Mrs. Bush Fight malaria malnutrition
Tue, 26 Jun 2007 17:00:35 GMTBy HEIDI VOGT, Associated Press Writer
DAKAR, Senegal - First lady Laura Bush picked vegetables and handed out mosquito nets Tuesday to emphasize that fighting AIDS in Africa also means tackling some of the continent's even more widespread afflictions — malnutrition and malaria.
"It's often overlooked that one of the essential things in the treatment of AIDS or HIV is good nutrition," she said after touring a garden whose produce is used to supplement the meals of AIDS patients at a Dakar hospital.
Mrs. Bush gave mosquito nets to AIDS patients as a doctor explained that insect-borne malaria — the biggest killer in Senegal — is even more dangerous for those who are HIV positive.
The first lady and her daughter Jenna are on a four-nation African tour in which Mrs. Bush is expected to focus on how the U.S. can help a poverty-stricken continent provide health care and economic opportunity. Mrs. Bush is also visiting Mozambique, Zambia and Mali on her third trip to Africa.
They were accompanied on Tuesday's visit by Senegal's first lady, Viviane Wade, and her daughter. The four women picked eggplants and kale at the Fann Hospital garden in this West African capital. AIDS patients at the hospital tend the garden, and they are instructed on how vegetables can boost their nutrition, and they are allowed to sell excess produce for income.
Malnutrition is a serious problem in Senegal and the surrounding region, where poverty often determines food choices. In parts of West Africa, fruits and vegetables disappear during the dry season, and diabetes is becomingly increasingly common in the region.
Last month, President Bush called on Congress to authorize an additional $30 billion to fight AIDS in Africa, a figure that would double the U.S. commitment to the continent. The current program, which provided $15 billion for five years, expires in 2008.
Bush's Emergency Program for AIDS Relief has supported treatment for 1.1 million people in 15 countries, he said in calling for the program's renewal. His wife did not discuss how the additional funds should be targeted.
The AIDS garden and the mosquito net program have both been recipients of U.S. funding. The U.S. government has allocated $16.7 million to anti-malarial programs in Senegal this year, and plans to continue at a similar level through 2010.
There are between 300 million and 500 million malaria cases each year in Africa and 1 million deaths. In some African countries, the disease accounts for up to half of all hospital admissions.
"We just eradicated malaria in the United States in about 1950. We know malaria can be eradicated, and so we stand with you as you try to eradicate malaria in Senegal," Mrs. Bush said.
Still, some international organizations have complained that the Bush administration has only truly committed to maintaining current funding levels at a time when the crisis is growing.
David Bryden of the Global AIDS Alliance lobbying group said the House has approved more than $5.4 billion in AIDS spending next year — a level that would about equal the president's proposal over five years. "If the Congress accepts his proposal, it would be a disaster, because the epidemic is expanding," Bryden said.
Still, West Africa generally has a lower prevalence of AIDS than eastern and southern Africa, and Senegal is often held up as an example that the disease has not doomed the continent.
The country has one of the lowest rates in the region. A range of reasons have been given, including an organized education effort by the government, a strong culture of conservative Muslim values, a tradition of male circumcision, and the distance from the southern African countries where AIDS first took hold in Africa.
In Senegal, the AIDS debate often takes a back seat to more pressing questions of poverty and lack of jobs. The former French colony is one of the world's poorest countries and thousands of its young men risk their lives annually on fishing boats bound for Europe.
Brazil offers morningafter pill to poor
Tue, 26 Jun 2007 19:26:29 GMTBy STAN LEHMAN, Associated Press Writer
SAO PAULO, Brazil - Brazil's government has added "morning after" pills to its newly expanded birth control program in hopes of helping poor people reduce unwanted pregnancies and dangerous illegal abortions.
Health Minister Jose Gomes Temporao announced the addition a month after President Luiz Inacio Lula da Silva said the government would provide cheap birth control pills at 10,000 drug stores across Latin America's biggest country.
Speaking at a round-table discussion Monday sponsored by the Folha de S. Paulo newspaper, Temporao called the morning-after pill "an important tool for the prevention of unwanted pregnancies that will definitely be part of our strategy" to help Brazil's poor have the same access to birth control as its rich elite.
