Journalists who have reported about rural health in the past year should start sifting through their clippings. The Kentucky Rural Health Association is awarding four writers $100 each for their efforts.
Entries will be judged on their relevance to rural health; the quality of the reporting; impact on health-care policy; and new insights that might have been generated by the reporting.
The contest features two divisions, daily and non-daily, with two categories in each division: series and single story. The contest period ranges from July 1, 2011 to June 15, 2012. Entries must be received by June 24. Winners will be announced during KRHA's annual conference in Aug. 16-17 in Bowling Green.
Entries can be submitted to David A. Gross, 222 Medical Circle, Morehead KY 40351. For more information, contract Gross at 606-783-6468 or e-mail at dagross@st-claire.org. (Read more)
Albert Delaney waits for his wife Agnes in Hopkinsville. (Photo by Kentucky New Era's Tom Kane)
Nick Tabor of the Kentucky New Era examines Christian County's doctor shortage, with the area averaging just one primary care physician for every 2,000 people. It's the latest health story in the small daily newspaper, which is committed to quality health reporting.
The shortage creates problems for residents, who must either travel to another area to see a doctor or go without preventive services because there is no one to see until serious illness occurs. When that happens, that "puts an undue burden" on the local hospital's emergency room.
The shortage is affected by the fact that "primary care physicians, which rural areas need in higher volumers than specialists, are entering the job market at alarmingly low rates," Tabor reports. "More medical students are becoming specialists, as these jobs promise better salaries and hours." Secondly, it is difficult to recruit doctors to rural areas. "Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities," said Teresa Bowers, Jennie Stuart Medical Center's physician recruitment director. "They're not throwing darts at a map and saying, 'I'm going to Hopkinsville.'"
The problem is not a new one. A 2007 report by the Kentucky Institute of Medicine shows there have been shortage issues for decades. "Even if all the barriers that have prevented a sufficient and well-dispersed supply of physicians were suddenly to disappear, the task of recruiting and educating an ample cohort of doctors would take years to accomplish," it reads.
The problem is liken to worsen, however, if the federal health-reform law is upheld by the U.S. Supreme Court, as 30 million more Americans will have insurance to see the doctor. A recent report found medical school enrollment is up by 30 percent, but more residency placements are needed to accommodate the influx. (Read more)
Kentucky will be the 17th state to opt out of a federal requirement that requires nurse anesthetists to be supervised by a physician, a move that Gov. Steve Beshear said will increase flexibility and efficiency in operating rooms.
The Kentucky Hospital Association applauded the effort. "Certified registered nurse anesthetists are an extremely important part of health-care delivery in Kentucky, particularly in the rural areas of the state," said Mike Rust, KHA president. "This opt-out will ensure patient access to quality anesthesia care."
"We've consulted with the Cabinet for Health and Family Services and health care providers, and this is clearly a change we need to make to improve access to critical medical care," Beshear said. "In cases like this, where the federal requirement is an obstacle to some of the best options for delivery of high-quality health care, we're pleased to take this step to opt out."
A 2010 report that analyzed Medicare data for 1999 to 2005 and published in the journal Health Affairs found no evidence opting out of the oversight requirement resulted in more patient deaths or complications. (Read more)
Appalachian Regional Healthcare, a hospital chain in Eastern Kentucky and southern West Virginia, is seeking an emergency injunction by a federal judge ordering Coventry Cares to let its Kentucky members continue receiving services from the hospitals, and to avoid widespread layoffs the chain says will happen if the judge doesn't intervene, reports Bill Estep of the LexingtonHerald-Leader. Coventry Cares is one of three state-approved companies to provide managed care services through Medicaid. It said it would cancel its ARH contract after Friday, which would affect about 25,000 Medicaid recipients.
With a few exceptions, Coventry members would lose access to treatment or have to travel long distances to get to other facilities approved by the company, which ARH and officials in affected counties say would be difficult for most because they don't have money or reliable transportation to make the trip. Coventry spokesman Matthew Eyles said the company would continue paying for some services at ARH hospitals, including ob-gyn services to women who are more than 12 weeks pregnant and have a relationship with an ARH doctor.
The state switched to managed-care last year as a way to save money, but as Estep reports, the move has been "rocky." Providers have complained about delayed payments from the companies and their cumbersome pre-approval processes for treatments. ARH sued Coventry and Kentucky Spirit, another provider, claiming the companies owed more than $18 million for services ARH had provided. Estep notes, "The state allowed another managed care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry, the company said." The company also said the state failed to implement a method to assess risks that would adequately compensate managed-care providers who have more high-risk patients."
