Beshear endorses statewide smoking ban as bill moves to the House floor; Williamsburg adopts its own ban

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

Gov. Steve Beshear endorsed a statewide smoking ban yesterday at a Frankfort rally to push the bill that would enact the ban.

"Beshear, who later acknowledged that he smoked in college but quit soon afterwards, said Kentucky ranks No. 1 in the nation in smoking and lung cancer," reports Jack Brammer of the Lexington Herald-Leader.

Noting that Kentucky leads the nation in smoking, Beshear said, "Our addiction hurts productivity, jacks up health care costs and literally kills our people. Yet we've never instituted a statewide law to protect Kentuckians from secondhand smoke." Noting that over one-third of Kentuckians live in jurisdictions with smoking bans, he said, "It's time that we extend that protection to all Kentuckians. . . . Years from now, people will wonder why we waited so long."

Republican Rep. Julie Raque Adams  of Louisville, a co-sponsor of the bill, noted at the rally that Williamsburg this week became the 23rd Kentucky locality to adopt a smoking ban.

The statewide measure, House Bill 190, was posted for passage in the House today but is not expected to be called for a vote unless supporters show Speaker Greg Stumbo that they have the votes to pass it.

Read more here: http://www.kentucky.com/2013/02/14/2517025/former-kentucky-basketball-star.html#storylink=cpy

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Value of tests to diagnose FIP

Jeffery U, Deitz K and Hostetter S. Positive predictive value of albumin: globulin ratio for feline infectious peritonitis in a mid-western referral hospital population. J Feline Med Surg. 2012; 14: 903-5. 
 
The definitive method to diagnose feline infectious peritonitis (FIP) is biopsy and histopathology. A previous report has indicated that a low serum albumin to globulin (A:G) ratio has a high positive predicative value for FIP in cats with clinical signs highly suggestive of the disease. Yet, FIP can present with more vague clinical signs. Predictive values (positive and negative) depend significantly on the prevalence of the disease in the tested population. The positive predictive value is the probability that an animal with a positive test truly has the target disease. When prevalence of the disease is high, the positive predictive value of a test will be greater than when prevalence is low. The authors of this retrospective study investigated the performance of low A:G ratio as a diagnostic test for cats with vague signs of illness consistent with a possible diagnosis of FIP. They wanted to establish the positive predictive value of A:G less than 0.8 and less than 0.6 for FIP in a referral hospital in a mid-west population of cats with one or more clinical signs compatible with FIP (lethargy and inappetance, along with weight loss, pyrexia, effusion, neurological signs, diarrhea, mild upper respiratory tract signs, ocular lesions, and jaundice).

The findings of this study show the importance of determining diagnostic test performance in relation to the population in which the test will be performed. In this study’s results, a cat with an A:G of 0.6 or more was highly unlikely to have FIP. Also, in this population of cats (those visiting a referral hospital in mid-west United States) where the prevalence of FIP is low, a low A:G is of little value in confirming FIP. Therefore, using an A:G of less than 0.8 or less than 0.6 to support a diagnosis of FIP in a patient from a population where FIP would be one of several differential diagnoses carries a high risk of a false-positive diagnosis. [VT]

See also: Fischer Y, Sauter-Louis C and Hartmann K. Diagnostic accuracy of the Rivalta test for feline infectious peritonitis. Vet Clin Pathol. 2012; 41: 558-67. 

Related blog posts:
Diagnosis of FIP (May 2011)
Development of new therapies for FIP (March 2012)

Jeffery U, Deitz K and Hostetter S. Positive predictive value of albumin: globulin ratio for feline infectious peritonitis in a mid-western referral hospital population. J Feline Med Surg. 2012; 14: 903-5. 
 
The definitive method to diagnose feline infectious peritonitis (FIP) is biopsy and histopathology. A previous report has indicated that a low serum albumin to globulin (A:G) ratio has a high positive predicative value for FIP in cats with clinical signs highly suggestive of the disease. Yet, FIP can present with more vague clinical signs. Predictive values (positive and negative) depend significantly on the prevalence of the disease in the tested population. The positive predictive value is the probability that an animal with a positive test truly has the target disease. When prevalence of the disease is high, the positive predictive value of a test will be greater than when prevalence is low. The authors of this retrospective study investigated the performance of low A:G ratio as a diagnostic test for cats with vague signs of illness consistent with a possible diagnosis of FIP. They wanted to establish the positive predictive value of A:G less than 0.8 and less than 0.6 for FIP in a referral hospital in a mid-west population of cats with one or more clinical signs compatible with FIP (lethargy and inappetance, along with weight loss, pyrexia, effusion, neurological signs, diarrhea, mild upper respiratory tract signs, ocular lesions, and jaundice).

