UK prof receives Kentucky Academy of Family Physicians award

Dr. Samuel Matheny has received the 2011 Distinguished Service Award from the Kentucky Academy of Family Physicians. "It is his peers recognizing him for some of his unselfish activities, particularly things focused on the overall good for patients in the commonwealth, improving quality of life for patients and for the family physicians that take care of patients," said Gerry Stover, executive vice president of KAFP.

Matheny practices in Lexington, and for the past 17 years, has been a professor and chair of Family and Community Medicine in the University of Kentucky College of Medicine, of which he is graduate. He is double board certified in family and preventive medicine.

In service to the KAFP, he has invited renowned speakers to speak to the membership. He has also created new awards that honor physician volunteers and opened up nominations to community members for the citizen doctor award. He has also addressed the needs of the physician workforce Kentucky.

Generals in Kentucky, the national leader in young-adult obesity, say the 'too fat to fight' trend is endangering national security

Recent commanders of the Kentucky National Guard say the country could be at risk because America's youth is too fat to fight, and they urge Congress to take action. A study recently showed more than half of adults 18 to 24 in Kentucky are overweight or obese — the highest share of any state. Nationally, one in four young adults are too overweight to enlist.

"What can we do to combat child obesity and help expand the pool of young adults qualified for military service?" former Adjutant Gens. Donald Storm (right), Michael Davidson and D. Allen Youngman write in an op-ed piece for Kentucky newspapers. "School is a good place to start. Many children consume nearly half of their daily calories at school, and more than half of kids eat at least one meal served in school every day."

The Healthy, Hunger-Free Kids Act, which updates school nutrition standards for the first time in decades and provides more funding for each meal served in school cafeterias, is a step in the right direction, they say, "but more is needed to prevent our childhood obesity crisis from becoming a national security crisis."

Updating school equipment and personnel seem necessary. A recent survey of 13 southeastern Kentucky school districts found that nine use deep fryers and only five use salad bars. The survey also found that the vast majority of districts do not have the funds necessary to update or repair equipment that will be needed to comply with the new nutrition standards. Also, 11 of the 13 school food-service directors said their cafeteria workers need more training in order to be prepared for new standards.

"We are urging members of Congress to help schools meet the standards of the new child-nutrition law and provide additional support for kitchen equipment and training," they write. "These funds will help ensure that all of our children can lead healthy lives and that those who wish to serve their country are fit enough to do so." (Read more)

128 Kentucky schools get money for fresh fruits and veggies

More than 50,000 students in 128 Kentucky elementary schools will be served fresh fruits and vegetables in the coming school years as part of the U.S. Department of Agriculture's Fresh Fruit and Vegetable Program.

The program ensures children are given a variety of free produce throughout the school day. The goal is is create healthier school environments by providing healthy choices; expand children's exposure to fresh produce; expand consumption of the foods; and improve children's diets.

For a list of all the schools that will receive the funds, click here. The selection was based on applications from elementary schools that have a student population with half or more of the students are eligible for free or reduced-price meals in the National School Lunch Program. Priority was given to schools with the highest percentages.

Kentucky received $2.65 million for the program. Each school will receive funds to operate the program based on approximately $52 per student enrolled.

Lexington is most sedentary city in U.S., Men's Health says

Lexington has been ranked as the most sedentary city in the country by Men's Health magazine. Or, to put it more bluntly, the laziest.

"What hurt Lexington most was the actual amount of activity, or exercise, people reported engaging in — any physical activity at all, which was relatively low. And they did have higher rates of deaths from deep vein thrombosis (DVT) as well," said Matt Marion, deputy editor of the magazine.

The rankings were compiled by looking at "how often residents exercise, the number of households that watched 15 hours of cable television a week and bought more than 11 video games a year, and the rate of DVT [deep vein thrombosis], a blood clot in a vein, usually in the leg, which is associated with inactivity," writes Patricia Reaney of Reuters.

Indianapolis and Jackson, Miss., also ranked very low, while Seattle, San Francisco and Oakland, Calif., were high. Southern cities ranked among the lowest on the list, which Marion said is in part due to their warm weather and lifestyle. "In certain cities there is a more laid-back lifestyle," he said. "That's fine, but there is not that same drive you'll see in certain parts of the northeast or California, or the northwest where people get up every morning and run or hit the gym."

The latest issue of Men's Health, with the rankings, hits newsstands Tuesday. (Read more)

State website helps Kentuckians get health insurance, info

A new government website is aimed at helping Kentuckians wade through the often overwhelming world of health insurance by providing information specific to the new health care law.

The Kentucky Health Insurance Advocate contains information for people who are uninsured, those who are soon to be uninsured, and those interested in private coverage options. It outlines specific information for seniors, children and young adults. It also contains a listing of companies selling individual, private insurance in Kentucky.

The website was compiled by the Kentucky Department of Insurance and has been in operation since the spring. "This is part of a consumer assistance grant we got as part of federal health reform," said Ronda Sloan, public information officer with the department. "We were trying to put all of the health reform information people would need in one location. ... We're trying to make it really user-friendly."

Part of of the effort is to get more Kentuckians insured. "And it's really for education too," Sloan said. "We're not trying to tell anybody, 'This is what you do,' we're trying to say, 'These are your options.' We're trying to walk people through the process."

In addition to perusing the website, people can call toll-free at 877-587-7222 to get more, personalized information. Since the department started advertising the site a few weeks ago, it has received more calls. "A lot of people are saying, 'I'm uninsured,' 'I have a pre-existing condition, what can I do?', 'I lost my job, I'm coming off COBRA,' things like that," Sloan said. "Insurance is not a simple thing and it's not something you think about until you need," she said. "We're trying to make it a little less complicated and try to ease people's minds a little."

New cigarette warning labels to be in use by fall 2012

Showing graphic photos of rotting teeth, a man with a zipper-like scar down the length of his chest and even a man with smoke coming out of his tracheotomy tube, the Food and Drug Administration unveiled this week the warnings that will be required on cigarette packages starting in fall 2012.

