Prevention and preparation is the key to a productive year at school for kids with asthma (and that's 1 in 10 students)

By Melissa Patrick
Kentucky Health News

As the beginning of a new school year approaches, parents of children with asthma and allergies need to make sure that not only does their child recognize what triggers their symptoms and how to treat a flare-up, but also that their school knows what to do.

One of every 10 school-aged children in Kentucky has asthma, and these students miss an average of four school days each year, according to the Cabinet for Health and Family Services. Kentucky has one of the highest rates of asthma in the United States.

Nationally, more than 10 million kids under age 18 have asthma, 11 percent have respiratory allergies and about six percent have food allergies, according to according to the American College of Allergy, Asthma and Immunology. And on any given day, more than 10,000 kids miss school due to asthma.

Preventative care and avoiding triggers will help children miss fewer days in the classroom and will also allow them to be more productive in all of their activities, the college said in a news release.

“Parents need to be advocates for their kids, to help ensure they’re breathing well with clear minds and able to navigate the triggers that sometimes stand in their way,” Michael Foggs, president of the college. “If kids are having difficulty breathing, are sneezing, have runny noses and itchy eyes, and haven’t slept well the night before, they won’t perform at their best.”

Here are some tips to help with symptom-free days in the classroom and outdoors:

• Create an action plan with your allergist specific to your child's needs. Include medications, doses, triggers, early symptoms of flare-up and what to do if there is a flare up.&

• Share your child’s action plan with your child's teacher and whoever else might come into contact with your child every day. Discuss how independently your child is able to deal with their asthma, give them contact numbers for you and your child's doctor and be sure your child and school staff knows how to work the peak flow meter and how to administer medications, especially if your child needs assistance.

• Assess any triggers for your child at school: mold, dust mites, cockroaches, chalk dust, perfumes, cleaning products or other chemicals, animal dander, saliva or urine. Work on a plan to minimize these triggers.

• Discuss how to handle emergencies. Children who are at risk for a life-threatening allergic reaction (anaphylaxis) also should have epinephrine to use. Be sure your child and school staff know how to use emergency medications.

• If your child has food allergies, send a bagged lunch to school every day and instruct your child to not share foods, napkins or utensils.

• Make sure you have a plan for recess and sports activities. The American College of Allergy, Asthma, Asthma and Immunology says in the release that "asthma symptoms during exercise may indicate poorly-controlled medications."

• Pay attention to the pollen counts if your child is allergic to pollen; it is suggested to start medications two weeks prior to when the levels are at their worst.

Proper asthma control helps kids sleep better at night, spend more time in the classroom, experience less anxiety about their condition and fully participate in all school activities, according to kidshealth.org.

'Hard times' help 13 more schools in Paducah area join about 20 in federal program that gives free meals to all students

Thirteen more schools in the Paducah area will offer free breakfasts and lunches to all students under a provision of the federal school-lunch program, joining about 20 others in the region, reports Genevieve Postelthwait of The Paducah Sun.

"Schools that are new to the program include Hendron-Lone Oak, Calvert City, Lowes, Wingo, Graves Central and North Livingston elementary schools; Fulton County elementary and middle school; South Marshall, Livingston and Ballard County middle schools, and Ballard Memorial, Fulton County and Graves County's Gateway Academy high schools," Postlethwait writes.

"They will join a group of about 20 other area schools that have qualified for and opted into the Community Eligibility Provision (CEP), a component of the Healthy, Hunger-Free Kids Act of 2010 that allows high-poverty schools to provide two square meals a day for all students at no cost to parents. . . . CEP schools must have 40 percent or more of their students "direct certified" as at-risk for food insecurity through state data. Direct-certified students include those whose households participate in the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families Cash Assistance (TANF) or Medicaid, as well as those who are in foster care, a Head Start program, or are homeless or migrant children."

In Ballard County, where all schools now have free meals, Food Service Director Amber Hayes told Postlethwait that CEP has made a difference has been critical for parents on "the bubble" because of layoffs at a paper mill, the U.S. Enrichment Corp. plant and the Honeywell Inc. plant in Metropolis, Ill., across the Ohio River from Paducah. "Good-paying jobs are hard to find," she said. "Some parents are making too much to qualify for most assistance programs, but it's still not enough." (Read more; subscription required)

Medicaid expansion has dramatically reduced share of uninsured in most counties; some legislators worry about future cost

The expansion of Medicaid under federal health reform has greatly reduced the number of Kentuckians without health insurance, but state legislators are wary of its future cost.

Medicaid Commissioner Lawrence Kissner dramatically illustrated the impact of the expansion by showing two county-by-county maps to the latest meeting of the Interim Joint Committee on Appropriations and Revenue. They showed the estimated percentage of uninsured under age 65 in each county in 2012 and this year, based on calculations by the Cabinet for Health and Family Services.

The map above is based on the Small Area Health Insurance Estimates by the Bureau of the Census. The map below adds data from the state health-insurance exchange, which asked applicants if they had insurance; 75 percent said they didn't. The map was created by adding 75 percent of the enrollees "to the original data, and recalculating the percentages," cabinet spokeswoman Jill Midkiff said.

“In the Appalachians there, we actually have done a tremendous job through an army of recruiters and ‘Kynectors’ and people to help get the enrollment through,” Kissner said, referring to the peopke paid to help others sign up for coverage on the state health-insurance exchange, branded as Kynect.