ARH and its Coventry patients think the company is trying to get more money out of the state. Many of ARH's patients are covered by Coventry, and ARH spokeswoman said about 300 to 400 jobs would be cut if Coventry cancels its contract. State officials are encouraging continues negotiation between ARH and Coventry. (Read more)
Meanwhile, Bardstown pediatrician and Passport Health Plan board member James Hendrick wrote a letter to the editor of The Courier-Journal offering Passport's services to "help the state get Medicaid back on track." He said he's been very impressed with the nonprofit's "strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality," adding that because Passport is a nonprofit, it's not concerned with appeasing shareholders. Passport has been managing Medicaid in the Louisville region for several years.
More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.
The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.
Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage – combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)
Taking opioids is still the best way to treat patients with pain, but the drugs are addictive because they do more than just alleviate physical suffering — they cause patients to feel good too. That's causing big problems in Kentucky, the state with the highest rate of opioid use and overdose.
In Perry County, for example, prescription medicines are the drugs of choice, second only to marijuana, and users may get more of them from relatives than from doctors. And their drug use appears to be part of a social support system.
Those were the findings of three separate studies presented at the second annual Appalachian Health Summit in Lexington last week.
Prescription-drug abuse is "an epidemic" that "seems to have started in rural Appalachia," Jennifer Havens, an associate professor in the University of Kentucky Department of Behavioral Science, said in presenting a study showing how disease spreads through the region.
Havens’ study of Hazard and Perry County found that prescription drug abuse in the county is second to marijuana use, and that painkiller abuse among high school seniors is at the same rate as in adults.
Though it’s not clear why prescription drug abuse is so rampant in the region, Havens speculated that lack of availability of other “hard” drugs, like heroin and cocaine, has led Appalachian drug users to turn to prescription medicine to get high. There are few drug-treatment options for users in the region, and many hospitals aren’t “financially viable” to care for drug abusers, she said.
An earlier study in which Havens was involved revealed that rural adults use more “alternate” methods to take drugs, including snorting and injecting. The study compared drug users in Perry County to those in Louisville and found that more than 40 percent of adults in the Hazard area were injecting prescription drugs to get high, and youth there were 25 percent more likely than those in Louisville to abuse such drugs.
The study found high rates of sharing drug-taking instruments, which increases risk for diseases such as hepatitis and HIV, Havens said. Almost 90 percent of participants said they shared snorting straws, and almost 1 in 3 said they shared syringes. No cases of HIV were found among the participants, but almost 43.7 percent of the 500 interviewed had hepatitis-C, and 11.5 percent had herpes-2.
Eighty percent were lifetime users, and about half first abused Oxycontin through injection. Havens said 28 percent of users had overdosed, and 58 percent had witnessed an overdose.
The study also found that a person’s likelihood of continuing drug use correlated with higher levels of social support, which Havens said contradicts long-held assumptions that drug users continue to abuse prescription pills because of low social support.
“Most people in the study depended on people also using drugs for social support,” Havens said. “As you can imagine, that’s not a good idea.”
No good alternative to prescribing painkillers
Despite widespread opioid abuse in Appalachia, such drugs are “still the best pain therapy,” UK physiology professor Karin Westlund High reported.
The purpose of her study was to determine what effect a high-fat and alcohol diet would have on “visceral pain” in the pancreas, and then what effect opioid gene therapy would have on the organ.
There are clusters of Appalachian counties at high risk for pancreatitis, which can lead to pancreatic cancer. Severe abdominal pain is associated with both, and morphine is typically used to treat it. However, High said, patients usually develop a tolerance to the drug over time.
She and other researchers used rats to test an opioid gene therapy involving herpes simplex-1, which 90 percent of Americans already have, to see if it would reduce pancreatitis pain without building tolerance in the rats. After 10 weeks of treatment, there was no tolerance present and the therapy seemed to be reversing damaged sections of the pancreas caused by the disease.
While opioids are effective in alleviating pain, "There are lots of different kinds of pain, but most opioids act as if they treat the same pain,” said Michelle Lofwall, a UK psychiatry and behavioral science assistant professor. Lofwall set out to discover how pain affects prescription drug abuse, since that is the main reason such drugs are prescribed or first used.
