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The New Mexico Insurance Division is responsible for regulating all types of insurance sold in the state of New Mexico - including health insurance policies.
If you are looking for health insurance coverage, the Insurance Division can help you find an insurance agent or insurance company that is licensed to do business in New Mexico. You can contact them at the phone number listed below.
If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Insurance Division. There are separate complaint forms for those who have managed care plans (HMO/PPO) and those who have indemnity insurance. If you are not sure whether you have managed care or an indemnity plan, contact the Insurance Division for help.
New Mexico Insurance Division
P.E.R.A. Bldg., 4th Floor
1120 Paseo de Peralta
Santa Fe, NM 87501
Phone: 505-827-4601 or 800-947-4722
U.S. Department of Labor
If you get your insurance through your job, your plan is also regulated by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees - for example, your employer cannot single out an individual employee to exclude her from the plan because she (or one of her dependents) has a costly illness. Also, if there are 20 or more employees at your job, you should be offered COBRA continuation coverage when you leave your job. The EBSA works to make sure that all of this happens and your rights are protected.
If you have concerns about your employer's practices in administering your job-based health coverage - for example, if you think you should have been offered COBRA continuation coverage, but were not, or if you feel that you were wrongly terminated from your health plan - contact your regional EBSA office.
U.S. Department of Labor Employee Benefits Security Administration
Dallas Regional Office
525 South Griffin Street, Room 900
Dallas, TX 75202-5025
Roger Hilburn - Director
Phone: 972-850-4500
Fax: 214-767-1055
Buying Individual Policies in New Mexico
As a general rule, insurers in New Mexico are allowed to reject your application for coverage based on your health status. However, you may qualify for coverage as a "HIPAA-eligible" individual if you:
* had at least 18 months of continuous creditable coverage, the last day of which was under a group plan AND
* you have exhausted all COBRA continuation coverage which was available to you.
People who are HIPAA-eligible are guaranteed the right to buy insurance through the New Mexico Medical Insurance Pool (described below). If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Insurance Division can help you find out.
New Mexico Medical Insurance Pool (NMMIP)
NMMIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers "HIPAA-eligible" individuals as described above. The NMMIP website has information on their eligibility requirements, as well as current premium rates and benefit packages.
New Mexico Medical Insurance Pool
P.O. Box 1594
Roswell, NM, 88201
Phone: 505-622-4711
New MexiKids - the State Children's Health Insurance Program
NewMexiKids provides health insurance coverage for children under age 19 whose family income is between 185% and 235% of the federal poverty level.
New MexiKids
New Mexico Human Services Department
2009 S. Pacheco, Pollon Plaza
Santa Fe, NM 87504
Phone: 888-997-2583
New Mexico Benefits Counseling Program
The New Mexico Benefits Counseling Program provides free one-on-one counseling for Medicare beneficiaries with questions about any aspect of Medicare, including the Medicare Part D prescription drug benefit, or Medigap coverage.
New Mexico Benefits Counseling Program
Phone: 866-451-2901
New Mexico Medicaid
Medicaid is a government program designed to help the poor and indigent obtain health care services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals. For more information about New Mexico Medicaid
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Making A Bigger Splash In The Gene Pool
We humans have a strong urge to reproduce, but if the environment steers us into putting off having children, we may be rewarded with both longer life and a bigger genetic footprint in future generations.
So concludes a new University of Minnesota study that reveals what may be a major force in shaping the evolution of most living things, including humans. Harnessing this natural effect could open the door to new means of delaying reproduction while promoting longer, healthier lives.
The work, led by ecology, evolution and behavior graduate student Will Ratcliff, was published online June 25 in the Public Library of Science.
The basic idea is simple. When environmental cues like food shortages signal that the population is about to shrink, individuals who can afford to wait until this has happened should do so; then their offspring, when they come, will represent a bigger fraction of the gene pool.
"When the population is declining, future kids make a greater splash in the gene pool than current kids," Ratcliff explains. "If there are tradeoffs between reproducing now versus later, delaying can be a good idea even if it reduces the number of kids you have during your lifetime."
Conversely, if hard times turn to good times and the population is about to boom, it's better to get those kids out there sooner, while the population is still small.
Rules of the waiting game
Over evolutionary history, early reproduction has reduced life expectancy due to the risk of complications in pregnancy, death in childbirth, damaging fights for mates or social status, and the demands of caring for and protecting offspring, says Ratcliff. Though lessened for modern humans, these risks shaped the evolution of our responses to stress.
For example, in some parts of Africa that suffer chronic food shortages--an environmental signal that the population will decline--girls experience their first menstrual period at later ages.
"Delaying reproduction to age 16 instead of 12 can really increase your chances, and your offspring's chances, of survival because having children very young is fraught with risk," says Ratcliff.
But in Western countries where girls have been getting richer food in recent years, the age of menarche has been receding. Rich food is an environmental signal that the population is poised to rise, and so the age of fertility has dropped.
Besides food availability, the environment may signal an imminent population decline chemically. Many food plants produce toxins that tend to depress reproduction and extend the lifespan. Humans may have eaten more of such plants when meat and other rich foods were relatively scarce, a sign that a population is facing a decline.
"A lot of these toxins extend life in ways that mimic dietary restrictions and have been shown to extend life in mice, fruit flies, roundworms, and yeast," says Ratcliff. "The whole point is that if a population is headed downhill, an individual who trades early reproduction for longevity can come out ahead."
One mechanism may involve testosterone, which suppresses the immune system, says R. Ford Denison, Ratcliff's faculty adviser and adjunct professor in the University's College of Biological Sciences. Thus, a toxin or other cue that reduces testosterone levels would tend to extend life as well as dampen reproductive behavior. Someday, the researchers say, harbingers of population decline may result in new drugs or lifestyle changes that lead to delayed reproduction and, potentially, longer and healthier lives.
What counts is the message organisms get from the environment, not necessarily the actual situation, the researchers say. For example, while the stress of regular fasting can delay reproduction and extend life, animal experiments have shown that the mere odor of food can reverse this effect.
Other authors of the paper were graduate student Peter Hawthorne and professor Michael Travisano of the Department of Ecology, Evolution and Behavior.
So concludes a new University of Minnesota study that reveals what may be a major force in shaping the evolution of most living things, including humans. Harnessing this natural effect could open the door to new means of delaying reproduction while promoting longer, healthier lives.
The work, led by ecology, evolution and behavior graduate student Will Ratcliff, was published online June 25 in the Public Library of Science.
The basic idea is simple. When environmental cues like food shortages signal that the population is about to shrink, individuals who can afford to wait until this has happened should do so; then their offspring, when they come, will represent a bigger fraction of the gene pool.
"When the population is declining, future kids make a greater splash in the gene pool than current kids," Ratcliff explains. "If there are tradeoffs between reproducing now versus later, delaying can be a good idea even if it reduces the number of kids you have during your lifetime."
Conversely, if hard times turn to good times and the population is about to boom, it's better to get those kids out there sooner, while the population is still small.
Rules of the waiting game
Over evolutionary history, early reproduction has reduced life expectancy due to the risk of complications in pregnancy, death in childbirth, damaging fights for mates or social status, and the demands of caring for and protecting offspring, says Ratcliff. Though lessened for modern humans, these risks shaped the evolution of our responses to stress.
For example, in some parts of Africa that suffer chronic food shortages--an environmental signal that the population will decline--girls experience their first menstrual period at later ages.
"Delaying reproduction to age 16 instead of 12 can really increase your chances, and your offspring's chances, of survival because having children very young is fraught with risk," says Ratcliff.
But in Western countries where girls have been getting richer food in recent years, the age of menarche has been receding. Rich food is an environmental signal that the population is poised to rise, and so the age of fertility has dropped.
