Study finds only counties in Appalachia, mostly in Kentucky, had increasing rates of death among both sexes as century turned

By Molly Burchett
Kentucky Health News

More than 40 percent of counties saw increases in female death rates as the 21st Century began, while the death rate for men rose in just 3 percent of counties, a study shows. Only Appalachian counties, mostly in Kentucky, had worsening rates for both sexes. (Click on a map for a larger version.)

Change In Male Mortality Rates From 1992–96 To 2002–06

Change In Female Mortality Rates From 1992–96 To 2002–06

On the Health Affairs maps above, blue counties showed substantial improvement, while those in aqua showed minimal improvement and worsening counties are in red.

The study identifies some shared characteristics among the 1,334 counties where more women are dying prematurely, but the main factors weren't medical or behavioral, according to David Kindig and Erika Cheng, authors of the study report.

Although counties with high rates of smoking and obesity had increased mortality rates, the report found socioeconomic factors in the Appalachian states of Kentucky and West Virginia, such as the percentage of a county’s population with a college education and the rate of children living in poverty, had more to do with increased mortality rates.

In Kentucky, Owsley County has been ranked last on health-related measures by the Population Health Institute. Areas like this in Appalachia suffered rising death rates in both sexes because college education is a rarity, child poverty is normal, recreational facilities are scarce, restaurants are mostly fast-food outlets, and adults lack social support, reports Geoffrey Cowley of msnbc.

The chart below shows how Kentucky compares to the national average in premature death and that Owsley County suffers from tremendously high rates.

County Health Rankings by University of Wisconsin's Population Health
Institute and the Robert Wood Johnson Foundation (countyhealthrankings.org)

These findings provide supporting evidence for the ever-increasing need for significant health improvement efforts in Appalachia. According to the report, efforts must extend beyond a focus on health care delivery and include stronger policies affecting health behaviors and the social and environmental determinants of health,with corresponding investments in those areas. (Read more)

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

By Molly Burchett
Kentucky Health News

More than 40 percent of counties saw increases in female death rates as the 21st Century began, while the death rate for men rose in just 3 percent of counties, a study shows. Only Appalachian counties, mostly in Kentucky, had worsening rates for both sexes. (Click on a map for a larger version.)

Change In Male Mortality Rates From 1992–96 To 2002–06

Change In Female Mortality Rates From 1992–96 To 2002–06

On the Health Affairs maps above, blue counties showed substantial improvement, while those in aqua showed minimal improvement and worsening counties are in red.

The study identifies some shared characteristics among the 1,334 counties where more women are dying prematurely, but the main factors weren't medical or behavioral, according to David Kindig and Erika Cheng, authors of the study report.

Although counties with high rates of smoking and obesity had increased mortality rates, the report found socioeconomic factors in the Appalachian states of Kentucky and West Virginia, such as the percentage of a county’s population with a college education and the rate of children living in poverty, had more to do with increased mortality rates.

In Kentucky, Owsley County has been ranked last on health-related measures by the Population Health Institute. Areas like this in Appalachia suffered rising death rates in both sexes because college education is a rarity, child poverty is normal, recreational facilities are scarce, restaurants are mostly fast-food outlets, and adults lack social support, reports Geoffrey Cowley of msnbc.

The chart below shows how Kentucky compares to the national average in premature death and that Owsley County suffers from tremendously high rates.

County Health Rankings by University of Wisconsin's Population Health
Institute and the Robert Wood Johnson Foundation (countyhealthrankings.org)

These findings provide supporting evidence for the ever-increasing need for significant health improvement efforts in Appalachia. According to the report, efforts must extend beyond a focus on health care delivery and include stronger policies affecting health behaviors and the social and environmental determinants of health,with corresponding investments in those areas. (Read more)

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

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Smoking ban gets 'a good scrubbing' before Judiciary Committee

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban is favored by three-fifths of Kentucky adults, but is dead for this session of the General Assembly. However, its supporters think they made some headway Monday as they laid groundwork for getting it through the state House a year from now.

The House Judiciary Committee held an informational hearing on House Bill 190 to "give it a good scrubbing" before a committee that is more skeptical of it than the Health and Welfare Committee, which approved it early in the session, the bill's sponsor, Rep, Susan Westrom, D-Lexington, said afterward.

