New regs could change way food industry markets to children

"The federal government proposed sweeping new guidelines on Thursday that could push the food industry to overhaul how it advertises cereal, soda pop, snacks, restaurant meals and other foods to children," The New York Times' William Neuman reports.

The guidelines, which were released by the Federal Trade Commission, target TV commercials, print ads, websites, product placement in movies, kids meals at fast food restaurants (Getty Images photo by David Paul Morris) and online games that serve to promote a product. "The inclusion of digital media, such as product-based games, represents one of the government's strongest efforts so far to address the extension of children's advertising into the online world," Neuman reports.

"Our proposal really covers all forms of marketing to kids, and the product packaging and the images and themes on the cereal boxes have tremendous appeal to kids," said Michelle K. Rush, a trade commission attorney. "The goal is to encourage children to eat more healthy foods because obesity is a huge health crisis."

Advertised food would have to be made of healthy ingredients, such as whole grains, fresh fruit and vegetables, or skim or 1 percent milk. They could not have high amounts of sugar, trans fats, salt or saturated fat. Cereals would only be able to have 8 grams of sugar per serving — they now often contain 12 grams — and salt would be limited to 450 milligrams per serving in packaged foods. A 15-ounce can of Chef Boyardee beef ravioli now has 750 milligrams.

Following the guidelines will be voluntary, but there will be pressure for companies to adopt them, Neuman reports. Those that elect to do so will have five to 10 years to revamp their products and marketing strategy.

A recent study in the American Journal of Public Health found that in 1997 to 2002 the average child saw about 4,000 television commercials advertising food each year. During Saturday morning cartoons, kids saw a food ad about every five minutes. Of that food advertised, about 95 percent of it was of poor nutritional value. In 2006, food companies spent almost $2.3 billion in children's advertising, the Federal Trade Commission found.

In response to the new guidelines, the food industry said it has "already taken significant steps to improve recipes and change the way it advertises to children," Neuman reports. (Read more)

National campaign targets distracted driving

With the aim of raising awareness about the dangers of distracted driving, national public-service campaign "Decide to Drive" kicked off this month.

With former boxer Joe Frazier as spokesman, the campaign features a website, as well as posters, postcards and displays for surgeons to use to educate their patients. "The goal is to get people to think before they do something dangerous behind the wheel, such as using a cellphone, sending a text, eating or even reaching for a child's toy," The Courier-Journal's Darla Carter reports.

The undertaking is funded by the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association. Orthopedic surgeons can mend a lot, but "there are some injuries you just can't make normal," said Dr. Marc Zussman, who practices in Rockford, Ill.

In 2009, 5,474 people died nationwide and another 448,000 were hurt in accidents thought to have involved distracted driving. In 2010, more than 54,000 accidents took place in which distracted driving was believed to be a factor. In July, it became illegal to text while driving in Kentucky. Drivers under the age of 18 cannot use cell phones at all while their vehicle is moving. As of January, texting and teen drivers can be stopped and fined for the violations.

To combat the issue, "a change in the entire safety culture is needed," as occurred with seat-belt awareness, said Boyd Sigler, director of the Kentucky Office of Highway Safety. (Read more)

More county-specific health data are available, painting detailed pictures of your local area's health

Five years' worth of county-specific data are now available for many types of health indicators on the Kentucky Health Facts website. The site features data on demographics, social and behavioral indicators, health outcomes, access to care, and maternal and child health, much of which can be useful to journalists all over Kentucky.

The Health Outcomes category, for example, looks at a county's premature-death rate, motor-vehicle deaths, prevalence of asthma, diabetes prevalence and cancer deaths. The Maternal and Child Health category looks at adequacy of prenatal care, infant mortality rates, teen birth rates and prevalence of youth who smoke cigarettes. It compares that data to the rest of the state and nation.

The data paint a detailed picture of what is happening in a specific area. One interesting nugget in the newly updated data on asthma show that in Warren County (Bowling Green), the percentage of adults with the respiratory condition has nearly doubled from 10 percent in 2003-05 to 19 percent in 2007-09. Here is the county asthma map:

The data come from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, which is the world's largest ongoing telephone health survey. It has tracked health conditions and risk behaviors in the United States on an annual basis since 1984.

The data can be viewed by going to www.kentuckyhealthfacts.org or by clicking here. Kentucky Health Facts is a service of the Foundation for a Healthy Kentucky.

High gas prices = fewer traffic accidents, including DUI mishaps

There is one benefit to gasoline prices reaching nearly $4 a gallon: The rate of traffic accidents, including drink-driving accidents, goes down as gas prices go up.

These were the findings in a study by Mississippi State University's Social Science Research Center, which "analyzed total traffic crashes between April 2004 and December 2008, comparing gas prices to traffic safety statistics," research reporting service Newswise reports. SSRC demographer Guangquing Chi looked at factors including age, gender and race.

"The results suggest that prices have both short-term and intermediate-term effects on reducing traffic crashes," Chi said. The short-term impact involves younger drivers. Intermediate-term impact is related to older drivers and men. Short-term impact "refers to immediate effects, for example how a current month's average gasoline prices affect the same month's traffic crashes. Intermediate-term impact refers to effects over a one-year subsequent time period," Newswise reports. (Read more)

Diabetic youth have medical costs of more than $9,000 a year

Children who have diabetes incur medical costs of more than $9,000 a year, a number that is six times greater than for children who don't have the disease, a new study by the Centers for Disease Control and Prevention has found.

Most of the expenses are for prescription drugs and outpatient care. "Most youth with diabetes need insulin to survive and the medical costs for young people on insulin were almost 65 percent higher than for those who did not require insulin to treat their diabetes," said Ann Albright, director of CDC's Division of Diabetes Translation.

Type 1 diabetics cannot produce insulin and so must receive insulin treatment. Type 2 diabetics, whose bodies no longer handle insulin properly and slowly lose the ability to make it, are generally treated with oral medications that control glucose levels in the blood. More than 90 percent of young diabetics are on insulin. Type 2 diabetes is extremely rare in children younger than 10 years of age. It is infrequent in children and teens 10 to 19 years old.

The study looked at medical costs for children and teens less than 20 years of age who were covered by employer-sponsored private health insurance plans in 2007. Estimates were based on administrative claim data from almost 50,000 children, including 8,226 diabetics. (Read more)

More than half of Ky. 18-to-24-year-olds have a weight problem

"More than half of 18-to-24-year-olds in Kentucky are overweight or obese — the highest percentage in the nation," The Courier-Journal's Laura Ungar reports. Their weight is not only bad for their health, but limits their ability to serve effectively in the military. (C-J chart)

These findings come from a report called "Too Fat to Fight," released Wednesday and compiled by Mission: Readiness, whose members are retired generals and other high-ranking military officials concerned about the physical fitness of the services' recruitment pools. The reports shows 51 percent of young adults in Kentucky were either overweight or obese in 2007-9, up from 38 percent in 1997-99. Nationwide, only about 1 on 4 17-to-24-year-olds were too heavy to serve in the military.

Another report released by the U.S. Centers for Disease Control and Prevention looked at what is being done to fight the obesity epidemic in each state, by examining behavioral indicators and environmental factors. The report showed nearly 36 percent of Kentucky students, such as those at Bloom Elementary in Louisville (C-J photo by David R. Lutman), drink at least one soft drink a day, compared to 29.2 percent nationwide. More than 68 percent of Kentucky middle and high schools allow the advertising of unhealthy foods, compared to 49 percent nationwide.

