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Past Blog Items on Health and Health Care

Sunday, February 17, 2008

Paper spotlights Appalachia's high rate of cervical cancer, a sign of lack of access to health care

http://bp2.blogger.com/_0ybRp_oCk7Q/R7ifA-Md6sI/AAAAAAAAAnc/rnoLQzrSiY4/s200/KyCountyCervCancer.jpgA high rate of cervical cancer indicates lack of access to health care in poor communities, and those communities tend to be rural. In parts of Appalachia, for example, death rates from cervical cancer are as high as in many poor, underdeveloped countries. Today, The Courier-Journal of Louisville takes a close look at the problem in Eastern Kentucky. (C-J map, from Kentucky Cancer Registry)

We're talking about "a preventable cancer that has largely been controlled in the United States," Ungar notes. A report from the National Cancer Institute says cervical cancer is high among "Appalachian and other rural whites; rural African Americans, particularly those in the Deep South; Latinas living near the Texas-Mexico border; and Vietnamese American and other Asian women, particularly those in California." For a copy of the report, which has maps showing the range of cancer rates for every county, click here . For Ungar's story and others, click here.

Tuesday, May 22, 2007

National Rural Health Association announces its 2007 award winners

The National Rural Health Association has announced its 2007 award recipients. (Click link for individual summary)

Rural Health Practitioner of the Year - Raymond D. Wells, MD; Inez, Kentucky

Louis Gorin Award for Outstanding Achievement in Rural Health Care - Sally K. Richardson; Executive Director, West Virginia University Institute for Health Policy Research, Charleston, West Virginia

Outstanding Rural Health Program - East Tennessee State University, Rural And Community Health and Community Partnerships, Bruce Behringer, Assistant Vice President; Johnson City, Tennessee

Outstanding Researcher - Sara A. Quandt, PhD, Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina

Outstanding Organization - Mount Desert Island Hospital Organization, Arthur J. Blank, CEO / President, Bar Harbor, Maine

Rural Health Quality Award - Tennessee Hospital Association, Bill Jolley, Vice President, Rural Health Issues, Nashville, Tennessee

Distinguished Educator - John R. Wheat, MD, Professor of Community and Rural Medicine, University of Alabama

Monday, May 21, 2007

The South posts another lead in a leading health problem: strokes

Strokes are most common in the South, according to the first state-by-state rankings of the No. 3 cause of death for adults in the U.S. The rankings come from a 2005 Centers for Disease Control and Prevention survey of 356,000 civilians, which didn't include people in nursing homes or other institutions.

Nationally, 2.6 percent of respondents answered "yes" when asked, "Has a doctor or other health professional ever told you that you had a stroke?" States higher than the national average were Mississippi, 4.3%; Oklahoma (and the District of Columbia), 3.4%; Louisiana, 3.3%; Alabama and Nevada, 3.2%; Kentucky, Missouri, and Tennessee, 3.1%; Arkansas, Illinois, Michigan, Texas and West Virginia, 3%; Georgia and South Carolina, 2.9%; Florida, Hawaii, and North Carolina, 2.8%; and Virginia, 2.7%. Some of the leading states are also some of the nation's more rural states.

The study was published in CDC's Morbidity and Mortality Weekly Report. "The journal also includes a separate study showing that fewer than half of U.S. stroke patients get to the hospital within two hours of the onset of stroke symptoms," writes Moranda Hitti of WebMD Medical News. "Swift treatment is essential for clot-busting stroke drugs." (Read more)

Friday, May 4, 2007

Problems of meth use worse in rural areas, where best treatment is scarce

Rural users of methamphetamine may suffer more severe problems in certain respects than urban users, according to a study at the University of Nebraska. The average starting age of a rural meth user is 3.6 years younger than urban users. Rural users showed much higher rates of intravenous use and alcoholism. They also displayed more signs of psychosis than urban addicts, reports The Associated Press.