Besides food availability, the environment may signal an imminent population decline chemically. Many food plants produce toxins that tend to depress reproduction and extend the lifespan. Humans may have eaten more of such plants when meat and other rich foods were relatively scarce, a sign that a population is facing a decline.
"A lot of these toxins extend life in ways that mimic dietary restrictions and have been shown to extend life in mice, fruit flies, roundworms, and yeast," says Ratcliff. "The whole point is that if a population is headed downhill, an individual who trades early reproduction for longevity can come out ahead."
One mechanism may involve testosterone, which suppresses the immune system, says R. Ford Denison, Ratcliff's faculty adviser and adjunct professor in the University's College of Biological Sciences. Thus, a toxin or other cue that reduces testosterone levels would tend to extend life as well as dampen reproductive behavior. Someday, the researchers say, harbingers of population decline may result in new drugs or lifestyle changes that lead to delayed reproduction and, potentially, longer and healthier lives.
What counts is the message organisms get from the environment, not necessarily the actual situation, the researchers say. For example, while the stress of regular fasting can delay reproduction and extend life, animal experiments have shown that the mere odor of food can reverse this effect.
Other authors of the paper were graduate student Peter Hawthorne and professor Michael Travisano of the Department of Ecology, Evolution and Behavior.
Today's Healthcare
Coffee drinkers may have another reason to pour that extra cup. When aged mice bred to develop symptoms of Alzheimer's disease were given caffeine – the equivalent of five cups of coffee a day – their memory impairment was reversed, report University of South Florida researchers at the Florida Alzheimer's Disease Research Center.
Back-to-back studies published online July 6 in the Journal of Alzheimer's Disease, show caffeine significantly decreased abnormal levels of the protein linked to Alzheimer's disease, both in the brains and in the blood of mice exhibiting symptoms of the disease. Both studies build upon previous research by the Florida ADRC group showing that caffeine in early adulthood prevented the onset of memory problems in mice bred to develop Alzheimer's symptoms in old age.
"The new findings provide evidence that caffeine could be a viable 'treatment' for established Alzheimer's disease, and not simply a protective strategy," said lead author Gary Arendash, PhD, a USF neuroscientist with the Florida ADRC. "That's important because caffeine is a safe drug for most people, it easily enters the brain, and it appears to directly affect the disease process."
Based on these promising findings in mice, researchers at the Florida ADRC and Byrd Alzheimer's Center at USF hope to begin human trials to evaluate whether caffeine can benefit people with mild cognitive impairment or early Alzheimer's disease, said Huntington Potter, PhD, director of the Florida ADRC and an investigator for the caffeine studies. The research group has already determined that caffeine administered to elderly non-demented humans quickly affects their blood levels of β-amyloid, just as it did in the Alzheimer's mice.
"These are some of the most promising Alzheimer's mouse experiments ever done showing that caffeine rapidly reduces beta amyloid protein in the blood, an effect that is mirrored in the brain, and this reduction is linked to cognitive benefit," Potter said. "Our goal is to obtain the funding needed to translate the therapeutic discoveries in mice into well-designed clinical trials."
Arendash and his colleagues became interested in caffeine's potential for treating Alzheimer's several years ago, after a Portuguese study reported that people with Alzheimer's had consumed less caffeine over the last 20 years than people without the neurodegenerative disease. Since then, several uncontrolled clinical studies have reported moderate caffeine consumption may protect against memory decline during normal aging. The highly controlled studies using Alzheimer's mice allowed researchers to isolate the effects of caffeine on memory from other lifestyle factors such as diet and exercise, Arendash said.
The just-published Florida ADRC study included 55 mice genetically altered to develop memory problems mimicking Alzheimer's disease as they aged. After behavioral tests confirmed the mice were exhibiting signs of memory impairment at age 18 to 19 months – about age 70 in human years – the researchers gave half the mice caffeine in their drinking water. The other half got plain water. The Alzheimer's mice received the equivalent of five 8-oz. cups of regular coffee a day. That's the same amount of caffeine – 500 milligrams -- as contained in two cups of specialty coffees like Starbucks, or 14 cups of tea, or 20 soft drinks.
At the end of the two-month study, the caffeinated mice performed much better on tests measuring their memory and thinking skills. In fact, their memories were identical to normal aged mice without dementia. The Alzheimer's mice drinking plain water continued to do poorly on the tests.
In addition, the brains of the caffeinated mice showed nearly a 50-percent reduction in levels of beta amyloid, a substance forming the sticky clumps of plaques that are a hallmark of Alzheimer's disease. Other experiments by the same investigators indicate that caffeine appears to restore memory by reducing both enzymes needed to produce beta amyloid. The researchers also suggest that caffeine suppresses inflammatory changes in the brain that lead to an overabundance of beta amyloid.
Since caffeine improved the memory of mice with pre-existing Alzheimer's, the researchers were curious to know if it might further boost the memory of non-demented (normal) mice administered caffeine from young adulthood through old age. It did not. Control mice given regular drinking water throughout their lives performed as well on behavioral tests in old age as normal mice who received long-term caffeine treatment, Arendash said. "This suggests that caffeine will not increase memory performance above normal levels. Rather, it appears to benefit those destined to develop Alzheimer's disease."
The researchers do not know if an amount lower than the 500 mg. daily caffeine intake received by the Alzheimer's mice would be effective, Arendash said. For most individuals, however, this moderate level of caffeine intake poses no adverse health effects, according to both the National Research Council and the National Academy of Sciences. Nonetheless, Arendash said, individuals with high blood pressure or those who are pregnant should limit their daily caffeine intake.
If larger, more rigorous clinical studies confirm that caffeine staves off Alzheimer's in humans, as it does in mice, this benefit would be substantial, Arendash said. Alzheimer's disease attacks nearly half of Americans age 85 and older, and Alzheimer's and other dementias triple healthcare costs for those age 65 and older, according to the Alzheimer's Association.
In addition to the Florida ADRC, Byrd Alzheimer's Center and Eric Pfeiffer Suncoast Alzheimer's and Gerontology Center at USF, researchers from the Bay Pines VA Healthcare System; Saitama Medical University, Saitama, Japan; and Washington University School of Medicine, St. Louis, collaborated on the research. The studies were supported by grants to investigators in the Florida ADRC, a statewide project sponsored by the National Institute on Aging and housed at the University of South Florida's Byrd Alzheimer's Center.
Back-to-back studies published online July 6 in the Journal of Alzheimer's Disease, show caffeine significantly decreased abnormal levels of the protein linked to Alzheimer's disease, both in the brains and in the blood of mice exhibiting symptoms of the disease. Both studies build upon previous research by the Florida ADRC group showing that caffeine in early adulthood prevented the onset of memory problems in mice bred to develop Alzheimer's symptoms in old age.
"The new findings provide evidence that caffeine could be a viable 'treatment' for established Alzheimer's disease, and not simply a protective strategy," said lead author Gary Arendash, PhD, a USF neuroscientist with the Florida ADRC. "That's important because caffeine is a safe drug for most people, it easily enters the brain, and it appears to directly affect the disease process."
Based on these promising findings in mice, researchers at the Florida ADRC and Byrd Alzheimer's Center at USF hope to begin human trials to evaluate whether caffeine can benefit people with mild cognitive impairment or early Alzheimer's disease, said Huntington Potter, PhD, director of the Florida ADRC and an investigator for the caffeine studies. The research group has already determined that caffeine administered to elderly non-demented humans quickly affects their blood levels of β-amyloid, just as it did in the Alzheimer's mice.
"These are some of the most promising Alzheimer's mouse experiments ever done showing that caffeine rapidly reduces beta amyloid protein in the blood, an effect that is mirrored in the brain, and this reduction is linked to cognitive benefit," Potter said. "Our goal is to obtain the funding needed to translate the therapeutic discoveries in mice into well-designed clinical trials."
