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)