Chronic Kidney Disease Tied to Heart Problems in Elderly

Chronic kidney disease is common among Americans over 80 years of age and is often linked with heart disease, a new study says. Researchers examined the prevalence of chronic kidney disease in 1,028 octogenarians in four U.S. communities enrolled in the long-term Cardiovascular Health Study All Stars. The prevalence of chronic kidney disease varied from 33 to 51 percent, depending on whether the researchers used blood serum levels of creatinine or cystatin C as markers of the disease.

The findings highlight the fact that using different formulas to assess kidney function in people in their 80s results in different estimates of the chronic kidney disease prevalence in this age group, the investigators said. The study authors noted that no "gold standard" to estimate the prevalence of chronic kidney disease in octogenarians has been developed or validated. However, no matter which formula was used to assess kidney function, chronic kidney disease in octogenarians was associated with cardiovascular disease. Participants with chronic kidney disease were 1.5 to two times more likely than those without chronic kidney disease to have coronary heart disease, heart failure or stroke, according to the report.

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For Teens, Privacy May Trump Health Care

If teens' desires for health care privacy aren't respected, their care could be compromised, a new study suggests. Teens are cautious about revealing sensitive information to health care providers for fear of being judged, and are reluctant to talk to unfamiliar or multiple medical staff, according to researchers at Cincinnati Children's Hospital Medical Center. The researchers conducted 12 focus groups for 54 teenagers and found that keeping health care information private was their most important issue. They also found that younger teens were more likely than older adolescents to want parental involvement.

In fact, some older adolescents said they might avoid a health care visit to prevent information being shared with their parents. Among the other findings:

* Teens of all ages said they would not discuss sensitive topics with health care providers if they thought the provider would judge them or "jump to conclusions."

* Younger teens said they did not have personal discussions with providers they didn't know or like, or if they believed the provider did not need to know the information.

* Only younger adolescents said they had concerns about violations of physical privacy.

* Kids with chronic illnesses better understood and accepted the need to share information with health care providers.

Doctors and other health care professionals need to make it as easy as possible for teens to share information, and need to respect their readiness or reluctance to disclose information, said lead author and adolescent medicine physician Dr. Maria Britto. "If the information isn't urgent, such as a routine health visit, providers may be better off waiting to ask sensitive questions until they know the teen better and can get better information once they've established trust," Britto said in a hospital news release.

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Race Seems to Impact Rate of Kidney Function Decline

Among patients with kidney disease in the United States, certain racial/ethnic groups, including blacks and some Hispanics, get sicker faster than whites do, researchers have found. "Racial/ethnic differences are present early, before chronic kidney disease has been established," study co-author Dr. Carmen A. Peralta, of the University of California, San Francisco, said in a news release from the American Society of Nephrology. "The observed differences were not fully explained by traditional risk factors," which include cholesterol, weight, tobacco use, diabetes and high blood pressure, Peralta noted. The researchers reached their conclusions after examining the medical records of almost 5,200 adults in the United States whose kidneys initially worked normally.

Based on five years of follow-up data, the researchers used mathematical equations to estimate age-related changes in kidney function. The kidneys of blacks declined faster on an annual basis than those of whites, about 60 percent faster judging by one method, the study authors noted. Among Hispanic groups, kidneys declined faster among Dominicans, followed by Puerto Ricans. But other Hispanics, as well as Chinese Americans, didn't suffer from a faster rate of decline than whites. The research "reflects a new opportunity to study how to best identify persons at high risk and to investigate prevention strategies," Peralta said. The study was scheduled to be presented at the American Society of Nephrology's annual meeting, held this week in Denver.

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Number of Uninsured American Adults Hits Record High

Nearly 50 million Americans have gone without health insurance for at least part of the past year up from 46 million people in 2008, federal health officials reported Tuesday. Those people included not only those Americans living in poverty, but an increasing number of middle-income people, according to a report from the U.S. Centers for Disease Control and Prevention. "The bottom line is that uninsurance of young and middle-class adults increased by 4 million people from 2008 to the first quarter of 2010," CDC Director Dr. Thomas R. Frieden said during a news conference Tuesday.

What's more, the number of people without insurance for a year or more increased from 27.5 million in 2008 to 30.4 million in the first quarter of 2010, Frieden said. "That's an increase of 3 million of chronically uninsured adults." These findings debunk two myths about health insurance, Frieden said. "The first myth is that it's only the poor who are uninsured. In fact, half of the uninsured are over the poverty level," he said. "The second myth is that it's only healthy people who are uninsured and that young healthy people make a choice not to have health insurance. In fact, more than two out of five individuals who are uninsured at some point during the past year had one or more chronic diseases," he said.