The move is aimed at getting smokers to quit, which could be especially beneficial in Kentucky, where 25 percent of adults are smokers, compared to 18 percent nationwide. The state has the second highest smoking rate in the country, data from the Centers for Disease Control and Prevention show.

The FDA hopes the images "will reduce the number of smokers by 213,000 by 2013 and save between $221 million and $630 million every year over the next 20 years," Rob Stein of The Washington Post reports. "With these warnings, every person who picks up a pack of cigarettes will know exactly what risk they are taking," Health and Human Services Secretary Kathleen Sebelius said.

The graphics, which represent the first time U.S. warnings have been overhauled in 25 years, are accompanied with messages such as "Warning: Cigarettes are addictive" or "Warning: Smoking can kill you." Warnings started appearing on cigarette packages in 1966, but remained limited to small text on the sides of packages and in ads. About 30 other countries, including Canada and Brazil, already require graphic warnings.

To prevent smokers from becoming desensitized to the images, the FDA plans to conduct studies to make sure the images are still having an effect. "What may seem quite shocking at the beginning, people get used to quite quickly," Sebelius said.

Several tobacco companies are challenging the move in court. They would not comment about the images, Stein reports. (Read more)

As for whether they will make a difference, Washington Post columnist Petula Dvorak polled some smokers, who seemed unfazed by the images. (Read more)

Tainted salad mixture was sold in Kentucky, has been recalled

Kentucky is among the states affected by a recall of Dole and Kroger salad mixtures that may be tainted with the disease listeriosis.

More than 2,800 Dole Italian Blend and 440 cases of Kroger Fresh Selections Italian Style Blend have been recalled, according to the U.S. Food and Drug Administration. The salad mixtures have a use-by date of June 19, Darla Carter of The Courier-Journal reports.

Symptoms of listeriosis including fever, muscle aches, nausea and diarrhea. In serious cases, stiff neck and confusion can result. The illness mostly affects older adults, pregnant women, newborns and adults with weakened immune systems.

For more information, click here.

Kentucky Medicaid spending is unsustainable, study will say

When it is released June 29, a study sponsored by the Bluegrass Institute for Public Policy Solutions will show Kentucky is an on "unsustainable path" when it comes to Medicaid spending.

A press release about the report says two of three children on Medicaid cannot get appointments with specialists. This happens to only one of 10 privately insured children. "Without essential, sweeping reform, Medicaid will continue wasting Kentucky's resources on a grossly over-expanded enrollee base while failing in its fundamental mission of providing access to health care for the truly impoverished," the release says.

While Medicaid has gaps in care, states are struggling to pay for it. Kentucky was $166 million short in meeting its Medicaid budget this year, prompting the state to turn to managed-care organizations. Help from the economic stimulus will run out June 30. "The end of this increase in federal matching funds means that an increase in the state share of Medicaid in all states comes at a time when states are still experiencing fiscal stress related to the economic downturn," a Kaiser Family Foundation release states.

A Kaiser fact sheet shows Kentucky spent nearly 23 percent of its total state spending on Medicaid in 2009. In anticipation of the effects of the economic downturn, the state received a considerable boost from stimulus funds in fiscal year 2011 to help pay for Medicaid; its federal medical assistance percentage, which was based on the state's per capita income, was about 81 percent compared to 56 percent nationwide. However, that number will drop to about 71 percent starting July 1. Even so, the state's unemployment rate is still 10 percent, 1 percentage point higher than the national average.

The Bluegrass Institute study's author, John Garen, a University of Kentucky professor of economics, projects Medicaid spending could rise exponentially in the coming years, even though state and federal spending already rose from $3.3 billion to $5.1 billion between 1999 and 2009.

The study was co-sponsored by the Bluegrass Institute and the BB&T Learning Laboratory on Capitalism. It will be released at 12:30 p.m. June 29 at Room 248 of UK's Gatton College of Business and Economics Building. (Read more)

Weight gain after gastric bypass is common; study will see if post-operative supervision helps keep it off

Though 200,000 people undergo gastric bypass surgery to lose weight each year, more than half of patients put back on at least 20 percent of the weight they lost, research-reporting service Newswise reports. A new study will test whether supervising patients' exercise and food intake post surgery will help the pounds from creeping back on. This should be of more than passing interest in Kentucky, given our high nrate of obesity.

"You wouldn't invest $25,000 to remodel your home and not maintain it. Shocking as it may seem, follow-up on diet and exercise just isn't the norm with gastric bypass," said Gary D. Miller, who will head the study at Wake Forest University in North Carolina. "With so many people seeking gastric bypass each year, we can improve the long-term outcome of gastric bypass by keeping up with patients as they figure out their new lifestyle."

In the sixth-month study, one group of patients who recently underwent gastric bypass surgery will receive aerobic training, such as walking or cycling, and resistance training three days a week. They will also be supervised by an exercise psychologist and will be asked to document what they eat in a food diary, which will later be analyzed. They will additionally be encouraged to exercise at least two more days a week.

A second group will receive post-surgery care that is standard to gastric bypass patients. Generally, these patients receive guidance about diet and exercise, but their fitness levels and eating habits are not supervised. "This could show that surgery plus supervised exercise and diet might be the best, most efficient option for weight loss in obese and morbidly obese people," Miller said. (Read more)

Study indicates risk of fatal birth defects is higher in counties with mountaintop-removal coal mining

"Children born in counties home to mountaintop coal mines had a 26 percent higher risk of suffering" a fatal birth defect "compared to ones born in non-mining regions," according to a new study, Dan Vergano of USA Today reports. The study, led by health economist Melissa Ahern of Washington State University in Spokane, will appear in the upcoming Environmental Research Journal. (Map shows counties with coal mines in 1996-2003, with "mountaintop" mining counties in darker gray)
Air and water pollution from mountaintop mining led Ahern and her colleagues "to look for health effects on infants" in West Virginia, Kentucky, Tennessee, and Virginia, Vergano writes. The researchers found birth defects in mountaintop mining areas were elevated above non-mining areas in six of seven categories, including heart, lung and gastrointestinal. Because of an already established connection between poverty and birth defects, the researchers then "controlled for social factors such as smoking, drinking, mother's education, race and other poverty-related factors" and found a 26 percent increased risk of fatal birth defects in mountaintop-mining counties, Vergano reports.

