Feeling exhausted and not sure why? Ask your health-care provider to check your vitamin B12

Some doctors are adding a vitamin B check to their standard "baseline" workup, especially vitamin B12, the one most commonly deficient, Dr. Leigh Erin Connealy reports for Newport Natural Health.

"By some estimates, up to 40 percent of the population does not have sufficient levels of B12," Connealy writes.

The B vitamins work together as a family to  perform many important functions throughout the body, such as helping to convert our food to fuel, allowing us to stay energized through the day, helping maintain heart health, preventing birth defects, creating red blood cells or assisting with the production and repair of DNA, to name a few.

Vitamin B12, or cobalamin, keeps our blood, nervous system and heart healthy. It is found primarily in animal-sourced foods—all meats, dairy products, eggs, and shellfish. Liver, sardines, and salmon contain the greatest amount.

Image from webmd.com

While it is not uncommon for vegetarians and vegans to have low levels of B12, Connealy says that even meat eaters can lack it, usually because of poor absorption.

Absorption issues in younger people are often caused by acid-blocking medications, disorders such as Crohn's disease, leaky gut, diarrhea and other gastrointestinal problems.  Older people with a condition called hypocholorhydria, where the stomach does not produce enough acid to help with the absorption of nutrients, can have low levels as well, Connealy notes.

B12 deficiency can cause a wide variety of debilitating symptoms ranging from exhaustion and lethargy to depression, anxiety, memory loss, confusion, and other Alzheimer’s-like symptoms.

WebMD adds rapid heartbeat and breathing, pale skin, sore tongue, bleeding gums, stomach upset and weight loss and diarrhea or constipation to the list of symptoms.

Connealy notes that there are differing recommendations for the amount of B12 that should be in a supplement. The Dietary Reference Intake recommends between 2-3 micrograms daily, while the Center for Food Safety and Applied Nutrition recommends 6 mcg daily, based on a 2,000-calorie diet.

Connealy recommends the higher dosage, especially since "absorption problems are so common with age" and "it's nearly impossible to overdose." She also recommends B12 injections for severe deficiencies. In particular, she says that vegetarians, vegans and those age 50 and older should take an oral B12 supplement every day.

CDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored

By Melissa Patrick
Kentucky Health News

Shaping Our Appalachian Region, the bipartisan effort to revitalize and diversify Eastern Kentucky's economy, will focus its health efforts on substance abuse, obesity and diabetes, SOAR Executive Director Jared Arnett told Kentucky Health News.

"We believe they have the greatest impact on our ability to create jobs and build a world class workforce," Arnett said in an email. He said David Roberts of the federal Centers for Disease Control and Prevention, determined the priorities after spending three months at the SOAR office in Pikeville.

The priorities differ from those put forth by SOAR's Health Working Group, which made two major recommendations after a series of public forums: a coordinated health program in schools, and a study of the health effects of large-scale surface mining. However, when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. No recommendations appear on the health group's webpage.

At the health session of SOAR's "Strategy Summit" May 11, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the CDC, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it, Al Cross reported for the Appalachian Kentucky page of The Rural Blog.  

"That dismayed me," Cross writes. Later, upon raising his hand and being recognized by Seymour, he told her and the audience that it was "disconcerting and almost unbelievable" that she was unaware of the recommendation about mountaintop mining. Seymour replied that she had, in fact, heard about it.

Cross wrote, "Noting that the Pike County Fiscal Court Room was nearly full, I told Seymour that a lot of people had attended meetings and made their concerns known, and that even though this issue was "a hot potato," because of the coal industry's role, she needed to "go back to the powers that be, and tell them there's a room full of people who want answers."

Cross wrote that he was not for or against a study on the health effects of mountaintop mining, and " Unless they're writing opinion pieces, journalists aren't supposed to take sides," he wrote. "But they do need to speak up when issues of broad community concern aren't being addressed, especially when those concerns have been solicited."

