Q: What are some types of skin cancer?
A: The three major types are basal cell, squamous cell and malignant melanoma. In general, one in five, or 20 percent of people in the U.S. have had or will have some type of skin cancer. In Australia where the sun is intense, two out of three skin cancers are basal cell, one in four are squamous cell, and one in twelve are malignant melanoma.

Q: Should I go to a dermatologist for screening?
A: The dermatologist is the most experienced with skin cancer, but primary care providers can help, too. Realize, however, that the first person to discover skin cancer should be you, along with a partner to look over places you cannot see. Self-screening is especially important for those at high risk for skin cancer.

Q: Who is at high risk for skin cancer?
A: At highest risk would be anyone who has had a bad sunburn or excessive lifetime sun exposure, especially when young, and those with light complexion, freckles, blue eyes, blond or red hair. At higher risk for malignant melanoma are those with many moles, with a prior personal history of skin cancer, and with a family history of malignant melanoma.

Q: Does sunscreen help prevent skin cancer?
A: This is widely presumed to be true but not yet scientifically proven. In fact, some speculate that people who use sunscreen may feel emboldened to expose themselves to more hours of damaging sunlight. Also, using sunscreen to shield skin from sunlight may possibly result in vitamin D deficiency. All that said, it is my opinion there is enough evidence to use sunscreen all year long and, if you live in the northern climates, take 2000 IU of vitamin D daily.

Q: How do I know when to go to the doctor?
A: The ABCDE mnemonic helps in knowing when a skin lesion might be dangerous. A: asymmetry or irregularly shaped; B: border fuzzy not sharp; C: more than one color in it; D: diameter wider than pencil width; and E: lesion evolving or changing. It is common to mistake a benign and safe look-a-like seborrheic keratosis for a possible malignant melanoma. Seborrheic keratosis is light brown to black, raised, and waxy. If one can partially peel or scratch off waxy material with a fingernail, then it is likely a benign keratosis. Malignant melanomas can be either flat or nodular…but never waxy.

No question, if ever you are in doubt, see your doctor.

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By RON WILSON
Huck Boyd National Institute for Rural Development

One plus one equals ten. Well, it’s obvious that I flunked new math. But today we’ll learn about one community which got together with another to co-create an exceptional new model of health care delivery in rural America.

Martha Hadsall is chair of the board of directors of the Patterson Health Center, a new health care facility in Harper County. Martha, a longtime teacher in Harper, was also involved with the local hospital.

Anthony, population 2,269, and Harper, population 1,473, are Harper County’s two largest communities, located 9 miles apart. Both had small, financially struggling hospitals. In 2012, a community health needs assessment identified integration between the two hospitals as the top concern. However, the two towns were longtime rivals.

In 2015, a proposal came from Neal Patterson, a native of Anthony who had grown up on a nearby family farm. According to the stories, when working in the fields, his father told Neal and his brothers to “do one more round after sundown.” Neal Patterson carried that work ethic and a brilliant mind into a career in medical information technology. He co-founded the highly successful Cerner Corporation in Kansas City.

Patterson was aware that the hospitals back in his home county were struggling with future plans. “He told us that if we were to do research on a merger that could create a new model of health care delivery, he would be our biggest benefactor,” Martha said.

Extensive research followed. Studies found that a new facility was the most financially sustainable option. The board committed to not increase property taxes for the new facility, and to not require a reduction in staff employment.

Following a successful petition drive, the two hospital districts merged and developed plans for a new joint facility. In 2017, the Patterson Family Foundation made a $35 million commitment to the new facility. Sadly, Neal Patterson passed away from cancer, but the commitment remained.

The boards selected the new site on 60 acres next to the shared high school, approximately halfway between Harper and Anthony. “We want to build connections,” Martha said. The next step was to design a state-of-the-art medical facility called the Patterson Health Center.

“It is intentionally called a health center, not a hospital,” Martha said. “We’re about health, not sickness.” It’s based on an integrated care model.

