To lose weight, burn more calories than you consume; you need to exercise more and eat less

As many can attest, just dieting or just exercising does not always lead to weight loss, and this often leads to frustration, especially in a society where more than one-third of U.S. adults are obese.

The solution to this problem is energy balance, according to a paper published collaboratively in the official journals of the American College of Sports Medicine and the Academy of Nutrition and Dietetics.

“It is time we collectively move beyond debating nutrition or exercise and focus on nutrition and exercise,” co-author Melinda Manore said. “Nutrition and exercise professionals working collaboratively, combined with effective public health messaging about the importance of energy balance, can help America shape up and become healthier.”

It is not as if U.S. adults don't think about their weight, diet or physical activity. The Pew Research Center found that 60 percent of U.S. adults say they track their diet, weight or exercise routine. But despite all this awareness, Americans remain obese.

Obesity is known to lead to diabetes, heart disease, cancer, high blood pressure other huge health issues in Kentucky. According to the F as in Fat report, 31.3 percent of Kentuckians are considered obese, a number that has increased steadily since 1990, when the rate was only 12.7 percent. And with this high rate of obesity, Kentucky has the diseases that go with it. Kentucky ranks first in the nation for cancer deaths, eighth in cardiovascular deaths and 13th in diabetes, according to a report from America's Health Rankings.

People need to understand that diet and exercise must be combined to move toward a solution to the obesity epidemic, according to the authors.

The National Institute of Health also encourages energy balance. Describing energy balance as the balance of calories consumed through eating and drinking (energy in) compared to calories burned through physical activity (energy out).  The same amount of energy in (calories consumed) and energy out (calories burned) over time will cause your weight to stay the same. More energy in than energy out over time will cause weight gain, and more energy out than energy in over time will cause weight loss.

The paper outlines the following steps to incorporate energy balance principles into public health outreach in the U.S.:

• Make energy balance a part of the curriculum for both exercise science and nutrition professionals. Collaboration is the key.
• Create competencies for schools, making physical education teachers energy balance advocates. 
• Use federally-funded nutrition programs to incorporate energy balance solutions.
• Develop a public relations strategy to promote energy balance solutions. 
• Recognize and support existing programs that already emphasize energy balance strategies. 

 “Our health professionals are currently working in silos and must work together to educate and promote energy balance as the key to better health,” Manore said. “The obesity crisis is one of the greatest public health challenges of our generation. Energy balance can help us work toward a solution so our children aren’t saddled with the same health challenges we currently face.”

HANDS program provides support and information to 12,000 Ky. parents to help them raise healthy, happy children

A Kentucky health-care program that focuses on families who are pregnant or expecting a baby currently supports around 12,000 households in an effort to promote better outcomes for these children, Don Weber reports for "Pure Politics" on cn|2, a service of TimeWarner Cable.

The Health Access Nurturing Development Services program, commonly called HANDS, has expanded its services to not only provide services for first-time families, but also help parents who have other children.

The program is designed to provide intensive support to families through home visits using a structured curriculum, Weber reports. Specialists talk to the parents in home visits about the importance of bonding with their child before birth, developmental stages of the child, and its specific needs—such as clothing, food and furniture—and safety issues. The specialist also provides a weekly sounding board for questions and concerns of often-stressed parents of newborns.

"When we come to visit with you, not only do we want to have fun, but we want to be able to share information with you about your baby's development, about pregnancy, just about new research that is coming out," HANDS specialist Amber Green told Weber. "But what we don't want to do is tell you the how-tos and the what-fors. We just want to share with you information about during pregnancy, maybe your child's development, what maybe you can expect around milestones; but we are there to do it in a way that you can choose what information works best for your baby."

The four goals of the outreach program, which Kentucky finances with money from the states' 1998 settlement with tobacco manufacturers, are:

• Providing positive pregnancy outcomes
• Optimal child growth and development
• Allowing children to live in healthy, safe homes
• Helping families make decisions that enhance long term independence over meeting short term or immediate needs.

Clark County is the "biggest user per capita" in Kentucky, serving more than 4,900 families through over 57,000 visits since the programs inception in 1999, Weber reports.

Health advocates recommend teaching children benefits of healthy food, even raw, to adapt to school-meal guidelines

Health advocates say that teaching people, especially children, about nutrition and the value of new federal guidelines for school meals can help improve Kentucky's health, Jacqueline Pitts reports for "Pure Politics" on cn|2, a news service of TimeWarner Cable.

Some schools have thrown away food because the students do not like the new, healthier meals and don't eat them. "The problem is the kids are saying they don't want this. You are trying to force them to eat things they don't want, and they go elsewhere," U.S. Rep. Hal Rogers, R-Somerset, said last month at a subcommittee meeting of the House Appropriations Committee, which he chairs and which approved a one-year waiver from the rules for schools losing money on meals.

Susan Zepeda

Foundation for a Healthy Kentucky President Susan Zepeda told Pitts that more education about nutrition needs is needed so students and parents will understand why healthier meals are so important. "If we saw kids throwing out the toothbrushes after we taught them how to brush and floss, we wouldn't stop teaching them how to brush and floss in schools," Zepeda said. "Sometimes as grownups and parents we have to nudge the children we are responsible for in a healthier direction."

Zepeda said that when she was young, she thought all vegetables were soft and mushy and didn't taste good because her mother used a pressure cooker, but when she started picking corn, tomatoes and peas, she found that raw vegetables tasted delicious. She said young Kentuckians should be taught to appreciate the "natural wonderful tastes of the foods we grow right here in Kentucky."

Rep. Leslie Combs

State Rep. Leslie Combs, D-Pikeville, who recently had a heart attack, told Pitts she is looking for ways to deal with the state's health issues and believes access to fast food and lack of physical activity play a significant role, especially in Eastern Kentucky, where several health issues connect.

"I think we need to work a lot on our role and in our capacity with our region to say 'we got to get this obesity rate down," Combs said. "That is huge because that ties itself to the high rate of diabetes that we've got. We still have a lot of smokers in our region, and this is a direct correlation between the health issues we've got, and the obesity brings itself into the heart issues." (Read more)

N.Y. Times, using lifespan, disability, obesity and 3 other factors, says 6 E. Ky. counties among 10 worst U.S. places to live

Six adjoining counties in the Eastern Kentucky Coal Field rank among the nation's 10 hardest counties to live in, as defined by six factors compiled by The New York Times to measure quality and longevity of life: education, income, unemployment rate, disability rate, obesity rate and life expectancy.

"Clay County, in dead last, might as well be in a different country," Annie Lowrey writes. "The median household income there is barely above the poverty line, at $22,296, and is just over half the nationwide median. Only 7.4 percent of the population has a bachelor’s degree or higher. The unemployment rate is 12.7 percent. The disability rate is nearly as high, at 11.7 percent. (Nationwide, that figure is 1.3 percent.) Life expectancy is six years shorter than average. Perhaps related, nearly half of Clay County is obese."

Also on the list from Kentucky are Breathitt, Jackson, Lee, Leslie and Magoffin counties. The article did not name the other four worst counties. Lowrey continues, "It’s coal country, but perhaps in name only. In the first quarter of this year, just 54 people were employed in coal mining in Clay County, a precipitous drop from its coal-production peak in 1980. That year, about 2.5 million tons of coal were taken out of the ground in Clay; this year, the county has produced a fraction of that — just over 38,000 tons."