Her study participants, who were all drug users, placed one arm in a cooler of ice to elicit pain, and then were asked about pain levels. The test was repeated after a dose of painkiller. Researchers were attempting to give the drug to treat patients’ pain only, and not to have the patient feel a high when the drug was in their system, but that failed.
“Unfortunately, in my patients I wanted to say, ‘Yes, let’s treat your pain and you won’t feel any good effects’,” Lofwall said. “I wasn’t able to say that to them.” She said they are now trying to help doctors better prescribe pain medication so that habits aren’t formed.
One of the biggest habit-forming painkillers is Oxycontin, which was introduced in 1996 but wasn’t abused on a large scale until doctors had to start documenting pain in 1999, Lofwall said. Sales of, treatment for, and death from prescription drug abuse have increased since then. She noted that Kentucky has the highest rates of opioid use and overdose.
The makers of Oxycontin have reformulated the drug to make it harder to crush, mix with water and snort, but a new drug has risen to take its place: Opana. Lofwall said researchers have been trying to study Opana use, but can’t get a study supply because it is in such high demand. She said she has seen more of a rise in heroin use by her patients because even heroin is easier to get than Opana.
Though legislators are grappling to curb the proliferation of "pill mills" in the state, Lofwall said "doctor shopping" may not be the problem it's been billed to be. According to the National Household Survey on Drug Use and Health, 56 percent of users get their supply from a relative, of whom 85 percent have a prescription from one doctor. The drug abuser may get the drug from the relative as a gift, by paying for it or by stealing it.
Asked about the Kentucky All Schedule Prescription Electronic Reporting system, which allows doctors to search a database for “doctor shoppers” before prescribing pain pills, Lofwall said KASPER is limited because it only covers Kentucky, but “I think the state’s ready to make it better.”
Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
More than 15 percent of physicians in the U.S. received training in lower-income countries, including India, Pakistan and the Phillippines, a new study has found, reports Lori Kersey of The Charleston Gazette. The study was a joint effort by the National Research Council and the Stanley Medical Research Institute, and was published online on PLoS ONE.
Most doctors from low-income countries practice in low-income areas of the U.S., where most U.S.-trained doctors don't usually want to go. West Virginia has the most such doctors, at 29 percent all of physicians in the state. Kentucky has 16 percent, just above the national average of 15.4 percent. Montana, Idaho and Alaska all have less than 2 percent.
The authors of the study said low-income countries that send most of their doctors to the U.S. lost more money training them than they receive in U.S. foreign aid. In 2010, the Phillippines spent $1.7 billion training more than 20,000 doctors who then came to the U.S., but was only given $33 million in U.S. foreign aid. The authors suggest the U.S. should pay those countries back in some way. (Read more)
“If a newspaper can’t stand for better health and better health care, then what in the world can it stand for?” This was the galvanizing statement of a talk today by Al Cross, director of the Institute for Rural Journalism and Community Issues, who keynoted the third annual Kentucky Health Literacy Summit. Cross discussed ways newspapers are — and aren’t — publishing health-related stories on their pages.
A research paper Cross presented with University of Kentucky graduate student Sarah Vos yesterday showed that with a few exceptions, rural newspapers in the state are not publishing many articles about health care and health. The vast majority of articles — 71 percent — run on the inside of the paper rather than on the front page. In large part, stories are institutionally oriented, Cross said, often pertaining to promoting the local hospital or reporting on problems with it.
Interviews with rural publishers and editors in Kentucky and Mississippi showed “while many of them believe health coverage is important, they are reluctant to be seen as crusading in the news columns for a cause, even if it is one that usually has no countervailing interest,” Cross said. He said Kentucky editors are specifically reluctant to point out health disparities comparing their community to neighbors, the state or nation, because they want to build up the community “rather than going out of their way to point out local problems that have no easy solutions.”
Another issue is that most of Kentucky’s 150 newspapers serve very small markets, which “mean less revenue, small staffs and low pay, so most of these newspapers lack the resources to do what we journalists call enterprise reporting,” Cross said. And with all but two Kentucky dailies owned by corporate chains, that can mean “less news space, fewer staff members, more focus on number of stories rather than quality, less focus on community service, more on bottom line,” he said.
However, rural newspapers continue to have considerable influence over their readership, with 60 percent of adults saying their local paper is their primary source of news. Their content is almost entirely local. Thus, Cross said, there are opportunities — and ones that don’t require a lot of legwork. A story about someone's life being saved because she got a cancer screening can make a big impact, he said, and sometimes an article written by an outside source, such as a local extension agent, “doesn’t need to be put on page 12.” Cross said. Newspapers can use social media, such as Facebook, to promote their stories and find local people willing to talk about a health issue.