Both reports concluded schools can play a key role in helping children lose weight. "Mission: Readiness urges Congress to help upgrade school equipment such as freezers, ovens and salad bars and train cafeteria workers to prepare meals with fresh ingredients," Ungar reports. (Read more)

New network including UK, Ohio State and Marshall joins leading researchers to address health issues in Appalachia

Seven academic centers and community organizations have come together to pool their resources and improve the health of Appalachian residents. They have formed the Appalachian Translational Research Network, which includes experts representing The Ohio State University, the University of Kentucky, Marshall University and the Appalachian Regional Commission.

"The causes of health issues in this region are multifactorial — poverty, education, access to care," said Kelley Kelleher, director of the Community Engagement Program at OSU's Center for Clinical and Translational Science. "A collaborative approach that pairs experts from many different specialties with organizations already working within the Appalachian community will help us reach better solutions faster."

"We are dedicated to seeing this region escape from being one of the sickest parts of America," said Phillip Kern, director of UK's Center for Clinical and Translational Science and Barnstable Brown Diabetes and Obesity Center.

Experts with the ATRN were among those who organized and attended the recent Appalachian Health Summit. It focused on the obesity epidemic, a major chronic health issue in the region. It also featured many research projects related to or complicated by obesity, including one to evaluate web-based smoking cessation programs with teen smokers; one using church communities to address obesity; and one to establish more than 60 diabetes community collaboratives in nine Appalachian states.

Appalachia runs from southern New York to northern Mississippi. With a population of 24.8 million, it stretches across all of West Virginia and part of 12 other states, including 54 Kentucky counties. Residents of many Appalachian counties are three times more likely to die from diabetes than others either living in the same state or in non-Appalachian states, Centers for Disease Control and Prevention numbers show.

Oldham faith-based clinic to reopen under oversight of nonprofit

A clinic that was the only one of its kind in Oldham, Henry, Trimble and Carroll counties will reopen under the oversight of a nonprofit organization. The facility, formerly known as the Community Care Clinic, will be re-christened the Hope Health Clinic. It will serve patients who do not have health insurance. Before it closed due to a $30,000 deficit, the clinic served about 700 people a year. A group of church leaders will form the nonprofit agency, which will be called the Oldham County Ministerial Association, The Courier-Journal's Andrea Uhde Shepherd reports.

The clinic will be in the same space off New Moody Lane, which will be leased to the nonprofit agency by Baptist Hospital Northeast for $1 a year. La Grange Baptist Church Executive Pastor Rick Davidson said he "hopes to run the clinic on donations from residents, churches, civic groups and businesses," Shepherd writes. Most of the staff will be volunteers. The facility will be modeled after Mercy Medical Clinic in Shelbyville, a faith-based facility that serves 2,300 people. (Read more)

Kenton Co. smoking ban yields 15 complaints; citations next?

There have been 15 complaints to the Northern Kentucky Health Department since Kenton County's smoking ban took effect nearly two weeks ago. Because enforcement does not take effect until next week, no one has been cited yet, Cindy Schroeder of the Kentucky Enquirer reports.

The ban went into effect after the outgoing Kenton Fiscal Court approved the ordinance in December. It bans smoking in most workplaces, including "restaurants, churches, factories, offices, bingo halls, bowling alleys and stores," Schroeder reports. It does allow exemptions for bar and private clubs. So far, 65 drinking establishments and five private clubs have applied for exemptions, 62 of which have been approved.

The biggest the challenge to the health department so far has been to inform owners what they need to do to comply with exemption requirements. "Those include having a separate enclosed smoking section with its own air system and its own entrance," Shroeder wrote. "Also, no one under 18 can be employed or admitted." (Read more)

Fewer maternity wards, fewer options for rural Kentucky women

The closing of the maternity ward at Mary Breckinridge Hospital in Hyden last year is part of a larger trend, leading to fewer options for women living in rural areas of the state, contends an op-ed piece in the Daily Yonder, the national online rural journal.

"There's a big dose of irony here," writes Kelli Haywood, a Lamaze certified childbirth educator. "Mary Breckinridge Hospital, located in Appalachian Kentucky, is named for a pioneer in maternal and infant health who brought the nurse midwifery model of care to the United States."

"With the closing of this facility, women of the entire southeastern Kentucky region lost an important and rare option for birth, as well as the expertise of the hospitals' midwives, most of whom either moved to other parts of the state or left Kentucky altogether," Haywood continues.

Similar closures are happening in other states as well, including Virginia, Ohio and Alabama, which has "lost 26 options for maternity care since 1980," Kaywood states. The reason for the closures has to do with numbers and reimbursements. Mary Breckinridge Hospital averaged just 12 births monthly, but in order to break even financially needed to attend more than twice that. In some cases, an aging population is leading to fewer births, but some rural areas are still underserved when it comes to maternity care.

The consequences means rural women will have to travel further, and incur related expenses, to receive maternity care. That will put pressure on other rural hospitals, which will in turn have consequences. Studies show medical interventions, such as cesarean sections, are more common in rural hospitals where "care providers are feeling the pressure of a high patient load," Haywood writes. But these procedures carry risks — a Mayo Clinic study showed the risk of death to the mother was four times greater when she delivered via caesearean section rather than vaginally — and are more costly. An uncomplicated vaginal birth costs between $3,000 and $6,000, while a c-section birth can be between $10,000 and $40,000, Haywood contends.

Haywood points to midwifery and free-standing birth centers as possible solutions, but admits there is no easy answer. However, a solution is needed. "In a healthcare system where maternity care providers are facing the highest malpractice premiums of any physicians, and as obstetricians become fewer in number, it is not surprising that we are seeing closures of maternity services in rural hospitals and increases in the rates of medical interventions. Rather than fighting to keep a system that is not benefitting rural women, healthcare providers, or state governments, we need new models of care and ways in which that care can be obtained safely, close to home." (Read more)

Free rural health journalism workshop June 3 in St. Louis

Health journalists are invited to attend a free workshop in St. Louis, Mo., aimed at finding the "untold rural health stories," on June 3.

The workshop will provide journalists with resources and story ideas. "You'll hear about how surroundings and behavior are molding rural health issues," said Jeff Porter, special projects director of the Association of Health Care Journalists. "The disconnection between food and health in the heartland, how Medicare decisions made in Washington can lead to stories in your own community, the changing landscape of the health workforce, and the growing problem of the abuse of legal drugs."

Reporters can expect panel discussions led by award-winning journalists with world-class experts.

The workshop will be held at the Renaissance St. Louis Grand Hotel. To view a schedule of the day's events, click here. AHCJ has a limited amount of travel assistance available. The event is free, but AHCJ membership is required.

Counties not allowed to ban pain clinics, attorney general says

County governments are not allowed to prevent pain-management clinics from opening within their limits, the state attorney general's office has found.

"Because such local ordinances infringe on the state's right to regulate medical practices, counties cannot ban legal practices within their lines," the Lexington Herald-Leader's Dori Hjalmarson and Bill Estep report.

The finding, written by Assistant Attorney General James Herrick, comes after Johnson County officials asked for Attorney General Jack Conway's opinion about bans on the clinics, which prescribe addictive painkillers like oxycodone. Owsley County and Booneville, which are also considering bans, likewise made requests to enact an ordinance "to declare pain clinics to be 'unlawful and ... a public nuisance, subject to closure,'" the opinion reads. Several counties have already called the clinics a public nuisance, thereby discouraging their operation.

But only state and federal governments have the right to regulate medical practices, the opinion says. "We fully acknowledge the scale and depth of the social problems posed by narcotics trafficking in Kentucky," Herrick wrote. "Nevertheless, to the extent that the proposed action might provide a remedy, the enactment of that remedy is reserved to the General Assembly."