A spokesman for the National Mining Association "suggested adding more demographic factors to the study might remove the elevated birth defects," Vergano writes, then quotes environmental and pediatric-health expert Lynn Goldman of George Washington University as saying "It isn't proof of cause and effect" and paraphrases her: "Because the study is the first of its kind, public health researchers will need to reproduce the study results to feel confident it has uncovered a real link, she cautions. Further studies will be needed to show how exposures in mountaintop mining communities could lead to more birth defects." (Read more)

Several Kentucky hospitals overdo CT scans, despite cost, risk

Despite the risk of exposing patients to more radiation and the fact that radiologists say it is very rarely necessary, Medicare outpatients are regularly receiving two CT scans on the same day at 12 Kentucky hospitals, according to analanysis of Medicare data by The New York Times, which produced a handy interactive map, a segment of which is copied here. To use the actual map, click on the map below.

Though only 5.4 percent of hospitals nationwide scan a patient's chest twice on the same day, nine Kentucky hospitals are double-scanning at least 15 percent of the time and three are doing it more than 30 percent of the time, accoding to data for 2008. Figures for 2009, which are expected to be similar, are due out next month from the federal Center for Medicare and Medicaid Services.

Clark Regional Medical Center in Winchester has the highest rate, double scanning 43 percent of the time. Monroe County Medical Center in Tompkinsville double scans 34 percent of the time, followed by Pineville Community Hospital at 32 percent.

Other Kentucky hospitals that are double scanning at least 15 percent of the time include: Clinton County Hospital, Albany, 30 percent; Paul B. Hall Regional Medical Center, Paintsville, 25 percent; Harlan Appalachian Regional Healthcare Hospital, 24 percent; Norton Hospitals, Louisville, 23 percent; Westlake Regional Hospital, Columbia, 23 percent; Spring View Hospital, Lebanon, 20 percent; Methodist Hospital Union County, Morganfield, 19 percent; T.J. Samson Community Hospital, Glasgow, 18 percent; and The Medical Center at Bowling Green, 18 percent.

There are two types of CT scans, one that uses iodine contrast to monitor blood flow and one that does not. In rare circumstances, performing both scans — each with a separate charge — could help spot a tumor, said Dr. Michael J. Pentecost, a radiologist and Medicare consultant. While doctors may opt to double scan to get the most information on their patient possible, experts say being so thorough is rarely necessary, particularly given the added cost to the system and the exposure to radiation for the patient.

As Kentucky's numbers indicate, double scanning happens more often at small, community hospitals, where treatment can involve transferring patients to larger facilities. Nationwide, 200 hospitals administered double scans more than 30 percent of the time.

The Medicare agency released the data last year to hospitals "to show how they performed relative to each other and to encourage more efficient, safer practices," Walt Bogdanich and Jo Craven McGinty of the Times report. "The Medicare agency believes hospitals can and should do more to change physician behavior ... The federal agency plans to use other, similar measurements to rein in what it considers to be unjustified — and potentially dangerous — medical procedures." (Read more)

Monday, June 27 is National HIV Testing Day

Kentuckians are being encouraged to find out their HIV status on Monday, June 27, National HIV Testing Day.

About 1,700 Kentuckians were diagnosed with HIV between Jan. 1, 2005 and Dec. 31, 2009. About 1 in 3 Kentucky adults under the age of 65 have been screened for HIV, the Foundation for a Healthy Kentucky notes. Christian, Hopkins and McLean counties have the highest rate of HIV testing, with 45 percent of adults being tested. Montgomery County has the lowest rate at 24 percent. For more county-specific information, click here.

The earlier that HIV is discovered, the better the treatment works, but early detection is not commonplace in Kentucky. By the time they are tested for HIV, 30 percent of Kentuckians already have full-blown AIDS. Though at one time 100 percent of Kentuckians infected with HIV died within five years, now 82 percent are alive after the same time period.

Kentucky ranks 19th in the country for the number of people who have the HIV infection that leads to AIDS. "Health officials say that at least one new HIV infection is discovered each day in Kentucky," Mary Meehan of Lexington Herald-Leader recently reported. National HIV Testing Day was founded by the National Association of People Living with AIDS in 1995. To find a testing site, click here.

Signups due tomorrow for nutrition workshops June 29-July 1

Tomorrow is the deadline to register for two affiliated workshops that will focus on school nutrition and the overall health of Kentucky children. The Coordinated School Health Institute will focus on how schools and communities can work toward creating healthier schools. The Growing Healthy Kids in Kentucky workshop will address how to create healthy, hunger-free communities.

The CSHI event is June 29. The Growing Healthy Kids gathering is June 30 and July 1. Both events will be at the Marriott Griffin Gate Hotel in Lexington. All school staff, community organizations, parents, dietitians, nurses, school food service staff, journalists and any stakeholder in the health of Kentucky children are welcome.

The CSHI workshop will cover topics focusing on fitness, staff wellness, school health services, mental health, school nutrition and Medicaid managed care. It is presented by the Foundation for a Healthy Kentucky.

The two-day Growing Healthy Kids event will address physical activity, farm-to-school success stories, local foods, the Let's Move initiative, Kentucky Proud, breastfeeding, worksite wellness and culinary arts programs. It is sponsored by the Kentucky Dietetic Association.

Click here to register online. The cost for both events if $205. For more information, click here.

New immunization rules for children take effect July 1

Starting July 1, Kentucky will have new immunization requirements for infants, toddlers and schoolchildren, including age-appropriate pneumonia vaccine for children up to 5 years of age and meningitis vaccine for entry to the sixth grade.