Arendash and his colleagues became interested in caffeine's potential for treating Alzheimer's several years ago, after a Portuguese study reported that people with Alzheimer's had consumed less caffeine over the last 20 years than people without the neurodegenerative disease. Since then, several uncontrolled clinical studies have reported moderate caffeine consumption may protect against memory decline during normal aging. The highly controlled studies using Alzheimer's mice allowed researchers to isolate the effects of caffeine on memory from other lifestyle factors such as diet and exercise, Arendash said.
The just-published Florida ADRC study included 55 mice genetically altered to develop memory problems mimicking Alzheimer's disease as they aged. After behavioral tests confirmed the mice were exhibiting signs of memory impairment at age 18 to 19 months – about age 70 in human years – the researchers gave half the mice caffeine in their drinking water. The other half got plain water. The Alzheimer's mice received the equivalent of five 8-oz. cups of regular coffee a day. That's the same amount of caffeine – 500 milligrams -- as contained in two cups of specialty coffees like Starbucks, or 14 cups of tea, or 20 soft drinks.
At the end of the two-month study, the caffeinated mice performed much better on tests measuring their memory and thinking skills. In fact, their memories were identical to normal aged mice without dementia. The Alzheimer's mice drinking plain water continued to do poorly on the tests.
In addition, the brains of the caffeinated mice showed nearly a 50-percent reduction in levels of beta amyloid, a substance forming the sticky clumps of plaques that are a hallmark of Alzheimer's disease. Other experiments by the same investigators indicate that caffeine appears to restore memory by reducing both enzymes needed to produce beta amyloid. The researchers also suggest that caffeine suppresses inflammatory changes in the brain that lead to an overabundance of beta amyloid.
Since caffeine improved the memory of mice with pre-existing Alzheimer's, the researchers were curious to know if it might further boost the memory of non-demented (normal) mice administered caffeine from young adulthood through old age. It did not. Control mice given regular drinking water throughout their lives performed as well on behavioral tests in old age as normal mice who received long-term caffeine treatment, Arendash said. "This suggests that caffeine will not increase memory performance above normal levels. Rather, it appears to benefit those destined to develop Alzheimer's disease."
The researchers do not know if an amount lower than the 500 mg. daily caffeine intake received by the Alzheimer's mice would be effective, Arendash said. For most individuals, however, this moderate level of caffeine intake poses no adverse health effects, according to both the National Research Council and the National Academy of Sciences. Nonetheless, Arendash said, individuals with high blood pressure or those who are pregnant should limit their daily caffeine intake.
If larger, more rigorous clinical studies confirm that caffeine staves off Alzheimer's in humans, as it does in mice, this benefit would be substantial, Arendash said. Alzheimer's disease attacks nearly half of Americans age 85 and older, and Alzheimer's and other dementias triple healthcare costs for those age 65 and older, according to the Alzheimer's Association.
In addition to the Florida ADRC, Byrd Alzheimer's Center and Eric Pfeiffer Suncoast Alzheimer's and Gerontology Center at USF, researchers from the Bay Pines VA Healthcare System; Saitama Medical University, Saitama, Japan; and Washington University School of Medicine, St. Louis, collaborated on the research. The studies were supported by grants to investigators in the Florida ADRC, a statewide project sponsored by the National Institute on Aging and housed at the University of South Florida's Byrd Alzheimer's Center.
Great Home Remedies
Eye drops will remove redness not only from your eyes but also from red blemishes. Freeze a drop in a spoon, place frozen over blemish and hold, it will shrink swelling.
Neosporin can help remove and heal acne overnight.
Toothpaste (white paste) will help heal acne breakouts.
Clay masks will draw out the black heads that tend to gather around the nose, by dehydrating the top layer of skin.
Cuticle scissors work well to trim those little nose hairs.
Fingers: Your most trusted tool. Can apply everything with them. (So, you don't have an excuse when you forget your kit). Concealer- the heat in your fingers will help melt a thick concealer into place (especially under the eyes). Can blend cream blushes. Apply lip balm or gloss on lips. Don't forget to clean your hands when going from one application/color to another.
Dab a Q-tip into Jell-O cherry flavored powder and apply to lips. Let sit for five minutes and lick it off. Will give your lips a natural red coat.
Toothbrush and Vaseline will exfoliate and plu
mp up your lips.
Eucerin lotion over lips provides soothing therapy and holds lip color.
Try applying a yellow eye shadow as a primer on your lips. It will warm up and change any lip color.
Vaseline added to any shadow can make a gel blush or lip stain.
Extra Virgin Olive Oil (EVOO) - is a great makeup remover. Use a damp washcloth to remove the excess…it will clean and moisturize all in one.
Parsley will help freshen your breath from the inside. Parsley contains chlorophyll, which is found in Certs and Clorets.
Honey and baby oil combined and rubbed on the body will make it incredibly soft. Be sure to rinse it off before leaving the bath.
Milk will add a smooth texture to the body; try adding some to your next bath.
A quick weight loss tip: Take two garlic tablets and two papaya enzymes before every meal. You can lose up to 5 lbs in one week.
Instead of shaving cream, use hair conditioner to shave your legs. It will leave them silky and smooth, as well as save you a moisturizing step.
Rub sea salt over face and body. It will give an invigorating feeling.
Gently rub baking soda (3/4 cup mixed with 1/4 cup water) for three minutes on face and rinse off. A great, inexpensive exfoliator.
Adding about 1/2 box of baking soda to the bath will also soothe itching skin, irritation and a sunburn.
Epsom salts will ease aching muscles and swelling.
Lemon juice will whiten brittle fingernails.
Orange slices added to your bath will provide a natural and easy aromatherapy.
Fruit Jell-O will take away foot odor. Submerge your feet into a fragrantly colored bucket and enjoy.
Lemon, lime, honey, & yogurt can lighten age and sun spots. Mix the juice from 1 lemon, 1 lime, 2 tablespoons of honey and 2 ounces of plain yogurt. Massage into desired spots at least once a week.
Lemons and powdered milk can act like an exfoliator and skin rejuvenator. Mix a paste with the juice of 2 lemons to 1 cup of powdered milk and the water necessary to get a thick paste. Let stand for 20 minutes, and then use the paste to gently massage off dead skin around the knees and elbows. The area will be naturally softened and bleached.
Caffeine is the main ingredient in those expensive cellulite creams. Your regular caffeinated coffee grounds (used from this morning) can be rubbed into those annoying cellulite areas. Since this can get a bit messy, try doing it in the bathtub or shower.
Herbal wraps are easy to make. Create your own, similar to the ones offered at the expensive spas, by using 1 cup corn oil, 1/2 cup grapefruit juice and 2 teaspoons of dried thyme. Combine the ingredients and work the mixture into the thigh, hip and butt areas. Cover the areas with a plastic wrap, locking in the heat from your body. To accelerate the results, lay a heating pad for several minutes over the desired areas.
Vitamins E, A or C capsules (in gel form) from your local drug store, can be used instead of the costly creams with these ingredients in them. Prick open the capsule and add it to your moisturizer. You’ll get all the benefits of the expensive creams without the extra chemicals or expense.
Hydrogen peroxide applied with a cotton ball makes a terrific astringent.
Pepto Bismol is a great face mask for sensitive skin. The same way it coats and soothes the stomach, it gently caresses the skin. Apply straight from the bottle with a cotton ball. Allow it to dry and rinse with cool water. It’s soothing and refreshing.
Vodka & Lemon tones up tired skin. (1/4 cup Vodka and juice from one lemon) Dab on face, neck and chest area with cotton. Not necessary to rinse off. It will evaporate with the air. The less rubbing, the better. Mix a bit extra (with some sugar) and have a cocktail.
Hairspray sprayed eight inches from face with eyes and mouth closed will create sealer for your makeup.