Though three state Senate bills were proposed earlier this year that would have regulated pain clinics, they never made it past committee. "I am ashamed of our state legislature's lack of backbone and not having the courage to pass the legislation desperately needed to help solve the problem," Johnson County Judge-Executive Tucker Daniel said. (Read more)

Prediction: smoking bans will be in effect nationwide by 2020

Bans of smoking in all workplaces, including restaurants and bars, will probably be in effect nationwide by 2020, a new study by the Centers for Disease Control and Prevention has concluded.

"It is by no means a foregone conclusion that we'll get there by 2020," Dr. Tim McAfee, director of the CDC's Office on Smoking and Health, told The Associated Press. "I'm relatively bullish we'll at least get close to that number."

The project looked at the rate at which states have been adopting comprehensive smoke-free laws. In the past 10 years, 25 states and the District of Columbia have enacted them. Kentucky is one of just seven states that has no statewide restrictions at all. The others are Indiana, Mississippi, South Carolina, Texas, West Virginia and Wyoming.

"Eliminating smoking from worksites, restaurants and bars is a low-cost, high-impact strategy that will protect nonsmokers and allow them to live healthier, longer, more productive lives while lowering health care costs associated with secondhand smoke," said CDC Director Thomas R. Frieden. To view the full report, click here.

Conway joins fight against fruity, high-proof malt beverage

Contending it promotes binge drinking in young adults, Attorney General Jack Conway has joined the fight against a fruit-flavored malt beverage made by Pabst Brewing Co.

Conway is one of 17 attorneys general asking the company to stop marketing Blast by Colt 45 to youth. The drink, which comes in a 23.5-ounce can, has an alcohol concentration of 12 percent, or 24 proof. Each can has the equivalent of five servings of alcohol. The drink comes in flavors like blueberry-pomegranate, strawberry lemonade and raspberry-watermelon.

Conway said Blast poses "a serious health and safety risk" for youth. The attorneys general have asked that the alcohol content be lowered. Pabst has not responded. (Read more)

Mary Breckinridge Hospital in Hyden is being acquired by Appalachian Regional Healthcare

Following the nationwide trend of independent hospitals joining larger organizations in order to stay viable, Hyden's Mary Breckinridge Hospital will be acquired by Appalachian Regional Healthcare.

ARH and the Frontier Nursing Service, which owns the facility, "hope to finalize the transaction within the next 60 to 90 days after the completion of due diligence," WYMT-TV reports.

"Much like the FNS, the ARH system has a deep history of serving the health care needs of the people of Eastern Kentucky," said Jerry W. Haynes, ARH president and CEO. "We are extremely proud that Mary Breckinridge Hospital and its related healthcare services will now be a part of the ARH system and our long-terms plans for the future of health care in Eastern Kentucky." (Read more)

Kentucky looking at 'telecare' for Medicaid patients to cut costs

Kentucky is considering making tele-caregivers — off-site guardians who provide care by monitoring cameras and sensors in a patient's home — available to some disabled Medicaid patients. The move is expected to save money by requiring less onsite care, The Courier-Journal's Patrick Howington reports. Because they are being monitored remotely, such as by telecaregiver David Crowe (C-J photo by Jordan Kartholl), it also allows patients to stay in their own home, rather than go to a nursing home.

The service is offered by Rest Assured, a subsidiary of ResCare, which is based in Louisville. The Cabinet for Health and Family Services "has asked permission from federal officials to use Medicaid funds for 'telecare' services like Rest Assured, as is allowed in Indiana and at least one other state," Howington reports.

Electronic monitoring is about half as expensive as in-home care and far less than the $5,000 or more a month it costs for a Medicaid patient to live in a nursing home. Rest Assured charges about $10 an hour for its service, resulting in $2,400 a month for eight hours of daily care. Though not expected to solve the state's Medicaid budget shortfall, "anything we can save at this juncture is wonderful," said state Sen. Julie Denton, R-Louisville.

Rest Assured has about 375 clients nationwide "Depending on clients' needs, the system can provide limited services such as medication reminders and food-preparation guidance for an hour or two a day or comprehensive monitoring for up to 24 hours," Howington writes. Telecaregivers use video and sensors that monitor temperature change, carbon monoxide levels and how long a patient is in the bathroom. (Read more)

Ky. Rural Health Assn. seeks entries for health reporting contest

The Kentucky Rural Health Association has started a free Newspaper Reporting Contest to encourage print media outlets to bring attention to Kentucky’s rural health-related issues, such as unusually high disease rates and strategies for addressing a county’s shortage of health care providers.

The contest is divided between daily and non-daily papers, with two categories in each division, series and single story). Each of the four winners will receive a plaque and $100 prize. The winners will be announced during KRHA’s 13th annual conference, scheduled July 21-22 in Bowling Green.

Winners will be selected based on the work’s relevance to rural health, the quality of reporting, its impact on health care policy, and any new insights that may be generated by the reporting.

The entries must have been published during the period from July 1, 2010 through June 15, 2011, and must be received by Friday, June 24, 2011.

Entries will be accepted from staff writers, editors, freelance writers, etc., who are affiliated with a Kentucky-based newspaper. Entries may also be submitted by KRHA members, or members of the community, on the writer’s or newspaper’s behalf.

Each entry should include three copies of the article or series as it originally appeared in the newspaper. There is no entry fee. Entries go to: David A. Gross, 750 Morton Blvd., Hazard, KY 41701. For additional information, you may contact him at 800-851-7512 or dagros3@email.uky.edu.

Fight against obesity needs to model the one against smoking, key federal official says at Appalachian Health Summit

By Tara Kaprowy and Al Cross
Kentucky Health News

Obesity is linked to so many other health problems that Americans need to see it as deadly as smoking cigarettes, the federal government's point man on the subject said at the first Appalachian Health Summit in Lexington Thursday.

"People don't see TV as a threat to public health nor do they see sugar drinks or fast food as threats," but all contribute to obesity, said Dr. William Dietz, director of the Division of Nutrition, Physical Activity and Obesity in the Center for Chronic Disease Prevention and Health Promotion, part of the federal Centers for Disease Control and Prevention.

"We are at the corner where tobacco was in the 60s, but we have not turned the corner," Deitz said. While increases in national obesity rates may have hit a plateau, "That doesn't mean we can become complacent," he said, "because this is a terribly costly problem."

That is especially true in Appalachian Kentucky and the rest of Central Appalachia, where four-fifths of counties have an obesity rate higher than the national average, so the University of Kentucky expanded its annual Clinical and Translational Science Conference to a program titled "Appalachian Health Summit: Focus on Obesity" and involved other universities in and near the region. The event drew more than 600 professionals to the Lexington Convention Center.

The battle against obesity is particularly difficult to win in Appalachia because it is so connected to social determinants like low education and income, said the leadoff speaker, Randy Wykoff, dean of the College of Public Health at East Tennessee State University. "Most people don't understand how strong these associations are," he said.

Complicating the problem are bad eating habits, limited access to healthy foods and a lack of safe, convenient places to exercise or even take a long walk, especially in rural communities far from county seats.

"We don't have a lot of recreational facilities out there," said William Betz, senior associate dean for osteopathic medical education at the Pikeville College School of Osteopathic Medicine. "In Pikeville, we have a Y, but that's it. . . . Where are the neighborhood parks in the hills of Appalachia? Where are the sidewalks?"

Deitz concurred: "You can't make a healthy choice if there's not a healthy choice to make."