Cross also recommended Kentucky Health News as a service editors can rely on for stories that can be used verbatim or be easily localized. Cross noted newspapers are using the service, and “We think we are moving the needle.”
Though studies suggest that newspapers can influence people's decisions about their health and can even lead to public-policy changes, for the most part Kentucky's rural newspaper editors are publishing very few health-related stories, a report compiled at the University of Kentucky concluded.
The six-month study found more than 1,200 articles primarily about health were published in 131 rural Kentucky newspapers, including opinion pieces, reprints, press releases, briefs and letters to the editor. That averaged to nine stories per newspaper in six months, though daily papers tended to run far more articles than non-dailies (52 percent of dailies ran health articles 1 to 2 times per week while 68 percent of non-dailies ran health articles less than once a month).
Speaking at the third-annual Kentucky Health Literacy Summit, study co-author Al Cross said he wasn't surprised by the findings, sensing "there wasn't a great deal of coverage out there to help people live healthier lives." But Cross said his goal as director of UK's Institute for Rural Journalism and Community Issues "is to help rural newspapers help define the public agenda."
"In Kentucky," he said, "that needs to be about health."
The topic of health-care funding and policy accounted for 35 percent of the articles published, though co-author Sarah Vos said that number is likely skewed because the time period analyzed included a legislative session during which there was extensive discussion about Medicaid.
Stories on drugs and alcohol accounted for 12 percent of the total, followed by tobacco/smoking (9.5 percent) and exercise, food, diet or obesity (8.6 percent). Vos also found stories that did run were often incomplete, with 40 percent failing to contextualize the problem for the reader. Only 20 percent mentioned health disparities, the differences in health between geographic areas and demographic sectors.
While there is a dearth of health reporting in rural newspapers — all newspapers but those that serve the Lexington, Louisville and Cincinnati areas were included in the study — they could have considerable pull in the health decisions people make. Vos cited one study showing media coverage can influence individual health decisions and preventive behaviors, and one that showed coverage of health issues can lead to both changes in public policy and public perception.
Rural newspapers are well read by their readership, with the average reader spending about 39 minutes reading their local paper. Sixty percent of adults say their rural paper is their main source of news, Vos said. "Rural newspapers have a special relationship with readers," she said. "It's intimate. One researcher even called them an extended member of the family."
The Patient Protection and Affordable Care Act is already making an impact, including for people who live in rural America. That was the message from Agriculture Secretary Tom Vilsack today on the second anniversary of the enactment of the federal health-care reform law.
In a teleconference, Vilsack noted several pieces of the law that are benefitting people, including the 2.5 million young adults who have insurance coverage because parents can keep them on their plan up to age 26. "That's providing a degree of comfort to moms and dads," he said.
The law has also helped 3.6 million seniors on Medicare, who saved $2.1 billion on their prescription drugs in 2011 because the law allowed them to get a 50 percent discount on brand-name drugs. Vilsack said seniors saved an average of $600 last year and were also "able to get a number of services, including preventive services like mammograms, for free."
Under the law, insurance companies are now required to spend 80 percent of their premium dollars on "actual health care, not overhead," Vilsack said, and they are not allowed to increase their premiums by more than 10 percent without an explanation. Children who were previously denied coverage because of pre-existing conditions can no longer denied, as per the law's mandate, and "in a couple of years that will extend to all people," Vilsack said. And thousands of new primary-care doctors and nurses are being encouraged to practice in rural areas and will receive higher payments.
Vilsack said his Department of Agriculture is working to improve the rural health-care landscape, through a joint effort with the USDA Rural Development division and the Department for Health and Human Services. In the past three years, Vilsack said 730 counties have received grants so they can "embrace telemedicine." Nearly 600 health-care facilities in rural communities have received money to fund equipment like CT scans, MRIs, ultrasound and lab equipment, Vilsack said. And rural citizens can now get care from a hospital outside their health plan's network when there is no time to get to a hospital that is farther away.