"The public debate about the haves and the have-nots tends to focus on the 1 percent, especially on the astonishing, breakaway wealth in cities like New York, San Francisco and Washington and the great disparities contained therein," Lowrey writes. "But what has happened in the smudge of the country between New Orleans and Pittsburgh — the Deep South and Appalachia — is in many ways as remarkable as what has happened in affluent cities. In some places, decades of growth have failed to raise incomes, and of late, poverty has become more concentrated not in urban areas but in rural ones."

James P. Ziliak, the director of the Center for Poverty Research at the University of Kentucky, told Lowrey, “One of the challenges that faces Eastern Kentucky is the remoteness of the area. It’s difficult to get to a lot of places. The communities are small, and they’re spread apart, so you lose that synergy that you want to spark development a lot of times... My view is that firms will never locate into a community with an unskilled labor force, unless the only labor they need is unskilled. And there has been a historic lack of investment in human capital in these areas.” (Read more)

Kentucky school nutritionists meet amid some opposition to federal school-lunch guidelines aimed at curbing child obesity

Kentucky schools are working to adjust to the federal nutrition requirements for school lunches, but are facing some opposition from students, parents and some school nutritionists. The U.S. Department of Agriculture guidelines, aimed at curbing childhood obesity, require schools to include a fruit and vegetable with every meal, to switch to 100 percent whole grains by next year, to impose age-based restrictions on calorie and sodium intake, and to serve 1-percent-fat milk. Now the School Nutrition Association, which recently started getting half its money from major food companies, and other groups are supporting legislation to offer a one-year waiver to schools losing money on meal programs.

School nutritionists from all over Kentucky, which ranks high in child obesity, are encouraging students to eat healthier food throughout the school day. "About 700 school cooks, managers and administrators are meeting for a statewide conference this week in Lexington," reports Stu Johnson of WEKU-FM and Kentucky Public Radio. from a meeting of the Kentucky School Nutrition Association.

KSNA President Sabrina Jewell told Johnson that many students in the upper grades are not eating the newfangled meals, and some are even leaving campus to eat elsewhere. Federal funding is based on participation, "so, if they don't eat, then we don't have the money to run our programs. General school taxes and all, they don't pay for school nutrition. We're paid off of the meals that we serve."

However, Jewell said elementary-school children are adapting better to the new standards than middle and high schoolers. The switch "is just taking a little longer than we anticipated," she said. (Read more)

First Kentuckian gets Caribbean virus, chikungunya or CHIK-V

State officials have confirmed Kentucky's first case of the Caribbean virus chikungunya—or CHIK-V. The first case is an Anderson County man who recently went to Haiti. Though CHIK-V is not native to Kentucky and doesn't usually result in death, officials encourage those who have recently visited the Caribbean and who may be experiencing symptoms to visit the doctor to make sure they don't have the disease, Josh James reports for WUKY-FM.

The mosquito-borne disease occurs most often in Africa, East Asia and the Caribbean islands, but the federal Centers for Disease Control has been observing the spread of the virus hoping that it won't become a significant issue in the United States like the West Nile did more than 10 years ago, Val Willingham reports for CNN. Several weeks ago, the number of cases in the Caribbean exceeded 170,000, and the number of deaths from the disease was 14, Lisa Schnirring reports for Center for Infectious Disease Research and Policy. 

The disease can cause joint pain and arthritis-like symptoms, and those with weak immune systems are especially at risk for worse symptoms. The disease is transmitted from mosquito to human and from human to mosquito. Though about 25 to 28 travelers bring CHIK-V to the U.S. every year, "We haven't had any locally transmitted cases in the U.S. thus far," said Roger Nasci, chief of the CDC's Arboviral Disease Branch in the Division of Vector-Borne Diseases.

"Someone would have to be bitten by an infected insect to become ill. Person to person contact does not spread the disease," Kevin Hall of the Lexington-Fayette County Health Department said, James writes. However, it's worth noting that Kentucky is "home to both species of mosquito known to carry the virus," James reports.

AARP ranks Kentucky last in the nation for long-term care and support for aging, disabled and family caregivers

Kentucky ranks last in the nation in its long-term care services and support for seniors, people with disabilities and family caregivers according to a report compiled by AARP, formerly the American Association of Retired Persons. The state ranked 46th in the last study, in 2011.

Long-term services and support, which includes home-care services, family-caregiver supports and residential services such as nursing homes, were evaluated in five different areas with a total of 26 indicators.

Kentucky ranked 51st in affordability and access, 50th in choice of setting and providers, 50th in quality of life and quality of care, 46th in support for family caregivers and 42nd in effective nursing-home transitions.

“The vast majority of older Kentuckians want to live independently, at home, as they age – most with the help of unpaid family caregivers,” Jim Kimbrough, state president of AARP Kentucky, said in the group's online newsletter. “Even facing tight budgets following the Great Recession, most states made clear progress to help older residents achieve that goal. It’s time for Kentucky to step up to the plate, and this Scorecard shows what we have to do.”

The highest ranked states – Minnesota, Washington, Oregon and Colorado – have implemented laws and policies that build stronger Medicaid programs and support family caregivers, AARP said. These states show a decreased use of nursing homes and a minimized disruption in the transition between health care settings.

The report said Kentucky spends 81 percent of its funds aging and physical disability on institutional care, and only 19 percent on community-based care. In addition, waiting list for many programs at the Department of Aging and Independent Living are as long as five years.

AARP reports that more than 730,000 Kentuckians are considered unpaid family caregivers often because the cost of long-term care remains unaffordable for most middle-income families.

Since 2011, 24 states increased the percentage of Medicaid funds that support home- and community-based services. Kentucky did not, and ranks 50th among the states and the District of Columbia.

"Marsha Hockensmith, executive director of Kentucky Protection and Advocacy, a state agency that advocates for Kentuckians with disabilities, said many people who end up in a long-term-care facility can often be cared for adequately at home if they had access to the services they need," Mike Wynn of The Courier-Journal reports.

29 Kentucky water systems violated health-related standards for drinking water in 2013; here's a detailed list

Twenty-nine Kentucky water systems committed health-related violations of federal drinking-water rules in 2013. Each public water system is required to give its customers an annual report on its adherence to the federal Safe Drinking Water Act and state regulations implementing it, but the notices usually produce few news stories, even when they are published in local newspapers.

The reports from the state Division of Water to the U.S. Environmental Protection Agency report the violations in the aggregate, not the specific, so Kentucky Health News asked the division for a list. The most common violations were for compounds that are usually a byproduct of drinking-water chlorination: trihalomethanes, some of which can cause cancer, and haloacetic acids, which are suspected of being carcinogenic but have not been proven to be so. Other violations were for the presence of coliform bacteria, which are common in the feces of warm-blooded animals, and turbidity, which has no direct effects but can make water more susceptible to contamination.

The systems in violation of the health-related standards were (one each unless noted): Beattyville (turbidity and coliforms), Campton (2 for haloacetic acids), Carlisle (trihaolmethanes, 2 for haloacetic acids), Cave Run Regional Water (2 for organic carbon), Christian County (coliforms), Earlington (coliforms), Falmouth (haloacetic acids), Franklin (turbidity), Hartford (3 for trihaolmethanes, 4 for haloacetic acids), Hazard (haloacetic acids), Jessamine County (coliforms), Jessamine South Elkhorn (coliforms), Kentucky-American Water Co. (turbidity), Kirksville (coliforms), Knox County (coliforms), East Laurel (coliforms), Liberty (2 for haloacetic acids), Lynch (4 for organic carbon), McKee (3 for turbidity), Martin County (trihaolmethanes, haloacetic acids), Mayking Head Start Center (trihaolmethanes), Millersburg (2 for haloacetic acids), North McLean County (turbidity, coliforms), Morehead (turbidity), Rattlesnake Ridge (coliforms), Salyersville (turbidity), Warren County (coliforms), Williamstown (turbidity), Ellis Park (coliforms) and Northpoint Training Center (haloacetic acids). For a list of the violations by category, click here.