Given such obstacles, and the difficulty in changing adults' behavior, some researchers think the fight against obesity should focus on children. Wykoff noted that in 60 percent of Central Appalachian counties, one in four children live in poverty, "and there is evidence this is getting worse."

In Pike County, Ohio, students are taking the "30-day Sodabriety Challenge," in which they pledge to stop drinking sugary drinks, including sports drinks, for a month. The project is being run by Laureen Smith, an assistant professor at Ohio State.

With 71 percent of adults and 44 percent of children in the area either overweight or obese — and diabetes rates high in turn — Smith turned to Pike County's high school to see if she could effect change. She found the average boy was drinking nearly four and a half sugar drinks a day, and girls were drinking more than three — some of which they were getting from a "secret" snack room in the school, despite state law prohibiting sugar drinks in school vending machines.

By getting a council of 10 students and two teachers together, they came up with a plan to get students aware of their consumption and its consequences. Students designed materials with the logo "What's in your cup?" They set up a Sodabriety Facebook page, delivered daily announcements and recruited more than half of the 100 students in the high school to take the challenge. As of Thursday, Smith said the students are halfway through the challenge, but are already remarking on weight loss.

Research in the community

More researchers are heading to Appalachian counties to come up with answers, and many were at the summit. "We believe if the problem is in the community, the solution is in the community," said UK's Mark Dignan, director of the Appalachia Community Cancer Network, repeating a maxim of Dr. Gil Friedell, founding director of UK's Markey Cancer Center.

Dignan said researchers should tackle such projects gingerly. "Appalachians have lots of experience with researchers," he said, and some "are very suspicious" that most of the money poured into such problems remains at research universities.

"It's all about the relationships," said UK's Nancy Schoenberg, who is working on Faith Moves Mountains, an obesity project based largely in Letcher County churches. She and her workers volunteer at church and community events, but must also gather data using standard research methods.

The scientific method calls for a control group that doesn't get the intervention received by the experimental group, but close-knit communities see the denial of a service to their neighbors as offensive, so Schoenberg's project involves every church that wants to participate — but involves some later to serve as a control group.

Researchers are also working with community collaboratives. In Ohio's Adams County, Farrah Jacquez, assistant professor at the University of Cincinnati, nurse practitioner Becky Basford and a host of community stakeholders worked together to build a fitness trail between two schools. "The community has knowledge of what needs to be done and know their community in a way I can't," Jacquez said. "Like, who knew in Adams County Zumba is a big deal?"

Disconnect at the doc's

One of the first places to start losing weight is a local doctor's office, but Stephanie Rose, an assistant professor at UK, found there is a disconnect between what physicians feel they're doing to counsel their patients about weight and what patients are hearing.

Though 92 percent of physicians in Rose's study said they felt it was their responsibility to talk to their patients about being overweight, only 42 percent of patients of normal weight and 78 percent of obese patients said their doctors had raised the subject. Further study showed just 55 percent of physicians said they felt they had time to talk to their patients about the issue and "a lot of primary care providers don't feel comfortable" talking about it, Rose said.

Betz said he's witnessed the phenomenon. "As physicians we dig our heads in the sand," he said. "We don't want to offend, we don't have the time."

Yet what a doctor tells his or her patients matters, Rose's study showed, indicating there was a "positive significant correlation" between a doctor counseling a patient about being overweight and that patient consequently trying to lose it.

Researchers have also found Americans do not recognize or acknowledge that they're overweight. "People will say, 'I have a weight problem, but I'm not obese'," said Deitz, of the CDC.

Betz said, "People look at themselves and think their weight is normal." He referred to a study that found 23 percent of women and 48 percent of men who are overweight think they have normal weight. "We have a 'norming up' situation," he said. "We're making the normal heavier. . . . What constitutes normal changes and so does the acceptance of it."

Kentucky needs system to track hospital infections, doctor says

Kentucky is in need of a single, accurate system that tracks hospital-acquired infections in order to improve health care and receive state and federal funding, an op-ed piece in The Courier-Journal contends. (Hospitals call these "healthcare-associated infections," keeping the HAI acronym but spreading the blame. --Editor)

"The need for accurate data cannot be overstated," writes Dr. Kevin Kavanagh of Somerset. "Data on infections is vital to address epidemics, to direct research, to develop antibiotics and for the state to receive grants and devise prevention protocols."

But Kentucky's reporting system is "duplicative and broken," Kavanagh contends, with no standardized system. "Facilities can make the same report to the Centers for Disease Control and Prevention, the [state] health department and to the hospital's Patient Safety Organization," he said. Though HAIs should be reported in Kentucky, only four outbreaks were conveyed by hospitals last year. "As of December, the definition of an 'outbreak' was not agreed upon, which makes data collection and grant funding difficult," Kavanagh writes.

To combat the problem, 22 states are using The National Healthcare Safety Network run for free by the CDC to collect their data, which Kavanagh advises. He also encourages transparency and commended Norton Healthcare for posting information about treatment of catheter- and ventilator-associated infections. Because of this transparency, the provider received an award from the National Quality Forum. But "the problem of hospital-acquired infections and conditions is too big, too important and has gone on far too long to depend solely upon hospitals to correct the problem," Kavanagh argues. (Read more)

New website shows how federal health reform will affect Kentucky

The state has launched an official website containing information about how Kentucky will implement the federal health care reform law, also called the Patient Protection and Affordable Care Act. The site can be accessed at http://healthcarereform.ky.gov/.

The site includes a summary and full text of the new law; a list of federal grants Kentucky has applied for or received; updates on how the state government will implement the new law; health reform news releases; and a comment section.

The Cabinet for Health and Family Services "is to be commended for providing this important news information resource," said Kentucky Voices for Health Executive Director Jodi Mitchell. "Thousands of Kentuckians stand to benefit from the Affordable Care Act, and having timely access to information about the implementation of the law in Kentucky will be critical to its success." (Read more)

State and school employees and retirees hit obstacles when seeking mental health treatment; doctor blames Humana

State government and school employees in Kentucky have trouble seeing a psychiatrist because of Humana Inc.'s low reimbursement rates and unrealistic requests for paperwork, an op-ed piece in the Lexington Herald-Leader contends.

Humana manages the Kentucky Employee Health Plan, which has 285,000 current and retired Kentucky workers as members. But those needing mental health services are apparently running into roadblocks, Dr. Jeffrey Tuttle writes:

"Humana dictates the fee, which is often significantly lower than the regional market rate. Humana also requires in-network psychiatrists to submit medical records and documentation so they can determine if an appointment is medically necessary." But many doctors are uneasy doing so "because it jeopardizes confidentiality and leaves major treatment decisions in the hands of any anonymous Humana employee."

Visits to out-of-network providers arte likewise complicated, Tuttle alleges, in large part because Humana only reimburses $69 per visit, though the going rate, according to the Healthcare Bluebook, is $160. That low reimbursement means many more visits to meet the health plan's $800 deductible.

However, visiting in-network providers can be difficult. "Of the 83 active psychiatrists with a primary office in Fayette County (excluding psychiatric residents in training), only 12 work in clinics accepting Humana plans," Tuttle writes. "To make the situation worse, several of these psychiatrists are not accepting new Humana patients." (Read more)

Humana did not respond to a request from Kentucky Health News for comment.

Drug czar offers plan to cut abuse of oxycodone, related drugs

The White House drug czar announced today he wants to cut misuse of oxycodone and other opioid drugs by 15 percent in the next five years, and revealed his strategy for how to make that happen.