The Health Ministry said he attended, but would not immediately confirm his remarks.
Brazil already distributes 254 million free condoms a year, many as part of an anti-AIDS program that makes a special effort just before each year's Carnival celebrations. Brazil also has handed out the morning-after pill and regular contraceptives at government pharmacies for years.
The newly expanded program offers regular contraceptives at commercial drug stores for sale at just $2.40 for a year's supply. Temporao didn't say whether the morning-after pills would be subsidized or entirely free. Previously, the government said it would distribute 50 million packages of regular birth control pills, each with a month's supply, by year's end.
Morning-after pills have high doses of the same drugs found in many regular birth-control pills, and can lower the risk of pregnancy by up to 89 percent if taken within 72 hours of unprotected sex.
Ana Lucia Cavalcanti, who heads women's programs for Sao Paulo, knew of no other Latin American nations that supply free or subsidized morning-after pills. She called on the government to launch education programs so poor women understand how to use them.
Brazil is the world's largest Roman Catholic nation, and the church has vehemently opposed any expansion of birth control. Brazilian Archbishop Orlando Brandes, who represents the church on this issue, was unavailable for comment Tuesday, his office said.
Temporao also has lobbied for a national referendum to legalize abortion up to the 12th week of pregnancy. Brazil now allows abortions only when women have been raped or their lives are in danger, and polls show Brazilians overwhelmingly oppose changes.
Women's rights groups estimate 800,000 illegal abortions happen in Brazil each year, and about 4,000 women die from the back-office procedures annually. Abortions are the fourth leading cause of maternal death in Brazil after hypertension, hemorrhages and infections.
Kidney heart disease spur each other
Tue, 26 Jun 2007 02:26:23 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Hearts and kidneys: If one's diseased, better keep a close eye on the other. Surprising new research shows kidney disease somehow speeds up heart disease well before it has ravaged the kidneys. And perhaps not so surprising, doctors have finally proven that heart disease can trigger kidney destruction, too.
The work, from two studies involving over 50,000 patients, promises to boost efforts to diagnose simmering kidney disease earlier. All it takes are urine and blood tests that cost less than $25, something proponents want to become as routine as cholesterol checks.
"The average patient knows their cholesterol," says Dr. Peter McCullough, preventive medicine chief at Michigan's William Beaumont Hospital. "The average patient has no idea of their kidney function."
Chronic kidney disease, or CKD, is a quiet epidemic: Many of the 19 million Americans estimated to have it don't know they do. The kidneys lose their ability to filter waste out of the bloodstream so slowly that symptoms aren't obvious until the organs are very damaged. End-stage kidney failure is rising fast, with 400,000 people requiring dialysis or a transplant to survive, a toll that has doubled in each of the last two decades.
And while CKD patients often are terrified of having to go on dialysis, the hard truth is that most will die of heart disease before their kidneys disintegrate to that point, something kidney specialists have recognized for several years but isn't widely known.
Indeed, the new research is highlighted in this month's Archives of Internal Medicine with a call for doctors who care for heart patients to start rigorously checking out the kidneys — and for better care of early kidney disease.
The link sounds logical. After all, high blood pressure and diabetes are chief risk factors for both chronic kidney disease and heart attacks.
But the link goes beyond those risk factors, stresses McCullough: Once the kidneys begin to fail, something in turn accelerates heart disease, not just in the obviously sick or very old, but at what he calls "a shockingly early age."
McCullough and colleagues tracked more than 37,000 relatively young people — average age 53 — who volunteered for a kidney screening. Three markers of kidney function were checked: The rate at which kidneys filter blood, called the GFR or glomerular filtration rate; levels of the protein albumin in the urine; and if they were anemic. They also were asked about previously diagnosed heart disease.
The odds of having heart disease rose steadily as each of the kidney markers worsened. More striking was the death data. At this age, few deaths are expected, and indeed just 191 people died during the study period. But those who had both CKD and known heart disease had a threefold increased risk of death in a mere 2 1/2 years, mostly from heart problems.
"This study is very much a wake-up call," McCullough says.