Westrom said she was encouraged by the hearing because it exposed weaknesses in the bill that she will correct for the next regular session, beginning in January 2014. For example, she said, Rep. Steven Rudy, R-Paducah, argued that the bill's language would make it illegal to use smoke in barns to cure the dark tobacco grown in Western Kentucky, largely for smokeless consumption.

"This is about vetting," Westrom told Rudy. "You have a different mindset that I do sitting on the Health and Welfare Committee."

Rudy acknowledged that secondhand smoke is not beneficial, but asked, "Has there ever been a death certificate that secondhand smoke killed this person?"

Dr. Sylvia Cerel-Suhl, Central Kentucky president of the American Heart Association, replied that Lexington recorded a significant drop in acute heart attacks after enacting a smoking ban, and said "thousands of studies" of secondhand smoke have shown exposure to it can cause premature death.

"The evidence is absolutely overwhelming," she said, and asked if anyone else had any questions. No one did, but the committee was one member short of a quorum.

Advocates told the legislators that 37 jurisdictions, covering 34 percent of the state's population, limit smoking in some way. Mark Hayden, a trial lawyer and former Campbell County commissioner, said a statewide ban is needed because enacting ordinances, writing regulations and enforcing them is a burden for local officials.

The bill would give local health departments power to enforce the ban. Scott Lockard, president of the Kentucky Health Departments Association and the health director in Clark County, said his agency has issued no court charges, only warning citations, since its board passed a ban, and Woodford County has issued only three citations.

Others appearing at the hearing included Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, and Lt. Gov. Jerry Abramson, who was invited by the Kentucky Smoke-Free Kentucky Coalition. He discussed enforcement of of the ban in Louisville, where he was mayor.

Rep. Tom Riner, D-Louisville, said the ban is "one of the most important pieces of legislation that has been brought before this body, because it literally affects every Kentuckian. . . perhaps the most important piece."

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

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban is favored by three-fifths of Kentucky adults, but is dead for this session of the General Assembly. However, its supporters think they made some headway Monday as they laid groundwork for getting it through the state House a year from now.

The House Judiciary Committee held an informational hearing on House Bill 190 to "give it a good scrubbing" before a committee that is more skeptical of it than the Health and Welfare Committee, which approved it early in the session, the bill's sponsor, Rep, Susan Westrom, D-Lexington, said afterward.

Westrom said she was encouraged by the hearing because it exposed weaknesses in the bill that she will correct for the next regular session, beginning in January 2014. For example, she said, Rep. Steven Rudy, R-Paducah, argued that the bill's language would make it illegal to use smoke in barns to cure the dark tobacco grown in Western Kentucky, largely for smokeless consumption.

"This is about vetting," Westrom told Rudy. "You have a different mindset that I do sitting on the Health and Welfare Committee."

Rudy acknowledged that secondhand smoke is not beneficial, but asked, "Has there ever been a death certificate that secondhand smoke killed this person?"

Dr. Sylvia Cerel-Suhl, Central Kentucky president of the American Heart Association, replied that Lexington recorded a significant drop in acute heart attacks after enacting a smoking ban, and said "thousands of studies" of secondhand smoke have shown exposure to it can cause premature death.

"The evidence is absolutely overwhelming," she said, and asked if anyone else had any questions. No one did, but the committee was one member short of a quorum.

Advocates told the legislators that 37 jurisdictions, covering 34 percent of the state's population, limit smoking in some way. Mark Hayden, a trial lawyer and former Campbell County commissioner, said a statewide ban is needed because enacting ordinances, writing regulations and enforcing them is a burden for local officials.

The bill would give local health departments power to enforce the ban. Scott Lockard, president of the Kentucky Health Departments Association and the health director in Clark County, said his agency has issued no court charges, only warning citations, since its board passed a ban, and Woodford County has issued only three citations.

Others appearing at the hearing included Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, and Lt. Gov. Jerry Abramson, who was invited by the Kentucky Smoke-Free Kentucky Coalition. He discussed enforcement of of the ban in Louisville, where he was mayor.