Russell Co. school board plans to make all campuses tobacco-free, renews free-lunch-for-all plan after breaking even

School districts in Kentucky often deal with health issues. The Russell County Board of Education dealt with two important ones, tobacco use and school lunch, in its meeting last week.

State officials are pushing to get schools to make their campuses tobacco-free as a way of discouraging smoking, since Kentucky has the highest percentage of smokers in the nation and ranks near the top in youth smoking.

The Russell County school board heard first reading of a policy that would ban use of tobacco products on all school campuses at any time, including events such as outdoor athletic contests. "Board Member Gerald Murray indicated that those who attended the meeting were for the complete ban, and wanted the public informed that if they had concerns, either for or against the ban, they need to attend the next board meeting to be heard," The Times Journal of Russell Springs reports. "The next reading and vote will be at a special called meeting on June 30."

June 30 was the original deadline for school districts to decide whether to participate in the federal program that makes free meals available to every student in school districts with certain levels of poverty and public assistance.

The board voted to stay in the program after Nutrition Director Susan Melton reported "the program has resulted in a 73 percent breakfast participation rate, an increase of 28 percent compared to 2012-2013 school year, and nearly double the state breakfast participation rate of 39 percent," the Times Journal reports. "The lunch participation rate was 90 percent over the last school year, up eight percent from 2012-2013."

The newspaper notes that the district has to pay only 6 percent of the cost, compared to 20 percent in the normal program, which charges some students regular or reduced prices for meals based on their family income. Some school districts have not joined the program, saying they might lose money on it, and Russell County feared likewise, but Melton said it "has been essentially 'break even' for the county" and has benefits; research has shown that hungry children are less able to learn.

“We went into this last year understanding we may lose $12,000 to $15,000,” Board Member Steve Kerr said. “But we all agreed that if we did lose that it was still well worth it. And with it being a break even situation you couldn't ask for anything better than that. And with the way it looks for the coming school year, I'm extremely pleased with it. Our students are the ones who benefit so that makes everything worth it.”

The state Department of Education expects about 100 of Kentucky's 173 public school districts to participate during the coming school year in a federal program that makes free meals available to all children in a school if at least 40 percent of its students already qualify for free meals through federal programs, Valarie Honeycutt Spears reports of the Lexington Herald-Leader reports.

State Supreme Court says county boards of health cannot enact smoking bans by regulation

By Al Cross
Kentucky Health News

County health boards in Kentucky do not have the power to ban smoking in public places, the Kentucky Supreme Court ruled without dissent Thursday.

The decision was a stiff blow to health officials who see smoking as the primary factor in making Kentucky one of the least healthy states, and have sought state and local smoking bans to limit exposure to second-hand smoke. It struck down a ban in Bullitt County and presumably will do likewise for those enacted by the Clark, Madison and Woodford county health boards, which joined the case. (Click on map for larger version)

Justice Bill Cunningham, who wrote the decision, noted that the U.S. surgeon general has found "many of the chemicals inhaled through second-hand smoke are known carcinogens" and "that even short-term exposure to second-hand smoke can result in serious health consequences. In 2009-10, overall second-hand smoke exposure by Kentucky adults was 51.4 percent, with 30 percent reporting exposure in the workplace and 32.8 percent reporting exposure in public places. Given such dismal data, it is understandable that many health-care professionals and government officials have sought to curtail the prevalence of this noxious fume. Promoting a smoke-free society is a reasonable goal grounded in sound research. However, when promotion becomes enactment, even the most virtuous causes must also be grounded in law."

Health boards enacting bans have relied on a 1954 state law that gives them to power to adopt regulations "necessary to protect the health of the people." To find that law as "sufficient grounding for the regulation," Cunningham wrote, the court would have to construe the law "as delegating the totality of the Commonwealth's police power to the health boards. Nothing would remain to be ceded by the General Assembly, including the critical legislative charge of distinguishing virtue from vice."

Cunningham said such a ruling would "promote an overly broad delegation of legislative sovereignty," in violation of the state constitution. He said the authorization of regulations was limited, and was based that view on what he called the law's legislative history. In 1954, he wrote, "It would have been
commonplace for members of the General Assembly to indulge in a cigarette or cigar in their offices, committee rooms, or even on the floors of the House and Senate chambers. Most likely, the . . . legislation was debated and voted in chambers fogged with a haze of smoke."

Thursday's decision overturned a 2-1 ruling of a Court of Appeals panel that relied partly on the 1984 Supreme Court decision that upheld a Jefferson County regulation on lead paint. Cunningham said that was based on a law that "specifically addressed lead poisoning and expressly authorized and encouraged action at the local level," and "There is no similar statutory mandate" in state law for smoking bans.

Cunningham also noted that most of the Jefferson County board is appointed by local officials, while health boards in other counties are appointed by the state health secretary "and not by duly elected representatives. When regulating controversial issues traditionally within the province of state or local legislative entities, this structure is constitutionally problematic in that it does not comport with traditional notions of representative government." In this case, the Bullitt County Fiscal Court filed a lawsuit challenging the health board's authority.

The appeals court, in rejecting the fiscal court's case and overturning the local circuit court, also relied on a 1967 decision upholding a local health board's regulation of private sewage disposal systems. Cunningham said that decision was strongly based on earlier cases on the topic, and in contrast, there is no "well-established line of authority regarding the need for administrative regulation of smoking and second-hand smoke."

Finally, Cunningham said legal precedents in Kentucky say that "Where reasonable doubt exists concerning the proper scope of an administrative agency's authority, it should be resolved against the agency," and "An increase in the aggregate power of administrative agencies over the recent decades, if left unchecked, invites the ascendance of a fourth branch of government—the regulatory state."

Foundation for a Healthy Kentucky reports putting 24 percent more money into grants last year than in 2012

The Foundation for a Healthy Kentucky made grants totaling $2,355,838 in 2013, a 24 percent increase over the 2012 total of $1,903,660, according to the annual report it released yesterday.

Last year was the first in which the foundation made grants for two major initiatives: Investing in Kentucky's Future, which it calls "a $3 million commitment to seven Kentucky communities where civic leaders have come together and committed to a process and a plan for collective impact on the future health of their children," and Promoting Responsive Health Policy, which tries to see that voices of under-represented populations are part of the health-policy conversation in Kentucky.

The first initiative's seven grantees are Fitness for Life Around Grant County, the Clinton County Schools (for the Healthy Hometown Coalition), the Foundation for Appalachian Kentucky (for the Perry County Health and Wellness Coalition), the Green River Area Development District (for the Partnership for a Healthy McLean County), the Kentucky Heart Foundation (for work in Boyd and Greenup counties), Kentucky River Community Care (for the Breathitt County Health Planning Council for Children) and the Louisville Metro Department of Health and Wellness (for the Coalition for Louisville Youth).

Under the policy initiative, the report says, grantees "are working to improve access to needed health care, support children's health, strengthen local public health and "increase the number of Kentuckians living in communities where workplaces are smoke-free." For a complete list of grants made by the foundation in 2013, click here. For a January press release about them, click here.

The foundation was established in 2001 to settle a lawsuit by then-Attorney General Ben Chandler against Anthem Inc. to recover the charitable assets that Anthem had gained in its merger with the old Kentucky Blue Cross/Blue Shield. The foundation's net assets grew to nearly $56.4 million last year, a 7.7 percent increase over the end of 2012.