Baby wipes are a fast and inexpensive way to remove makeup. We use them for the celebrities on the set all the time.
Mud Mask/Wrap: Kitty Litter (100% natural clay only), without additives or chemicals. Combine 1 tablespoon clay with water to create a muddy paste. Apply to face, let dry and slightly harden. Then rinse off with warm water and washcloth. It's easy and refreshing and will feel just like those expensive spa mud masks.
Crush cucumbers into a pulp, and pat over face and neck. Good for oily skin and to unclog pores.
Sweet almond oil will moisturize extra dry skin, help lashes grow and can remove makeup. Will also sooth sunburned skin.
Lemon juice will dry up and help get rid of a pimple.
Crisco oil will remove makeup and moisturize your skin. It can even be used to treat psoriasis and eczema.
Neosporin can help remove and heal acne overnight.
Toothpaste (white paste) will help heal acne breakouts.
Clay masks will draw out the black heads that tend to gather around the nose, by dehydrating the top layer of skin.
Cuticle scissors work well to trim those little nose hairs.
Fingers: Your most trusted tool. Can apply everything with them. (So, you don't have an excuse when you forget your kit). Concealer- the heat in your fingers will help melt a thick concealer into place (especially under the eyes). Can blend cream blushes. Apply lip balm or gloss on lips. Don't forget to clean your hands when going from one application/color to another.
Dab a Q-tip into Jell-O cherry flavored powder and apply to lips. Let sit for five minutes and lick it off. Will give your lips a natural red coat.
Toothbrush and Vaseline will exfoliate and plu
mp up your lips.
Eucerin lotion over lips provides soothing therapy and holds lip color.
Try applying a yellow eye shadow as a primer on your lips. It will warm up and change any lip color.
Vaseline added to any shadow can make a gel blush or lip stain.
Extra Virgin Olive Oil (EVOO) - is a great makeup remover. Use a damp washcloth to remove the excess…it will clean and moisturize all in one.
Parsley will help freshen your breath from the inside. Parsley contains chlorophyll, which is found in Certs and Clorets.
Honey and baby oil combined and rubbed on the body will make it incredibly soft. Be sure to rinse it off before leaving the bath.
Milk will add a smooth texture to the body; try adding some to your next bath.
A quick weight loss tip: Take two garlic tablets and two papaya enzymes before every meal. You can lose up to 5 lbs in one week.
Instead of shaving cream, use hair conditioner to shave your legs. It will leave them silky and smooth, as well as save you a moisturizing step.
Rub sea salt over face and body. It will give an invigorating feeling.
Gently rub baking soda (3/4 cup mixed with 1/4 cup water) for three minutes on face and rinse off. A great, inexpensive exfoliator.
Adding about 1/2 box of baking soda to the bath will also soothe itching skin, irritation and a sunburn.
Epsom salts will ease aching muscles and swelling.
Lemon juice will whiten brittle fingernails.
Orange slices added to your bath will provide a natural and easy aromatherapy.
Fruit Jell-O will take away foot odor. Submerge your feet into a fragrantly colored bucket and enjoy.
Lemon, lime, honey, & yogurt can lighten age and sun spots. Mix the juice from 1 lemon, 1 lime, 2 tablespoons of honey and 2 ounces of plain yogurt. Massage into desired spots at least once a week.
Lemons and powdered milk can act like an exfoliator and skin rejuvenator. Mix a paste with the juice of 2 lemons to 1 cup of powdered milk and the water necessary to get a thick paste. Let stand for 20 minutes, and then use the paste to gently massage off dead skin around the knees and elbows. The area will be naturally softened and bleached.
Caffeine is the main ingredient in those expensive cellulite creams. Your regular caffeinated coffee grounds (used from this morning) can be rubbed into those annoying cellulite areas. Since this can get a bit messy, try doing it in the bathtub or shower.
Herbal wraps are easy to make. Create your own, similar to the ones offered at the expensive spas, by using 1 cup corn oil, 1/2 cup grapefruit juice and 2 teaspoons of dried thyme. Combine the ingredients and work the mixture into the thigh, hip and butt areas. Cover the areas with a plastic wrap, locking in the heat from your body. To accelerate the results, lay a heating pad for several minutes over the desired areas.
Vitamins E, A or C capsules (in gel form) from your local drug store, can be used instead of the costly creams with these ingredients in them. Prick open the capsule and add it to your moisturizer. You’ll get all the benefits of the expensive creams without the extra chemicals or expense.
Hydrogen peroxide applied with a cotton ball makes a terrific astringent.
Pepto Bismol is a great face mask for sensitive skin. The same way it coats and soothes the stomach, it gently caresses the skin. Apply straight from the bottle with a cotton ball. Allow it to dry and rinse with cool water. It’s soothing and refreshing.
Vodka & Lemon tones up tired skin. (1/4 cup Vodka and juice from one lemon) Dab on face, neck and chest area with cotton. Not necessary to rinse off. It will evaporate with the air. The less rubbing, the better. Mix a bit extra (with some sugar) and have a cocktail.
Hairspray sprayed eight inches from face with eyes and mouth closed will create sealer for your makeup.
Baby wipes are a fast and inexpensive way to remove makeup. We use them for the celebrities on the set all the time.
Mud Mask/Wrap: Kitty Litter (100% natural clay only), without additives or chemicals. Combine 1 tablespoon clay with water to create a muddy paste. Apply to face, let dry and slightly harden. Then rinse off with warm water and washcloth. It's easy and refreshing and will feel just like those expensive spa mud masks.
Crush cucumbers into a pulp, and pat over face and neck. Good for oily skin and to unclog pores.
Sweet almond oil will moisturize extra dry skin, help lashes grow and can remove makeup. Will also sooth sunburned skin.
Lemon juice will dry up and help get rid of a pimple.
Crisco oil will remove makeup and moisturize your skin. It can even be used to treat psoriasis and eczema.
Drug-eluting Stents Found Safe, Superior To Bare Metal Stents, Study Suggests
Drug-eluting stents were safe and superior to bare metal stents in preventing death and heart attacks among 262,700 "real-world" patients enrolled in a nationwide registry of cardiovascular disease, according to researchers from Duke University Medical Center.
The findings were presented today at the i2Summit at the American College of Cardiology's 58th Annual Scientific Session. They also appear online in the Journal of the American College of Cardiology.
The study is the largest of its kind to date and may end years of controversy over the safety of the devices.
"We hope these findings will finally lay to rest any doubt about the safety of drug-eluting stents," says Pamela Douglas, M.D., a cardiologist and member of the Duke Heart Center at Duke University Medical Center and the lead author of the study. "Our results clearly show that drug-eluting stents are indeed safe."
Stents are small tubes that can prop open blocked coronary arteries. The earliest versions were made of bare metal mesh, but later models were designed to release a medication that could suppress restenosis, or the growth of new tissue that could cause the artery to clog up again. Physicians have been debating their relative merit for years.
After initially proving more effective than bare metal stents in preventing restenosis, drug-eluting stents suffered a setback when recent clinical trials found them associated with higher long-term death rates. Those findings led to warnings from the Food and Drug Administration and confusion over which option is better.
Douglas and colleagues followed patients over age 65 enrolled in the National Cardiovascular Data Registry who had received stents from 2004 through 2006. Most of the patients had received a drug-eluting stent; only 17 percent were implanted with the bare metal variety. Investigators matched the patients' data with their Medicare claims and followed them for two and one-half years, measuring rates of death, heart attack, stroke, bleeding and the need for additional artery-opening procedures.
They found that over the 30-month period, patients in the drug-eluting stent group had a 25 percent reduction in death and 24 percent reduction in heart attacks, when compared with those who received bare metal stents, but no significant difference in the incidence of stroke, major bleeding or need for additional artery-opening procedures.
