much in favor of more health education

Tuesday, September 25, 2012

Vitamin D: Possible cure for baldness?

About Dr Kevin Lau

About Dr Kevin Lau

Monday, September 24, 2012

Walmart, Humana to give discount on healthier grocery choices like veggies, fruit, lean meat, skim milk, certain packaged goods

18 Kentucky hospitals cited as 'top performers' on accreditation board's annual list

After two days with doctors at work, Herald-Leader columnist wonders about patients and future of health-care system

White children exposed to high levels of chemical BPA are five times more likely to be obese, study concludes

Lexington lawyer writes booklet helping Kentucky businesses to break down health-care reform law

New approaches to treatment of feline diabetes mellitus