The foundation is a non-profit philanthropy with a mission of addressing the unmet health-care needs of Kentuckians. It has invested more than $24 million in health-policy research and pilot-project grants that invests in communities and informs health policy through grant making, research and education. It says it is "committed to improving access to care, reducing health risks and disparities and promoting health equity."

The foundation also acts as a convener, through its annual Howard L. Bost Health Policy Forum, its "Health for a Change" workshops and webinars, funding of conferences held by others and meeting space at its new offices in eastern Jefferson County for more than 21 community and statewide organizations.

It also acts as a communicator, through its annual Kentucky Health Issues Poll and other research, and it funds independent health reporting by Kentucky Educational Television and the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, which publishes Kentucky Health News.

Parents can help teens make healthy food choices this summer by strategically stocking the pantry

A steady diet of junk food can be especially harmful to teens, who tend to experience a growth spurt during these years, and these poor nutritional choices as teens can affect their health in years to come, reports Newswise, a research-reporting service.

“While it’s important to eat healthy at every age and stage, the growth and physical maturation occurring during adolescence makes good nutrition all the more critical,” Kristen Kizer, a clinical dietician with Houston Methodist Wellness Services, said in the release. “Teens are growing, meaning that their cells are diving rapidly. This means increased calorie and protein needs, as well as increased need for vitamins and minerals like calcium, vitamin D, iron, and folate.”

So, as parents stock their refrigerators and pantries for the summer, it is important for you to remember to include healthy foods that are quick, easy and tasty to teens, while paying special attention to providing foods high in calcium and vitamin D.

Calcium and vitamin D intake should be of particular importance for teens because about half of peak bone mass occurs during the teen years, Kizer explains in the release. If teens don't get adequate amounts of calcium and vitamin D, they can become adults with poor bone density, setting themselves up for osteoporosis and bone fractures in later years.

The National Institute of Health says teenagers need 1,300 milligrams of calcium each day. Kidshealth.org offers a list of foods that are high in calcium that includes dairy products, veggies including broccoli and dark green, leafy vegetables, soy products, calcium-fortified foods, beans and canned fish.

Parents and teens should also remember that good eating habits and a healthy weight are important to establish during the teen years because approximately 90 percent of overweight and obese teens will remain overweight or obese as adults, Newswise reports.

“Most teens aren't thinking about chronic disease 30 years down the road, reminding them that the foods they choose now have an impact on their appearance, athletic performance, or academics can help them make healthier choices,” Kizer says in the release. “Girls especially may be struggling with body image issues, so helping them select foods that will make them physically feel well can also improve their mood and emotional health.”

Kizer's suggestions for healthy food choices:

• Guacamole, made from a jar of salsa and avocados, and baby carrots. The vitamin C in the salsa will keep the guacamole from turning brown and the healthy monounsaturated fat from the avocado will keep your hungry teens satisfied.
• Whole wheat rotini and veggies and pasta sauce, all mixed together and ready to heat. This meal provides fiber, magnesium, manganese and selenium.
• Greek yogurt with fruit. The added protein from the Greek yogurt will keep your hungry teen full and he or she will also be getting fiber from the fruit, as well as vitamin C, potassium, folic acid, and calcium.
• Cereal. Look for cereals that include no more than 6 grams of sugar.
• Baked chips instead of full-fat chips.
• Low-fat ice-cream sandwiches or 100 percent frozen fruit bars.
• Whole-wheat thin crust pizza that features veggies rather than high-fat meat like sausage and pepperoni.

30 participants contribute to 'Expressions of Courage' art exhibit at UK cancer center for National Cancer Survivorship Month

The University of Kentucky Markey Cancer Center held its first "Expressions of Courage" event, an art exhibit showcasing art connected to an experience with a cancer diagnosis or created in memory of a Markey patient, on June 6 as part of National Cancer Survivorship Month.

The artistic entries from the 30 participants who responded were on display in the Combs Research Building at Markey. They included paintings, drawings, photography, sculpture, and quilting as well as performing and literary art performances, Allison Perry and Abby Besson report for UKNow.

"The artwork is very moving and inspiring, and actually will bring tears to your eyes if you read some of the pieces," Cindy Robinson, a nurse practitioner at Markey and one of the organizers of the event, told the authors. " We have some pieces here from patients that are no longer with us, and we personally know those people."

Expressions of Courage was made possible by gifts from the Markey Cancer Foundation and Biological Systems Consulting, Inc.

Norton Cancer Center and Markey patient Phillip Meeks contributed a drawing created by his daughter depicting the "unlikely good fortune of his treatment."

Meeks was diagnosed with acute myeloid leukemia in 2012 and required a bone marrow transplant to survive, the authors write. As an African-American - a population that makes up around seven percent of the bone marrow registry - and an adoptee without biological siblings or parents to get tested, the odds of finding a match were against him.

Upon admission to the hospital, Meeks found a token underneath his hospital bed that said "Believe in Miracles" on one side and "Faith" on the other. He told the authors that he took this token as a sign from God that he wasn't alone and to not be afraid. This token was the inspiration for his daughters art.

Meeks received his life-saving transplant in January 2013. He told the authors that not only was Expressions of Courage a day to showcase talent, but a day survivors could show their appreciation to the staff of Markey.

"I just want to give back," Meeks said. "That's my big thing. How can you thank so many people that are involved in saving your life? There's not a gift that you can give that's big enough. Hopefully this is my one little piece to say thank you for everything that everybody has done for me."

Some school districts reject federal offer of free lunch for all students, saying schools would lose money on the deal

Some school districts are rejecting a federal program that would provide free meals to all students in districts with a certain percentage of students in poverty, Jared Nelson reports for The Times Leader in Princeton, after the Caldwell County Schools decided against joining the Community Eligibility Program.

“Right now, we are not at the economically feasible point to do that. We would lose money,” District Food Service Director Will Brown told Nelson.

Nelson writes, "The district’s food service program is largely self-sufficient, earning income based on students and teachers who pay full-price for meals, and federal reimbursement for those meals and those provided to students qualifying for free or reduced-rate lunches."

If everyone gets a free lunch, “You are losing all of your students on full paid status,” Brown said. “You’re losing that revenue.” He said the number of qualifying students is “not high enough to do that.”

In other words, Nelson writes, "Having a percentage sufficient to qualify ... is different from having a percentage that would make the program viable locally. . . . Brown said other districts have signed on to the CEP program in prior years and been adversely affected. . . . The revenue earned each year allows the food services department to be able to use its own funds to cover the costs of most repairs, new equipment, and other expenses required during the school year and in the summer.

The program "is expanding nationwide this year, after being tested in 11 states, including Kentucky," Nelson notes. Qualifications are based on students in households in the Supplemental Nutrition Assistance Program (food stamps), the Kentucky Transitional Assistance Program, certain Medicaid recipients and foster children. (Read more; subscription required)

How to keep kids safe from traumatic brain injuries this summer

About 1.7 million people in the U.S. suffer a traumatic brain injury each year, and nearly half a million children under 15 visit an emergency room for TBI. A brain injury is traumatic if it disrupts the normal function of the brain.

Dr. Michael Egnor, vice-chairman of neurology at New York's Stony Brook University Hospital and director of pediatric neurosurgery at Stony Brook Children's Hospital, provides ideas for how parents can help protect their children from brain injuries this summer.

Families are going on more bike rides, but not everyone knows that bicycle accidents are most likely to happen within five blocks of home. "Make sure your child wears a helmet every time he or she rides a bicycle, scooter or skateboard," Egnor said. "We're seeing the most head injuries right now in skateboarding, especially in young teens, who might think it's just not cool to wear a helmet."