The findings of this study show the importance of determining diagnostic test performance in relation to the population in which the test will be performed. In this study’s results, a cat with an A:G of 0.6 or more was highly unlikely to have FIP. Also, in this population of cats (those visiting a referral hospital in mid-west United States) where the prevalence of FIP is low, a low A:G is of little value in confirming FIP. Therefore, using an A:G of less than 0.8 or less than 0.6 to support a diagnosis of FIP in a patient from a population where FIP would be one of several differential diagnoses carries a high risk of a false-positive diagnosis. [VT]

See also: Fischer Y, Sauter-Louis C and Hartmann K. Diagnostic accuracy of the Rivalta test for feline infectious peritonitis. Vet Clin Pathol. 2012; 41: 558-67. 

Related blog posts:
Diagnosis of FIP (May 2011)
Development of new therapies for FIP (March 2012)

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Frontier Nursing University in Hyden helps bring better family health care to rural America with distance learning

Midwives and nurse practitioners who recently graduated from Frontier Nursing University in Hyden address the unique challenges of rural areas, including shortages of health care providers, by bringing local health care to rural communities across the country. FNU was featured in a recent report from the Robert Wood Johnson Foundation.

FNU, a graduate program that offers distance education to nurses with an interest in nurse-midwifery and family nurse practitioner and women’s health specialties, aims to build a pipeline of highly educated nurses serving in rural or underserved areas, reports RWJF, one of its funders.  Many scholars and grantees sponsored by RWJF go on to spearhead projects to improve access to high quality nursing care in remote areas, the foundation says.

“We’re trying to introduce primary care providers into rural areas in such a way that they can provide high quality care and preventive services too,” says Suzan Ulrich, associate dean of midwifery and women’s health at FNU and an RWJF executive nurse fellow.

Demand for health care is rising nationwide because of an aging population that is living longer, but sicker, with multiple chronic conditions. The need for health care providers will intensify next year, when millions of new patients will become eligible for health insurance under the health-reform law.

Rural parts of the country face unique challenges and shortages of health providers, including nurses, can be particularly acute in rural areas, said Alan Morgan, CEO of the National Rural Health Association. These nurses and other providers have less access to education programs, which tend to be located in more densely populated areas. Programs that offer advanced degrees, from the baccalaureate to the doctorate, can be especially difficult to access for students living in rural areas, according to RWJF.

Identifying and educating nurses from rural areas is a key goal of FNU, which offers distance education programs that enable students to remain in their home communities and a “bridge” program that allows nurses with associate’s degrees to move more easily into master’s and doctorate programs. “These students really love where they live,” Ulrich said. “If we can educate them to stay within their communities, then those communities are going to have a provider who’s going to be there a long time." (Read more)

Midwives and nurse practitioners who recently graduated from Frontier Nursing University in Hyden address the unique challenges of rural areas, including shortages of health care providers, by bringing local health care to rural communities across the country. FNU was featured in a recent report from the Robert Wood Johnson Foundation.

FNU, a graduate program that offers distance education to nurses with an interest in nurse-midwifery and family nurse practitioner and women’s health specialties, aims to build a pipeline of highly educated nurses serving in rural or underserved areas, reports RWJF, one of its funders.  Many scholars and grantees sponsored by RWJF go on to spearhead projects to improve access to high quality nursing care in remote areas, the foundation says.

“We’re trying to introduce primary care providers into rural areas in such a way that they can provide high quality care and preventive services too,” says Suzan Ulrich, associate dean of midwifery and women’s health at FNU and an RWJF executive nurse fellow.

Demand for health care is rising nationwide because of an aging population that is living longer, but sicker, with multiple chronic conditions. The need for health care providers will intensify next year, when millions of new patients will become eligible for health insurance under the health-reform law.