The SOAR working groups concluded their meetings last summer and submitted their final reports. Since then, the SOAR executive board has decided to launch a SOAR Advisory Council and hold annual roundtables, or more as needed. They have made a request for a community health representative to be appointed to serve on this council, and Arnett said he expects this person to be appointed by June 1 or so. 

In addition, a follow-up CDC representative will be assigned to the SOAR office for one year beginning in late summer to help put together a strategic plan to address the three areas of focus recommended by the CDC at the summit. This person will also lead a Community Health Action Team for SOAR to work on building a blueprint for improved public health in the region, Arnett said.

"We are focused on working with our corporate partners and the Community Health roundtable to address these issues identified by the CDC on what can have the broadest reach and the greatest impact," Arnett said. A full report of all of the CDCs recommendations is expected in the near future, he said.

Kentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011

By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths—a majority of which are from prescription drugs—in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."

KentuckyOne Health is offering mobile screenings for risk of heart attack and stroke, and cancer prevention, for a price

For a price, KentuckyOne Health is offering a new, mobile, preventive screening program at various locations around the state.

Screening packages range from $179 to $347 and are designed to evaluate an individual’s risk of heart attack, stroke and cancer. Patients are responsible for the cost, since KentuckyOne is not accepting Medicare, Medicaid or private insurance funding to pay for it at the time of service, but patients can submit their final report findings to their health provider and insurer for consideration of reimbursement.

“Through mobile screenings we can now expand cardiovascular and other health screenings throughout the commonwealth, including areas that may have limited access to these tests,” Alice Bridges, KentuckyOne's vice president for healthy communities said in a press release. “A major goal of this program is to help people become more aware of their health status and encourage active involvement in proactively managing their health.”

Tests included in the exam are: echocardiogram; electrocardiogram (ECG or EKG); hardening of the arteries test; stroke/carotid artery ultrasound; abdominal aortic aneurysm ultrasound; peripheral arterial disease test; Know Your Numbers®; high sensitivity c-reactive protein test (hs-CRP); thyroid-stimulating hormone test; testosterone test; and prostate specific antigen test (PSA).

The screening unit has  private exam rooms and the process takes less than an hour, according to the release. Technicians use painless ultrasound technology to examine the patient's heart and arteries to identify potential health risks, and then board certified physicians examine all results before providing patients with the report. The process takes approximately one week. Patients are encouraged to take their report back to their primary health provider for follow-up.

Mobile screenings are also available for partners of KentuckyOne Workplace Care.

 “Mobile screenings will allow us to bring services to the employer to help employees monitor their health and meet wellness goals," Shirley Kron, regional director of KentuckyOne Health Workplace Care, said in the release.

More information, including dates and locations, is available at Kentuckyonehealth.org/screenings or -855-721-8378.

Proposals sought for research of Appalachian 'bright spots' where health is better than socioeconomic factors would indicate

A three-year research project to determine factors that can support a culture of health in Appalachia and whether that knowledge can be translated into actions that address the region's health disparities has released its Request for Proposal to invite proposals from qualified research teams and consultants who would like to work on this project.

The project,“Creating a Culture of Health in Appalachia: Disparities and Bright Spots,” is sponsored by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky and will run through the end of 2017.

The research for this project will identify Appalachian “bright spots,” where health outcomes are better than would be expected based on unemployment and poverty rates and other community factors, and try to figure out why. Researchesr will also try to determine why health outcomes in some communities are not as good as would be expected.

The request for proposals offers detailed guidelines for submissions, which are due June 8. Applicants are encouraged to register for a webinar, detailed on the RFP, to be held May 7 at 10 a.m. EDT. Click here for more information.

Fate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.

Higher-income Kentuckians' reported health keeps declining; reports from those with lower incomes go up, marginally

A statewide poll again finds that Kentuckians with higher incomes consider themselves in better health than those with lower incomes.

The latest Kentucky Health Issues Poll, taken Oct. 8 through Nov. 6, found that 55 percent of Kentucky adults who are above 200 percent of the federal poverty level (FPL) said their health was either "excellent" or "very good," compared to 29 percent of Kentucky adults at or below 200 percent of the FPL. The FPL for a family of four in 2014 was $47,700.