"No one should have to go without health care because of where they live, and for too long, rural Americans have been getting the short end of the health-care stick," he said. "The Affordable Care Act is helping millions of young people access health care, strengthening Medicare, and training thousands of new doctors to serve rural areas to give middle-class families the health security they deserve." (Read more)
For the first time, there is conclusive evidence that growing up on a farm is good for the immune system. Researchers from the University of Bristol's veterinary sciences school have published a study showing that "spending early life in a complex farm environment" increases the number of T-cells one has, reports Sarah Muirhead of Feedstuffs. T-cells have been identified as universal regulators of immune systems, with low numbers increasing risk of developing allergies, autoimmune and inflammatory diseases. Researcher Marie Lewis said it wasn't previously known whether farm life increased immunity to allergies, or if people more prone to allergies weren't living on farms.
Piglets were used in the study since they share many aspects of human physiology, metabolism, genetics and immunity. Some of the piglets were nursed by their mother on the farm, while the others were kept in an isolator unit under hygenic conditions and fed formula milk to reflect the "extremes of environment" in which many humans are raised. Farm-raised piglets had increased levels of T-cells compared to those raised in the isolator. Lewis said it's not clear yet exactly what caused the increase in T-cells in farm-reared piglets, but said previous work shows that intestinal bacteria "plays a pivotal role." (Read more)
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.
In our experience, most weekly newspapers don't have editorial pages, much less editorials, so when one puts an editorial on the front page and also runs an editorial about the decision, and the work is well-written and well-argued, it's worth noting.
The Adair County Community Voice in Columbia, Ky., noted county government's bailout of the "collapsing" county-owned hospital; elected officials' request that they have "a say in any final decision to sell the hospital" and that "the hospital administration will try just as hard to keep the hospital independent as they will to sell it;" and some appointed board members' dislike of the requests.
"It seems like little to ask of someone who is $13 million in debt and asking you for $1.7 million," the editorial said, noting that one member said the board had been "a rubber stamp" for agents who secured the bonded debt. That admission "saves us the trouble of trying to prove that board members acted irresponsibly in overseeing the hospital’s business," the editorial said. "Now the question has to be, 'Why are they still on the board?'" It said the board not only "ran the hospital into the ground" but is "in control of a document that will show if any criminal activity took place," a forensic audit that gives board members "a personal stake in any damaging evidence that may come out."
In her explanatory editorial, Editor-Publisher Sharon Burton said she put the editorial out front because "We believe this is a critical time for our community, and we believe bad decisions will continue if the board is left as it is. We believe it’s our job to bring the issue to the forefront, and there is no better place to do that than on the front page of the Community Voice." The explanatory editorial also included useful background and perspective, including: "At small newspapers we don’t have the luxury of separating the people who cover the news from the people who write opinion pieces. Instead, we work hard to provide fair and unbiased coverage of local news. Then, we look at how that news impacts the people in our community and take a stand as needed on our editorial page."
Burton told us in an email that the editorial generated responses by phone, emails, Facebook messages "and of course being stopped at church and the grocery store," all of them positive except a letter from the daughter of a board member, which is running this week. The Community Voice doesn't put editorials or most news online, but PDFs of the pages with the editorials are available on the Institute for Rural Journalism and Community Issues website. The front page, with color, is 3.5 MB; the inside page is 682 KB.
Many rural hospitals could be forced to close because of cuts to the Critical Access Program and the fact that, according to the National Rural Health Association, , 41 percent of critical-care hospitals are losing money, reports Jenny Gold of Kaiser Health News. This would be devastating to many rural communities, with a great impact felt by low-income and elderly residents. "A small hospital is often one of the biggest employers in a rural town, and closures 'can have an outsized economic impact,'" Eric Zimmerman, a health care lawyer and Washington lobbyist, told Gold.
More than 1,300 U.S. hospitals and nearly one in four acute-care facilities are designated as "critical access," giving them slightly higher Medicare and Medicaid reimbursements in return for limits on care they can provide. Many such hospitals like Hood Memorial, about an hour outside New Orleans, are dealing with uninsured patients, inability to collect payments from patients, and fewer funds from federal and state agencies, Gold reports. Many of these hospitals "tend to provide lower quality care" and are "less financially efficient than other facilities, according to a 2010 study published in the Journal of Health Politics, Policy and Law. Hood, for example, had $700,000 in losses last year despite the higher reimbursements. "It's a lot of variables, and all of them right now are working against us," CEO Hoppie Jones told Gold.