“These results suggest that rural meth users face higher risks associated with their drug use,” writes Eric Chudler of the University of Washington in Neuroscience for Kids. “For example, the higher rates of intravenous drug use may lead to more people with infectious diseases such as hepatitis and AIDS. Higher levels of alcohol abuse may lead to more cases of alcoholism and liver disease. Unfortunately, rural areas often lack the mental health and medical facilities necessary to treat drug addiction.” (Read more)

Dr. Jennifer Sharpe Potter, an opiate specialist at Harvard-affiliated McLean Hospital in Belmont, Mass., told AP there are few options to treat meth addiction and the best aren't usually in rural areas. (Read more)

Wednesday, May 2, 2007

Bill allows rural Mo. physicians’ assistants to operate semi-independently

The Missouri Legislature has passed a bill allowing physicians’ assistants in rural health care clinics to operate unsupervised a third of the time. “The bill allows physician assistants, or PAs, to treat patients unsupervised 34 percent of the time as long as their supervising doctor is on site 66 percent of the time,” reports Kathleen O'Dell of the News-Leader in Springfield. Without the new guidelines, the Board of Healing Arts would have required doctors to be present 100 percent of the time, effective in August, which would have been the most restrictive such law in the country.

Some had feared that rural health care access would be threatened if PAs were required to always have doctors present all the time, because those doctors may be hard to come by in rural areas, reports O'Dell. “Some health clinics would have been forced to reduce operating hours or close completely, leaving thousands of Missourians to travel greater distances for medical treatment, or go without, said Paul Winter, president of the Missouri Academy of Physician Assistants.”

When not on site, each clinic’s doctor must still be readily available for consultation via telecommunication and must be within 30 miles of the facility, reports O'Dell. “Among other bill provisions, a supervising physician and PA together may apply to the Board of Healing Arts for alternate amounts of on-site supervision if they are in designated "Health Professional Shortage Areas," where there is a recognized shortage of primary care providers. With a waiver, the PA could practice up to 50 miles from the supervising physician.”

Monday, April 30, 2007

Rural areas, key source of troops, are lacking in health care for veterans

The Department of Veterans Affairs has been criticized for providing inadequate access to health care for rural vets though a disproportionate number of soldiers come from rural areas. “Realigned in the 1990s to concentrate specialized care in urban areas, the system now finds itself overwhelmed by the wounded from wars in Iraq and Afghanistan -- engagements that have, even more than other modern-day conflicts, been fought by soldiers from rural America,” writes Charles Sennott of the Boston Globe.

Research by the National Rural Health Association found that about 44 percent of recruits have come from rural areas, while these areas make up only about 20 percent of the national population. “There is evidence the VA has known for some time about the need to focus more on rural care,” Sennott writes. “A 2004 VA study of 750,000 veterans found that those living in rural areas tended to have more serious and costly health problems than their urban counterparts.”

Jeff Hall, the VA's rural outreach coordinator for Iraq and Afghanistan war veterans in Wisconsin and Minnesota, has seen a close in the urban-rural gap in care, but the system is complex, reports Sennott. “There is, Hall said, a disconnect between the military and the VA computer systems that can confound efforts to coordinate treatment, or even to simply identify those veterans living in areas far from the VA hospital centers.” Rural vets may find themselves unenrolled in the VA health care program if they fail to fill out the proper forms. “Another common complaint among veterans is that rural medical care providers, tired of the paperwork and long delays involved in the federal benefit system, often do not accept TRICARE, the military's health insurance for active-duty soldiers and their families.” (Read more)

Thursday, April 26, 2007

Clot-busting drug treatment, guided by phone, saves rural stroke patients

"Stroke patients in rural hospitals can get safe, effective treatment with the use of a clot-busting drug when a doctor from a larger hospital is on the telephone guiding the treatment," reports Newswise, a research-reporting service." These new findings have important implications for overcoming barriers to optimal stroke care in rural settings," using a clot-buster that must be administered within three hours of the stroke.

“Expert guidance of this treatment over the telephone appears to be safe, practical, and effective,” said the author of the study, Dr. Anand Vaishnav of the University of Kentucky Medical Center.

The study evaluated 121 stroke patients who were treated with the drug tissue plasminogen activator (tPA) at a rural community hospital by a stroke neurologist who was on the telephone guiding the treatment. It found that 2.5 percent of rural patients treated by telephone had symptomatic bleeding in the brain, and 7.5 percent died, compared to 6.4 percent and 17 percent, respectively, in an urban study several years ago.

