First showing of 'Remaking Rural Health' is tonight on KET; focuses on people who are making a difference

The spotlight often shines on rural Kentuckians' alarming health problems, but far less attention goes to the people in those communities who are making a difference. "Remaking Rural Health: A KET Special Report" focuses on the advocates who are making inroads in improving conditions in these areas. The first airing of the report is at 9 p.m. Eastern Time tonight.

The report focuses on the expanded use of nurse practitioners, specifically those at Alliance Coal LLC, where a team of practitioners, overseen by Dr. Raymond Wells, run on-site clinics at seven mine sites in the state. It also looks at people like Dr. Phillip Bale of Glasgow who are focused on prevention. Bale runs one of the only "prevention clinics" in the state, spending nearly 30 minutes with each of his patients to identify risks for conditions like heart disease.

With boots on the ground, the goal of the University of Kentucky Rural Cancer Prevention project is to promote prevention by increasing testing and screening for four major cancers, educating through the use of Facebook and text messaging, and having advocates go to places like Walmart to reach out to people.

Awareness is another focus of these advocates. In Montgomery County, the Hispanic population prompted the health department to start the Promotora Program, in which leaders of the Hispanic community are trained in health issues in order to share their knowledge with members of the community. And the Hazard-Perry County Community Foundation aims to build health values in the community to try to change health outcomes.

The report will air again at 10 p.m. EST Monday, Feb. 13, and will be available online. For more information, click here.

Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

Most women over 65 don't need annual Pap smears anymore

Many women over the age of 65 no longer need to get an annual Pap smear in order to detect cervical cancer, the American Cancer Society, the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force agree. For low-risk women in that age bracket, there is no additional benefit to routine yearly screening, reports Paula Span for The New York Times.

"In women who have had normal annual Pap tests for many years and are in monogamous relationships, the risk of cervical cancer is very low," said Dr. Sarah Feldman, a gynecologist oncologist at Brigham and Women's Hospital in Boston.

However, there are some exceptions. If a woman received a Pap for reasons other than a routine screening, she should continue to be tested. She should have received three normal tests in the past decade; if not, she should get a Pap whether she's over 65 or not. And a woman should still have discussions with her doctor about any problems she might be having.

Though studies show the Pap test is not necessary for women over 65, it may be difficult for women, and their doctors, to agree to stop getting it. "People have gotten comfortable with that annual Pap smear," Feldman said. "They don't want it to stop." "It's a habit that might prove difficult to break," Span reports. (Read more)

New technology at UK allows for more comprehensive breast imagery, especially for women with much dense or fatty tissue

Technology that will enable radiologists to see individual breast structures without overlapping tissues obstructing their view will begin being used at the breast care center at the University of Kentucky Markey Cancer Center. It will be the only center in the state to use the 3-D technology known as tomosynthesis.

"In addition to providing the traditional top and side images of the breasts taken during a regular mammogram, tomosynthesis also allows the technician to take multiple X-ray pictures of each breast from many angles," a UK press release said. "A computer than combines all this information into one 3-D image."

The technology is expected to be especially useful for women who have dense or fatty breast tissue. More than 50 percent of women under the age of 50 have dense tissue and more than 30 percent of women over 50 have dense tissue. (Read more)

Dec. 1 is World AIDS Day; 1.2 million Americans are thought to be infected, but only 1 in 5 know it

Friday is World AIDS Day, an opportunity to learn the facts about the virus and show support for people living with it.

In the United States, there are 1.2 million people living with the HIV infection, which leads to AIDS. Of those who are infected with the virus in the U.S., only one in five know they have it, the Centers for Disease Control and Prevention report. Each year, about 50,000 Americans become infected. About 1,700 Kentuckians were diagnosed with HIV between Jan. 1, 2005 and Dec. 31, 2009; Kentucky ranks 19th in the country for the number of people who have the HIV infection.

Since the epidemic began, nearly 594,500 people have died with AIDS in the U.S. Between 1981 and 2007, more than 25 million people have died from the virus around the world.

Secretary of State Hillary Rodham Clinton spoke of the epidemic in a Nov. 8 address at the National Institutes of Health. "The fight against AIDS began three decades ago in June 1981. American scientists reported the first evidence of a mysterious new disease," she said. "Thirty years later, we ... know a great deal about the virus itself. We understand how it is spread, how it constantly mutates in the body, how it hides from the immune system. And we have turned this knowledge to our advantage."

Most at risk are gay, bisexual or other men who have sex with men. The CDC estimates that though this population accounts for just 2 percent of the U.S. population, it accounted for 61 percent of all new HIV infections in 2009. But heterosexuals and people who inject drugs can also contract the disease. Heterosexuals account for 27 percent of new cases. Another 9 percent of people who contracted the virus did so by using injected drugs.

Blacks accounted for 44 percent of new HIV infections in 2009, though they only represent 14 percent of the U.S. population. In 2009, the rate of new infection was 6.5 times greater for black men than it was for white men.

People can now be tested for the infection using a saliva sample and have the results in just 15 to 20 minutes. To find an HIV/AIDS prevention and service provider by county, click here.