To prevent closures of rural hospitals and ensure "Americans in in isolated areas would still have access to health care," the federal government started the critical access program in 1997. To qualify, hospitals had to have 25 or fewer beds and be at least 35 miles away from another facility. However, states could waive the distance requirement, and many did, leaving hospitals like Hood with at least four other competing hospitals "within a 26 mile radius," Gold reports.
"Farmers' stark commitment to work is borderline obsessive, and researchers are beginning to develop new guidelines to better understand farmers, whose strong cultural and emotional ties to the farm drive their work ethic," reports Karin Pekarchik of the University of Kentucky College of Agriculture about a study by the UK College of Nursing's Deborah Reed. Findings show that 40 percent of 1,423 Kentucky and South Carolina farmers aged 50 and over defined health as the "ability to work," causing them to work well after retirement age. Reed told Pekarchik she hopes these results will help medical personnel better understand farming culture so they can better relate to farmers.
"The average Kentucky farmer is 57 – 13 years older than the average worker. Kentucky's farming population mirrors that of the entire United States, making this a nationwide topic," Pekarchik writes. Reed told her most farmers have two jobs and don't list farming as their primary occupation, keeping doctors from screening for things like skin cancer and cataracts, common ailments associated with working outdoors.
Another alarming statistic is that farmers have the highest suicide rates of any occupation, most likely because they're "exposed to unrelenting and multifaceted stress and pressure," Pekarchik writes. The resulting stress from hard physical labor, long work days throughout the year, enduring vagaries of nature and livestock, adverse weather conditions, market fluctuations, government policy changes and family pressure can lead to suicide.
Reed told Pekarchik farmers, even from a young age, should be aware of the physical and mental problems that could ail them later in life. Reed suggests farmers use sunscreen, wear wide-brimmed hats, use hearing protection and wear sturdy shoes and use a walking stick to eliminate falls. (Read more)
The University of Kentucky’s Center for Excellence in Rural Health celebrated its 20th anniversary this week and announced the addition of a new baccalaureate degree in medical laboratory science, which will start next fall at the facility in Hazard.
At a ceremony honoring current and former faculty, staff and students of the center, speakers include UK President Eli Capilouto, 5th District U.S. Rep. Harold "Hal" Rogers and Dr. Wayne Myers, the center’s first director and a former director of the federal Office of Rural Health Policy.
Capilouto, a dentist by trade, said “With approximately 80 percent of the center’s graduates working in Appalachia or other rural communities, it’s a testimony to the fact that this idea worked.” More than 550 people are graduates of the center's academic programs. The center also includes Kentucky Homeplace, a nationally recognized community health worker initiative; the Kentucky Office of Rural Health; and the East Kentucky Family Medicine Residency Program, a UK news release said.
Just weeks after announcing part-time employees would no longer receive health insurance benefits, Walmart said Monday it is planning to offer extended medical services in its stores, report NPR's Julie Appleby and Sarah Varney. Since many of its stores are in rural areas, this move could extend medical coverage to people who often can't afford transportation to a doctor. The retailer "sent out a request for partners to help it 'dramatically lower the cost of health care by becoming the largest provider of primary health care services in the nation.'"
In a 14-page request, Walmart asks health-care providers to define their expertise in a variety of medical areas, including managing patients with chronic health problems like asthma, HIV, arthritis, depression and sleep apnea. The retailer is also trying to find health partners who can monitor patients with diabetes and high blood pressure. Appleby and Varney say "The move would capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance." This effort could also capitalize on "collaborations between doctors and hospitals to streamline care and lower costs," they report.
Though expansion of medical services in Walmarts "could help lower costs for some patients and increase access to primary care services," it has its fair share of nay-sayers. Glen Stream, president of the American Academy of Family Physicians, tells Abbleby and Varney that Walmart's "proposal takes health care in the wrong direction by further fragmenting care. Ann O'Malley, physician and senior researcher at the Washington think tank Center for Studying Health System Change, said she's not sure Walmart's approach will work. She said she "would be surprised if this were a model that could truly attack cost problems." Colin McGranahan, retail analyst for Sanford C. Bernstein & Co., said this could simply be a move to boost foot traffic and sales in Walmarts: "If you get someone in the door, you can also sell them milk and a shotgun." (Read more)
Nov. 17, 2011 will be the first annual National Rural Health Day sponsored by the National Organization of State Offices of Rural Health. The goals of the event are to highlight rural communities as wonderful places to live and work, increase awareness of rural health-related issues and promote the roles of state rural-health offices in addressing those issues.