Douglas says the study is important on several fronts. "First, the data show that over a two and one-half year follow up, drug-eluting stents are safe among patients in a real-world, highly variable environment. Patients who enroll in clinical trials are generally younger, healthier and on fewer medications that the population at large, and that means that clinical trials can generate findings that may not hold up in larger, more variable, community populations," says Douglas.
"In addition, we believe this is the first time that anyone has been able to link so much clinical data with Medicare claims. What that essentially has given us is an excellent model for future post-marketing evaluation," says Douglas, who adds that such studies may be particularly attractive to payers, health care policy makers and anyone interested in health care reform who needs real-world data, as opposed to that generated by clinical trials.
The study was funded by the Agency for Healthcare Research and the ACC's National Cardiovascular Data Registry.
Colleagues from Duke who helped with the study include senior author Eric Peterson, Lesley Curtis, J. Matthew Brennan, Ghazala Haque, Kevin Anstrom, Eric Eisenstein, David Dai, David Kong, Bradley Hammill and David Matchar. Additional co-authors include Ralph Brindis, of Kaiser Permanente and the American College of Cardiology; and Art Sedrakyan, of the Agency for Healthcare Quality Research.
Drug-eluting Stents Found Safe, Superior To Bare Metal Stents, Study Suggests
Drug-eluting stents were safe and superior to bare metal stents in preventing death and heart attacks among 262,700 "real-world" patients enrolled in a nationwide registry of cardiovascular disease, according to researchers from Duke University Medical Center.
The findings were presented today at the i2Summit at the American College of Cardiology's 58th Annual Scientific Session. They also appear online in the Journal of the American College of Cardiology.
The study is the largest of its kind to date and may end years of controversy over the safety of the devices.
"We hope these findings will finally lay to rest any doubt about the safety of drug-eluting stents," says Pamela Douglas, M.D., a cardiologist and member of the Duke Heart Center at Duke University Medical Center and the lead author of the study. "Our results clearly show that drug-eluting stents are indeed safe."
Stents are small tubes that can prop open blocked coronary arteries. The earliest versions were made of bare metal mesh, but later models were designed to release a medication that could suppress restenosis, or the growth of new tissue that could cause the artery to clog up again. Physicians have been debating their relative merit for years.
After initially proving more effective than bare metal stents in preventing restenosis, drug-eluting stents suffered a setback when recent clinical trials found them associated with higher long-term death rates. Those findings led to warnings from the Food and Drug Administration and confusion over which option is better.
Douglas and colleagues followed patients over age 65 enrolled in the National Cardiovascular Data Registry who had received stents from 2004 through 2006. Most of the patients had received a drug-eluting stent; only 17 percent were implanted with the bare metal variety. Investigators matched the patients' data with their Medicare claims and followed them for two and one-half years, measuring rates of death, heart attack, stroke, bleeding and the need for additional artery-opening procedures.
They found that over the 30-month period, patients in the drug-eluting stent group had a 25 percent reduction in death and 24 percent reduction in heart attacks, when compared with those who received bare metal stents, but no significant difference in the incidence of stroke, major bleeding or need for additional artery-opening procedures.
Douglas says the study is important on several fronts. "First, the data show that over a two and one-half year follow up, drug-eluting stents are safe among patients in a real-world, highly variable environment. Patients who enroll in clinical trials are generally younger, healthier and on fewer medications that the population at large, and that means that clinical trials can generate findings that may not hold up in larger, more variable, community populations," says Douglas.
"In addition, we believe this is the first time that anyone has been able to link so much clinical data with Medicare claims. What that essentially has given us is an excellent model for future post-marketing evaluation," says Douglas, who adds that such studies may be particularly attractive to payers, health care policy makers and anyone interested in health care reform who needs real-world data, as opposed to that generated by clinical trials.
The study was funded by the Agency for Healthcare Research and the ACC's National Cardiovascular Data Registry.
Colleagues from Duke who helped with the study include senior author Eric Peterson, Lesley Curtis, J. Matthew Brennan, Ghazala Haque, Kevin Anstrom, Eric Eisenstein, David Dai, David Kong, Bradley Hammill and David Matchar. Additional co-authors include Ralph Brindis, of Kaiser Permanente and the American College of Cardiology; and Art Sedrakyan, of the Agency for Healthcare Quality Research.
New Mexican Health-care Program Successful At Reducing Crippling Health Care Costs
Seguro Popular, a Mexican health care program instituted in 2003, has already reduced crippling health care costs among poorer households, according to an evaluation conducted by researchers at Harvard University in collaboration with researchers in Mexico.
The study was designed and led by Gary King, David Florence Professor of Government and director of the Institute for Quantitative Social Science at Harvard. The results are published in the current issue of The Lancet.
"The success of Seguro Popular in reducing catastrophic health expenditures is remarkable," says King, "not least because governmental money spent on the poor in many countries rarely reaches the intended recipients."
King's study of about 500,000 people is the largest-ever randomized health policy experiment. It features innovative research designs and statistical methods he and his colleagues developed that increase what we learn from an evaluation while simultaneously saving a great deal of money. The design includes several failsafe components that preserve the experimental randomization even if politics or other problems intervene, including those which have ruined most previous large scale public policy evaluations. The approach is now being implemented or considered for evaluations of many other public policy programs around the world.
Passed in 2003, Seguro Popular was developed to provide health care to 50 million Mexicans who otherwise lack coverage. Voluntary enrollment in the program, at no cost to the poor, provides access to health clinics, drugs, regular and preventative medical care, and the money to pay for it all. The program's primary goal is the reduction of catastrophic health expenses, those exceeding one-third of a household's yearly disposable income.
About a half a million people in 118,569 households were included in this study, which was conducted over 10 months. In the treatment clusters, 44 percent of households reported participating in the program, compared to 7.3 percent in control communities, which was approximately as expected. Among participating households, those suffering catastrophic health expenses were reduced by almost 60 percent, contributing to a 30 percent reduction in catastrophic health expenses across treatment communities.
The evaluation also highlighted areas in which the program was ineffective. Contrary to prior non-randomized studies, the researchers found no increase in utilization of health services, although longer-term research may show an increase. Health outcomes will also take longer to show an effect.
Before the program was instituted, 174 communities were paired up based on having similar background variables, such as the health of the community, size, and the number of schools. Then one community within each pair was randomly chosen to receive treatment: Families were encouraged to enroll in Seguro Popular, health facilities were built or upgraded, and medical personnel, drugs, and other supplies were provided. In the other community within each pair, no changes were made.
"One advantage of this design is that if one of the communities was to drop out of the study, due to interventions by politicians or for other reasons, the paired community would be removed as well, and the balance between the treated and control groups would not be affected. In contrast, classical randomized experiments are destroyed when even one community is lost. The matched pair design also decreased the margin of error to as little as one-sixth of what it would be with traditional experimental methods," says King. "That's the equivalent of collecting many more respondents, or randomizing throughout many more communities, for the same cost."
Seguro Popular in Mexico covers about the same number of people as are uninsured in America. King points out that there may be lessons for other countries to learn in the success of Seguro Popular.
King's co-authors were Emmanuela Gakidou of the University of Washington; Kosuke Imai of Princeton University; Jason Lakin, Clayton Nall, and Nirmala Ravishankar of Harvard; Ryan Moore of Washington University in St. Louis; Manett Vargas of the Ministry of Health in Mexico; Martha María Téllez-Rojo and Juan Eugenio Hernández Ávila of the National Institute of Public Health in Mexico; Mauricio Hernández Ávila of the Ministry of Health in Mexico and the National Institute of Public Health in Mexico; and Héctor Hernández Llamas of Conestadistica. Gakidou, Imai, Lakin, Nall, Ravishankar, Moore, and Vargas are all King's current or former students and affiliates at the Harvard Institute for Quantitative Social Sciences.