However, the percentage of Kentucky adults in the higher-income category reporting excellent or very good health has dropped significantly since the poll started asking this question in 2008, to 55 percent in 2014 from 66 percent in 2008. So has the overall percentage of Kentucky adults reporting excellent or very good health, dropping to 41 percent in 2014 from 49 percent in 2008.

The percentage of lower-income Kentucky adults reporting excellent or very good has been about the same since 2008. This year the poll found a 3 percent increase among those in this group who reported very good or excellent health. The difference is not statistically significant, but coincides with implementation of federal health reform, and and if it continues could show the law's impact.

The poll also found that 52 percent of adults age 45 and younger considered their health as excellent or very good while 33 percent of those over age 45 reported excellent or very good health.

“KHIP provides important data regarding the connections among a person’s age, earnings level and perceived health status,” said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “By asking the same question year to year, we can spot trends in perceived health. The latest results are an important reminder of the links between poverty and poor health.”

The poll is conducted by the Institute for Policy Research at the University of Cincinnati and is co-sponsored by Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,597 adults via land lines and cell phones, and has a margin of error of plus or minus 2.5 percentage points. That applies to each figure, making the 3 percent difference statistically insignifcant.

New health-related laws deal with heroin, dating violence, end-of-life care, prescriptions, colon-cancer and newborn screening

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The Kentucky General Assembly passed several health-related bills this session, including high-profile measures on heroin and dating violence. It did not pass many others, including one that would have a great influence on the state's health: a statewide smoking ban, which passed the House for the first time ever, but never got out of an unfavorable committee in the Senate. Here's a roundup:

Heroin: Kentucky's heroin-overdose epidemic was caused partly by a 2012 legislative crackdown on prescription painkillers, which steered users to the illegal drug. Last year's bill died because of deadlock over sentences for traffickers and needle-exchange programs for addicts, and Gov. Steve Beshear and legislators gave this year's bill top priority. It was not finally negotiated until a few hours before passage, but Beshear signed Senate Bill 192 into law less than 12 hours after it passed so that its emergency clause could put it into effect immediately.

SB 192 includes both a needle-exchange program and harsher penalties against traffickers, the main points of contention between the House and Senate, but requires local governments to approve needle exchanges and allows judges to be lenient in sentencing addicts, to help them get treatment. It allocates money for drug-treatment programs, allows increased access to Naloxone, a drug that reverses the effects of an overdose, and allows jailers to provide medically assisted treatment for inmates with opiate addiction.

Dating violence: After 10 years of lobbying and debate, the dating violence bill will allow dating partners to get interpersonal protective orders from a judge if they have been the victim of dating violence, sexual abuse or stalking. This year's bill largely dissolved social conservatives' opposition by creating a new chapter in the law for dating violence, with the same protections as the domestic-violence law. Kentucky is the last state to offer protection to dating-violence victims. House Bill 8 was sponsored by Rep. John Tilley, D-Hopkinsville, who also sponsored the House heroin bill.

Beshear has signed these bills into law:

Prescription synchronization: SB 44, sponsored by Sen. Julie Raque Adams,R -Louisville, will allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

Medical order scope of treatment: SB 77, sponsored by Sen. Tom Buford, R-Nicholasville. will create a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care.

Colorectal cancer screening: SB 61, sponsored by Sen. Ralph Alvarado, R-Winchester, will require that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The governor also signed a similar measure, HB 69, sponsored by Rep. Tom Burch, D-Louisville, which contains an amendment by Sen. Julian Carroll, D-Frankfort, for a Medicaid savings study.

Newborn screenings for fatal disease: SB 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, will require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur.

Spina bifida: SB 159, sponsored by Adams, will require medical providers to supply written, up-to-date, accurate information to parents when their unborn child is diagnosed with spina bifida so they can make informed decisions on treatment.