Vaishnav will present his research May 2 at the meeting of the American Academy of Neurology in Boston. (Read more) For more information about the academy, visit http://www.aan.com.

Friday, April 6, 2007

Lack of rural transport can pose health risks, by delaying treatment

Lack of transportation can pose a health risk for rural residents, who may be delayed in seeking help for their conditions, according to a 2006 study commissioned by the Connecticut Office of Rural Health. At least three local organizations offer low-cost transportation, “but advance scheduling is required and services are not always available when needed,” writes Jim Moore of the Republican-American in Waterbury, Conn. A senior center's rides are limited to seniors and the disabled.

Health care isn’t the only transportation concern for rural residents, reports Moore. Ellen Schroeder, director of the Blanche McCarthy Winsted Senior Center, said medical appointments get priority and someone who needs groceries may have to work around the schedule of the van. A follow-up study is being conducted to address non-emergency transportation needs nationwide. The study should be complete by the end of May and results will help to identify ways transportation services could be combined to be more efficient. It will also help to make the case for more funds for these providers, if needed. (Read more)

Thursday, April 5, 2007

Laws drive meth labs from rural America to Mexico, which ships to U.S.

Tighter state regulation of chemicals needed to make methamphetamine has driven meth labs from rural America to Mexico. To meet U.S. demand, Mexican “superlabs” have begun to appear, churning out a more potent and dangerous product than have been made in “mom and pop” labs, reports Howard Berkes of National Public Radio, part of a NPR series on the Mexican meth problem. (Listen to the story)

Starting in 2004, restrictions on chemicals needed for meth, such as ephedrine and pseudoephedrine, common components of cold medicine, have reduced the number of meth-lab busts. They are down 88 percent in Nebraska, 73 percent in Iowa and Kansas, and 55 percent in Missouri. But seizures of meth on the California-Mexico border has risen 40 percent in the last year, and border seizures at El Paso, Tex., have increased an exponential 479 percent since 2002.

Superlabs put out “Ice” or “crystal,” a purer, more addictive form of the drug. One of these labs can make 10 pounds of meth in one batch, enough for 150,000 hits, reports NPR's Carrie Kahn. “Treatment counselors at Ozark Center in Missouri say their meth patients become addicted sooner and longer. The center's flow of meth patients didn't ease up one bit when small local labs began to decline,” reports Berkes. The estimated number of meth users has doubled in the past five years and more of those users have become addicted, according to the National Survey on Drug Use and Health. (Listen to the story)

Chemicals needed for meth, such as the decongestant pseudoephedrine, are easy to get in Mexico. “According to the U.S. State Department, Mexico is now the world’s second largest importer of pseudo,” Kahn reports. As recently as 2004, Mexico’s legal pseudoephedrine imports topped 200 tons, nearly three times the amount Mexicans need to control their colds each year. Add to that the pseudoephedrine smuggled into the country, like last year’s seizure of 5.1 million tablets hidden in the shipment of ceiling fans from China, and the country is awash in chemicals.” (Listen to the story)

Sunday, March 25, 2007

Where rural meets urban, deer carry ticks that bring Lyme disease

As housing developments expand into rural areas, wildlife often remain. Deer can be the most noticeable, and the most troublesome, dining on landscape plants. Increasingly in some areas, they carry the threat of lyme disease, carried by ticks. "Lyme disease has become a way of life" and "a serious public health issue" in Fairfax County, Virginia, reports Amy Gardner of The Washington Post.

"Suburban lots with azaleas and rhododendrons is just like laying out a buffet for deer," Jorge R. Arias, who fights disease-carrying insects for the county, told Gardner. "We have created in suburbia what is essentially a perfect habitat for them." He said about 15 percent of deer ticks in the area have the bacteria of Lyme disease, which can lead to cause heart, mental, nervous-system and arthritic complications. (Read more)

Friday, March 23, 2007

Rural youths more likely to abuse prescription drugs, get them from home

Youths in rural areas and small metropolitan areas are more likely to abuse prescription drugs than their urban counterparts. According to the National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration, most of those who abuse prescription drugs are between 12 and 25. Pain killers such as codeine, Vicodin and Percocet are those most often used. “The NHSDA shows that the annual number of new users of pain relievers has been increasing since the mid-1980s, from about 400,000 initiates to 2 million in 2000. Other drugs being increasingly abused are stimulants, tranquilizers and sedatives,” reports the Muskogee (Okla.) Phoenix.