Additional requirements include a second dose of varicella vaccine for students going into kindergarten and sixth grade; one dose of tetanus-diphteria-acellular pertussis vaccine for students going into sixth grade; and a second dose of measles-mumps-rubella for children by the time they turn 6.

The new regulations bring the state more in keeping with recommendations by the Centers for Disease Control and Prevention and with national pediatric standards. For more information about the Kentucky Immunization Program, click here. For a story from The Associated Press, click here.

Rural emergency rooms frequented by the poor and uninsured

A new report from the federal Agency for Healthcare Research and Quality shows that low-income adults accounted for 56 percent of the 8 million rural emergency room visits in 2008. In nonrural hospitals, low-income adults accounted for only 30 percent of emergency room visits. According to the report, 44 percent of adult visits to rural emergency departments were paid for by Medicaid, were uncompensated, or billed to uninsured patients. Only 31 percent were paid for by private health plans. In nonrural hospitals, 37 percent of adult visits were paid for by private health plans, and 42 percent were paid for by Medicaid, uncompensated or billed to uninsured patients.

Emergency business is mainly just that for rural hospitals. Only 8.3 percent of rural emergency department visits resulted in a hospital admission, compared to 16 percent of non-rural emergency department visits.

The report also noted the lack of rural hospitals with trauma-level emergency departments. Nationally, only 2.4 of rural emergency departments held any level of trauma designation. Among non-rural emergency departments, 35.5 percent had a trauma designation. Read more here.

In Kentucky, approximately 75 of the state's 130 hospitals are in rural areas, according to the Kentucky Hospital Association. The state has been working to improve its trauma system and will soon begin designating level IV trauma centers in some of the state's smallest hospitals, said Dick Bartlett, emergency preparedness and trauma coordinator for the Kentucky Hospital Association. Already, Marcum & Wallace in Irvine and Livingston Hospital in have met requirements for the designation and will be certified, once the state approves the new level IV designation. (The national report focused on levels I-III; in Kentucky, level I-III are certified by the American College of Surgeons.)

The new designation is part of an effort by Kentucky to improve trauma care statewide. Having a level IV trauma center means better trauma care for Kentuckians injured in rural areas, Bartlett said. "It improves your potential for survival," he said. These hospitals have committed to providing certain levels of staffing, including a board-certified emergency room physician, and to following protocols to quickly decide whether a patient can be treated at their facility or if a patient should be transported to another, higher-level facility.

A map showing Kentucky's current trauma hospitals and those hospitals seeking trauma certification is available here.

The urge to merge hospitals is driven by health care reform

Mergers that are creating large hospital groups in Kentucky are part of a national trend being driven in part by last year's health-care reform law.

There are three key reasons for this, according to Barton Walker, a North Carolina attorney with McGuireWoods, who specializes in health care mergers. Reform is decreasing revenues, increasing costs, and rewarding integration among providers, Walker said during a webinar last fall. Because the federal government is rewarding hospitals that can demonstrate quality -- and measuring quality takes investment -- larger organizations are better poised to take advantage of the changes, he said. Fior more from Leigh Page of Becker's Hospital Review, click here.

On Tuesday, the University of Louisville's hospital and its James Graham Brown Cancer Center joined with Jewish Hospital and St. Mary's HealthCare in forming a system to be led by the parent of Lexington-based St. Joseph Health System. The partners announced that their boards had approved a merger that would combine the three health care groups. The merger plan was announced last November, about the same time that the University of Kentucky and Norton Healthcare announced a similar plan that was fleshed out last week.

The system including U of L will be the largest hospital group in Kentucky. It will be led by Denver-based Catholic Health Initiatives, which owns St. Joseph and is a partner in Jewish and St. Mary's. The group will hold 10 of the 18 seats on the new organization's board in return for an investment of $620 million in the new system.

The new group must be approved by regulators and Catholic Church officials, a process that could take up to a year. It brings together hospitals, clinics, specialty institutions, home health agencies and satellite primary care centers, where more than 3,000 academic and community physicians work. “We will be increasing access to basic and advanced health services,” said Bob Hewett, a long-time St. Joseph board member who will be the first chair of the system’s community board of trustees. "That will lead to improving the health not only of individual patients, but of entire communities.” For more from The Courier-Journal, click here.

Despite the glowing appraisals and the promises of improved health care from of the proposed merger, some fear that the merger may mean less health care access. According to a story in Monday's Courier-Journal, members of the Louisville Board of Health are worried that the merger may interfere University Hospital's mission to care for the poor. In addition, the members are worried that the new merger may reduce access to reproductive services, as some Catholic hospitals limit their reproductive services. Hospital officials responded that there was no need for such worries, and U of L President James Ramsey told cn|2 Politics that the reproductive servcie would be provided at outpatient facilities.

UK finally wins $20 million grant to translate medical research into action at the bedside and in the field; now 'a member of the club'

The University of Kentucky announced Tuesday that the National Institutes of Health had awarded it $20 million over five years to help move research discoveries from the laboratory to the bedside. The grant, one of the largest research awards in the university's history, will support the UK Center for Clinical and Translational Science.

The grant, which UK had sought for five years, will support research to apply or trnslate discoveries into practical applications. “Translational research, often referred to as 'bench to bedside,' means turning laboratory findings into preventions, treatments and cures for patients through collaborations across academic units with interdisciplinary research teams,” said UK President Lee T. Todd Jr.

UK Executive Vice President for Health Care Michael Karpf told the Lexington Herald-Leader that, in addition to provide funding, the grant acknowledges UK's excellence in translational research. "This grant is recognition by the NIH that we are one of the places," Karpf said. (Read more)

The grant could mean better care for patients, not only in the UK hospital. Dr. Philip Kern, left, director of the center, told Mike Wynn of The Courier-Journal that it will affect community engagement, information management and direct patient care. "One focus of the community-based research involves improving the delivery of treatment for patients who don't receive the health care they need, Wynn reports, quoting Kern: “That is probably the one form of research that will impact Kentuckians most quickly.”

