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.

'Superbug' considered the worst one yet is still not widespread in Kentucky hospitals, but officials predict it is coming

A new deadly superbug that is almost totally resistant to antibiotics and kills about half who get bloodstream infections has found its way to community hospitals in the Southeastern United States, Laura Ungar reports for The Courier-Journal.

 "We haven't seen much here, but I'm sure it's coming," Forest Arnold, an epidemiologist at University of Louisville Hospital and an associate professor of infectious diseases at the university, told Ungar.

CRE, short for carbapenem-resistant Enterobacteriaceae, are a family of bacteria that have, over time, become resistant to antibiotics called carbapenems, which are considered drugs of last resort for this type of infection. It can cause a range of illnesses depending on where it infects the body, ranging from gastrointestinal illness to pneumonia to bloodstream infections.

A recent study in the journal Infection Control and Hospital Epidemiology indicates CRE increased "fivefold" at community hospitals in several southeastern states from 2008 to 2012, Ungar reports. Kentucky was not part of the study, but researchers say the rates "reflect a growing problem across the region and throughout the country." 

"People need to be aware," Arnold told Ungar. "It will eventually get here."

Experts report that overuse of antibiotics is one of the main reasons for these superbugs, Ungar writes. And Dr. Kevin Kavanaugh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, told Ungar that  Kentucky has one of the nation's highest rates of antibiotic use, sometimes prescribed unnecessarily.

"CRE is very dangerous," Kavanagh said. "It is almost totally resistant to antibiotics."

Ungar reports that local hospitals have seen growing numbers of CRE, citing examples of University Hospital with a case last year in which the patient died, and Norton Healthcare, with three cases in the first three months of last year and 10 others between 2010 and 2013.

Last year, the federal Centers for Disease Control and Prevention warned that CRE had spread from one medical facility in 2001 to numerous facilities in 46 states in 2013, Ungar notes. CDC Director Tom Frieden has labeled  CRE "nightmare bacteria," calling them the worst of the growing list of antibiotic resistant germs that "take hold in health care settings."

 One in 25 hospitalized patients has at least one health care-associated infection on any given day, according to the U.S. Centers for Disease Control and Prevention, with C. difficile, which causes 14,000 American deaths per year and MRSA, which one study shows kills 18,000 Americans a year, being  two of the most common, Ungar reports.

Doctors say they hope to control CRE before it becomes as common as MRSA, which has spread to communities, Ungar reports.

 "So far, CRE are just in the health care setting," Kavanagh told Ungar. " 'If it continues to grow and escape into the community, it will be an even bigger problem' and the medicines doctors count on to cure bacterial infections will no longer work against them."

Kavanaugh told Ungar that "antibiotics should be used only when they are absolutely necessary, and hospitals must remain vigilant about ensuring health care workers wash their hands often, keep rooms and medical equipment clean, wear gowns and gloves when appropriate and separate infected patients from others."

"If the emergence and spread of superbugs aren't prevented,'we'll be in a post-antibiotic era'," Kavanagh told Ungar. "And the danger is not going to go away unless we change the course of how we do things."

University of Louisville gets $14.7 million federal grant to develop tobacco protein for HIV and AIDS prevention

Researchers from the University of Louisville are leading an international effort to develop a gel from tobacco plants that will contain a specific protein to prevent the transmission of HIV.

The project is being funded by a five-year, $14.7 million grant from the National Institutes of Health, according to a press release from the university.

The plan is to develop a gel containing a protein called griffithsin, which has been shown to prevent HIV in the lab. The gel will be meant for use during sexual intercourse by people at risk for HIV transmission, according to the release.

They will develop this microbicide by injecting a synthetic copy of the protein into a tobacco mosaic virus and then this virus will carry the protein into the tobacco leaves. After 12 days, the researchers harvest the leaves and extract the mass-produced protein for development into the vaccine, the release says.

Kenneth Palmer (University of Louisville)

“Our goal is to optimize the delivery system of the protective agent, which in this case is a gel, and determine its safety and estimates of its efficacy, leading to a first-in-humans clinical trial,” said research leader Kenneth Palmer, professor of pharmacology and toxicology and director of the Owensboro Cancer Research Program of U of L’s James Graham Brown Cancer Center.

“People may question why a cancer program is conducting research into HIV prevention,” center Director Donald Miller said in the release. “In fact, cancer can be a result of every major disease that we know about, and HIV infection is no exception.”

David L. Dunn, the university's executive vice president for health affairs, said: “Approximately seven years ago, U of L and Owensboro Health created a joint venture to develop a world-class plant pharmaceutical program that would have an impact globally. Today’s announcement, coupled with the announcement we made in May about the Helmsley Charitable Trust providing funding to our research into two other cancer vaccines utilizing tobacco plants, demonstrates that the vision is becoming a reality.”

U of L President James Ramsey said, "The development of a low-cost method to prevent transmission of HIV certainly is something that is desperately needed and the use of tobacco plants as a method of carrying the vaccine appears to be key in the process."

The grant provides for three steps. The first involves the manufacturing of the microbicide active ingredient, the second ensures that the vaccine is safe and actually provides protection from infection, and the third involves conducting a clinical trial, as well as conducting the first-in-humans testing.