Emergency care for strokes: SB 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, requires that local emergency services have access to a list of stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky. Emergency medical providers will set their own protocols for assessment, treatment and transport of stroke patients.

Alcohol and drug counselors: HB 92, sponsored by Rep. Leslie Combs, D-Pikeville, creates an enhanced licensing program to recognize three levels of certified alcohol and drug counselors, with different levels of education. The goal is to increase the number of counselors in the state.

UK cancer research center: HB 298, sponsored by Rep. Rick Rand, D-Bedford, revises the state budget to authorize $132.5 million, half of the cost, for a new medical research center at the University of Kentucky. The university says it will raise money to cover the other half.

These health bills awaited the governor's signature Monday morning:

Physician assistants: HB 258, sponsored by Rep. Denver Butler, D-Louisville, to allow physicians to supervise up to four physicians at the same time, rather than two.

In-home care: HB 144, sponsored by Burch, to establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services.

Pharmacist-practitioner collaboration: HB 377, sponsored by Rep. Dean Schamore, D-Hardinsburg, to allow collaboration between pharmacist and practitioners to manage patients' drug-related health needs.

Tax refund donations: SB 82, sponsored by Sen. Max Wise, R-Campbellsville, to put an income tax check-off box on tax forms to allow people the option of donating a portion of their tax refund to support pediatric cancer research, rape crisis centers or the Special Olympics.

Health related bills that were left hanging:

The smoking ban, HB 145, sponsored by Rep. Susan Westrom, D-Lexington, never got a hearing in the Senate Veterans, Military Affairs and Public Protection Committee, and neither did the Senate companion bill, SB 189, sponsored by Adams.

Three bills challenged Medicaid managed-care companies. SB 120, sponsored by Alvarado, would have created a process for health-care providers to appeal the companies' decisions to the state passed the Senate, but not the House.  And the following two bills that never got out of the Senate: SB 88, also sponsored by Alvarado, which challenged the $50 "triage fees" MCOs pay for emergency-room visits that they conclude were not emergencies, and would have required them to pay contracted fees instead and SB 31, sponsored by Buford, which would limited the amount of co-payments. Also not getting House action was Alvarado's SB 6 would have created review panels for lawsuits seeking damages from health-care providers.

Researchers blame Walmart, other bulk suppliers for part of obesity epidemic

Part of the rise of obesity in America can be linked to the availability of cheap food sold in bulk from warehouse stores like Walmart, says a study released this week by researchers from Georgia State University, the University of Iowa, the University of Virginia and the University of Louisville, . Wal-Mart is the biggest retailer in the U.S. and a staple of many rural areas.

"We live in an environment with increasingly cheap and readily available junk food. We buy in bulk. We tend to have more food around. It takes more and more discipline and self-control to not let that influence your weight," Charles Courtemanche, assistant professor of economics at Georgia State, told Danielle Paquette of The Washington Post.

Obesity in America has surged from 1960, when 13 percent of adults were obese, to 2012, when 35 percent of adults were, Paquette writes. The first Walmart store opened in 1962, the first Sam's Club in 1983 and the first Walmart supercenter in 1988. In addition to Walmart, numerous other warehouse-style stores, like Target and Costco, have followed Walmart's lead by selling in bulk.

The study found that opening an additional Walmart store "per 100,000 residents increased an area’s average body mass index by 0.24 units, or 10.8 percent of the sample obesity rate," Paquette writes. Researchers wrote, “These estimates imply that the proliferation of Walmart supercenters explains 10.5 percent of the rise in obesity since the late 1980s.” (Read more) (Growth of Wal-Mart since 1962)(Growth of Walmart since 1962)

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.

Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.

Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

Depression should not be a taboo subject; rural Kentucky news editor details writes about her victory over it

By Tim Mandell
Institute for Rural Journalism and Community Issues

Depression is a subject people often shy away from discussing, but a large percentage of Americans suffer from, or have suffered from, serious depression. Around 50 million have become seriously depressed at some point during their lives, according to a report by the University of Kentucky Cooperative Extension Service. ­

The suicide last month of actor Robin Williams brought depression to the forefront of the national news for a few weeks, but as the national focus shifted to other stories, community journalists should continue to talk about depression, especially in rural areas where people might feel they will be ostracized if they express how they feel.