Wynn notes that 60 universities have received such grants, and writes, "The university would have lost any prospect of ranking among the top 20 research institutions without Tuesday's grant and recognition, said UK Provost Kumble Subbaswamy." (Read more)

Until now, the center has had to compete with other university units for funding. Now it will have a stready stream of money, and that goes beyond the grant, because some grant opportunities are open only universities with such continuing grants, and that usually gives each of them anotrher $2 million a year, Kern said. "This gives us much greater stability," he said. "There will be opoportunities that will come down the pike because we are now a member of the club."

The grant will help research both at the UK hospital and in the field. Patients involved in research must have beds dedicated to that purpose, to make sure the hospital has room for regular patients, and that requires not only dedicated space, but funding, Kern said.

He said one example of the type of field research that the grant can support is a project being run by Dr. Nancy Schoenberg, right, in Letcher County, using faith-based organizations to find the best ways to help individuals and community groups fight obesity.

The grant will also help UK partner with other schools, especially those in a new Appalachian translational science network. Kern said Schoenberg and a colleague at Ohio State, which is in the network, have already received a pilot grant for a community-based project to leverage social networks to increase colorectal cancer screening in Appalachia. For a description of the project, click here.

Cities' efforts to combat obesity get state, national attention

The efforts of two Kentucky cities to slim down made news this week. On Monday, The New York Times ran a story about Louisville's programs to encourage healthy eating and physical activity in an attempt to combat obesity. On Tuesday, the Lexington Herald-Leader ran a short story about the move to healthier snacks at two public pools. (Eric Crawford, sports columnist for The Courier-Journal, notes in a blog post, partly about his own weight issues, that Men’s Health magazine says Lexington ranks No. 25 in fatness nationally, while Louisville is No. 51.)

The Times story describes Louisville's eight-year effort to combat obesity by establishing bike lanes, creating pocket parks, and making sidewalks wider and safer. The effort involves multiple city agencies and grants from the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention. The results are hard to measure, sort of like a new dieter on a scale, reporter Stephanie Strom writes: "Successes on one front are countered by setbacks on another, and signs that the needle has moved overall are slight and mostly anecdotal."

Former Louisville Mayor Jerry Abramson, who started the initiative, told Strom that the impetus to reduce the city's obesity rate was economic. “For businesses, a healthy work force is more productive and less costly, so it became a competitiveness issue,” he said. “Every city was offering tax incentives, every city was offering real estate deals but not every city had the weight problem we do.”

The Herald-Leader article focuses on menu changes at two park pools' snack stands. The new menus include options like fresh fruit, grilled chicken, and yogurt. The change is a joint effort of the city Parks Department and the Tweens Nutrition and Fitness Coalition in Lexington to encourage healthier eating. As Coalition Chairman Anita Courtney told the Herald-Leader, "Concession stands are like pantries for kids in the summer. What they are stocked with is what they'll eat."

Data on hospital-acquired infections, other conditions online

The federal Centers for Medicare and Medicaid Services (CMS) has posted information about hospital-acquired conditions on its website, and The Courier-Journal not only has a story about it today, it has an easily searchable database of Kentucky hospitals.

This is not information that the Kentucky Hospital Association or the American Hospital Association wants online, at least in its current form. “You have to look at the totality of the care. And these little snapshots that CMS wants to pick out are very misleading,” KHA Senior Vice President Nancy Galvagni told C-J reporter Patrick Howington. She said the data don't allow for differences between hospitals, such as specialities, that may cause higher rates of acquired conditions.

However, Doug Leonard, president of the Indiana Hospital Association, told Howington that the industry needs to “embrace transparency. Sometimes we don't like the results of that, but I think transparency is good for us and good for the public.” Dr. Kevin Kavanagh of Somerset, chairman of the nonprofit group Health Watch USA, "said the data's greatest value may be to help hospitals spot areas that need improvement, rather than to help patients choose between hospitals," Howington writes. "In fact, a hospital shown as having a high complication rate 'may be the safest hospital to go to, because they were under pressure to get the problem corrected.'" (Read more)

The conditions tracked are trauma such as falls, infections from catheters, bedsores, poor blood-sugar control for diabetics, foreign objects left in bodies, air or gas bubbles in blood vessels, and transfusions of the wrong blood type.

Partnership between UK and Norton extended, further defined

They still haven't agreed on how to spell "health care," and don't do it as we do, but the partnership announced last November between UK HealthCare and Norton Healthcare to implement stroke, cancer, transplant, obesity, obstetrics and heart initiatives has been extended and further defined.

"We have worked to identify opportunities for collaboration to improve the access and quality of care for Kentuckians close to their homes while making sure that patients with the most complex medical issues receive the care they need without have to leave the state," said Stephen A. Williams, Norton's president and CEO.

The partnership will establish and extend stroke and obesity education programs; expand teaching programs for UK medical students so they can do a rotation at Norton hospitals; and establish a transplant and specialty clinic in Louisville. Research initiatives in obesity and cancer are also part of the collaboration.

All of the work being done is meant to target what outgoing UK President Lee Todd calls "the Kentucky uglies," the state's most troubling and chronic health issues. According to Business Lexington, Kentucky ranks 15th nationwide in deaths per 100,000 caused by stroke or related disease. Kentucky is in the top five for cancer incidence and leads the country in lung cancer. In 2009, Kentucky's obesity rate was the fourth highest in the country and cost the state about $1.3 billion in health costs. And there is a shortage of obstetricians in the state, with as many as 71 of the state's 120 counties without an obstetrician. (Read more)

Legislators question if Medicaid is ready for managed care

"State lawmakers on Thursday questioned whether the state has the resources and expertise to oversee moving the $6 billion Medicaid program to private, for-profit managed care companies," Beth Musgrave of the Lexington Herald-Leader reports.