Gil Kerlikowske, the national drug policy director, wants to see a national education campaign, stepped-up law enforcement and pill-tracking databases in all 50 states, "with particular emphasis on Florida, where 85 percent of all oxycodone pills in the nation are prescribed," Curt Anderson of The Associated Press reports. The strategy also calls for more training for the more than 1 million doctors who are authorized to prescribe the drugs, though that move would need to be approved by Congress.

Details of the strategy come just a few months after Kerlikowske, right, visited Kentucky and surrounding states to assess the problem. His visit was preceded by in-depth reports on prescription pill abuse by The Courier-Journal and The Lexington Herald-Leader. Kentucky legislators, including U.S. Rep. Harold "Hal" Rogers, spoke to Kerlikowske candidly about the problem during his visit and voiced their displeasure about plans to nix a monitoring database in Florida. Florida Gov. Rick Scott has since reversed course and will support the implementation of a drug monitoring problem in his state.

Though a 15 percent cut seems like a small goal, Letcher County Sheriff Danny Web supports the move. "Anything would help, because we're drowning in it up here in Eastern Kentucky," he said. Overdose deaths from painkillers have risen from under 4,000 in 2000 to more than 11,000 in 2007, Centers for Disease Control and Prevention numbers show. In Kentucky, more people die from prescription drug overdoses than traffic accidents. Nationally, the total exceeds that for fatal gunshots. (Read more)

High use of meds earns Louisville bad name for allergies, which are becoming more common as pollination periods expand

Louisville is the second worst American city for spring allergy sufferers, based on use of allergy medicine, says the Asthma and Allergy Foundation of America. Though the city has only an average pollen score and an average number of board-certified allergists, it has an above average number of patients who use allergy medicine, the Spring Allergy Capitals 2011 survey concluded.

Only Knoxville, Tenn., ranked higher than Louisville. Charlotte, N.C., came in third, followed by Jackson, Miss., and Chattanooga, Tenn. "The worst cities are always in the South, where the temperatures are warmer and the plant life flowers earliest," Dr. Joseph Leija, an allergist who performs the Gottlieb Allergy Count, told research-reporting service Newswise.

Louisville ranked second last year as well, first in 2009, and 21st in 2008. In the past nine years the survey has been conducted, pollen concentrations have increased. "There's a lot of evidence that trees, grasses and weeds are pollinating more, said Mike Tringale, vice president for external affairs at the foundation. There is also evidence that the pollination season is lengthening, starting 10 to 15 days sooner and lasting 10 to 15 days longer.

As a result, more people are suffering. "Allergy prevalence has more than doubled in the past 30 years," Tringale said. "No one is really sure why. One of the leading theories is global warming." Today, between 12 to 14 percent of people have nasal allergies.

As for why some cities are affected more than others, Tringale said he didn't have an answer. Researchers will be looking at patterns and correlations next year in time for the 10th year of the study.

The study looked at the number of prescriptions that are written and refilled for all allergy medications, "whether eye drops, nasal sprays or oral pills," Tringale said. It also looked at all of the over-the-counter versions of allergy medicines that are sold at pharmacy counters, which account for about 20 percent of all over-the-counter sales. Medications sold at regular check-out aisles and at grocery stores were not accounted for, nor were medicines sold at Walmart. "Walmart doesn't give out data," Tringale said. Though Tringale acknowledged the low percentage of OTC sales tracked is a weakness of the study, he said it was done in this way "to standardize the data between cities."

Pollen counts were collected weekly "from thousands of different stations," Tringale said. The American Board of Medical Specialties provided the data regarding the number of board-certified allergists. (Read more)

Most Kentuckians in favor of banning cell phone use while driving

Though three of four Kentuckians admit to talking on the phone while driving, just as many would support a law banning cell phone use while operating a vehicle, the Kentucky Health Issues Poll has found.

"Although most Kentucky adults use their cell phones while driving, interestingly, they seem to recognize that this isn't a safe behavior," said Dr. Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. "Research has shown that drivers who are talking on a cell phone perform similarly to drivers who are legally drunk."

The poll found that more than 80 percent of Kentucky adults have a cell phone. Nearly 30 percent said they never use their cell phone when behind the wheel; 25 percent said they almost never do; 30 percent said they occasionally talk on the phone while driving; 10 percent said they talk on the phone almost every time they're in the car and 6 percent said they make calls every time.

While they do use their cell phones to talk, 8 out of 10 Kentucky adults do not text while driving, which is banned in Kentucky. Just 1 in 7 Kentucky adults said they occasionally or rarely use their cell phone to text or write emails when driving. Another 2 percent said they text every time they drive.

The U.S. Department of Transportation has identified texting as the most alarming road distraction and attributed 5,500 deaths on American roads to distracted driving in 2009. About 200 of those deaths happened on Kentucky roads.

The poll, conducted annually by the Institute for Policy Research at the University of Cincinnati, is jointly funded by the foundation and The Health Foundation of Greater Cincinnati. Its statewide sample of 1,677 results in a maximum margin of error of plus or minus 2.4 percentage points; regional samples are smaller and have higher error margins, around 5 percentage points. The foundation is the principal funder of Kentucky Health News. Other poll results can be found by clicking here.

U of L physician groups tied to Passport Health Plan must release salary and expense records, attorney general rules

Two groups representing University of Louisville's faculty physicians have been deemed public agencies and are subject to open records laws, Kentucky Attorney General Jack Conway has ruled. The groups therefore violated the Kentucky Open Records Act when they denied a request by The Courier-Journal's Tom Loftus for five years' worth of records showing employee salaries, sources of income and expenses. U of L doctors have a majority on the board of Passport Health Plan, which manages the Medicaid program for Jefferson and 15 surrounding counties.

The matter concerns the University Physicians Association and the University of Louisville Physicians. In December, Loftus requested the salary and expense documents after state Sen. Tim Shaughnessy of Louisville, right, asked the Kentucky Health and Family Services Cabinet to "examine the flow of Medicaid funds from the state through Passport to UPA," Loftus writes. State Auditor Crit Luallen did not look into the issue in her November report, which pointedly criticized Passport for excessive spending and conflicts of interest.

Though the physician groups contended they were non-profit corporations, Conway said UPA is a public agency "because it was established and created, and is controlled, by the University of Louisville School of Medicine," Conway concludes. "In all material respects, ULP mirrors UPA in the manner of its establishment, creation and control ... We are not prepared to casually dismiss these facts as 'coincidence born of practicality,' and instead find that ULP and the School of Medicine 'act as one and the same.'"

In its articles of incorporation, UPA says its mission is "to further the research mission and teaching of the praction of medicine at the University." Moreover, UPA and ULP were established and continue to be run by U of L medical school administrators, department chairs and professors. "We agree with The Courier-Journal that the suggestion that these physician administrators and/or professors, each the chair or interim chair of their respective medical school departments, came together of their own accord, and as private actors to establish and create UPA defies logic."

Shaughnessy was impressed with the findings. "It causes me to ask: How could they think they are not a public entity? What remains to be seen is whether the university accepts this ruling or continues its arguments that it is not subject to public openness." (Read more)

Number of HIV/AIDS cases is increasing in Louisville area

The number of newly diagnosed AIDS and HIV cases in Louisville is increasing even as the fear of the deadly disease wanes. The number of newly diagnosed cases in Jefferson County rose from 80 in 2005 to 107 cases in 2008, The Courier-Journal's Laura Ungar reports. The number of new HIV cases increased from 136 cases to 154 in the same period.

"People think it's a disease of the past. Unfortunately it's very much alive," said Janet Mann, director of program development for AIDS Interfaith Ministries of Kentuckiana.