That’s why it’s important when journalists like Shelley Spillman, news editor of The Anderson News in Lawrenceburg, Ky., step forward and write columns detailing their own battles with depression. Spillman, who was inspired to write a column after Williams’ death and the suicide of a local man who suffered from depression, said in an interview, “This is not something we normally talk about and maybe we should. Maybe these people wouldn’t feel so alone."

"As journalists we’re part of the community too," she said. "I really enjoy people getting to know me, my real struggles in life and the things I’ve been through. It’s amazing how relating to people on a human to human level is one of the most difficult things to do. But it’s so important.”

In her column, Spillman wrote: “I, too, have suffered from the cold, metallic grip of depression. I know what it’s like to be in a room full of people and still feel alone. You’d give anything to feel the warmth of company without having to go through the mental gymnastics of plastering on a fake smile just so you don’t have to be berated with ‘are you OK?’ or ‘what’s wrong?’ It’s not their fault. Most people don’t know how to deal with people who suffer from depression. Even in our daily interactions people stop and ask ‘How are you doing?’ without sticking around long enough to hear anything other than a one-word utterance of ‘Fine.’”

“It does get better; give it time. I understand, though, that giving depression time, when a day with it can feel like carrying around the weight of a giant boulder, seems impossible, but you can. Sometimes when I think about my time with depression it seems so far away, like I’m at the fair soaring on one of those giant swings, examining bad memories of someone else’s life. I can feel black fog of depression permeating in my brain, trying to find a way back in, but I immediately recognize the intruder and sent it packing. Like I said, it’s a parasite, it’s always looking for a host to attach to.”

Spillman added, “You’ll find that you are a lot stronger than you may even realize now. You can make it out of this, and one day the clouds will part and you’ll be able to see the sun again. Let me tell you the sun feels glorious on your skin after a longtime in the dark.”

Spillman told The Rural Blog: “Readers who have called appreciate my honesty in my columns. It’s hard to put yourself out there and be that vulnerable, but I like for my columns to be honest and real. It’s a way for people to know who I am.” She said that writing a column like this is “a good way to get the ball rolling to get people talking about (depression).” She said she hopes columns like this can lead to there being more resources for people with depression, especially in small communities, and lead to depression being a subject that’s less taboo to discuss. (The Anderson News is behind a paywall but can be reached by clicking here.)

The Extension Service report details signs and types of depression, suggestions for those suffering from depression and suggestions for friends and family members of people who are depressed. Other valuable sources are available here, here, here, here and here.

Kids Count report says hard times in early childhood are more likely in Ky. than rest of U.S.; bad times have long-term effects

By Melissa Patrick
Kentucky Health News

One of every five children in Kentucky, by the time they are 5 years old, has experienced two or more adverse childhood experiences such as child abuse, economic hardship, exposure to violence, living in a household with mental illness or substance abuse, or where a family member has been incarcerated.

That is one of the major points of the 24th annual Kids Count report, released Tuesday by Kentucky Youth Advocates. The report is part of a state-by-state effort with county-by-county data; nationally, only one in eight children by age 5 have had two adverse experiences, defined as events or circumstances that can affect the quality of the child's adult life, including their health and length of life.

"The higher the total number of these events a child experiences, the higher the risk of obesity, chronic illness, substance abuse, smoking and mental health problems," the report says. Another study cited in the report found that "Children who had experienced four or more adverse events had lower incomes, lower education attainment and lost more days of work or school as adults due to problems with physical or mental health."

“We know when children experience traumatic events such as abuse and neglect or having an incarcerated parent, it negatively impacts their health and often causes barriers to success later in life. Kentucky leaders need to enact solutions to prevent these experiences in the first place and when they do happen, help children successfully recover,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release.