Kissner "noted a number of improvements in visits and screenings, such as a 15.8 percent jump in annual dental visits, 36.7 percent hike in preventative services among adults, 20.6 percent increase in cervical cancer screenings and 16.1 percent more colorectal cancer screenings compared to last year," Kevin Wheatley reports for The State Journal in Frankfort.

"Data showing Medicaid reimbursements to hospitals are bittersweet, as some rise while others fall in a short two-year window," Wheatley writes. "Still, one table showed that of 100 hospitals listed, 45 had received more reimbursements from Medicaid expansion in the first six months of 2014 than disproportionate-share payments, which hospitals receive to compensate for treatment given to uninsured or underinsured patients, in all of fiscal year 2013." The so-called DISH payments are to be phased out under the reform law, though implementation of that has been delayed.

Enrollment in Medicaid has been larger than expected, and Kissner said he did not know how much the new enrollees will cost the state when it has to begin paying 3 percent of their cost in 2017, rising to the law's cap of 10 percent in 2020.

"To hear the head of Medicaid say we don’t have any idea whatsoever what we’re going to be paying, that’s, again, very worrisome,” said Sen. Chris McDaniel, R-Taylor Mill. “I mean, we’ve got tons of priorities in this state, and it’s going to be a big number.” (Video from cn/2)


Democratic Gov. Steve Beshear has said the expansion will pay for itself by creating more jobs in, and tax revenue from, health care. "Sen. David Givens, R-Greensburg, asked Kissner how the General Assembly should gauge financial success in the budget-writing process for the 2017-18 biennium," Wheatley reports.

In addition to the studies indicating that expansion would pay for itself, Kissner said, “If you make your population healthier, what happens? What’s the long-term ramification of that? Do they work more? Do they have more working hours?” Kissner asked. “We’re 48th in poor mental health days and 49th in poor physical health days in the country. … Health care is not a zero-sum game. Building a healthy population results in more time at work, more efficient at work, maybe more head in the game at work.”

If you've had a stroke, learning how take your pulse and recognize an irregular heart beat could prevent second stroke

Regularly monitoring your pulse after a stroke is a simple and effective first step in detecting an irregular heartbeat, which is a major cause of having a second stroke, according to research recently published online in Neurology, the medical journal of the American Academy of Neurology.

“Screening pulse is the method of choice for checking for irregular heartbeat for people over age 65 who have never had a stroke. Our study shows it may be a safe, effective, noninvasive and easy way to identify people who might need more thorough monitoring to prevent a second stroke,”  Bernd Kallmünzer, author of the study, said in a release.

Stroke is the leading cause of death in the United States, killing nearly 130,000 Americans each year, according to the Centers for Disease Control and Prevention. In 2010, stroke was the No. 5 killer in Kentucky, according to the American Heart Association.

For the study, 256 participants, all who had experienced the same type of stroke, and the patients´ relatives were given instructions on how to take a pulse and how to detect an irregular heartbeat. The manually taken pulse measurements were then compared to electrical recordings of the pulse. Six people in the study had false positive results and 17 people had false negative results.

“The low rate of false positives in this study shows that health care professionals, caregivers and patients can be guided to use this simple tool as a first step in helping to prevent a second stroke,” Kallmünzer said in the release. For more information about the signs and symptoms of stroke click here.

Medicaid managed-care forums for health-care providers to be held around Kentucky in next six weeks

The Cabinet for Health and Family Services has scheduled a new round of forums for health-care providers in each of the eight Medicaid regions during August and September.

The forums will be attended by senior officials from CHFS, including cabinet Secretary Audrey Tayse Haynes, Medicaid Commissioner Lawrence Kissner, Public Health Commissioner Dr. Stephanie Mayfield and Behavioral Health Commissioner Mary Begley, among others.

 “Our first series of forums for health providers were so successful in opening the lines of communication and making connections that allow us to work better together,” Haynes said in a press release. “We decided to not only repeat but expand the scope of the forums this year, bringing new topics to the forefront like behavioral health, which is particularly timely due to improved access allowed by the Affordable Care Act. Once again, we will also allow time for private meetings with the managed-care organizations,” or MCOs.

Medical providers will be able to meet with MCO representatives, the Department of Insurance and the cabinet to discuss concerns about proper billing, appeals processes and any specific regional issues, in addition to a general conversation about how to improve the overall system of health care delivery in Kentucky. Sessions will also discuss behavioral-health opportunities, improving overall health and community workforce capacity, among other topics, according to the release.

The sessions will begin at 9 a.m. and concluding at 5 p.m., with an optional second day of workshops running from 9 a.m. to noon. The dates and locations are:
 · Aug. 5-6: Adron Doran University Center, Morehead State University
 · Aug. 11-12: Frankfort Convention Center
 · Aug. 20-21: Hazard Community College
 · Aug. 25-26: James E. Bruce Convention Center, Hopkinsville
 · Aug. 27-28: Owensboro Convention Center
 · Sept. 3-4: Northern Ky. University METS Center, Erlanger
 · Sept. 10-11: University of Louisville Shelby Campus
 · Sept. 15-16: Center for Rural Development, Somerset

Providers who would like to register or get additional information should visit the Department for Medicaid Services website.