The research was funded by the Mexican Ministry of Health, the National Institute of Public Health in Mexico, and the Harvard Institute for Quantitative Social Science.
Partner Behavior Better Predicts STD Risks
Risky behaviors such as not using condoms or having sex with multiple people put young adults at risk for contracting sexually transmitted diseases, but perhaps not as much as the characteristics of their sexual partners, University of Florida researchers say.
The findings, which UF and University of Pittsburgh researchers report in the April issue of Sexually Transmitted Diseases, could help health-care providers better screen patients for STD risks, said Stephanie A. S. Staras, Ph.D., a UF assistant professor of epidemiology and health policy research in the UF College of Medicine.
"If you are choosing high-risk partners, you are much more likely to have an STD, even when we account for your condom-use patterns," said Staras, the lead author of the study. "The theory is simple: You need to have sex with someone who has an STD to get an STD. Based on the prevalence of STDs in the United States, it seems like the public may not fully understand their risk."
The study examined the sexual activities, partner characteristics and STD diagnoses of 412 subjects between the ages of 15 and 24. Among the subjects whose partners were categorized as high-risk, half were diagnosed with an STD. By comparison, about 40 percent of the young adults whose own behaviors were labeled as high-risk were diagnosed with an STD.
According to the Centers for Disease Control and Prevention, about 19 million people in the United States contract STDs each year. About half of them are between the ages of 15 and 24.
Health-care providers often ask patients about their own sexual behaviors, but inquiring only about a person's own behaviors may cause some patients to slip through the cracks, Staras said. For example, some subjects in the study reported very low-risk behaviors but were having sex with very high-risk partners.
Adding a few simple questions about partner characteristics during STD screenings could help providers catch more patients who need to be tested and educated about condom use and other protective measures, Staras said.
"Partner selection is an area of STD prevention that could complement what we are already doing with promoting condom use, and could possibly really help people," Staras said. "If somehow we could convince individuals to incorporate this information in a meaningful way into their decision-making, then we could reduce STDs."
UF researchers measured five specific characteristics to gauge how risky certain partners were. These characteristics included whether the partner has a problem with marijuana or alcohol, was at least five years older or younger, had been in jail, had sex with other people in the past year or had an STD in the past year.
The researchers then created a composite, totaling up the number of negative partner characteristics for each subject and comparing them against the number of each person's own individual risky behaviors, which ranged from how often they used condoms to how many people they had sex with.
Overall, researchers found considering all of the partner characteristics together was the strongest predictor for STDs. Young adults whose partners had five or more risk characteristics were three times more likely to have an STD than those whose partners had no more than two characteristics.
Of these characteristics, the most telling were if a partner already had an STD and if a couple had an age difference of more than five years. Subjects whose partners were five years older or younger than them were more than twice as likely to be diagnosed with an STD than those whose partners were around the same age, the researchers found.
"It's all about the risk of the partner and sometimes we forget that," said Richard A. Crosby, Ph.D., the DDI endowed professor and chairman of the department of health behavior at the University of Kentucky and a co-director of the Rural Center for AIDS/STD Prevention.
But Crosby, who was not involved in the UF study, said it's also important for people to remember that the risks mentioned in the study are just generalizations, not set-in-stone giveaways for STDs.
"From a public health perspective, it's important to understand these findings," he said. "From a practical and prevention perspective, we still need to rely on people using valid methods of protection to avoid being infected or infecting."
New Mexican Health-care Program Successful At Reducing Crippling Health Care Costs
Seguro Popular, a Mexican health care program instituted in 2003, has already reduced crippling health care costs among poorer households, according to an evaluation conducted by researchers at Harvard University in collaboration with researchers in Mexico.
The study was designed and led by Gary King, David Florence Professor of Government and director of the Institute for Quantitative Social Science at Harvard. The results are published in the current issue of The Lancet.
"The success of Seguro Popular in reducing catastrophic health expenditures is remarkable," says King, "not least because governmental money spent on the poor in many countries rarely reaches the intended recipients."
King's study of about 500,000 people is the largest-ever randomized health policy experiment. It features innovative research designs and statistical methods he and his colleagues developed that increase what we learn from an evaluation while simultaneously saving a great deal of money. The design includes several failsafe components that preserve the experimental randomization even if politics or other problems intervene, including those which have ruined most previous large scale public policy evaluations. The approach is now being implemented or considered for evaluations of many other public policy programs around the world.
Passed in 2003, Seguro Popular was developed to provide health care to 50 million Mexicans who otherwise lack coverage. Voluntary enrollment in the program, at no cost to the poor, provides access to health clinics, drugs, regular and preventative medical care, and the money to pay for it all. The program's primary goal is the reduction of catastrophic health expenses, those exceeding one-third of a household's yearly disposable income.
About a half a million people in 118,569 households were included in this study, which was conducted over 10 months. In the treatment clusters, 44 percent of households reported participating in the program, compared to 7.3 percent in control communities, which was approximately as expected. Among participating households, those suffering catastrophic health expenses were reduced by almost 60 percent, contributing to a 30 percent reduction in catastrophic health expenses across treatment communities.
The evaluation also highlighted areas in which the program was ineffective. Contrary to prior non-randomized studies, the researchers found no increase in utilization of health services, although longer-term research may show an increase. Health outcomes will also take longer to show an effect.
Before the program was instituted, 174 communities were paired up based on having similar background variables, such as the health of the community, size, and the number of schools. Then one community within each pair was randomly chosen to receive treatment: Families were encouraged to enroll in Seguro Popular, health facilities were built or upgraded, and medical personnel, drugs, and other supplies were provided. In the other community within each pair, no changes were made.
"One advantage of this design is that if one of the communities was to drop out of the study, due to interventions by politicians or for other reasons, the paired community would be removed as well, and the balance between the treated and control groups would not be affected. In contrast, classical randomized experiments are destroyed when even one community is lost. The matched pair design also decreased the margin of error to as little as one-sixth of what it would be with traditional experimental methods," says King. "That's the equivalent of collecting many more respondents, or randomizing throughout many more communities, for the same cost."
Seguro Popular in Mexico covers about the same number of people as are uninsured in America. King points out that there may be lessons for other countries to learn in the success of Seguro Popular.
King's co-authors were Emmanuela Gakidou of the University of Washington; Kosuke Imai of Princeton University; Jason Lakin, Clayton Nall, and Nirmala Ravishankar of Harvard; Ryan Moore of Washington University in St. Louis; Manett Vargas of the Ministry of Health in Mexico; Martha María Téllez-Rojo and Juan Eugenio Hernández Ávila of the National Institute of Public Health in Mexico; Mauricio Hernández Ávila of the Ministry of Health in Mexico and the National Institute of Public Health in Mexico; and Héctor Hernández Llamas of Conestadistica. Gakidou, Imai, Lakin, Nall, Ravishankar, Moore, and Vargas are all King's current or former students and affiliates at the Harvard Institute for Quantitative Social Sciences.
The research was funded by the Mexican Ministry of Health, the National Institute of Public Health in Mexico, and the Harvard Institute for Quantitative Social Science.
Partner Behavior Better Predicts STD Risks
Risky behaviors such as not using condoms or having sex with multiple people put young adults at risk for contracting sexually transmitted diseases, but perhaps not as much as the characteristics of their sexual partners, University of Florida researchers say.
The findings, which UF and University of Pittsburgh researchers report in the April issue of Sexually Transmitted Diseases, could help health-care providers better screen patients for STD risks, said Stephanie A. S. Staras, Ph.D., a UF assistant professor of epidemiology and health policy research in the UF College of Medicine.