Rural parts of the country face unique challenges and shortages of health providers, including nurses, can be particularly acute in rural areas, said Alan Morgan, CEO of the National Rural Health Association. These nurses and other providers have less access to education programs, which tend to be located in more densely populated areas. Programs that offer advanced degrees, from the baccalaureate to the doctorate, can be especially difficult to access for students living in rural areas, according to RWJF.

Identifying and educating nurses from rural areas is a key goal of FNU, which offers distance education programs that enable students to remain in their home communities and a “bridge” program that allows nurses with associate’s degrees to move more easily into master’s and doctorate programs. “These students really love where they live,” Ulrich said. “If we can educate them to stay within their communities, then those communities are going to have a provider who’s going to be there a long time." (Read more)

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Senate advances bill to allow Christian heath coverage cooperative back into Kentucky

Without dissent, the state Senate approved a bill Wednesday, Feb. 13, that would grant Christian health cost-sharing organization Medi-Share an exemption from the state's insurance laws and enable it to resume operation in Kentucky.

The Florida-based health care ministry was forced out of Kentucky last year by Franklin Circuit Judge Thomas Wingate, who ordered Medi-Share to stop operating in Kentucky. He acted at the request of the state Department of Insurance, which said the organization didn't comply with insurance regulations.

Sen. Tom Buford, R-Nicholasville, chairman of the Banking and Insurance Committee and sponsor of the bill, said the legislation would allow about 800 Kentuckians to rejoin Medi-Share. It would remove Medi-Share and two similar ministries operating in Kentucky out from oversight of the insurance department.

"The Department of Insurance regulates insurance companies. This is not an insurance company," Buford told the committee. Medi-Share does not include any contractual agreement to pay medical bills, but users are matched with each other to help pay for medical expenses through community giving, according to its website.

Medi-Share's plans resembles secular insurance in some ways but only allows participation by people who pledge to live Christian lives with no smoking, drinking, using drugs or engaging in sex outside of marriage, reports Beth Musgrave of the Lexington Herald-Leader.

The bill would require Medi-Share to tell members it's not an insurance company and does not guarantee that all medical bills would be paid, notes Roger Alford of The Associated Press.

The Rev. Dewayne Walker, pastor of Mount Olivet Baptist Church in Lexington, told the committee Medi-Share paid about $250,000 in medical bills for his wife, who had cancer. Medi-Share President Tony Meggs testified in court last year that the group has helped arrange to pay for some $25 million in medical bills for Kentuckians over the past 10 years, Alford reports.

Without dissent, the state Senate approved a bill Wednesday, Feb. 13, that would grant Christian health cost-sharing organization Medi-Share an exemption from the state's insurance laws and enable it to resume operation in Kentucky.

The Florida-based health care ministry was forced out of Kentucky last year by Franklin Circuit Judge Thomas Wingate, who ordered Medi-Share to stop operating in Kentucky. He acted at the request of the state Department of Insurance, which said the organization didn't comply with insurance regulations.

Sen. Tom Buford, R-Nicholasville, chairman of the Banking and Insurance Committee and sponsor of the bill, said the legislation would allow about 800 Kentuckians to rejoin Medi-Share. It would remove Medi-Share and two similar ministries operating in Kentucky out from oversight of the insurance department.

"The Department of Insurance regulates insurance companies. This is not an insurance company," Buford told the committee. Medi-Share does not include any contractual agreement to pay medical bills, but users are matched with each other to help pay for medical expenses through community giving, according to its website.

Medi-Share's plans resembles secular insurance in some ways but only allows participation by people who pledge to live Christian lives with no smoking, drinking, using drugs or engaging in sex outside of marriage, reports Beth Musgrave of the Lexington Herald-Leader.

The bill would require Medi-Share to tell members it's not an insurance company and does not guarantee that all medical bills would be paid, notes Roger Alford of The Associated Press.

The Rev. Dewayne Walker, pastor of Mount Olivet Baptist Church in Lexington, told the committee Medi-Share paid about $250,000 in medical bills for his wife, who had cancer. Medi-Share President Tony Meggs testified in court last year that the group has helped arrange to pay for some $25 million in medical bills for Kentuckians over the past 10 years, Alford reports.