This report by Kentucky Youth Advocates measures 16 indicators to determine the overall well-being of children in Kentucky counties and focuses on four areas considered critical to well-being: economic security, education, health, and family and community strength.

The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Woodford, and Calloway; the lowest are Martin, Owsley, Wolfe, Clay and Elliott.

Overall Child Well-Being, based on four factors:
economic security, education, health, and family and community.

The 2011-12 survey said that Kentucky children are more likely to experience two or more adverse events  (30 percent) than children are nationally (22.6 percent). The four most common adverse events among Kentucky's children, says the report, are economic hardship, living with a parent or guardian who got divorced or separated, living with anyone who had a problem with alcohol or drugs, and living with a parent or guardian who was incarcerated.

This study evaluated four indicators of health: smoking during pregnancy, low-birthweight babies, children and young adults without health insurance and teen births.  Oldham and Boone counties scored higher than the other counties on health and Elliott County ranked last.

Overall Health: County Comparisons.  Based on county
scores for the four indicators in the report.  

The study found Kentucky has the highest rate of mothers who smoke during pregnancy, one in five, compared to states with comparable data, reporting that the county rates varied widely in this area with less than 14 percent of expectant mothers in Fayette, Jefferson, and Oldham counties smoked, compared to 40 percent or more of mothers in Clay, Elliot, Lee, and Owsley counties.

The percentage of low-birthweight babies in Kentucky, often a result of smoking during pregnancy, between 1994-2012 (8.7 percent) was found to be consistently higher than the U.S. percentage (8.0 percent).

“All parents want what is best for their children, and we know that smoke is bad for kids,” Bethany Hodge, a pediatrician in Louisville, said in the release. “Kentucky needs an indoor smoke-free law so working mothers-to-be do not have to choose between their jobs and protecting their unborn babies.”

One in eight under 26 lacked health insurance in this study, but this number is expected to decline.

“Kentucky has effectively connected young people to health insurance, especially with the outreach efforts of KCHIP over the past few years and kynect over the past year,” Brooks said in the press release. “It’s important to build on those successes with innovative ways to connect all young people to coverage. One solution is to automatically enroll youth aging out of foster care in Medicaid to make sure they maintain health insurance as they leave the state’s care.”

As for teen births, in 2012, Kentucky's rate of births to teen mothers (42 per 1,000) "substantially" exceed the national rate (29 per 1000).

Many of Kentucky's children face adverse childhood experiences related to economic security.

According to the report, Kentucky has now had four consecutive years in which more than one in every four children lives in poverty, which is consistently higher than the national average. It also reports that more than two in every five Kentucky children live in a high-poverty area.

The report says, " A family's earnings and its poverty status, the level of poverty in its neighborhood and the affordability of housing can all affect how a child grows, learns and ultimately succeeds as an adult."

Boone, Oldham and Spencer counties have the highest scores for economic security, while Lee, Martin and Wolfe have the lowest.

Economic security, based on scores for the four indicators in the report.

The results of the well-being of Kentucky's children around education are concerning.

More than half (51 percent) of Kentucky's children entering kindergarten are not adequately prepared for school and more than half  (51 percent) of its fourth graders are not proficient in reading and "therefore not on the path to high school graduation," according to the report. The study also found that over half (55 percent) of Kentucky eighth graders are not proficient in math and that one in seven Kentucky high school students did not graduate on time.

Oldham and Lyon counties "stand apart" at the top of the  education county comparison, with Clinton, Knox, Menifee and Clay counties ranking last.

Education, based on scores for the four indicators in the report. 

Family and community indicators in the report found that Kentucky is not putting as many youth in jail as in previous years; nearly one in five births were to moms without a high school degree; the number of children living in a single-parent home has grown to 37 percent from 35 percent; and over the course of 2013, over 12,700 children were placed in foster care due to abuse or neglect.

Oldham, Boone, Carlisle, Ballard and Spencer counties rank at the top of the family and community county comparisons, with Powell, Clay, Elliott, Owsley and Carroll counties ranked at the bottom.