Staff of the Interim Committee on Program Review and Investigations, chaired by Republican Sen. Jimmy Higdon of Lebanon, left, reviewed reports and found state Medicaid staff did not adequately analyze their current program to determine if there were savings or if there were waste and abuse. These reports "quite frankly, have us concerned that the cabinet is not fully prepared" to switch to and monitor managed care by July 1, as per the deadline, Higdon said.

In testimony, officials with the Cabinet for Health and Family Services told lawmakers they do feel they have the expertise to handle managed-care contracts. Neville Wise, acting Medicaid commissioner, said part of the contract monitoring will be done by an independent contractor. He did not say the cabinet would be ready to implement managed care by July 1.

Sen. Vernie McGaha, R-Russell Springs, also asked cabinet officials how they will assess whether managed-care organizations save the state money once they are implemented en masse. The cabinet could not determine if the only managed care organization already in place, Passport Health Plan in the Louisville region, saved the state money. That was one of the weaknesses pointed out in a highly critical audit by state Auditor Crit Luallen.

Moving to managed care is the centerpiece of Gov. Steve Beshear's proposal to fill a $166 million gap in the Medicaid budget. Senate President David Williams, R-Burkesville, says he is unconvinced. Williams is running against Beshear for governor in the Nov. 8 election. (Read more)

Nine breast cancer programs get total of $360,000 from Komen

Nine programs in Central and Eastern Kentucky will share $360,000 for breast cancer screening, treatment, education and patient navigation.

The grants go to breast cancer-specific projects of the Lexington-Fayette County Health Department; the Kentucky Pink Connection; Central Baptist Hospital; St. Joseph Breast Center; King's Daughters Medical Center; Mountain Comprehensive Health Corp.; Our Lady of Bellefonte Hospital; Dayspring Family Health Center; and North Central Area Health Education Center. Programs chosen were determined to have the greatest impact on underserved women in a 58-county service area, the Lexington Herald-Leader reports.

The grants were awarded by the Lexington affiliate of Susan G. Komen for the Cure. Another $100,000 raised in Kentucky went to the Susan G. Komen for the Cure National Grants Program to fund research. (Read more)

Heartburn on the rise, driven by overeating; avoid minty antacids

As overeating has become more common, Americans have been suffering from a lot more heartburn, the American Gastroenterology Association has found. About 25 million people say they experience daily symptoms of acid reflux, up from 15 million a decade ago, with another 60 million saying they have heartburn once a month.

"Blame stress and an aging population — and above all, experts say, blame Americans' habit of eating too much," reports The Courier-Journal's Anita Creamer.

Though it can occur at any age, acid reflux is most common in middle age. It is caused when acid backwashes into the esophagus while a person is digesting, the result of the sphincter muscle at the top of the stomach being weak. Acid reflux, which can cause heartburn, nausea, coughing and hiccups, can be especially common at night if a person goes to bed with a full stomach. "Anything that increases stomach pressure increases reflux," said Dr. Ronald Hsu, a gastroenterologist at Sutter Roseville (Calif.) Medical Center. "People who are more obese have more symptoms. Pregnant women can have more reflux."

To get relief, avoid mint-flavored antacids. Mint relaxes the valve between the stomach and esophagus, compounding the problem. Losing weight can help. So can avoiding chocolate, citrus fruits, alcohol, caffeine or spicy foods. Over-the-counter medications like Prilosec and Prevacid can block the release of stomach acid and provide relief.

People who regularly have acid reflux are more prone to developing esophageal cancer, which has been relatively rare but is difficult to treat and is quickly becoming more common. Most at risk are middle-age and elderly men who have long suffered from acid reflux and often are obese. (Read more)

EPA says DEET is safe for fighting off skeeters when used correctly; some natural alternatives are also effective

Though April showers did bring May flowers, May's seemingly constant rain also grew something else in Kentucky: mosquitoes — and lots of them. To protect oneself from the irritating suckers (Getty Images), there is a host of products from which to choose.

The most obvious are products containing DEET, a synthetic compound that was approved for the general public in 1957, reports Amanda Leigh Mascarelli of the Los Angeles Times. DEET is used by 30 percent of Americans each year, the Environmental Protection Agency reports. A 2009 market survey showed products containing the compound accounted for 90 percent of the insect repellent market.

(LAT photo Kirk McKoy) Though popular, DEET has its drawbacks. It can dissolve some plastics, such as soldier's goggles, watchbands and computer keyboards. It can pollute soil and water, is sticky on skin, is not effective against all insects, and is smelly. Is it unsafe? That is a common conception, but EPA insists it is safe when used properly. "There really is no chemical out there that works better than DEET," said Donald Roberts, a retired professor of tropical public health at the Uniformed Services University of the Health Sciences. (Read more)

There are more natural alternatives on the market. Oil of lemon eucalyptus (LA Times photo by Hatley Mason), which is sold under the name Citriodiol, has been proven effective for six or more hours and is found in brands like Repel, Cutter and Coleman Botanicals. Though more natural than DEET, it is still considered a hybrid natural/synthetic product.

A pine oil derivative called isolongifolenone also shows great promise, though testing is still ongoing. "It does look as if this organic repellent functions pretty much at an equal level with DEET, maybe even better," Roberts said. "Until we have a lot more test data, it would be hard to give a definitive statement on that, but I would say that it shows real promise." It is hoped the product will be on the market within 18 months.

Unlike compounds such as DEET, natural repellents are characterized as "minimum-risk pesticides" by EPA, making them "exempt from safety testing because their active and inert ingredients have been deemed safe for intended use," Mascarelli reports. But the manufacturers do not have to prove how well these natural repellents work. For the most part, they do work, but generally not for very long. The lemon-eucalyptus and pine oil alternatives seem to be the exception. (Read more)

Kentucky and other states slow to adopt health-law mandates

Though it's one of the centerpieces of the new health care law, most states have not taken steps to establish a health insurance exchange, and that incluides Kentucky. The exchanges are meant to make it easier and less expensive for people who buy their own coverage to compare health plans.