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28% of Ky. adults 18-64 say they lack health coverage; 41% lacked it sometime in last year; employer coverage down since '08

Nearly three in 10 working-age adults in Kentucky are not covered by any form of health insurance, and the number who get health insurance from their employer, or their spouse’s employer, has plummeted since 2008, the first year of the Great Recession, according to the latest Kentucky Health Issues Poll. The decline accelerated in the last year, and was accompanied by a big jump in the percentage on public insurance.

The poll, taken Sept. 20 through Oct. 14, found that 28 percent of adults aged 18 to 64 said they had no health insurance at the time they were interviewed, and 41 percent said they had been uninsured at some point in the previous year.

The survey found that 37 percent get their insurance from an employer or spouse’s employer, well below the 55 percent figure in a similar poll in 2008. Conversely, 27 percent are now covered by some form of public insurance, way up from the 10 percent in 2008.

Medicaid in Kentucky covers households with incomes up to 70 percent of the federal poverty threshold; 43 percent of working-age adults living at or below that level reported being uninsured last fall. Among those with incomes more than double the poverty level for their size household, 15 percent said they were uninsured.

The poll was conducted for the Foundation for a Healthy Kentucky and the Health Foundation of Greater Cincinnati by the Institute for Policy Research at the University of Cincinnati. Pollsters contacted a random sample of 1,680 adults throughout Kentucky by telephone, including landlines and cell phones. The poll questioned only working-age adults about insurance because 98 percent of seniors have some form of health coverage. The poll has a margin of error of plus or minus 2.5 percentage points.

Nearly three in 10 working-age adults in Kentucky are not covered by any form of health insurance, and the number who get health insurance from their employer, or their spouse’s employer, has plummeted since 2008, the first year of the Great Recession, according to the latest Kentucky Health Issues Poll. The decline accelerated in the last year, and was accompanied by a big jump in the percentage on public insurance.

The poll, taken Sept. 20 through Oct. 14, found that 28 percent of adults aged 18 to 64 said they had no health insurance at the time they were interviewed, and 41 percent said they had been uninsured at some point in the previous year.

The survey found that 37 percent get their insurance from an employer or spouse’s employer, well below the 55 percent figure in a similar poll in 2008. Conversely, 27 percent are now covered by some form of public insurance, way up from the 10 percent in 2008.

Medicaid in Kentucky covers households with incomes up to 70 percent of the federal poverty threshold; 43 percent of working-age adults living at or below that level reported being uninsured last fall. Among those with incomes more than double the poverty level for their size household, 15 percent said they were uninsured.

The poll was conducted for the Foundation for a Healthy Kentucky and the Health Foundation of Greater Cincinnati by the Institute for Policy Research at the University of Cincinnati. Pollsters contacted a random sample of 1,680 adults throughout Kentucky by telephone, including landlines and cell phones. The poll questioned only working-age adults about insurance because 98 percent of seniors have some form of health coverage. The poll has a margin of error of plus or minus 2.5 percentage points.

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Kentucky ranks 10th in nation for injury-related deaths

Injuries are the third leading cause of death nationally, the leading cause of death for Americans between the ages of 1 and 44. Kentucky is among the nation's most problematic states, and it could take several more steps to prevent injuries, says a new state-by-state report on injury-prevention policy.

Kentucky ranks 10th in the nation for injury-related deaths, with a rate of 76.5 such deaths per 100,000 people, and the state spends about $26.8 million for injury-related medical expenses. New Mexico has the highest rate of injury-related deaths, 97.8 per 100,000 people, and New Jersey has the lowest at 36.1. The national rate is 57.9, so Kentucky's rate is almost a third higher than the nation.

Kentucky scored with only three of a set of 10 key indicators for injury prevention: its primary seat belt law, which most states also have; its prescription drug monitoring program, driven by heavy abuse of painkillers; and a strong law on youth sports concussions. Among the injury-prevention indicators that Kentucky lacks, it does not:

• Require bicycle helmets for all children.
• Require that children ride in a car seat or booster seat to at least the age of eight.
• Require helmets for all motorcycle riders. (It once did, but when the law was repealed, deaths rose 50 percent, the report says.)
• Does not require mandatory ignition interlocks for convicted drunk drivers.
• Does not allow people in dating relationships to get protection orders.

The report by the Trust for America’s Health and the Robert Wood Johnson Foundation concludes that millions of injuries could be prevented and billions of dollars could be saved in medical costs each year if more states adopted, implemented and enforced additional research-based injury prevention policies and programs. (Read more).