"People think: All I have to do is take a few pills every day. But it still kills people ... and it affects quality of life," said Bobby Edelen (left, by C-J's Kylene Lloyd). Edelen has lived with the disease that causes AIDS for 21 years. "Every day is not a picnic."

Complacency, drug use and lack of education are causing the numbers to increase, health officials say. But while numbers rise, there is less money to deal with the growing need. HIV/AIDS funding to the Kentucky Department of Public Health dropped from $11 million in 2008 to $9.4 million in 2010.

There is still no cure for HIV/AIDS, but there is medicine that can "keep people somewhat healthy by preventing the virus from reproducing or by blocking it from entering cells," Ungar reports. But people respond to medicine in different ways. "Taking meds for HIV is similar to cancer patients taking chemotherapy. Some are able to take it. Some are deathly sick," Edelen said. (Read more)

Appalachian Health Summit to be held in Lexington Thursday

Focusing on obesity, a topic that affects most adult Kentuckians, the Appalachian Health Summit will be held Thursday in Lexington. The meeting is designed for clinicians and researchers, but will also be a place for journalists interested in the issue to find story ideas and sources.

The first session of the gathering will focus on health disparities and health behaviors in Appalachia. Topics include "Socioeconomic status and its impact on health in Appalachia," "Culture of Choice and Culture of Care in Appalachia" and "Lessons Learned from the Appalachia Community Cancer Network."

The keynote address will discuss federal, state and local initiatives that address the obesity epidemic. It will be given by Dr. William Dietz, director of the Division of Nutrition, Physical Activity and Obesity with the Center for Chronic Disease Prevention and Health Promotion.

Concurrent sessions will discuss childhood obesity, food and nutrition; research networks and collaboratives; social networking for energy balance; and the link between obesity and cancer.

The summit is sponsored by the University of Kentucky, The Ohio State University, the University of Cincinnati, Marshall University, the Pikeville College of Osteopathic Medicine and the Appalachian Regional Commission.

The summit will be held from 8 a.m. to 5 p.m. on the third floor of the Lexington Convention Center. For more information, click here.

Switch to electronic medical records not without concerns

Though touted as a way to improve patient care and supported by federal funding, Kentucky physicians have concerns about switching to electronic medical records. Doctors are worried about cost, lost productivity, the possibility that the technology becomes obsolete and that systems can't share information, The Courier-Journal's Laura Ungar reports.

"The main reason is financial. It's just so expensive," Dr. Emily Johnson of Kaplan Barron Pediatric Group, told Ungar. "Also, we'd have to take time out of the day and do training. It would be expensive to learn this new thing." Johnson's group plans to stick with its paper-based patient charts (Photo: Rebecca Dorwart, medical receptionist and recordkeeper, by C-J's Matt Stone)

But the Obama administration and health professionals say EHRs will "help reduce costs and make health care safer by avoiding such problems as duplicate medical tests and allergic reactions to medications," Ungar notes. The new health law will pay $20 billion in incentives to eligible doctors and hospitals who make the switch. Thoe who don't will get smaller Medicare and Medicaid reimbursements.

Last year, a Kentucky Medical Association survey of rural doctors (left) showed 45 percent didn't have an EHR system, and about half said they had no plans to have one. "The most frequently cited barriers to e-record adoption were lack of initial capital for software and training, concerns about loss of productivity and lack of technical support within the practice," Ungar reports. (Read more)

Kenton County goes it alone with smoking ban in Northern Ky.

Kenton County's smoking ban took effect today, making it the first county in Northern Kentucky "to ban smoking in most public places," Cindy Schroeder reports for The Kentucky Enquirer. "The controversial ordinance approved by the outgoing Kenton Fiscal Court in December requires offices and public establishments such as restaurants, churches, bowling alleys, bingo halls and retail stores to go smoke-free. Private clubs and 'drinking establishments' that meet certain requirements can apply for an exemption." (Enquirer photo by Patrick Reddy: Richard Gordon of Florence, in Boone County, lights up at the Super Bowl in Erlanger, in Kenton County.)

The urban counties on either side of Kenton have no smoking bans. Advocates of a ban tried to get all three counties to adopt the same legislationm, but Boone County rejected the idea, and a newly elected fiscal court in Campbell County repealed a ban that was enacted by the former court last year and had not gone into effect. Now Kenton County businesses fear the sole ban in the region will drive customers to other counties, and "Both opponents and supporters of smoke-free legislation agree that Kenton County's partial ban allowing exemptions for some, but not all public places, is confusing and will be difficult to enforce," Schroeder writes. Still, "People on both sides of the issue say it's only a matter of time, however, before all of Kentucky goes smoke-free, just as Ohio and 22 other states have done." (Read more)

Fla. governor agrees to implement prescription drug monitoring

"Florida Gov. Rick Scott reversed course Thursday and said he will allow a prescription drug monitoring program that Kentucky officials have demanded to help block the flow of illegal prescription drugs coming from the Sunshine State," the Lexington Herald-Leader reports.

The recently elected Republican said during a congressional hearing that private companies will fund the program for two years. Democratic Gov. Steve Beshear, who also testified at the hearing, said he was "very excited and pleased" at Scott's announcement.

"It was a rare moment of unity for the two governors," Halimah Abdullah writes for McClatchy Newspapers. "Their previous ideological differences on whether Florida should implement a prescription drug monitoring program to help stem the flow of drugs led to a tense standoff. Scott previously objected to such a program, citing privacy concerns, and turned down a $1 million donation from pharmaceutical giant Purdue Pharma, the maker of OxyContin, meant to help pay for a prescription database." (Read more)

State gives six residential substance-abuse centers federal money for operating costs

First Lady Jane Beshear Tuesday presented $1.5 million in funding for six Recovery Kentucky substance-abuse centers, further securing the program started in Republican Ernie Fletcher's administration, and attending a ceremonial opening of the center in Paducah, which was completed in December.

The six residential centers each getting $250,000 in federal community development block grants from the state for continued operational costs are in Erlanger, Evarts, Florence, Henderson, Hopkinsville and Richmond. Besides those cities and Paducah, centers are also in Morehead, Owensboro and Campbellsville. Four more are to be built in the next four years.

Recovery Kentucky is an initiative to help Kentuckians recover from substance abuse, which often leads to chronic homelessness. Construction of the facilities, five for men and five for women, was financed in part through the state-controlled Kentucky Housing Corp.

About 4,000 Kentuckians have received treatment in the centers since the first one opened four years ago, but Beshear noted that more than 44,000 Kentuckians over 26 are dependent on drugs and alcohol. “Recovery Kentucky centers are vital for the state to be able to assist individuals suffering from this disease,” she said.

Most Ky. communities not friendly to walkers, joggers, cyclists

Few Kentuckians live in walkable communities, according to the latest Kentucky Health Issues Poll for the Foundation for a Healthy Kentucky. Only 32 percent of Kentucky adults said there are a number of destinations within an easy walking distance from their home, and only 47 percent said they live in communities with sidewalks or shoulders on streets that allow for safe walking, jogging or biking.

"Walkable communities aren’t just safe for walkers, but cyclists, joggers and those engaging in other forms of recreation as well," the foundation said in a news release. It noted that the results varied regionally, with 60 percent of Northern Kentucky residents and 63 percent in the Lexington area saying they have safe places for walkers, joggers and and cyclists. Eastern Kentucky reported the least access, with 28 percent. Louisville and Western Kentucky fell in the middle at 49 percent and 47 percent, respectively.