Each year more than 200,000 children suffer from injuries on playgrounds in the U.S., according to the U.S. Consumer Product Safety Commission. The main cause is falls. Egnor suggested looking for shredded mulch, pea gravel, crushed stone and other loose surfaces and being extra careful on asphalt and concrete.

Parents with older children and teens should be aware of possible diving accidents. "In about 50 percent of cases of catastrophic injuries, alcohol or drugs is involved," Egnor said. "Ensure that responsible adults supervise pool parties and other events where swimming and diving are involved."

Egnor also warned of concussions during summer sports. He said, "The few serious injuries we treat from organized sports are usually accidents that probably could not have been prevented," he said, while many of the concussions he treats are mild because many sports require helmets.

Dealing with serious injuries quickly is key, Egnor said. "The full extent of the injuries may not appear immediately." (Read more)

Panel of physicians at national conference discuss future of rural primary care, how to solve doctor shortages

More needs to be done to address the shortage of primary-care physicians, a big problem in rural areas and much of Kentucky, according to a panel of physicians at "Rural Health Journalism 2014," Kris Hickman writes for the Association of Health Care Journalists, which sponsored the conference.

Almost half of rural U.S. counties, 44 percent, struggle with primary care physician shortages, said Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care of the American Academy of Family Physicians. According to a presentation at the 2013 Kentucky Rural Medical Educators Conference, Kentucky had a 1,287:1 primary care physician to citizen ratio, which is 557 short of the national average.

The national shortage is expected to worsen soon because almost 27 percent of those providers are older than 60, said Mark A. Richardson, M.D., dean of Oregon Health and Science's School of Medicine.

Bazemore said the medical community needs to draw more attention to the need for more primary care physicians in rural areas. He also said that for every dollar spent on health care, only six or seven cents are spent on primary care. "States facing a shortage should remember that primary care is the logical basis of any health care system," Bazemore said.

Richardson recommended that medical schools try to recruit students who have rural backgrounds because they're more likely to return to practice in rural areas. He and Bazemore agree that students who practice in rural areas should be given loan forgiveness or scholarships. "Debt prevents many people from choosing primary care," Bazemore said.

Richardson said the most important factor for where medical students end up practicing is where they completed their training. "Rural training is one of the highest predictors of a rural practice and should be required," he said. To do this, the government-imposed cap on graduate medical education spending would have to be abolished.

"Medical care is not a free market dynamic," Richardson said. "We pay for health care transactions, rather than health." (Read more)

Study concludes that fasting can reduce cholesterol levels for people in danger of developing diabetes

New research suggests that occasional fasting can help pre-diabetics from developing diabetes, which is more common in Kentucky than most states.

After 10 to 12 hours of fasting, the body looks for other energy sources to sustain itself, so it removes LDL (bad) cholesterol from fat cells and converts it into energyaccording to researchers at the Intermountain Heart Institute at Intermountain Medical Center in Murray, Utah.

"Fasting has the potential to become an important diabetes intervention," in addition to lifestyle changes and weight loss, said Benjamin Home, the lead researcher.

The study focused on prediabetics between the ages of 30 to 69 with at least three of the following metabolic risk factors: a large waistline, a high triglyceride (type of fat in the blood) level, a low HDL (good) cholesterol level, high blood pressure and high blood sugar after fasting.

"Over a six-week period cholesterol levels decreased by about 12 percent in addition to the weight loss," Home said. "Because we expect that the cholesterol was used for energy during the fasting episodes and likely came from fat cells, this leads us to believe fasting may be an effective diabetes intervention."

The removal of LDL cholesterol from the fat cells for energy use should help stop insulin resistance, which happens when the pancreas keeps producing more and more insulin until it can't make enough for the body, and the blood sugar rises. "The fat cells themselves are a major contributor to insulin resistance, which can lead to diabetes," he said. "Because fasting may help to eliminate and break down fat cells, insulin resistance may be frustrated by fasting."

Home noted that although fasting might be effective for protecting against diabetes, the results were not immediate. "How long and how often people should fast for health benefits are additional questions we're just beginning to examine." (Read more)

Proposed waiver from school nutrition guidelines sparks debate

The controversial school lunch waiver debate that began in Washington has migrated to Kentucky. While supporters claim that the proposal assists rural schools, some opponents say it defeats the purpose of years of work to fight one of the U.S.'s highest childhood obesity rates, John Moritz writes for McClatchy Newspapers, parent of the Lexington Herald-Leader.

Next week the House of Representatives is expected to vote on a measure that would let schools ask for a one-year waiver to get out of the new federal school lunch nutritional standards—if the school can show that meeting those guidelines would require them to keep operating meal programs at a loss. The measure is part of a spending bill for the Department of Agriculture passed by the House Appropriations Committee, headed by 5th District Rep. Hal Rogers, R-Somerset.

Michael Saucedo, 9, eats lunch at Russell Cave Elementary
School in Lexington. (Herald-Leader photo by Pablo Alcala)

USDA guidelines, enacted in 2012, call for schools to serve a fruit and a vegetable with each meal. "The guidelines also mandated a switch to 100 percent whole grains by this summer, required milk servings be 1 percent or fat-free and imposed calorie and sodium limitations based on age group," Moritz writes. "Standards also were set for a limited amount of saturated fats per serving, while banning the use of trans fats."

Although the Fayette County Public Schools lunch program will not likely apply for a waiver because the system's meal program is operating in the black, Director of Child Nutrition Michelle Coker told Moritz the waivers would helps smaller Kentucky school districts.

Scott County Nutritional Services Director Mitzi Marshall told Moritz the district is losing money because fewer students are buying the healthier lunches, and even some students who could get free or on-sale lunches have been bringing food from home. She said the guidelines have "gone a little overboard." Coker said cafeteria workers told her that students do not eat the healthy food, forcing the district to increase trash collection. "She estimated that as much as 75 percent of the fruits and vegetables were thrown away," Moritz writes.

"You can put the best meal out there, the most healthy meal, but if they are not eating it, they are not healthier," Coker told Moritz. Before the new guidelines, schools provided fruits and vegetables as an option for children instead of as a requirement.

Supporters of the guidelines argue that tastes can change and schools need to come up with creative strategies for that. "Our schools need to be an environment that makes the healthier and easier choice for our children," said Susan Zepeda, president of the Foundation for a Healthy Kentucky.

According to a report by the Trust for America's Health and the Robert Wood Johnson Foundation, Kentucky ranks eighth in the nation for obesity among children ages 10 to 17 and third among high-school students.

Anita Courtney, who helped the Better Bites program that aims to offer healthier food items for children at swimming pools, public parks and after-school programs, said, "Great work has been done to shift the food that our tax dollars pay for our kids. It just boggles my mind that [Congress] would consider pulling the plug on that."

Coker said a waiver wouldn't mean a school district reverts to its old ways of offering greasy, fatty and sugary foods, but would give an extra year to meet all the requirements. (Read more)

Altria, parent of Philip Morris, reports spending most on lobbying the 2014 legislature but says it didn't fight smoking ban

The parent firm of the nation's largest cigarette company again reported spending more than anyone else on lobbying the Kentucky General Assembly, but says it did not fight the bill that would have imposed a statewide smoking ban in most public places.

"Altria Group, the parent company of Philip Morris USA and U.S. Smokeless Tobacco, reported spending $156,200, "far more than any other company or group, Tom Loftus reports for The Courier-Journal. "And it got the things it wanted from Kentucky lawmakers: tobacco taxes were not increased, no new tax was put on electronic cigarettes and the tobacco-industry supported bill to ban the sale of electronic cigarettes to minors passed."