Family and Community, based on scores for the four indicators in the report. 

The report recommends implementation of strong policies to combat children's exposure to adverse childhood experiences. "The best option for Kentucky is to find ways to prevent adverse childhood experiences. Ensuring safe, stable and nurturing environments will shield children from toxic stress and its deleterious effects," says the report.

Click here for the Annie E. Casey Foundation Kids Count Data Center, which includes current and historical data. Note that the indicators included in the 2014 rankings are different than those included in the 2013 County Data Book. Therefore, current rankings should not be compared to last year’s county rankings.

UK-EKU center gets $5 million to address occupational health and safety issues in Central Appalachia and Kentucky

A center based in the University of Kentucky College of Public Health has received a five-year, $5 million grant to advance occupational health and safety in Central Appalachia and Kentucky, the university reports.

The grant was funded by the National Institute for Occupational Safety and Health at the federal Centers for Disease Control and Prevention. It will support the Central Appalachian Regional Education and Research Center as a "cohesive, fully equipped and recognized resource for occupational safety and health research and training in Central Appalachia," a UK release says.

It says Central Appalachia has "high proportions of fatal occupational injuries related to transportation and highway incidents; injuries in agriculture, forestry, fishing and hunting, and mining." However, "Systematic attention to the safety and health concerns of its work force has been limited," CARERC Director Wayne Sanderson said.

CARERC was formed in 2012 by the colleges nursing, public health and engineering at UK as well as the College of Justice and Safety at Eastern Kentucky University. It is one of only 18 such centers in the nation and provides interdisciplinary graduate education for students and health professionals in five programs: agricultural safety and health, occupational epidemiology, mining engineering safety and health, occupational health nursing, and occupational safety.

Seventy percent of the funding will support students in the CARERC program. The center also serves as a resource for industry, labor, government agencies, and other stakeholders and is partnering with stakeholders in the mining industry to develop new methods to reduce miners' coal-dust exposure.

"There aren’t many courses or programs where you're out in the field working with nurses, epidemiologists, and safety experts," Sanderson said in the release. "Everything we do is very interdisciplinary, which is how the real world works — people working together to solve problems."

UK, CDC announce two new health initiatives for Appalachia

University of Kentucky President Eli Capilouto, joined by U.S. Rep. Hal Rogers and Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, announced during Frieden's visit to the region Tuesday two new UK initiatives toward improving the health of Appalachian Kentucky.

The Appalachian Cancer Patient Navigation Project will allow UK and its partners to establish an infrastructure to train patient navigators over the next five years in five Appalachian states, a UK press release said. The navigators will serve as advocates for patients and help them connect with the services they need.

This $1.5 million project, funded by the CDC and the Appalachian Regional Commission, will also address cancer and other chronic diseases by promoting screening and prevention in the region. The program is part of a new multi-year partnership with the CDC's Division of Cancer Prevention and Control.

“Patient navigators can help Kentuckians get screened for cancer—finding it early can save your life,” Frieden said in the release. “By training more patient navigators where they are most needed, this CDC grant can help people in Appalachian areas live longer, healthier, cancer-free lives.”

The second initiative announced was the launch of the Community Leadership Institute of Kentucky, "a three-week intensive leadership development program designed to enhance research and capacity-building competencies in community leaders who play a key role in using data and decision-making related to health and health care," Powell writes.

Training for this program is competitive and will begin in October and November. Selected participant organizations will receive a $1,500 grant for completion of their proposed project over a 12-month period. Applications are currently being accepted through Aug. 29 for the first class of eight to 10.

"Our commonwealth is only strong if every community is strong," Capilouto said in the UK release. "And every community will only be strong when every community is healthy."

“We owe a great debt of gratitude to the University of Kentucky,” Rogers said in the release. “UK has helped transform the availability of health care in the mountains—improving access to specialists, spending thousands of dollars on cancer research and screening projects, and training students who want to come home to practice medicine.”