"If you are choosing high-risk partners, you are much more likely to have an STD, even when we account for your condom-use patterns," said Staras, the lead author of the study. "The theory is simple: You need to have sex with someone who has an STD to get an STD. Based on the prevalence of STDs in the United States, it seems like the public may not fully understand their risk."
The study examined the sexual activities, partner characteristics and STD diagnoses of 412 subjects between the ages of 15 and 24. Among the subjects whose partners were categorized as high-risk, half were diagnosed with an STD. By comparison, about 40 percent of the young adults whose own behaviors were labeled as high-risk were diagnosed with an STD.
According to the Centers for Disease Control and Prevention, about 19 million people in the United States contract STDs each year. About half of them are between the ages of 15 and 24.
Health-care providers often ask patients about their own sexual behaviors, but inquiring only about a person's own behaviors may cause some patients to slip through the cracks, Staras said. For example, some subjects in the study reported very low-risk behaviors but were having sex with very high-risk partners.
Adding a few simple questions about partner characteristics during STD screenings could help providers catch more patients who need to be tested and educated about condom use and other protective measures, Staras said.
"Partner selection is an area of STD prevention that could complement what we are already doing with promoting condom use, and could possibly really help people," Staras said. "If somehow we could convince individuals to incorporate this information in a meaningful way into their decision-making, then we could reduce STDs."
UF researchers measured five specific characteristics to gauge how risky certain partners were. These characteristics included whether the partner has a problem with marijuana or alcohol, was at least five years older or younger, had been in jail, had sex with other people in the past year or had an STD in the past year.
The researchers then created a composite, totaling up the number of negative partner characteristics for each subject and comparing them against the number of each person's own individual risky behaviors, which ranged from how often they used condoms to how many people they had sex with.
Overall, researchers found considering all of the partner characteristics together was the strongest predictor for STDs. Young adults whose partners had five or more risk characteristics were three times more likely to have an STD than those whose partners had no more than two characteristics.
Of these characteristics, the most telling were if a partner already had an STD and if a couple had an age difference of more than five years. Subjects whose partners were five years older or younger than them were more than twice as likely to be diagnosed with an STD than those whose partners were around the same age, the researchers found.
"It's all about the risk of the partner and sometimes we forget that," said Richard A. Crosby, Ph.D., the DDI endowed professor and chairman of the department of health behavior at the University of Kentucky and a co-director of the Rural Center for AIDS/STD Prevention.
But Crosby, who was not involved in the UF study, said it's also important for people to remember that the risks mentioned in the study are just generalizations, not set-in-stone giveaways for STDs.
"From a public health perspective, it's important to understand these findings," he said. "From a practical and prevention perspective, we still need to rely on people using valid methods of protection to avoid being infected or infecting."
Hispanics Appear To Face Poorer Quality Nursing Home Care
Nursing homes serving primarily Hispanic residents provided poorer quality care compared to facilities whose patients were mostly white, according to Brown University research. Details were published recently in the Journal of the American Medical Directors Association.
Researchers reached their conclusions after looking at the rate of bed sores at nursing homes with high concentrations of Hispanic patients, compared to others with low concentrations. Hispanics at nursing homes with a high rate of Hispanic residents were more likely to have bed sores, compared to Hispanics living in nursing homes with fewer Hispanic residents.
Michael Gerardo, adjunct assistant professor of community health at the Warren Alpert Medical School of Brown University, led the research. Two others served as co-authors — Joan Teno, M.D., professor of community health and medicine and an expert on end-of-life care, and Vincent Mor, chair of the Department of Community Health, whose work focuses on nursing home care among other areas.
Gerardo and the other professors said that more research is needed to determine the implications of their findings, directed specifically at the root cause for disparities between high-quality and low-quality nursing homes.
“A systemic evaluation of the difference in the process of care between high- and low-quality nursing homes is warranted in order to reduce nursing home disparities,” Gerardo said.
Their work comes less than two years after a landmark 2007 study, published in Health Affairs, that suggests blacks are more likely than whites to live in poor-quality nursing homes. That study found that the problem was worst in the Midwest, and that inequalities in care are closely correlated to racial segregation. Mor was lead author for that study.
For the study of Hispanics in nursing homes, the researchers looked at two data sources. One, the national repository of the Minimum Data Set, is a federally mandated report of health status, function and demographics on all nursing home residents. The other, which is known as the Oscar database system, collects information on patients and nursing homes, via the Centers for Medicaid and Medicare Services.
Residents were included if they were age 65 or older, living at free-standing nursing homes in California, New Mexico, Texas, Arizona or Colorado.
Funding from the National Institutes of Health, National Institute on Aging, A National Research Service Award Institutional Training Grant and the Commonwealth Fund helped support the study.
Hispanics Appear To Face Poorer Quality Nursing Home Care
Nursing homes serving primarily Hispanic residents provided poorer quality care compared to facilities whose patients were mostly white, according to Brown University research. Details were published recently in the Journal of the American Medical Directors Association.
Researchers reached their conclusions after looking at the rate of bed sores at nursing homes with high concentrations of Hispanic patients, compared to others with low concentrations. Hispanics at nursing homes with a high rate of Hispanic residents were more likely to have bed sores, compared to Hispanics living in nursing homes with fewer Hispanic residents.
Michael Gerardo, adjunct assistant professor of community health at the Warren Alpert Medical School of Brown University, led the research. Two others served as co-authors — Joan Teno, M.D., professor of community health and medicine and an expert on end-of-life care, and Vincent Mor, chair of the Department of Community Health, whose work focuses on nursing home care among other areas.
Gerardo and the other professors said that more research is needed to determine the implications of their findings, directed specifically at the root cause for disparities between high-quality and low-quality nursing homes.
“A systemic evaluation of the difference in the process of care between high- and low-quality nursing homes is warranted in order to reduce nursing home disparities,” Gerardo said.
Their work comes less than two years after a landmark 2007 study, published in Health Affairs, that suggests blacks are more likely than whites to live in poor-quality nursing homes. That study found that the problem was worst in the Midwest, and that inequalities in care are closely correlated to racial segregation. Mor was lead author for that study.
For the study of Hispanics in nursing homes, the researchers looked at two data sources. One, the national repository of the Minimum Data Set, is a federally mandated report of health status, function and demographics on all nursing home residents. The other, which is known as the Oscar database system, collects information on patients and nursing homes, via the Centers for Medicaid and Medicare Services.
Residents were included if they were age 65 or older, living at free-standing nursing homes in California, New Mexico, Texas, Arizona or Colorado.
Funding from the National Institutes of Health, National Institute on Aging, A National Research Service Award Institutional Training Grant and the Commonwealth Fund helped support the study.
Diabetes Insipidus
What is diabetes insipidus?
Diabetes insipidus (DI) is a rare disease that causes frequent urination. The large volume of urine is diluted, mostly water. To make up for lost water, a person with DI may feel the need to drink large amounts and is likely to urinate frequently, even at night, which can disrupt sleep and, on occasion, cause bedwetting. Because of the excretion of abnormally large volumes of dilute urine, people with DI may quickly become dehydrated if they do not drink enough water. Children with DI may be irritable or listless and may have fever, vomiting, or diarrhea. Milder forms of DI can be managed by drinking enough water, usually between 2 and 2.5 liters a day. DI severe enough to endanger a person’s health is rare.
[Top]
What is the difference between diabetes insipidus and diabetes mellitus?
DI should not be confused with diabetes mellitus (DM), which results from insulin deficiency or resistance leading to high blood glucose, also called blood sugar. DI and DM are unrelated, although they can have similar signs and symptoms, like excessive thirst and excessive urination.
DM is far more common than DI and receives more news coverage. DM has two main forms, type 1 diabetes and type 2 diabetes. DI is a different form of illness altogether.
[Top]
How is fluid in the body normally regulated?