Spokesman David Sutton "said not a penny of Altria's lobbying campaign went to defeat the so-called 'smoke-free' bill, though he said the company opposes such complete smoking bans within private businesses," Loftus reports. "He said he suspected Altria's lobby spending topped the list because 'We fully disclose everything'," including research time of its legal staff and its "grassroots activation" work to rally its supporters in Kentucky.

The Campaign for Tobacco Free Kids, "which reported spending $6,284 during the session, earlier this month blamed Altria for leading the successful defeat of the bill to ban smoking in indoor public places like bars and restaurants," The Courier-Journal reports.

"They've spent a lot of money on lobbying for years," the campaign's Betsy Janes told Loftus. "They've sent their message out for so long and have relationships with legislators. It's hard for us to compete with that." (Read more)

The campaign's Amy Barkley told Kentucky Health News that Altria's assertion "is very hard to believe. That said, I don’t have any hard evidence to dispute their claim. We all know the tobacco industry’s influence is very deep in Frankfort, so perhaps they didn’t need to overtly lobby against the smoke-free bill."

The Kentucky Farm Bureau Federation, which gets funding from Altria for some of its programs, lobbied against the smoking ban. It ranked eighth in lobbying expenses, with $68,821. For The Courier-Journal's lst fo top lobbying interests, click here.

At least one additional health-insurance company is expected to sell policies on Kynect exchange next year

The five insurance companies that sold policies this year on Kynect, Kentucky's health-benefit exchange, want to return in 2015, and Dayton, Ohio-based CareSource wants to join as well. Officials said they believe other insurers will sign up to sell policies next year, too, which will benefit consumers, Jack Brammer writes for the Lexington Herald-Leader.

""Consumers benefit from the choices that come with more competition," Insurance Commissioner Sharon P. Clark said. Cabinet for Health and Family Services Secretary Audrey Tayse Haynes said she hopes than even more Kentucky residents will set aside time to examine the plans on Kynect when the second round of open enrollment begins Nov. 15.

Anthem, Humana, Bluegrass Family Health, United Healthcare of Kentucky and Kentucky Health Cooperative offered plans on the exchange this year, and Humana was the only one that didn't offer small group market insurance, for two to 50 people. Humana, Anthem and the cooperative offered individual coverage.

Jonathan Copley, CareSource's executive director for Kentucky, said the company's participation in Kynect is "an extension of our commitment to provide affordable coverage to Kentuckians who need it most. We are expanding our reach to one of Ohio's bordering states to offer affordable health care coverage. Kynect represents a successful model on the marketplace, and we are excited to offer CareSource."

Though the tentative deadline for insurers to request to be on the exchange was April 1, the official deadline has been extended as a result of inquiries, Brammer reports.

In Kynect's first open-enrollment period, from Oct. 1 through March 31 about 421,000 Kentuckians enrolled for coverage, and the increasing number of insurers seems to be a sign even more people will sign up next year. Last month The New York Times reported that "8 million people signed up for coverage in 2014 under the federal health care law and that estimates put next year's national enrollment near 13 million," Brammer writes.

This year monthly rates for those enrolled in Kynect ranged from $47 for older couples without dependents to $403 for families of four with a total income of $70,000 per year. Health and Family Services spokeswoman Jill Midkiff told Brammer that an average premium wasn't calculated because of the many variables such as age and family membership. (Read more)

FDA issues warning label for tanning bed use by minors; sponsor of bill for a state ban says he will try again

Soon tanning beds will have a "black box" warning that those younger than 18 should not be using them, but some doctors, tanning companies and legislators do not think this will be sufficient to keep minors from tanning. "Consequently, some want a new Kentucky law prohibiting bed use by minors," Annie Garau writes for the Lexington Herald-Leader.

Lexington Herald-Leader graphic

The U.S. Food and Drug Administration announced May 29 new regulations that moved sunlamps from the category of low-risk devices—like dental floss and tongue depressors—to moderate-risk devices. Tanning beds are dangerous because they emit ultraviolet rays like the ones from the sun. These ultraviolet rays not only cause wrinkles and eye damage but also cause skin cancers, including melanoma, which is the most deadly kind of skin cancer, according to the FDA and local doctors.

"There's really no way to get a tan right now without incurring the risk of cancer," said Dr. John D'Orzio, a researcher and pediatric oncologist at Kentucky Children's Hospital. "I don't want to tell people not to go outdoors at all because that would be ridiculous, but the actual ultraviolet radiation from the beds can be up to 10 times more than from standing in the sun." D'Orazio said his biggest concern is that children under 18 have access to the tanning beds. Currently Kentucky only requires "signed parental consent for teens ages 14 to 17 and in-person parental consent for anyone younger than 14," Garau writes.

Mark Wells and Cheryl Ledford, co-owners of Southern Rays Tanning, do not think the new warnings will turn customers away. "There has always been some kind of warning on the beds," Ledford said, "and they haven't stopped people from tanning."

Wells said there are health benefits to tanning, such as increased Vitamin D, the fading of acne and getting a "base tan" indoors to prevent burning outside. D'Orazio disagreed. "A base tan is not going to help you avoid the risks," he said. "You're still getting ultraviolet radiation while you're getting that base tan. Also, it really only takes about one minute of standing in the sun to get enough vitamin D. . . . This is a multibillion-dollar industry. That's a lot of money going into downplaying the negative consequences."

American Academy of Dermatology President Dr. Brett Coldiron said that although sometimes dermatologists prescribe phototherapy as a treatment, "The difference between phototherapy and indoor tanning is that phototherapy is closely monitored and supervised by a dermatologist. This type of medical care isn't provided at an indoor tanning salon, where operators have minimal knowledge about the potential side effects of UV light, and tanning bed lamps have variable amounts of UVA and UVB light."

State Rep. David Watkins, a Democrat and retired physician from Henderson, wanted to prevent Kentucky minors from using tanning beds without a medical prescription, but the Senate Health and Welfare Committee killed his House-passed bill. "I think I'm going to have to work a little harder and make sure my colleagues in the Senate understand that I'm not trying to limit freedoms," Watkins told Garau. "I'm trying to protect some of our most vulnerable constituents." (Read more)

Lexington auto mechanic becomes neurosurgeon; now researching traumatic brain injury diagnosis and treatment

In the early 1980s, Geoff Manley was a mechanic, and some of his clients were University of Kentucky faculty. That is how he met microbiology professor Shelly Steiner and started on the road to a new career: neurosurgery and a multi-million-dollar research project.

"Some kids are polite—you know, 'Yes, yes, sir'—but disengaged. Geoff was clearly intelligent and focused," Steiner told Laura Dawahare of UKNow. "You can talk to someone for just a few minutes and know right away how bright they are. Geoff was like that."

Because no one in Manley's family had gone to college, Steiner's suggestion that he finish his GED and attend UK, was a "transformative moment," Manley said. He graduated in 1988 then earned his MD-PhD at Cornell University. Now he is the vice chair of neurosurery at the University of California-San Francisco.

"Manley's earlier work with Steiner and a colleague in the lab influenced his decision to pursue a career in the neurosciences; his particular interest is in traumatic brain injury, or TBI," Dawahare writes.

Though the public often hears about athletes' concussions, TBI results even more often from auto accidents or slips-and-falls. Every year at least 1.7 million people in the U.S. get medical attention for TBI. "I did a lot of bench work earlier in my career, but I was torn between my interest in the basic sciences and my desire to do something directly relevant for TBI patients," Manley said. "So I began to explore a new translational research approach to TBI."