Rep. Tom Riner, D-Louisville, said the ban is "one of the most important pieces of legislation that has been brought before this body, because it literally affects every Kentuckian. . . perhaps the most important piece."

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

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Legislature sends fix of last year's pill-mill bill to Beshear

"After more than a year of debate, a bill that would revamp Kentucky’s prescription-drug law to more strictly focus on pill abuse and ease requirements on patients is heading to the governor’s desk," Mike Wynn reports for The Courier-Journal. On a 36-0 vote, the Senate sent House Bill 217 to Gov. Steve Beshear, who said he will sign it tomorrow.

The chief lobbyist for the Kentucky Medical Association said the physicians' group did not get all the changes it requested in last year's law but is satisfied with the bill. It "would exempt hospitals and long-term care facilities from many of the requirements that doctors must follow before prescribing drugs," Wynn writes. "It also creates a 14-day exemption for surgery patients and gives doctors more discretion in examining patients before a prescription is given." (Read more)

"After more than a year of debate, a bill that would revamp Kentucky’s prescription-drug law to more strictly focus on pill abuse and ease requirements on patients is heading to the governor’s desk," Mike Wynn reports for The Courier-Journal. On a 36-0 vote, the Senate sent House Bill 217 to Gov. Steve Beshear, who said he will sign it tomorrow.

The chief lobbyist for the Kentucky Medical Association said the physicians' group did not get all the changes it requested in last year's law but is satisfied with the bill. It "would exempt hospitals and long-term care facilities from many of the requirements that doctors must follow before prescribing drugs," Wynn writes. "It also creates a 14-day exemption for surgery patients and gives doctors more discretion in examining patients before a prescription is given." (Read more)

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Lesions in the oral cavity of cats

Santarelli GA, Matteo I, Bellucci C and Lepri E. Lesions of the oral cavity in the cat: a review on 228 cases (2005-2010). Veterinaria (Cremona). 2012; 26: 7. 
 
Oral lesions are common in cats. Many are associated with the teeth and supporting structures (e.g., tooth resorption, gingivitis, stomatitis, etc.) but other types of lesions occur not associated with dental disease. These lesions may appear as ulcerative or proliferative tumor-like abnormalities. In this retrospective study, the investigators examined biopsy findings from 228 cats with oral disease. 

Most lesions were not cancerous, but were inflammatory in nature (61%). Of the inflammatory lesions, the majority were classified as chronic lymphoplasmacytic stomatitis. Tumors were found in 25% of the cases, with squamous cell carcinoma being the most common type. Thus, the majority of oral lesions are not cancerous; when cancerous, they may be ulcerative in nature rather than proliferative. Only a biopsy with microscopic examination of tissues (histopathology) can definitively diagnose oral lesions in cats. [MK]

See also: Buelow ME, Marretta SM, Barger A and Lichtensteiger C. Lingual lesions in the dog and cat: recognition, diagnosis, and treatment. J Vet Dent. 2011; 28: 151-62. 

Related blog articles:
Improving treatment for feline oral cancer (Sept 2012)
Oral cancer in cats (August 2010)

More on cat health:
Winn Feline Foundation Library
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Santarelli GA, Matteo I, Bellucci C and Lepri E. Lesions of the oral cavity in the cat: a review on 228 cases (2005-2010). Veterinaria (Cremona). 2012; 26: 7. 
 
Oral lesions are common in cats. Many are associated with the teeth and supporting structures (e.g., tooth resorption, gingivitis, stomatitis, etc.) but other types of lesions occur not associated with dental disease. These lesions may appear as ulcerative or proliferative tumor-like abnormalities. In this retrospective study, the investigators examined biopsy findings from 228 cats with oral disease. 

Most lesions were not cancerous, but were inflammatory in nature (61%). Of the inflammatory lesions, the majority were classified as chronic lymphoplasmacytic stomatitis. Tumors were found in 25% of the cases, with squamous cell carcinoma being the most common type. Thus, the majority of oral lesions are not cancerous; when cancerous, they may be ulcerative in nature rather than proliferative. Only a biopsy with microscopic examination of tissues (histopathology) can definitively diagnose oral lesions in cats. [MK]

See also: Buelow ME, Marretta SM, Barger A and Lichtensteiger C. Lingual lesions in the dog and cat: recognition, diagnosis, and treatment. J Vet Dent. 2011; 28: 151-62. 