"So much of this stuff is speculation," state Rep. Tom Burch (D-Louisville) told The Washington Post when asked why the state has not moved to set up an exchange. He said his party was "simply waiting for the Obama administration to issue regulations spelling out federal requirements in more detail." Burch is chairman of the House Health and Welfare Committee.

Despite a deadline of January 2013 to prove to the federal government they are getting ready to establish the exchanges, just seven states have adopted laws that outline the details of them. Two others, Virginia and North Dakota, have adopted legislation showing intent to form an exchange. Seven more states have not passed any legislation that pertains to an exchange, but have accepted grants meant to prepare for them. More than 10 states have defeated or haven't acted on proposed bills to establish exchanges. About 13 other states haven't even broached the matter on their committee floors.

States also seem to be grappling with an impending Medicaid deadline. Because the new health-care law expanded the income guidelines for Medicaid eligibility, states will have to provide care for a broader range of Americans starting in 2014. But a report by the National Governors Association and the National Association of State Budget Officers shows that states are struggling to pay for the program as it is now.

The report shows 43 states have passed laws to contain Medicaid costs, and nearly half of the states have reduced payments to physicians, hospitals and other health-care providers. More than 20 have agreed to lower spending on prescription drugs, and 20 have restricted some services. For the coming year, "45 governors proposed further cuts, the report says, without specifying which reductions were adopted by legislators," Goldstein and Aisenman report. (Read more)

Kentucky legislators grappled in a special session to fill a $166 million gap in Medicaid funding this year, and the state is turning to managed-care organizations to run the program.

On 30th anniversary of AIDS detection, it is no longer a death sentence, but Kentuckians die because they delay testing

Though life expectancy for people living with AIDS has improved, the disease "remains a serious health threat, with Kentucky's minorities and poor being affected in disproportionate numbers," reports the Lexington Herald-Leader's Mary Meehan.

Part of the problem is the stigma associated with the disease, which was first reported by the Centers for Disease Control and Prevention 30 years ago yesterday. It is especially problematic in rural parts of the state. "We have clients in rural areas of Kentucky who hide their medication so if something happens to them, their family members won't find out," said Mark Royse, executive director of AVOL, an education- and support-based organization for people living with AIDS.

The stigma is associated with the perception of the disease, which in turn prompts people to avoid being tested. "AIDS was marginalized early on as a 'gay' disease," said Dr. Robert Crosby, an AIDS researcher and chairman of the department of health behavior in the University of Kentucky's College of Public Health. "Later, it was associated with drug users, promiscuous heterosexuals or people who live in other countries, such as Africa. "The point to drive home is that a lot of people think of Africa or China or India when they think of AIDS," Royse said. "This issue is still very real here at home."

Kentucky ranks 19th in the country for the number of people who have the HIV infection that leads to AIDS, according to the Kaiser Family Foundation. "Health officials say that at least one new HIV infection is discovered each day in Kentucky," Meehan reports. Nationally, about 20 percent of people who have HIV don't know they are infected.

The earlier people discover they have HIV, the better the treatment works, but early detection is not commonplace in Kentucky. By the time they are tested for HIV, 30 percent of Kentuckians already have full-blown AIDS. Still, that diagnosis is no longer a death sentence. Though at one time 100 percent of Kentuckians infected with HIV died within five years, now 82 percent are alive after the same time period. However, there has been a spike in infection among 18- to 24-year olds, despite early education to avoid unprotected sex. "They say, 'That person doesn't look like they have AIDS'," so decide to have unprotected sex with that person, said Jessica DuMaurier, in charge of the HIV program at the Lexington-Fayette County Health Department. (Read more)

Ten counties getting $5,400 each for farm-to-school programs

More than $50,000 in grants were awarded to Kentucky school districts this week to start or expand farm-to-school programs, an effort meant to support local farmers and get healthier meals in school cafeterias. Funding was given to Calloway, Carlisle, Daviess, Fayette, Madison, Marshall, Mercer, Owsley, Perry and Woodford counties. Each county got $5,400.

County health departments will form teams of school food-service directors, teachers, farmers and community advocates. "These teams will implement activities in local schools that include three program areas — cafeteria, classroom and community — as a way of educating children about what they eat; what they learn about food; and what they observe in their communities," said a press release from the Kentucky Department for Public Health.

Funding was awarded by the department's Obesity Prevention Program. For more information about farm-to-school programs in Kentucky, click here.

Teens don't need sports drinks unless they are playing sports, and shouldn't consume energy drinks, experts say

Though teens are increasingly consuming sports and energy drinks, the beverages don't offer them any benefits, a report contends. In fact, teens should only consume sports drinks like Gatorade if they're actually playing sports and avoid caffeinated energy drinks like Red Bull entirely, reports Alice Park of Time magazine's Healthland. "Water, not sports drinks, should be the major source of hydration for adolescents," said Dr. Marcie Schneider said.

The report was compiled by the American Academy of Pediatrics' Committee on Nutrition and its Council on Sports Medicine and Fitness. It found many teens consume sports drinks (Getty Images photo) in the school cafeteria, in part because sodas are increasingly being taken out of school vending machines. Sports drinks have extra carbohydrates and electrolytes, which can be beneficial after intense workout sessions. "But outside that setting — and honestly most of our teens and children are way outside that setting — they don't need sports drinks," Schneider said. The extra carbs are just extra calories. They also can erode enamel from teeth and cause dental problems.

Energy drinks are similar to sports drinks, but have the added ingredient of caffeine, which kids also don't need. "We know that caffeine raises heart rate, blood pressure, speech rates and motor activity, and affects how much acid your stomach secretes, your body temperature and how much you sleep or don't sleep" Schneider said. These drinks can make children who are already anxious have more anxiety and rev up kids with attention deficity hyperactivity disorder even more. "Do these kids really need caffeine as part of their lives? The answer is no." (Read more)

Plate is replacing food pyramid as guide to a balanced diet

A segmented plate is the U.S. Department of Agriculture's new icon for what to eat. It will replace the long-used food pyramid, which critics say is confusing. It makes clear a general consensus of nutrition experts about what amounts of what types of foods should make up a balanced diet.