“The good news is that we’re seeing more local governments finding innovative ways to support healthier lifestyles with small policy changes, like re-striping a country road to provide clear paths for walkers and bikers,” said Dr. Susan Zepeda, CEO of the foundation. “While we’re not surprised by the results, the foundation is concerned about the lack of walkable communities, considering the obesity epidemic we’re facing in Kentucky.”

According to Walk Score, a website dedicated to promoting walkable neighborhoods, communities that provide more safe walking options have healthier residents, less pollution and higher property values than more sprawling areas. Residents of walkable communities have places to go within an easy distance of their home, and can often make quick trips or run errands without using a car or public transportation.

The poll, conducted annually by the Institute for Policy Research at the University of Cincinnati, is jointly funded by the foundation and The Health Foundation of Greater Cincinnati. Its statewide sample of 1,677 results in a maximum margin of error of plus or minus 2.4 percentage points; regional samples are smaller and have higher error margins, around 5 percentage points. The foundation is the principal funder of Kentucky Health News.

Fellowships of $10,000 available for reporting on mental health

Each year the Carter Center Mental Health Program awards six Rosalynn Carter Fellowships for Mental Health Journalism to six American journalists. They get a stipend of $10,000 to report on a mental health topic of their choice. "The fellowships are designed to increase accurate reporting on mental health issues and decrease incorrect, stereotypical information," says a release from the center founded by former president Jimmy Carter.

The deadline to apply is Monday, April 18. Applicants must have at least three years of professional experience in print or electronic journalism, submit an application packet and attend orientation and presentation meetings in September at the beginning and end of the fellowship year. Fellows are not required to leave their current employment. Awards will be announced July 15, 2011. For more about the program and an application packet, click here.

Cabinet seeks proposals for managed-care Medicaid services

Acting on Gov. Steve Beshear's promise to moved to managed care for Medicaid recipients in order to lower costs, implemented by the recent special session of the General Assembly, the Cabinet for Health and Family Services is asking organizations to submit proposals to provide physical, mental and dental health care services for Kentuckians on Medicaid.

The goal is to improve health care outcomes, particularly in the areas of diabetes, coronary artery disease, colon cancer, cervical cancer, behavioral health, prenatal care and oral hygiene. The effort also also aims to lower costs, improve coordination of care and reduce overuse of services such as unnecessary visits to emergency rooms. Responses to the request for proposals are due May 25, and the cabinet says contracts should be in place by July 1. (Read more)

Passport Health Plan drops secrecy as managed care expands

Passport Health Plan, the managed-care organization for Medicaid in the Louisville area, announced today that it would no longer fight to keep its records secret, deciding not to appeal a ruling by Attorney General Jack Conway that it had to give records to The Courier-Journal because most of its money comes from the state.

Passport's interim CEO, Mark Carter, said in an article on the Louisville newspaper's op-ed page that the decision "was not based upon legal advice but was made as part of the continuing evolution, perhaps even transformation, of the plan." He said state Auditor Crit Luallen's scathing report on the plan "has served as a very beneficial wake-up call to our organization."

Today the state issued a request for proposals to expand Medicaid managed care to other parts of the state. Luallen told The C-J's Deborah Yetter, “I think if government is going to privatize services … we have to have a higher level of accountability, not a lower level of accountability.” (Read more)

Play about breast cancer set for premiere at UK April 22

A woman dealing with her faith after being diagnosed with breast cancer is the subject of a new play that will premiere at the University of Kentucky this month.

"Nevertheless: A Story of Resolve" is a story of faith, hope and perseverance. "I want to engage the audience with a meaningful story that will impact their lives," said playwright Lisa A. Brown, left. "Each of us has been affected by breast cancer. We either have a personal history with it or we know someone who has," said Brown, who works in the UK School of Journalism and Telecommunications. "Breast cancer does not discriminate based on race, economic status, political affiation or even gender."

The play will premiere April 22 and also be presented April 23, April 29 and May 1 at UK's Memorial Hall. Tickets are $20 in advance and $25 the day of the performance and are available online at www.ticketmaster.com, by phone at (859) 257-TICS or by visiting the UK Student Center Ticket Office, room 253.

The performances on April 22 and May 1 will include a question and answer session with the cast and playwright. The April 29 performance will include sign interpreters and special seating will be designated for the hearing impaired. To further raise awareness about breast cancer, a local representative of the Susan G. Komen Foundation will be at each performance to hand out information about the disease. (Read more)

Nonpartisan budget office says Republican's Medicare plan would make those now under 54 pay more

A proposal meant to reduce the federal deficit and cut spending would have future retirees paying more for health care, the non-partisan Congressional Budget Office estimates. The proposal by House Budget Committee Chairman Paul Ryan would repeal many of the much-touted benefits of the new health care law but is likely to die in the Senate, Ricardo Alonso-Zaldivar of The Associated Press reports.

Under Ryan's plan, future retirees now 54 and younger would be enrolled "in a different kind of health care program when they retire," Alonso-Zaldivar reports. "Instead of coverage for a set of benefits prescribed from Washington, they'd get a federal payment to buy private insurance from a choice of government-regulated plans." That would mean those retirees would pay more than they would under the current program, the nonpartisan Congressional Budget Office estimated.

Ryan, left, of Wisconsin, proposes repealing health-insurance expansion, which is expected to cover 30 million people who don't have coverage now; bringing back the coverage gap or "doughnut hole" in the Medicare prescription drug benefit; gradually raising the Medicare eligibility age (starting in 2022, it would rise by two months each year until it reaches 67 in 2033); and the amount of money juries could award in medical malpractice suits would be limited. (Photo: AP's J. Scott Applewhite)

The proposal would reduce spending by about $5 trillion over the next 10 years, but would not balance the federal budget. Ryan's plan "would shift more of the risk from rising health care costs from federal taxpayers to individual beneficiaries, medical service providers and states, giving them all a powerful incentive to avoid waste and aim for quality and efficiency," Alonzo-Zaldivar reports. "If it doesn't work, as the budget office suggests might happen, future Medicare beneficiaries, providers and states will feel the pain directly. That could send them right back to Washington clamoring for more subsidies." (Read more)

Public Health Week tips remind us that safety is part of health

In celebration of 2011 National Public Health Week, being honored April 4-10, the Kentucky Department of Public Health offers tips on preventing injuries. Each year, injuries account for $80 billion spent on medical care and another $326 billion in lost productivity.

"Kentuckians can make a real difference in their homes and communities by committing to safe behaviors for themselves, their children and families," said Dr. William Hacker, commissioner of the department. "Implementing preventive measures into our daily routines can make a dramatic difference in both the overall health of our population and the amount of health care dollars spent on injury treatment."

To prevent injuries, the department recommends: wearing a helmet and protective gear while playing sports; wearing sunscreen with an SPF of 15 or higher; having a physical before starting a new sport; warming up before playing sports; putting away items like toys and shoes lying on the floor or staircase to prevent falls; monitoring children while they play; drinking lots of water to prevent dehydration; always wearing a seatbelt; and avoiding distracted driving by not talking on the phone, texting or eating.

"We need to realize that public health requires more than the obvious examples we all know, such as eating fruits and vegetables, getting vaccinations and quitting smoking," Hacker said.

More Kentuckians had health insurance in 2010, survey finds

Fewer Kentuckians lacked health insurance in 2010, the Kentucky Health Issues Poll has found. About one in four Kentuckians ages 18 to 64 were uninsured last year, much the same as in 2008. Last year, at the depth of the recession, the uninsured were one out of three.

Young adults tend to be uninsured more often than older adults. More than one-third of adults ages 18 to 29 in the latest poll said they did not have health insurance, double the rate for adults 46 to 64.