Rural youths don’t need a dealer to find prescription drugs because they don’t get them off the street, these drugs come from home, reports the Phoenix. However, the solution for parents is not to lock up their medicine cabinets, said Jackie Luckey, a prevention associate at Area Prevention Resource Center, part of Green Country Behavioral Health Services Inc. Children need to be raised with more boundaries, he said. Narconon Arrowhead, a non-traditional drug rehabilitation and education facility in Canadian, Okla., blames much of the abuse problems on the availability of these drugs. (Read more)

Thursday, March 1, 2007

Rural areas struggling to recruit and keep doctors use incentive tactics

To attract doctors to underserved areas, rural communities have hired recruiters, applied for federal grants and offered to pay back school loans from medical school. There is a high turnover rate for doctors in rural areas where there is less money to be made and they may be unprepared for a small town lifestyle, reports Chana Joffe-Walt of Marketplace, a radio service of American Public Media.

“Rural areas across the U.S. struggle to find family doctors,” reports Joffe-Walt. “The money is in specializing. Plus the workload in a small town is intense — you have no colleagues, and you have to convince your spouse to move to the sticks.” Foreign doctors seeking American citizenship have been made to work in underserved communities for a mandatory amount of time, but they often leave once that time is up. Doctor Syed Zafar ismoving from Pomeroy, Wash, population 1,400, to Atlanta, where he won’t be the only Bangladeshi.

This week the National Governors Association has been meeting in meeting in Washington and rural health coverage is among the lobbying, reports Joffe-Walt. “But the problem is only expected to get worse. Baby boomers are aging and fewer Americans are going into the medicine. The situation will be especially bad in rural areas.” (Read more)

Friday, Jan. 26, 2007

Rural children, especially Latinos, behind in health coverage

As many as 1 in 4 children in rural Oregon do not have health insurance, well behind the state’s urban average. Race also factors into the equation. Overall, 12 percent of children in the state have no insurance, but 23 percent of Latinos and Native Americans are not covered, reports Bill Graves of The Oregonian.

“Rural counties in Oregon are also more economically disadvantaged than urban areas, with more unemployment, lower salaries, and higher rates of abuse, infant mortality, dental decay and other problems affecting the health and well-being of children, according to a report on the status of children released by Children First for Oregon,” writes Graves.

According to 2005 data from the National Survey of Children's Health, 90.3 percent of children in small rural and isolated areas had health insurance, only slightly lower than the 91.2 percent average of children nationwide. The study found that in rural areas 4.9 percent of white children, 5.2 percent of black children, 23.8 percent of Hispanic children, 6.1 percent of multiracial children and 15.2 percent of Native American children lacked health coverage. (Read more)

The Institute for Rural Journalism and Community Issues helps non-metropolitan media define the public agenda in their communities, through strong reporting and commentary on local issues and on broader issues that have local impact. Its initial focus area is Central Appalachia, but as an arm of the University of Kentucky it has a statewide mission, and it has national scope. Cooperating institutions include Appalachian State University, East Tennessee State University, Eastern Kentucky University, Indiana Universiy of Pennsylvania, Marshall University, Middle Tennessee State University, Ohio University, Southeast Missouri State University, the University of North Carolina-Chapel Hill, the University of Tennessee-Knoxville, Washington and Lee University, West Virginia University and the Community Journalism Fellows program at the University of Alabama. To get notices of Rural Blog postings and other Institute news, click here.

Institute for Rural Journalism & Community Issues
School of Journalism and Telecommunications, College of Communications & Information Studies
122 Grehan Building, University of Kentucky, Lexington KY 40506-0042
Phone 859-257-3744 - Fax 859-323-3168

Al Cross, director al.cross@uky.edu