Related blog articles:
Improving treatment for feline oral cancer (Sept 2012)
Oral cancer in cats (August 2010)

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

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Kentucky's well-being ranks next to last, just above West Virginia

Kentucky ranks next to last in the annual Gallup-Healthways Well-Being index, just ahead of West Virginia. The Bluegrass State ranked last in the index's Healthy Behaviors category, which measures the percentage of residents who smoke, exercise frequently and eat healthy daily.

The chart on the left shows Kentucky's score in each of the six categories. The state's rankings haven't changed much since last year, with the exception of the Work Environment index, which fell from 8th to 31st.  The colored chart on the right shows the state's overall and category rankings for 2011 and 2012 (1 is the highest rank and 50 is the lowest). Click here for the detailed report on Kentucky.


Left: Kentucky Well-Being Indexes     Right: Well-Being rankings of Kentucky among the states

West Virginia, with an index score of 61.3, had the lowest well-being for the fourth year in a row. The report shows West Virginians were the least likely to be thriving and also had the nation's worst emotional health. They had the lowest score in the Physical Health category, which reflects having the highest percentage of obese residents in the nation.

There were few changes from 2011 to 2012 among states with the highest and lowest well-being scores. Hawaii residents had the highest well-being for the fourth straight year, followed by Colorado, Minnesota, Utah, and Vermont.

The report shows a consistent regional pattern in well-being over the past five years. Western and Midwestern states earned seven of the 10 highest overall scores, while New England states held the other three spots. Southern states had the six lowest scores, and Southern states had eight of the 10 lowest well-being scores.

Kentucky ranks next to last in the annual Gallup-Healthways Well-Being index, just ahead of West Virginia. The Bluegrass State ranked last in the index's Healthy Behaviors category, which measures the percentage of residents who smoke, exercise frequently and eat healthy daily.

The chart on the left shows Kentucky's score in each of the six categories. The state's rankings haven't changed much since last year, with the exception of the Work Environment index, which fell from 8th to 31st.  The colored chart on the right shows the state's overall and category rankings for 2011 and 2012 (1 is the highest rank and 50 is the lowest). Click here for the detailed report on Kentucky.


Left: Kentucky Well-Being Indexes     Right: Well-Being rankings of Kentucky among the states

West Virginia, with an index score of 61.3, had the lowest well-being for the fourth year in a row. The report shows West Virginians were the least likely to be thriving and also had the nation's worst emotional health. They had the lowest score in the Physical Health category, which reflects having the highest percentage of obese residents in the nation.

There were few changes from 2011 to 2012 among states with the highest and lowest well-being scores. Hawaii residents had the highest well-being for the fourth straight year, followed by Colorado, Minnesota, Utah, and Vermont.

The report shows a consistent regional pattern in well-being over the past five years. Western and Midwestern states earned seven of the 10 highest overall scores, while New England states held the other three spots. Southern states had the six lowest scores, and Southern states had eight of the 10 lowest well-being scores.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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House sends Senate pill-mill and Medicaid managed-care fixes

The state House yesterday approved without dissent two bills aimed at improving Kentucky's health care.

House Bill 217 addresses some "unintended consequences" of last year's "pill mill bill" by easing some of the bills regualtions. The bill also tightens restricitions on prescription drugs, reports Ryan Alessi of cn|2.

The other measure, House Bill 5, deals with payment problems of the Medicaid managed care system. Itl would apply the prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints and disputes to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

Both bills are expected to see action in the Senate.

The state House yesterday approved without dissent two bills aimed at improving Kentucky's health care.

House Bill 217 addresses some "unintended consequences" of last year's "pill mill bill" by easing some of the bills regualtions. The bill also tightens restricitions on prescription drugs, reports Ryan Alessi of cn|2.

The other measure, House Bill 5, deals with payment problems of the Medicaid managed care system. Itl would apply the prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints and disputes to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

Both bills are expected to see action in the Senate.

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