MyPlate dedicates the most space to vegetables and grains, with fruits and protein each getting less than a fourth of the plate. Looking like a glass or cup on the side of the plate, a circle for dairy products gets a bit less. The graphic makes a clear point: "Make half your plate fruits and vegetables," Robert Post, an official at USDA's Center for Nutrition Policy and Promotion, told told Brian Vastag of The Washington Post.

The new graphic was unveiled Thursday at USDA headquarters. First Lady Michelle Obama, who is a strong advocate for improving child nutrition, attended and said, "Kids can learn to use this tool now and use it for the rest of their lives. It's an image that can be reinforced at breakfast, lunch and dinner." Indeed, children will be exposed to the image, as they were the food pyramid, through USDA's school-food programs. The new graphic was designed to combat obesity, Agriculture Secretary Tom Vilsack said. (Read more)

Retiring Boyle County health director has played important roles in the community; many of his counterparts do likewise

The man behind Danville's smoke-free ordinance is stepping down from his position as Boyle County's public health director. "I've got a 100-acre farm and I plan to pursue those interests and do some extensive traveling," Roger Trent told The Advocate-Messenger's Mandy Simpson. (Advocate-Messenger photo)

Trent has been at the helm of the health department for 12 years. During his tenure, he "successfully lobbied the Danville City Commission to pass an ordinance banning smoking in all enclosed public places of employment," Simpson reports. He also started smoking cessation classes at the health department, collected food for families in need, and headed efforts during the 2009 ice storm. "He will certainly be missed, and I hope we can find somebody equivalent," said David C. Liebschutz, chairman of the Boyle County Board of Health.

Al Cross, director of the Institute for Rural Journalism and Community Issues and publisher of Kentucky Health News, commented on Trent's impact on his community: "County health directors rarely get noticed except when they create controversy or retire," he said. "They play, or should play, a more important role in the community than local news media might suggest." (Read more)

Pediatrics academy tells parents to monitor kids' online activities

A report from the American Academy of Pediatrics stresses children's physicians can play a vital role in educating parents about setting limits for kids when it comes to technology like texting and Facebook.

"Pediatricians are in a unique position to help families understand these sites and to encourage healthy use," the report says. The academy recommends that parents communicate often with their kids about time spent on computers, both to make sure it is not harmful to them and it doesn't conflict with family time. "I think even in the tween years, this has to be happening because ... more and more, pop culture is percolating down to tweens," Dr. Kathleen Clarke-Pearson, a North Carolina pediatrician and co-author of the report, told The Courier-Journal's Darla Carter.

Parents should look for signs of sleep deprivation and "Facebook depression," which can happen when children spend a lot of time on social media sites. Parents should also have a plan regarding when electronics should be allowed to be used at home, during dinner or at bedtime, for example. Parents should also talk to their children about how to be a "responsible digital citizen," Clarke-Pearson said, which involves talking about subjects like sexting, cyberbullying or posting inappropriate matter or comments.

Kids and teens can be influenced by social media and other websites to try risky behavior, such inhaling chemicals or trying the choking game, experts say. "The mantra basically is it's not going to happen to me, so they will do these things because everybody else is," Dr. Hatim Omar, a pediatrics professor at the University of Kentucky, told Carter.

Earlier this year, the academy reported about one in five teens log onto their favorite social media site more than 10 times a day, and more than half log on more than once a day. "It also notes that 75 percent of teens own cell phones and 25 percent use them for social media while 54 percent use them for texting and 24 perfect use them for instant messaging," Carter notes. (Read more)

Louisville doctors help woman with extremely rare condition

Louisville doctors have helped a woman with an extremely rare type of dwarfism deal with the deterioration caused by her disorder. Monica Zaring, who is one of just two women in the world who has osteodysplastic microcephalic dysplasia, has had her shoulder joint replaced using custom-made implants and instruments, The Courier-Journal's Laura Ungar reports.

The 3-foot-6 Bellarmine University student (C-J photo by Matt Stone) started having problems when she woke up one morning last year and couldn't move her right arm. Over time, she was able to move it again, but not without severe pain. Doctors found arthritis had caused the cartilage to deteriorate, causing the joint's bony surfaces to rub on each other. "We needed to do something," said Dr. Ryan Krupp of Norton Orthpaedic Specialists, who was the lead surgeon.

So began months of preparation, part of which involved designing a custom-made shoulder stem, head and socket. Custom instruments were also needed to install the implants. "Krupp even flew to a company lab in New Jersey to try the instruments on a cadaver to make sure they would work," Ungar reports.

The Dec. 7 operation took 90 minutes and Zaring spent four days in the hospital, resulting in a $85,000 hospital bill; she is covered through her mother's insurance. Norton Healthcare officials would not say how much the procedure cost, but the custom implant was 47 percent more expensive than a standard one. However, the operation was considered necessary. Zaring, who plans to graduate in December with a degree in communications, does not dwell on future health problems that will likely be caused by her condition. "I have challenges," she said. "But if if I let them get me down, I'd always be sad." (Read more)

E-cig, hookah ban takes effect Monday in Madison County

Electronic cigarettes and water pipes known as hookahs will be banned in enclosed public places in Madison County beginning Monday under an amendment to the county's existing smoking ban.

The ban, which has been in effect since 2007, was amended in April by the Madison County Board of Health. In addition to adding the e-cig and hookah regulations, the amendment also prohibits smoking in retail tobacco stores, reports the Lexington Herald-Leader's Greg Kocher.

Madison County is not the first jurisdiction to ban e-cigs and hookahs. Bardstown and Glasgow prohibit the use of e-cigarettes in their smoking bans. The Bullitt County Board of Health also approved a ban, which takes effects in September, that prohibits them. Effective July 1, a campus-wide tobacco-free policy that includes e-cigarettes and hookahs takes effect at St. Catharine College in Washington County. Lexington's smoking ban does not include e-cigarettes. (Read more)