Leaders in health care and education meet on child obesity and what can be done about it, and not just in the schools

By Al Cross

Kentucky Health News

Children who are physically active are likely to be better learners, but not enough Kentucky schools seem to put that knowledge into practice, speakers suggested at last week's Kentucky Summit on Childhood Obesity and Physical Activity at the University of Kentucky.

Kentucky ranks eighth in child obesity, and nationally, adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

"Many of the adults who will be obese in 2030 are the children in Kentucky schools today," said Dr. Mary Lynne Capilouto, the wife of UK President Eli Caiplouto. The couple hosted an opening brunch for the conference, and at one small-group session.

The conference was an unusual gathering of people from education and health care, who don't discuss common interests enough, said Terry Brooks, executive director of Kentucky Youth Advocates, which staffed the conference. "Our intent is to put together a guiding coalition . . . and make something happen in 2015-16."

That would probably include legislation, but "We can't legislate ourselves out of this problem," educator Leon Mooneyhan told the group. "We need to change the mindset of our society," with multifaceted solutions. Mooneyhan, a former superintendent in Shelby County, is CEO of the Ohio Valley Educational Cooperative, which assists school districts.

He said each district needs a strong "wellness committee" to focus on health, nutrition and physical activity and promote such measures as integrating physical activity into the classroom and not using denial of recess as punishment for misbehavior. "We really need to focus at the elementary schools," he said. "That's where it starts."

The biggest obstacle may be the educational system itself.

An example of classroom-based physical activity,
from Dr. Heather Erwin's PowerPoint presentation

Some schools are reluctant to carve out time for physical activity because of pressure to spend time preparing students for annual achievement tests, but research shows that more physical-activity time "does not appear to to adversely impact academic performance," said Heather Erwin, Ph.D., a UK specialist in kinesiology, the study of human movement.

Erwin said some schools have started intensive math instruction lasting 90 minutes, and students could benefit from two of three physical-activity breaks in such a long classroom session. She said, "So many teachers will say after implementing physical activity, why haven't we been doing this all along?"

"If your butt is numb, your brain is, too," said Jamie Sparks, director of the School Health and Physical Education Network for the state Department of Education.

Sparks said it's unfortunate that some schools are using recess as extra study time before achievement tests. Stu Silberman, executive director of the Prichard Committee for Academic Excellence, said research has shown that students do better on achievement tests on days that they have physical activity.

"There is an achievement gap related to obesity," but many teachers don't see the connection, Silberman said. When students take part practical, in-class programs like those Erwin mentioned, "it becomes a habit for the rest of their lives. . . . Frankfort's not the answer on this.

Tom Shelton, who succeeded Silberman as superintendent in Fayette County, said asking teachers "to do one more thing is almost criminal," they are so busy, but nations such as India and China emphasize physical activity, and "It's amazing to me that we're going the other way. . . . We know for a fact that healthy students are better learners."

Shelton said "Poverty is the number-one barrier to student achievement," and part of that is "lack of good food options."

The face of poverty has changed to one of obesity, said David Jones Jr., a member of the Jefferson County school board and a Louisville venture capitalist. Poor people often eat poor food and don't get enough exercise. "The problem is, we don't know how to eat. We don't know how to deal with calorie-rich environments," Jones said.

Jones was among those who said the solution to child obesity lies in the community at large, not just in its schools.

"It has to be parents and schools and the community and legislators," said Susan Zepeda, president of the Foundation for a Healthy Kentucky, which funded the conference. "This challenge is about nutrition policies, physical-activity policies and building our environment with health in mind."

Saint Joseph Hospital Foundation and Verizon team up to help certain patients with chronic diseases monitor their health

Verizon and the Saint Joseph Hospital Foundation have teamed up to help select patients who have a chronic disease manage their condition from home, according to a press release from KentuckyOne Health, St. Joseph's parent organization.

The program will help patients age 50 and older monitor and manage their health with new technologies after being discharged from Saint Joseph Hospital and Saint Joseph East in Lexington, and Saint Joseph Mount Sterling.  It will also be available to some patients who have certain health issues by referral from their primary care provider or patients can enroll in the program if they have been treated for congestive heart failure, acute myocardial infarction, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft surgery, diabetes, hypertension, hyperlipidemia as well as some other concerns.

The goal is to enroll 300 patients in the first year of the program, according to the release.

Funding to create this program came from a $125,000 grant from the Verizon Foundation and in-kind donations of technologies, which includes 4G LTE powered smartphones and tablets, from Verizon Wireless. Grant funds will purchase biometric devices to better self-manage the participants conditions and share that information with their team of health care providers. 

Patients will use the smartphones and tablets for six months to access pre-loaded health apps, such as Glucose Buddy and Fooducate, according to the release. The grant will also provide items such as digital weight scales, blood pressure monitors, FitBit activity trackers, CalorieKing Calorie, Fat and Carbohydrate Counter book and digital food scales/nutritional calculators.  Some will get glucose test strips. Individualized health-coaching will also be available.

"Verizon is also supplying all of the technology protective gear for the devices, the data plans to allow that technology to work, plus funding for a part-time dietitian and research assistant for the program," the release says.