What about the heart's effect on the kidneys? Researchers at Tufts-New England Medical Center in Boston evaluated more than 13,000 people who had participated in two large heart-health studies. People diagnosed with heart disease at the studies' start had twice the risk of declining kidney function in the next nine years.
That makes sense. Heart disease narrows arteries all over the body, kidneys included. Also, some heart imaging tests use compounds that may harm kidneys.
But McCullough suspects a more complex culprit: Both the heart and kidneys send various signals to the bone marrow, which produces a type of stem cell that keeps those organs in good repair. When either starts to fail, this key repair mechanism falters, too, he explains.
Cause aside, what does the research mean for patients today?
_Cardiologists and primary care physicians should carefully monitor heart disease patients for declining kidney function, Wake Forest University physicians urge in an editorial accompanying the two studies.
_Anyone with kidney risk factors — a relative with kidney disease, or someone with diabetes, high blood pressure or a relative with either — should get their GFR tested, advises Dr. Leslie Spry of the National Kidney Foundation. McCullough goes further, and says every adult should know that number. Surveys suggest such routine screening even of the high-risk is rare today.
A normal GFR is 120. If it slips below 60, they have kidney disease.
_Treat kidney disease aggressively. Fewer than a third of CKD patients are prescribed pills proven to protect their damaged kidneys from getting worse — pills such as ACE inhibitors or "angiotensin II receptor blockers" that also lower blood pressure and thus are good for the heart, too.
McCullough adds that CKD patients should have other heart-related risk factors controlled even more tightly than doctors often recommend. Systolic blood pressure — the top number — should never be above 130, and the so-called "bad" or LDL cholesterol should be below 70.
___
EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
On the Net:
National Kidney Foundation: http://www.kidney.org
CDC About 2M more Americans uninsured
Tue, 26 Jun 2007 02:26:35 GMTBy MIKE STOBBE, AP Medical Writer
ATLANTA - The number of adults without health insurance jumped by 2 million from 2005 to 2006, according to a new federal report.
Uninsured Americans numbered 43.6 million last year, a 6 percent increase from 2005, according to the U.S. Centers for Disease Control and Prevention.
Almost all the increase was in the non-elderly adult population — a trend attributed to diminishing employer coverage and pricier private insurance.
The change in non-elderly adults was significant, but the overall increase was not, CDC officials said. The overall count of the uninsured has been fluctuating between 41 and 44 million over the last five years and is not really trending up, they said.
"It's kind of bobbled around," said Robin Cohen, a CDC statistician who is lead author of the report released Monday.
The CDC is one of at least three federal agencies that estimate the number of Americans without health insurance. The U.S. Census Bureau puts out what is perhaps the best-known number, but that agency's 2006 estimate is not to be released until August.
Like the Census Bureau, the CDC's estimate is based on a survey. The CDC interviewed about 75,000 Americans last year, asking if they were uninsured at that point in time. About 15 percent said yes, leading to the estimate that 43.6 million Americans were uninsured.
The number was 41.2 million in 2005; the figure has fluctuated between that mark and 43.6 million for the past five years.
But there was more than a bobble in the number of adults age 18 to 64 without health insurance. That estimate rose to 36.5 million in 2006, from 34.5 million the year before.
Rising health insurance costs have caused employers to drop coverage, and stopped people from buying it privately, experts said.
"The real key issue is we've got to find means to make health care more affordable," said Ken Thorpe, an Emory University health policy professor.
Meanwhile, the number of uninsured children has dropped from about 10 million to about 7 million from 1997 to 2006. The State Children's Health Insurance Program — a federal program to expand public health insurance programs for kids that started in 1997 — seems to be the main explanation, said Sherry Glied, a Columbia University professor who studies the uninsured.
In past policy debates, some worried that the SCHIP program would merely shift children from private coverage to public insurance without actually diminishing the number of uninsured. But the new CDC report shows that wasn't the case, Glied said.
"The kids result was interesting. I haven't really seen that in other studies," Glied said.
Between 2005 and 2006, however, there was actually a slight increase in the number of uninsured kids — from 6.5 million to 6.8 million.
Glied and others said the CDC numbers are roughly comparable to the Census Bureau estimates. The Census Bureau estimated that in 2005, 44.8 million people or 15.3 percent of the population were without health insurance.