"It's encouraging to see the number of currently uninsured Kentuckians decreasing because this suggests that they will have better access to needed health care services," said Dr. Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. "However, we remain concerned about the one-third of Kentuckians who had a gap in health coverage at some point in the past year. If a serious illness strikes, it can have catastrophic effects on an uninsured family's finances."

The poll was conducted Dec. 3-22 and Dec. 27-28 by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,677 adults, 1,469 by landline phone and 208 via cell phone. The poll was also sponsored by The Health Foundation of Greater Cincinnati.

Respondents were asked more than 50 questions that covered a range of health-related topics, including financial stresses related to health care; characteristics of their neighborhood (examples: is it easy to buy fresh produce or ride a bicycle?); degree of civic engagement, such as donation of blood, work on a community project or attendance at a political meeting or rally; using cell phones while driving; health insurance coverage; the new health care law; and smoking policy. To see poll results on the majority of these issues, click here.

National poll shows opposition to major cuts in Medicaid

In this year's legislative sessions, Kentucky lawmakers wrangled to find a solution for a $166.5 million hole in the Medicaid budget. Now Congress is looking at reducing the federal deficit by reducing spending on programs and services. Medicaid is likely on the chopping block, which will likely leave Kentucky legislators scrambling again. The program, which provides health insurance for low-income people and people with disabilities, covers 60 million people nationwide. In Kentucky, 800,000 people are covered by the program.

The fact that Congress is eyeing Medicaid as a target does not come as a surprise to Drew Altman, president and CEO of the Kaiser Family Foundation. He writes, "Conservatives don't like Medicaid on ideological grounds; it's a government entitlement program. Providers complain about the program's reimbursement rates. And liberals have long complained about the program's limitations, especially the gaps in whom Medicaid covers and the large variations in coverage among states."

But a new poll  by the foundation shows only 13 percent of U.S. adults support major reductions to Medicaid, in the same neighborhood as the 8 percent who said they support major reductions to Social Security and Medicare. Nearly half of those polled said they'd prefer to see no reductions to Medicaid at all. In the same poll, 39 percent of people said the program was "very important" to them and their family. A little more than 1 in 5 people said it was not important to them at all.

Two conferences this summer will focus on children's health

The 2011 Coordinated School Health Institute conference is set for June 29 in Lexington. The conference will focus on the roles community partners and families play in creating healthy places to learn and work.

The Growing Healthy Kids in Kentucky conference will follow June 30 and July 1. The conference will address how to create healthy, hunger-free communities.

Both conferences will be at the Marriott Griffin Gate hotel. Cost for both events is $205. To register, click here.

Yum! Brands asks state to allow elderly, disabled and homeless to use food stamps at restaurants

Louisville-based Yum! Brands, which owns the KFC, Pizza Hut and Taco Bell chains, wants the homeless, disabled and elderly to be able to pay for their meals with food stamps. The company registered last month to lobby the administration of Gov. Steve Beshear on the matter. Yum! executives have given to Beshear's re-election campaign, The Courier-Journal's Tom Loftus notes.

"Under the federal food-stamp program, states may authorize (use of food stamps) by the elderly, disabled or homeless, who often have difficulty preparing meals," Loftus writes. "Only Michigan, Arizona and parts of California have done so."

"We think it's a win-win," said Paul Carothers, the company's vice president for government affairs. "It's obviously of interest from a business standpoint, and it provides access to the elderly, homeless and disabled who are often underserved."

But state Rep. Jim Wayne, D-Louisville, told Loftus, "My concern is that so much of that food is the most unhealthy food in America ... and it leads to obesity and all kinds of other health problems."

Carothers said he did not see a difference between customers being able to pay for their meals at KFC, Pizza Hut and Taco Bell with food stamps and being able to buy candy bars and soda at the grocery store, which is allowed. "The only thing they cannot use their benefits for ... now are household products, alcohol, tobacco and those sorts of things," Carothers said, adding that Yum! meals "stack up nutritionally quite well. For some of these people access to a restaurant may be their only opportunity for a hot meal."

The Cabinet for Health and Family Services told Loftus that about 814,000 Kentuckians receive food stamps, but could not say what percentage are elderly, disabled or homeless. (Read more)

April 21 Appalachian Health Summit will focus on obesity

Focusing on obesity, a topic that affects the majority of adult Kentuckians, the Appalachian Health Summit will be from 8 a.m. to 5 p.m. April 21 in Lexington. The meeting is designed for clinicians and researchers, but it would alos be a place for  journalists interested in the issue to find story ideas and sources. The registration deadline is Friday, April 8.

The first session of the gathering will focus on health disparities and health behaviors in Appalachia. The keynote address will discuss federal, state and local initiatives that address the obesity epidemic. It will be given by Dr. William Dietz, director of the Division of Nutrition, Physical Activity and Obesity with the Center for Chronic Disease Prevention and Health Promotion.

Concurrent sessions will discuss childhood obesity, food and nutrition; research networks and collaboratives; social networking for energy balance; and the link between obesity and cancer.

The summit is sponsored by the University of Kentucky, The Ohio State University, the University of Cincinnati, Marshall University, the Pikeville College of Osteopathic Medicine and the Appalachian Regional Commission. To read details and register, click here.

Kentucky continues to lead nation in cancer death rate

Though cancer deaths rates are falling nationwide, Kentucky continues to rank worst in the country for its number of cancer deaths, The Courier-Journal's Laura Ungar has determined. (C-J graphic shows rates for the nation, Kentucky and Indiana, the southern part of which the Louisville newspaper serves.)

Ungar's analysis stems from Thursday's release of the Annual Report to the Nation on the Status of Cancer, which concluded cancer death rates declined about 1.6 percent each year between 2003 and 2007 nationwide. Kentucky's death rate declined an average of 0.7 percent each of those years.

The state had a cancer death rate of 213.7 per 100,000 residents in 2007, which translates to about 9,700 Kentuckians dying each year from cancer. In 2007, Kentucky had a lung cancer death rate 50 percent higher than the national average, ranking it highest in the nation. It also ranked eighth highest in brain and other nervous-system cancers and higher than average for colorectal, prostate and breast cancer death rates.

Lung cancer is the most deadly cancer in the country, though researchers found, for the first time, a decrease in the number of women who die from lung cancer nationwide. The decline comes "more than a decade after deaths began dropping in men," Ungar reports.

Doctors are hoping to make more strides in battling the disease in the years to come. Thomas Tucker, director of the Kentucky Cancer Registry, told Ungar that smoking bans, higher cigarette taxes and anti-smoking messages should help drive down lung cancer rates. There has also been progress in the percentage of Kentuckians who are getting colonoscopies, a screening for colon cancer. Though more Kentuckians died of colorectal cancer than any other state in 2007, the rate has declined since. (Read more)

Many school districts need more school nurses, report finds

Many if not most Kentucky public school districts have fewer school nurses than national guidelines call for, a Kentucky Youth Advocates report says.

"A Picture of Health: School Health Services in Kentucky" found that "only 38 percent of school districts responding to its survey met or exceeded a National Nurses Association recommendation calling for one school nurse for every 750 students. The average Kentucky district provided one nurse for every 1,254 students," the Lexington Herald-Leader's Jim Warren reports.

The report also found the average  district spends less than 1 percent of its operating budget on health services. That number only factored in direct spending by the districts and did not include support that might come from health departments, universities or other organizations.

Of Kentucky's 174 districts, 137 responded to the survey. KYA Executive Director Terry Brooks called the report a "starting point" for looking at ways to expand health services in schools. (Read more)