During the past 10 years, the number of U.S. adults without insurance for at least part of the year has risen an average of 1.1 million people a year, and about half are middle-income adults, according to the report. People without health insurance are more likely to skip medical care because of cost. This can lead to poorer health, higher long-term health care costs and early death, the report said. Uninsured adults with chronic medical problems are three times more likely to skip medical care, compared to those with insurance. For instance, more than 40 percent of people without insurance who suffer from diabetes, high blood pressure or asthma skipped getting care due to costs, the report found.

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Most Americans Still Not Eating Enough Fruits, Veggies

In 2000, the U.S. government set modest goals for the amount of fruit and vegetables people should eat, but a decade later the majority of Americans are not even close to reaching those thresholds, health officials said Thursday. In fact, according to the U.S. Centers for Disease Control and Prevention, in 2009, 67.5 percent of adults ate fruit less than two times daily and 73.7 percent ate vegetables less than three times per day. The goals of Healthy People 2010 were for 75 percent of people to eat at least two servings of fruit and 50 percent to eat at least three servings of vegetables every day. "Over the last decade we have looked at behavioral intervention, like counseling to get people to include their fruits and vegetables," said report co-author Dr. Jennifer Foltz, a researcher in the CDC's National Center for Chronic Disease Prevention and Health Promotion. "But it's not so easy."

"In the next decade, we are going to work on making the healthy choice the easy choice," she said. New programs will involve promoting gardening, farmer's markets and bringing more fruits and vegetables into schools and workplaces, Foltz said. In addition, Foltz said there could be programs to help retailers increase the availability of fruits and vegetables through incentives like tax breaks as well as making it easier for low-income people to afford fresh fruit and vegetables. Foltz noted that low-income Americans are more likely not to have access to fresh fruits and vegetables at affordable prices, which is why programs specifically targeted at this population are needed.

The report is published in the Sept. 10 issue of the CDC's Morbidity and Mortality Weekly Report. Despite efforts to increase healthy eating, over the past decade there has been a 2 percent decrease in fruit consumption and no change in the vegetable consumption, the researchers found. No state has yet met the Healthy People 2010 goals, Foltz said. In fact only one state, Idaho, rose in the amount of fruits and vegetables ate while 10 states saw a decrease in fruit and vegetable consumption. The 10 states where significant decreases in fruit and vegetable consumption were seen are Arizona, Kansas, Maryland, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee and West Virginia, according to the report.

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Health Care Reform: Will It Empower or Perplex Consumers?

Are American consumers "health literate" enough to play a leading role in their health care and coverage decisions? That question will be put to the test in 2014, when more than 30 million uninsured adults begin shopping for health plans through state insurance exchanges a core element of the national health reform package signed into law by President Barack Obama in March. Stakeholders hope to avoid another debacle like the one that occurred nearly five years ago when Medicare launched its then-new prescription drug benefit, called Medicare Part D. "If you look back at Part D, we learned a lot about how multiple choices in plans and in drug-plan coverage overwhelms, confuses, undermines people's confidence that they can manage the system," said Christina Zarcadoolas, an associate professor in the department of preventive medicine at the Mount Sinai School of Medicine in New York City and a health literacy expert.

Health literacy the capacity to obtain, process and understand basic health information to make appropriate health decisions isn't a new concept. But as consumers are encouraged to play a more active role in choosing health insurance coverage, using preventive services and screening tests and managing chronic health conditions, it's becoming more critical. "Health literacy is needed to make health reform a reality," U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement in May announcing the National Action Plan to Improve Health Literacy, a set of goals and strategies for creating a "health-literate society." "Without health information that makes sense to them, people can't access cost-effective, safe and high-quality health services," she said.

More than one-third of U.S. adults have only basic (22 percent) or below basic (14 percent) health literacy. Just 12 percent have "proficient" health literacy skills, while less educated and poorer individuals, in general, have lower health literacy, according to a U.S. Department of Education analysis. To improve health literacy, the Department of Health and Human Services (HHS) is encouraging health organizations and insurers to use plain language and pictures or graphs to communicate with consumers, among other enhancements. These strategies "have the potential to both reduce the complexity and demands of the health care delivery system and educate and empower Americans so they are able to fully benefit from the Affordable Care Act and take charge of their health," an HHS spokeswoman said in statement prepared for HealthDay.

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