In addition to state-of-the-art equipment, the inpatient, outpatient, and emergency services are structured to maintain privacy, meet modern needs, utilize technology, and encourage collaboration among physicians and specialists. The facility will also include a rehabilitation area, hydrotherapy pool, tornado shelters, helipad, outdoor patios, and a café open to the public. Pat Patton was hired as CEO.

“Our theme is `Together for a healthy future,’ and the architects created `Two communities under one roof,’” Martha said. Together, the two hospital districts are able to eliminate duplication and achieve benefits. For example, the two existing hospitals each had what is called a 16 slice CT scanner, which required each one to have a $40,000 maintenance policy. The Patterson Health Center will have one new 64 slice CT scanner which operates in a matter of microseconds.

Inside the entrance, there is a beautiful wooden display of a map of the health center’s service area from Wellington to Medicine Lodge. Anthony and Harper are shown in the center, with Patterson Health Center in between. Outlying rural communities are shown as well, such as Milan, population 82, Danville, population 38, and Freeport, population 5 people. Now, that’s rural.

At the staff entrance, there is a huge and beautiful rendering of a pretty prairie sunset. “It’s a reminder to the staff of what Neal Patterson’s father said, to `make one more round after sundown,’” Martha said.

The Patterson Health Center is to be dedicated on July 19, 2019. See www.hhd5.com for more information.

One plus one equals ten. No, it’s not new math. It’s an example of two communities coming together to create something great. We commend Martha Hadsall, Pat Patton, and all those who are making a difference by creating this new model of rural health care. I hope it becomes a perfect 10.

The majority of Americans consider fake news and misinformation to be serious threats to democracy — and that fear may actually be making us better and savvier news consumers.

Last week, the First Amendment Center of the Freedom Forum Institute released the results of the 2019 State of the First Amendment survey. We’ve been conducting this survey since 1997, taking stock of what Americans know and how they feel about their expressive freedoms — and each year we brace ourselves for bad news.

So, it was a bit of a shock for us to look at the data and find that this year’s results are, relatively speaking, actually pretty good.

Knowledge of the five First Amendment freedoms — speech, religion, press, assembly and petition — is at an all-time high. This year, 71 percent of Americans were able to name at least one of the five freedoms, up from 60 percent in 2018. More people could name specific freedoms than in years past.

Comparing 2019 to 2018, those naming free speech rose to 64 percent from 56 percent; those naming freedom of religion rose to 29 percent from 15 percent and respondents naming freedom of the press rose to 22 percent from 15 percent.

My colleague Gene Policinski wrote a piece cautioning against too much giddiness in the wake of these findings, because the rise in awareness is most likely due to the fact people are increasingly worried about losing these freedoms.

Fair point. But still, it’s nice to see that our anxiety is making us slightly sharper.

Nowhere was this more evident than in the responses to the questions we asked about how Americans feel about the news and those who provide it. Seventy-seven percent of our survey respondents agreed that misinformation on the internet and the spread of fake news were serious threats to democracy. One might expect that fear to translate into a rising distrust in the press at large. But that wasn’t the case. Instead, our data showed that more Americans think the news media reports the news accurately and without bias than they did in 2017, the last time we asked that question (48 percent vs. 43 percent).

Furthermore, a majority of Americans agree that it is important for our democracy that the news media act as a watchdog on government — 72 percent, up from an all-time low of 68 percent in 2017. These might not seem like drastic improvements, but they are significant ones. They indicate that the specter of fake news hasn’t eroded all trust in all media — instead, it seems that Americans are putting greater trust in media outlets that do real reporting.

They’re also becoming more media literate. Americans are taking more steps to verify and review the news they read online, by:

• • Talking with others (80 percent, up from 73 percent in 2016);
  • Looking at other news stories (78 percent, up from 72 percent in 2016);
  • Reading comments about the story (71 percent, up from 58 percent in 2016);
  • Looking for a rating from a fact-checking website (46 percent, up from about 42 percent in 2016).

None of these tactics is foolproof, but the uptick in each of them suggests Americans are no longer taking everything they see on the internet at face value — and that’s a good thing for our democracy.

Lata Nott is executive director of the First Amendment Center of the Freedom Forum Institute. Contact her via email at [email protected], or follow her on Twitter at @LataNott.