The announcements came during a symposium at Hazard Community and Technical College, the second Shaping Our Appalachian Region "Health Impact Series" event with Frieden. “I am thrilled to have such an impressive group of experts in health care here this week to focus on our health issues,” Rogers said. “We’re laying out our problems on the table.”

Tuesday’s symposium, sponsored by Appalachian Regional Healthcare, also featured presentations by Stephanie Mayfield, commissioner of the Kentucky Cabinet for Public Health, CDC Deputy Director Dr. Judith Monroe and a panel discussion of health care experts moderated by Dr. Nikki Stone, associate professor of the UK College of Dentistry/Medicine and chair of the SOAR Health Work Group.

Common themes in the discussions included "wellness, healthy foods, the smoke-free initiative, a focus on children and coordinated school health, oral health, diabetes/obesity, seniors, the need for mental health assessments and services beginning in early childhood and the drug epidemic," the UK release says.

Compared to the national averages, the prevalence of heart disease is 84 percent higher in the region. Diabetes is 47 percent higher, obesity is 26 percent higher and the state's lung cancer mortality rates are among the highest—at 67 percent above average—according to the Kentucky Department for Public Health. Kentucky as a whole has the nation's third highest rate of deaths from drug overdoses.

Rogers presented "Health Impact Awards" at the meeting to celebrate the "great work" of these organizations in awareness and prevention efforts, Powell writes. The awards went to Appalachian Regional Healthcare, the UK Gill Heart Institute-Appalachian Heart Center, the Hazard Police Department, the Knott County Drug Abuse Council and Kentucky Homeplace.

CDC director to attend a series of events Aug. 4-6 to talk about health issues in Appalachian Ky.; public is invited to attend

The director of the federal Centers for Disease Control and Prevention will participate in four events in Eastern Kentucky next week to discuss and look for solutions to the many health issues that plague the region.

Dr. Thomas Frieden

Dr. Thomas Frieden and his team will take part in the first-ever Health Impact Series, which is part of the Shaping Our Appalachian Region initiative launched by Republican U.S. Rep. Hal Rogers of the 5th District and Democratic Gov. Steve Beshear.

Topics of discussion will include the high rates of cancer, diabetes, heart disease and obesity in Appalachian Kentucky.

"While the diagnosis of illnesses like cancer and diabetes are heartbreaking, we know that hope is abundant. We've made great strides in awareness and prevention, but I am eager to hear Dr. Frieden's prescription for Eastern Kentucky and what we can do to help save lives and improve healthy living," Rogers said in a press release. "Dr. Frieden not only plans to share information with us, but wants to hear what medical professionals and health coalition leaders are already doing to change lives. This is our chance to speak directly to an international leader in healthcare about the long-time health disparities in our small corner of the world."

Compared to the national averages, the prevalence of heart disease is 84 percent higher in the Appalachian Kentucky. Diabetes is 47 percent higher, and obesity is 26 percent higher. from 2006 to 2010, the region had the highest number of people in the nation die from lung cancer, 67 percent higher than the national average. Kentucky as a whole has the nation's third highest rate of deaths from drug overdoses.

Frieden said in the release, “In working to improve health, we are all in this together. The more effectively we are connected, the more effectively we can address these opportunities. This visit to Kentucky is an important step.”

Accompanying Frieden will be Dr. Judith Monroe, deputy director of the CDC, who was raised in Lawrenceburg, earned her undergraduate degree from Eastern Kentucky University and first practiced medicine in the Appalachian region.

Here is the schedule of events:
Monday, Aug. 4: 6:30 p.m. reception & 7 p.m. dinner, Center for Rural Development, Somerset.
Tuesday, Aug. 5: 10 a.m. to 2 p.m., Hazard Community and Technical College; 5:30-7:30 p.m., Ramada Paintsville Hotel and Conference Center.
Wednesday, Aug. 6: 10 a.m. to 2 p.m., Morehead Convention Center.

All the events are free and open to the public, but registration is recommended to ensure meal service. To register, contact Cheryl Keaton at ckeaton@centertech.com or 606-657-3218.