Injuries are the third leading cause of death nationally, the leading cause of death for Americans between the ages of 1 and 44. Kentucky is among the nation's most problematic states, and it could take several more steps to prevent injuries, says a new state-by-state report on injury-prevention policy.

Kentucky ranks 10th in the nation for injury-related deaths, with a rate of 76.5 such deaths per 100,000 people, and the state spends about $26.8 million for injury-related medical expenses. New Mexico has the highest rate of injury-related deaths, 97.8 per 100,000 people, and New Jersey has the lowest at 36.1. The national rate is 57.9, so Kentucky's rate is almost a third higher than the nation.

Kentucky scored with only three of a set of 10 key indicators for injury prevention: its primary seat belt law, which most states also have; its prescription drug monitoring program, driven by heavy abuse of painkillers; and a strong law on youth sports concussions. Among the injury-prevention indicators that Kentucky lacks, it does not:

• Require bicycle helmets for all children.
• Require that children ride in a car seat or booster seat to at least the age of eight.
• Require helmets for all motorcycle riders. (It once did, but when the law was repealed, deaths rose 50 percent, the report says.)
• Does not require mandatory ignition interlocks for convicted drunk drivers.
• Does not allow people in dating relationships to get protection orders.

The report by the Trust for America’s Health and the Robert Wood Johnson Foundation concludes that millions of injuries could be prevented and billions of dollars could be saved in medical costs each year if more states adopted, implemented and enforced additional research-based injury prevention policies and programs. (Read more).

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Tips to help avoid a preventable return trip to the hospital

Patients too often leave the hospital without knowing how to care for themselves, leading to a preventable return. Here are tips to improve your chances of a successful recovery at home:

Be sure you understand your illness, and the care you received in the hospital.

Ask if you will require help at home. Can you bathe yourself? Climb stairs? Will you need bandages changed or shots? If so, do you have a caregiver to help, or will you need to arrange a visiting nurse?

Repeat back your care instructions to those who give them, to be sure you understand them.

Ask for a written discharge plan that lists your medical conditions, your treatments, and the plan for your ongoing care.

Get a list of all medications, how to use them, and what to do if you experience side effects. Be sure to ask whether to continue medications you were taking before this hospitalization.

Ask what symptoms suggest you’re getting worse and what to do if that happens, especially at night or during the weekend.

What follow-up appointments will you need and when? Ask if your hospital will make the appointments for you, and send your records.

Do you have transportation home, to follow-up appointments, and to the drugstore?

If you have a regular physician, make sure the hospital sends a report of your hospital stay.

If you are uninsured or will have difficulty affording prescriptions, a hospital discharge planner or social worker may be able to link you to community resources that can help.

Get a name and number to call if questions about your hospitalization or discharge arise.

Sources: The Associated Press; Dr. Eric Coleman, University of Colorado; Robert Wood Johnson Foundation; Journal of the American Medical Association.

Patients too often leave the hospital without knowing how to care for themselves, leading to a preventable return. Here are tips to improve your chances of a successful recovery at home:

Be sure you understand your illness, and the care you received in the hospital.

Ask if you will require help at home. Can you bathe yourself? Climb stairs? Will you need bandages changed or shots? If so, do you have a caregiver to help, or will you need to arrange a visiting nurse?

Repeat back your care instructions to those who give them, to be sure you understand them.

Ask for a written discharge plan that lists your medical conditions, your treatments, and the plan for your ongoing care.

Get a list of all medications, how to use them, and what to do if you experience side effects. Be sure to ask whether to continue medications you were taking before this hospitalization.

Ask what symptoms suggest you’re getting worse and what to do if that happens, especially at night or during the weekend.

What follow-up appointments will you need and when? Ask if your hospital will make the appointments for you, and send your records.

Do you have transportation home, to follow-up appointments, and to the drugstore?

If you have a regular physician, make sure the hospital sends a report of your hospital stay.

If you are uninsured or will have difficulty affording prescriptions, a hospital discharge planner or social worker may be able to link you to community resources that can help.

Get a name and number to call if questions about your hospitalization or discharge arise.

Sources: The Associated Press; Dr. Eric Coleman, University of Colorado; Robert Wood Johnson Foundation; Journal of the American Medical Association.

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