The National Institutes of Health (NIH) gave him $18.8 million over five years to do worldwide research about concussion and traumatic brain injury. TBI is complex, which makes diagnosis and therapy development difficult. Dr. Manley and his colleagues want to change the current TBI measures. "Here we are in the 21st Century, and we classify TBI in one of three ways: mild, moderate or severe," Manley said. "Cancer, by comparison, can be characterized in a very precise way, and treatments are customized to each patient's needs." Therefore, Dr. Manley wants to establish a set of classifications for TBI that are as detailed as the ones used for cancer.

"We expect that our approach will permit researchers to characterize and stratify patients more effectively, will allow meaningful comparisons of treatments and outcomes and will improve the next generation of clinical trials," Manley said. "Advancing our understand of TBI will ultimately lead to successful, patient-specific treatments."

Manley said that Steiner's encouragement helped him not only finish his GED and college but also get where he is today. Steiner said, "Geoff would have made it anyway—he had the intellectual octane and the motivation. He may think others helped him, but it really was his trip." (Read more)

WellCare of Kentucky removes co-pays for most Medicaid members and offers to pay for GED course for many

WellCare Health Plans Inc. is improving its Medicaid benefits in Kentucky by removing most members' co-pays and covering the cost of the General Educational Development test and its corresponding coursework for eligible members.

The co-pay and GED benefits will become available on July 1 and continue through the end of the year, except in Medicaid Region 3, comprising 16 Kentucky counties near Louisville. Region 3’s benefits will be determined in fall 2014 to align with its open enrollment. Region 3 is Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington counties.

Open enrollment for the rest of the state ends Wednesday, June 18, so WellCare is offering the new benefits as an incentive for Medicaid recipients to switch form other managed-care companies.

All WellCare of Kentucky Medicaid members will have no co-pays except for non-emergency visits to the emergency room and, only in the Louisville region, a $4 co-pay for preferred-brand medications.

Recipients  of the GED benefits must be at least 16 years old, must not be currently enrolled in high school, cannot be graduates from an accredited high school and cannot have received a high school equivalency certificate or diploma. Members need to complete the required GED coursework at an adult testing center.

For more information about these and other WellCare Medicaid benefits in Kentucky, please visit http://kentucky.wellcare.com/member or call 1-877-389-9457.

Study finds personalized text messages helps some quit smoking

Smoking is a hard habit to break. A recent study, reported in the American Journal of Preventive Medicine, found that sending smokers personalized text messages was twice as effective as giving them self-help materials, Valerie DeBenedette writes for Health Behavior News Service.

Participants chose a date to quit smoking and received five text messages during that day and two per day for the rest of the week. Then the text messages decreased to three per week, then to one per week. "Encouraging texts included top health reasons to quit smoking and the amount of money saved by quitting," DeBenedette writes.

"Previously, phone texting programs to help people quit smoking have been shown to be effective in other countries, said Lorien C. Abroms, Sc.D., the lead author of the study and associate professor of prevention and community health at The George Washington University. "This is the first long-term study in the United States."

More than 500 smokers were placed in one of two groups: the group that received text messages and the group that received self-help materials. They were then surveyed about their experience with the program one, three and six months afterward. Researchers tested mailed saliva samples for cotinine to determine if participants had stopped smoking.

Of those who received texts, 11.1 percent stayed off tobacco, compared to 5 percent in the control group. When asked to self-report, "nearly 20 percent of the texting group said they had quit, compared to 10 percent of the control group," DeBenedette writes.

Abroms said texting is cost-effective. Some programs offer it along with telephone counseling. "The potential for reach is wide, and they are fairly low cost compared to more traditional types of therapy," she said.

Chris Bostic, J.D., deputy director for policy at Action on Smoking and Health, an advocacy group in Washington, told DeBenedette, "Even if something like texting only has a marginal effect on the quit rate, it should be added to [the] menu of options available to smokers who want to quit." (Read more)

Steven J. Stack will be second Lexington physician in three years to lead the American Medical Association

Dr. Steven J. Stack, an emergency physician in Lexington, is the new president-elect of the American Medical Association, the nation’s largest organization for physicians

Stack, at 43, is the youngest president of the organization in a century, Laura Ungar reports for The Courier-Journal. He is the first board-certified emergency physician elected to the post, which he will fill in June 2015.

“It’s an immense honor and a total joy and a thrill,” Stack told Ungar.

Stack will be the second Lexington doctor in three years to hold the office. AMA's immdiate past president is Dr. Ardis Dee Hoven, an infectious disease specialist.

“It’s a fluke of history,” Stack told Ungar.

Stack is a practicing physician and former medical director for emergency departments at St. Joseph East in Lexington and St. Joseph Mt. Sterling.

Stack's experience as the chair of the AMA’s Health Information Technology Advisory Group from 2007 to 2013 and also as a member of the federal advisory groups for the Office of the National Coordinator for Health Information Technology puts him in a position to help further one of the many goals of the Affordable Care Act—to expand information technology.

Stack told Ungar he also plans "to work on improving medical education, reducing diabetes and pre-diabetes in the population and helping ensure doctors are satisfied with their jobs so they can better help patients."

Stack came to Lexington with his wife Tracie, a pediatric allergist, and their 9-year-old daughter in 2006, Ungar writes. He has been active in the AMA for years and has held several offices. He has also been a legislative voice for local Kentucky issues, such as prescription drug abuse and medical liability reform. (Read more)

National poll finds many who need health coverage didn't even shop for it because they didn't think they could afford it

By Melissa PatrickKentucky Health News

The top two reasons people gave for getting health insurance under the Patient Protection and Affordable Care Act were compliance with the law and a desire to see a doctor, according to a recent survey by PerryUndem Research/Communication for Enroll America, a group promoting the law.

The poll also found that many people needed health coverage but didn't even shop for it because they thought they couldn't afford it. UPDATE, June 14: "Convincing Americans that they could afford insurance was the White House's biggest challenge in making Obamacare work," Ezra Klein reports on Vox.

Four in 10 of those surveyed who did enroll that they might not have signed up if the 2010 law hadn't required them to do so. Mike Perry of PerryUndem told Louise Radnofsky of The Wall Street Journal that the poll suggested that "The mandate was a big factor even if it wasn't politically popular."

The survey also found there was a high demand for health insurance during the first open enrollment period, which ended in April. Kentucky also found this to be true, said Gwenda Bond, assistant communications director for the Cabinet For Health and Family Services.

"In Kentucky, we definitely experienced high demand from the beginning of open enrollment Oct. 1, which continued to increase right up through the end of the open enrollment period," Bond said in an e-mail.

Kentucky ended up providing coverage to about 420,000 people in the state, with about three-fourths reporting they did not have insurance before signing up through Kynect, the state's health-insurance exchange.

Despite the demand,the national poll found that 61 percent of those who did not enroll still wanted coverage and the main reason they did not even look for it was because they thought they couldn't afford it.

Some of these people may not have been aware that they could qualify for free coverage through Medicaid. Almost 25 percent of the newly enrolled cited "I qualified for Medicaid" as a reason they enrolled, and over half of that population said it was the main reason.

Kentucky is working on this issue of affordability perception, Bond said. "We will be working to make it easier for individuals and small businesses to get information or a quote up front that estimates the amount of subsidies or discounts they may qualify for, before they ever begin an application,"she said in the email.

More than eight out of 10 surveyed nationally said they will consider enrolling next time.

The poll surveyed 671 newly enrolled people and 853 who remained uninsured. It was conducted April 10-28. The margin of error for the total sample is plus or minus 2.9 percentage points.