On Nov. 17, the organization will host a series of free webinars in conjunction with the observance. To learn more about the webinars, click here. The group also has a series of free tools newspapers can use to promote the event. (Read more) The Center for Rural Health is hosting a photo contest to promote the event. To find your state's rural health office, click here.
Children in rural areas face more health challenges than those in urban parts of the country, and are more likely to be poor, more vulnerable to death from injuries, and more likely to use tobacco. Rural families also have more difficulty in gaining access to health care. But the majority of parents, regardless of whether they live in urban or rural communities, say their kids are healthy.
These findings are from a report entitled "The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007," compiled by the U.S. Department of Health and Human Services' Health Resources and Services Administration. The report's results are based on the National Survey of Children's Health, conducted in 2007.
The survey classified children as living in an urban area, a large or well-populated rural area or a small or isolated rural area. Large rural areas include large towns with populations of 10,000 to 49,999. Small rural areas include small towns with populations of 2,500 to 9,999. Survey results were not broken down by state.
The report found children's overall health status does not vary substantially according to location. Four-fifths of parents said their children are in excellent or very good health, regardless of where they live.
But the analysis found rural children, as a whole, face more health risks than their urban counterparts. Only 67.6 percent of children in large rural areas and 69.8 percent in small rural areas are breast-fed, compared to 77 percent of urban children. (About 59 percent of new mothers breast-feed in Kentucky, compared to 75 percent nationwide.)
Rural children are also more likely to be overweight or obese — 34.6 percent of children in large rural areas and 35.2 percent in small rural areas compared to 30.9 percent of urban children. Rural children are also more likely to live with someone who smokes — one in three children in large rural areas and 35 percent in small rural areas do. Only one in five urban children do.
Though about 90 percent of children surveyed had health insurance, those in rural areas were more likely to have public coverage like Medicaid or CHIP. Urban children were more likely to have private insurance. Access to health care also remains a factor. Of the 2,052 non-metropolitan counties identified in 2010, 704 were designated as health professional shortage areas. Of those, 467 had shortages for dental care and 521 lacked adequate mental health services. To find if a Kentucky county is in a health professional shortage area, click here.
There are some advantages for rural children, however. They tend to be better protected and more connected to their families and communities. More than half of children in small rural areas shared a meal with their families every day in the past week. Children in small rural areas are also more likely to get physical activity every day (34.7 percent), though they are less likely to have access to community centers, parks or playgrounds. However, rural children are more likely to spend more than an hour each weekday watching television or videos — 60.9 percent of children in large rural areas did so, compared to 53 percent in small rural areas and 53.9 percent of urban children.
The data for the National Survey of Children's Health was generated using a random telephone survey, in which 2.8 million telephone numbers were randomly generated. After non-working and non-residential numbers were eliminated, the remaining numbers were called and surveyors spoke to respondents to see if children less than 18 years of age lived in the household. From each of those households, one child was randomly selected to be the focus of the interview and parents responded to the survey questions. Surveys were conducted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean.
Millions of Americans are farther away from trauma care than they were 20 years ago, with some having to travel more than 30 minutes to get treatment. Experts say getting help within the first hour is crucial.
A study published in the journal Health Affairs found the distance to a trauma center "increased for 69 million people between 2001 and 2007," reports the Daily Yonder, the national online rural journal. The average amount of travel time was 10 minutes. But for 16 million people, the amount of time it took to travel to a trauma center increased by 30 minutes or more.
"The greatest impact from diminished access has been on people in rural communities," as well areas with a high percentage of African-American residents, low-income people and those without health insurance, The Associated Pressreported.
Though U.S. Census numbers show cities growing in population while rural areas decline, Kentucky is still considered a largely rural state (see right), ranking 23rd in the country for population density.
The reason for the increased travel times is due to facilities closing. In 1990, there were 1,125 trauma centers in the country. By 2005, nearly 340 of them had closed, in most cases because of financial hardship; they were treating too high a percentage of people who do not have insurance, Daily Yonder reports.
President Obama's recent call to cut Medicare premiums to critical access hospitals, as well as close CAHs that are within 10 miles of each other, would further burden rural areas, said a panel of experts in Lexington Wednesday.
Medical experts say a trauma patient has the highest change at survival if treated within the first hour. "We're not saying that we should build a trauma center on every street corner," said Dr. Renee Hsia, lead researcher on the study. "But we do have evidence that access for certain populations is already pretty bad, and it's getting worse." (Read more)