Other key findings in the poll included: 69 percent of the newly enrolled thought the process was "easy," especially if they enrolled in person instead of the phone; 74 percent of those in private plans felt confident they can afford their premiums, and many more think their plans have enough doctors than not (56 percent vs. 13 percent). The self-reported health status of those who enrolled and those who didn't was similar.

Doctors in emergency rooms say they are busier since Obamacare began; hospitals struggle to handle extra patients

Nearly half of emergency-room doctors say their ERs have seen an increase in patients since health reform went into effect, and 86 percent say they expect the increase to continue, according to a poll by the American College of Emergency Physicians. Of the 1,845 completed surveys, 9 percent said ER visits had increased greatly and 37 percent said they had increased slightly. When asked what they think will happen over the next three years, 41 percent said visits will increase greatly and 45 percent said they will increase slightly. (ACEP graphic)

"Dr. Jay Kaplan, a member of ACEP's board of directors, said he wasn't surprised by the findings given the large influx or Medicaid enrollees and the difficulty in locating primary-care doctors who will see those patients," Paul Demko reports for Modern Healthcare. Kaplan told him, “When people get insurance, they feel like they deserve healthcare. When they deserve health care, and there's nobody else they can see, they come to us.”

77 percent of respondents
said their ER is not prepared
for an increase in patients

But some hospitals say many patients are going to the ER for ailments that are not emergencies, Laura Ungar reports for The Courier-Journal. Lewis Perkins, vice president of patient care and chief nursing officer at Louisville's Norton Hospital, said the emergency room is seeing 100 more patients per month, an increase of 12 percent. "We're seeing patients who probably should be seen at our (immediate-care centers)," he told Ungar. "And we're seeing this across the system."

ER visits at the University of Louisville Hospital are up 18 percent, while Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physicians' group, said ER services are up 7.5 percent in that city. He told Ungar, "It's a perfect storm here. We've given people an ATM card in a town with no ATMs." (Read more)

Phil Galewitz of Kaiser Health News reports that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years. Hospital officials around the country told him that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care.

In selling proposed limits on CO2, Obama administration emphasizes health improvement, not climate-change fight

By Melissa Landon and Al Cross
Kentucky Health News

As it announced its plan to reduce carbon dioxide emissions from power plants by 30 percent by 2030, the Obama administration emphasized the health angle, not climate change, which has been the driving force for the proposed regulations but is a more controversial cause than improving health.

"For the sake of our families' health and our kids' future, we have a moral obligation to act on climate," EPA administrator Gina McCarthy said in her announcement.

Juliet Eilperin and Steven Mufson note in The Washington Post that when a climate bill stalled in the Senate four years ago, environmental and public health activists began pressuring Preisdent Obama to mandate carbon limits. Opponents to the measure include coal producers, some utilities and many Republicans, who say that the EPA has not proposed a plan that can work using current technology.

Under the new rules, states would use different strategies—such as energy efficiency, shifting from coal to natural gas, investing in renewable energy and making power plant upgrades—to achieve state-by-state goals. The reductions will be measured from 2005 levels; Environmental Protection Agency data reveal that power plants in the U.S. have already diminished carbon dioxide emissions by almost 13 percent since 2005, The Associated Press reports.

EPA estimates the rules will prevent as many as 6,600 premature deaths, 150,000 asthma attacks in children, up to 490,000 missed work and school days—saving $93 billion, Connie Hedegaard writes for EurActiv. The federal Centers for Disease Control reports that "exposure to particle pollution may cause worsening asthma symptoms, breathing problems, adverse birth outcomes, lung cancer and early death," Healio reports.

The new rules are intended to assist Washington in achieving international obligations to reduce U.S. greenhouse gas emissions deemed responsible for global warming, but Obama is focusing on the human health benefits to encourage Americans to adopt the movement, Jeff Mason wres for Reuters.

Although federal law has been employed to regulate other pollutants—such as soot, mercury and lead—this is the first time it has been applied to greenhouse gases, Fox News reports, quoting Obama: "We limit the amount of toxic chemicals like mercury, sulfur and arsenic that power plants put in our air and water. But they can dump unlimited amounts of carbon pollution into the air. It's not smart, it's not safe, and it doesn't make sense."

Safety-net hospitals, haven for the uninsured, are seeing more covered patients since the expansion of Medicaid

By Melissa Patrick
Kentucky Health News

Hospitals that most often treat the poor and uninsured  are seeing fewer uninsured patients since the new health law's expansion of Medicaid, Phil Galewitz reports for Kaiser Health News. Kentucky's safety-net hospitals have also seen a drop in their uninsured patients.

Safety-net hospitals, which are often not paid for the billions of dollars it costs to care for the disproportionate share of poor and uninsured people they care for, will benefit most from the health law's expansion to more than 13 million people this year, Galewitz writes.

Hospitals across the country had expected this outcome, but told Galewitz in interviews that it has happened "faster and deeper" than anticipated -- "at least in the 25 states that expanded Medicaid in January."

Kentucky is one of the states that agreed to the Medicaid expansion and has expanded health coverage to some 413,000 people, with 75 percent of them reporting that they did not have coverage before signing up on Kynect, the state's health insuance exchange.

Michael Rust, president of Kentucky Hospital Association, said figures from his members won't be available until July, but "Anecdotally, I can tell you that more people do have coverage," adding later that "most are on Medicaid."

The University of Kentucky has seen a decrease in uninsured patients. “The number of uninsured patients seeking care at UK HealthCare since Medicaid expansion took effect in January has decreased,” said Mark D. Birdwhistell, UK vice president for health system administration. “Even though we have seen a double-digit increase in the number of services provided, request for financial assistance is down when compared to this period last year.”

Investor-owned hospitals are also being affected by the expansion of coverage. HCA, Tenet Healthcare Corp., Community Health Systems, some of which own safety-net hospitals, told Galewitz "they saw their rates of uninsured patients drop by as much as a third in the first quarter of 2014 in hospitals located in Medicaid-expansion states," he writes.

"An Urban Institute study published in the May edition of Health Affairs estimated the costs of uncompensated care to hospitals were as high as $45 billion in 2013, with government programs defraying an estimated 65 percent of those costs," Galewitz reports. That made the hospital industry one of the first to support the Affordable Care Act, he notes, agreeing to take funding cuts "exceeding $150 billion over a decade" in return for more paying patients.

However, because the Supreme Court ruled that states could not be forced to expand Medicaid, hospitals in the 24 states that didn't are suffering the funding cuts, without the "corresponding reduction in uncompensated care," Galewitz writes.

Hospital officials told Galewitz that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care. Kentucky ERs have reported a surge in patients since the law took effect. Galewitz notes that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years.

Success of Kynect puts both Senate candidates in a pickle

"The early success of Kentucky’s health care exchange, Kynect, is creating quandaries for both Mitch McConnell and Alison Lundergan Grimes as they address Obamacare" in Kentucky's U.S. Senate race," James R. Carroll reports for The Courier-Journal.

"For McConnell, the Senate minority leader, continued attacks on Obamacare — i.e., the Affordable Care Act — pose risk because the law’s implementation under Kynect has produced 421,000 enrollees in the Bluegrass State, and more public support than opposition," Carroll writes. "For Grimes, the issue is whether to fully embrace the exchange’s success as she tries to rally key elements of the Democratic base that is largely for the health-care law — while still separating herself from President Obama, who is unpopular in the state."

Carroll quotes Susan Zepeda, president of the Foundation for a Healthy Kentucky: “Campaign politics does not lend itself to a deep-dive into the complexities of multifaceted issues of what access to health care and payment for health care means to Kentucky communities and to Kentuckians,” so the debate is more complicated than “repeal Obamacare” or “support Kynect,” Carroll writes, in a story that goes on to explain it all.