The body has a complex system for balancing the volume and composition of body fluids. The kidneys remove extra body fluids from the bloodstream. These fluids are stored in the bladder as urine. If the fluid regulation system is working properly, the kidneys make less urine to conserve fluid when water intake is decreased or water is lost, for example, through sweating or diarrhea. The kidneys also make less urine at night when the body’s metabolic processes are slower.
The hypothalamus makes antidiuretic hormone (ADH), which directs the kidneys to make less urine.
To keep the volume and composition of body fluids balanced, the rate of fluid intake is governed by thirst, and the rate of excretion is governed by the production of antidiuretic hormone (ADH), also called vasopressin. This hormone is made in the hypothalamus, a small gland located in the brain. ADH is stored in the nearby pituitary gland and released into the bloodstream when necessary. When ADH reaches the kidneys, it directs them to concentrate the urine by reabsorbing some of the filtered water to the bloodstream and therefore make less urine. DI occurs when this precise system for regulating the kidneys’ handling of fluids is disrupted.
[Top]
What are the types of diabetes insipidus?
Central DI
The most common form of serious DI, central DI, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids.
Nephrogenic DI
Nephrogenic DI results when the kidneys are unable to respond to ADH. The kidneys’ ability to respond to ADH can be impaired by drugs—like lithium, for example—and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic DI is never discovered.
Desmopressin will not work for this form of DI. Instead, a person with nephrogenic DI may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times.
Dipsogenic DI
Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid overload can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain. Scientists have not yet found an effective treatment for dipsogenic DI.
Gestational DI
Gestational DI occurs only during pregnancy and results when an enzyme made by the placenta destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that develops with the fetus. The placenta allows exchange of nutrients and waste products between mother and fetus.
Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.
Diabetes Insipidus
What is diabetes insipidus?
Diabetes insipidus (DI) is a rare disease that causes frequent urination. The large volume of urine is diluted, mostly water. To make up for lost water, a person with DI may feel the need to drink large amounts and is likely to urinate frequently, even at night, which can disrupt sleep and, on occasion, cause bedwetting. Because of the excretion of abnormally large volumes of dilute urine, people with DI may quickly become dehydrated if they do not drink enough water. Children with DI may be irritable or listless and may have fever, vomiting, or diarrhea. Milder forms of DI can be managed by drinking enough water, usually between 2 and 2.5 liters a day. DI severe enough to endanger a person’s health is rare.
[Top]
What is the difference between diabetes insipidus and diabetes mellitus?
DI should not be confused with diabetes mellitus (DM), which results from insulin deficiency or resistance leading to high blood glucose, also called blood sugar. DI and DM are unrelated, although they can have similar signs and symptoms, like excessive thirst and excessive urination.
DM is far more common than DI and receives more news coverage. DM has two main forms, type 1 diabetes and type 2 diabetes. DI is a different form of illness altogether.
[Top]
How is fluid in the body normally regulated?
The body has a complex system for balancing the volume and composition of body fluids. The kidneys remove extra body fluids from the bloodstream. These fluids are stored in the bladder as urine. If the fluid regulation system is working properly, the kidneys make less urine to conserve fluid when water intake is decreased or water is lost, for example, through sweating or diarrhea. The kidneys also make less urine at night when the body’s metabolic processes are slower.
The hypothalamus makes antidiuretic hormone (ADH), which directs the kidneys to make less urine.
To keep the volume and composition of body fluids balanced, the rate of fluid intake is governed by thirst, and the rate of excretion is governed by the production of antidiuretic hormone (ADH), also called vasopressin. This hormone is made in the hypothalamus, a small gland located in the brain. ADH is stored in the nearby pituitary gland and released into the bloodstream when necessary. When ADH reaches the kidneys, it directs them to concentrate the urine by reabsorbing some of the filtered water to the bloodstream and therefore make less urine. DI occurs when this precise system for regulating the kidneys’ handling of fluids is disrupted.
[Top]
What are the types of diabetes insipidus?
Central DI
The most common form of serious DI, central DI, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids.
Nephrogenic DI
Nephrogenic DI results when the kidneys are unable to respond to ADH. The kidneys’ ability to respond to ADH can be impaired by drugs—like lithium, for example—and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic DI is never discovered.
Desmopressin will not work for this form of DI. Instead, a person with nephrogenic DI may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times.
Dipsogenic DI
Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid overload can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain. Scientists have not yet found an effective treatment for dipsogenic DI.
Gestational DI
Gestational DI occurs only during pregnancy and results when an enzyme made by the placenta destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that develops with the fetus. The placenta allows exchange of nutrients and waste products between mother and fetus.
Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.
Kidney Disease of Diabetes
The Burden of Kidney Failure
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes.1 Kidney failure is the final stage of chronic kidney disease (CKD).
Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases.1 Even when diabetes is controlled, the disease can lead to CKD and kidney failure. Most people with diabetes do not develop CKD that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, 2 and nearly 180,000 people are living with kidney failure as a result of diabetes.1
People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2005, care for patients with kidney failure cost the United States nearly $32 billion.1
Source: United States Renal Data System. USRDS 2007 Annual Data Report.
African Americans, American Indians, and Hispanics/Latinos develop diabetes, CKD, and kidney failure at rates higher than Caucasians. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to kidney disease of diabetes—factors including heredity, diet, and other medical conditions, such as high blood pressure. They have found that high blood pressure and high levels of blood glucose increase the risk that a person with diabetes will progress to kidney failure.
1United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.
2National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics, 2007. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2008.
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The Course of Kidney Disease
Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes.
Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. This first stage of CKD is called microalbuminuria. The kidney’s filtration function usually remains normal during this period.
As the disease progresses, more albumin leaks into the urine. This stage may be called macroalbuminuria or proteinuria. As the amount of albumin in the urine increases, the kidneys’ filtering function usually begins to drop. The body retains various wastes as filtration falls. As kidney damage develops, blood pressure often rises as well.
Overall, kidney damage rarely occurs in the first 10 years of diabetes, and usually 15 to 25 years will pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases.
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Diagnosis of CKD
People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
eGFR. eGFR stands for estimated glomerular filtration rate. Each kidney contains about 1 million tiny filters made up of blood vessels. These filters are called glomeruli. Kidney function can be checked by estimating how much blood the glomeruli filter in a minute. The calculation of eGFR is based on the amount of creatinine, a waste product, found in a blood sample. As the level of creatinine goes up, the eGFR goes down.
Kidney disease is present when eGFR is less than 60 milliliters per minute.
The American Diabetes Association (ADA) and the National Institutes of Health (NIH) recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.
Urine albumin. Urine albumin is measured by comparing the amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amounts of creatinine but almost no albumin. Even a small increase in the ratio of albumin to creatinine is a sign of kidney damage.
Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine, with or without decreased eGFR.
The ADA and the NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more.
Kidney Disease of Diabetes
The Burden of Kidney Failure
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes.1 Kidney failure is the final stage of chronic kidney disease (CKD).
Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases.1 Even when diabetes is controlled, the disease can lead to CKD and kidney failure. Most people with diabetes do not develop CKD that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, 2 and nearly 180,000 people are living with kidney failure as a result of diabetes.1
People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2005, care for patients with kidney failure cost the United States nearly $32 billion.1
Source: United States Renal Data System. USRDS 2007 Annual Data Report.
African Americans, American Indians, and Hispanics/Latinos develop diabetes, CKD, and kidney failure at rates higher than Caucasians. Scientists have not been able to explain these higher rates. Nor can they explain fully the interplay of factors leading to kidney disease of diabetes—factors including heredity, diet, and other medical conditions, such as high blood pressure. They have found that high blood pressure and high levels of blood glucose increase the risk that a person with diabetes will progress to kidney failure.
1United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.
2National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics, 2007. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2008.
[Top]
The Course of Kidney Disease
Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes.
Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. This first stage of CKD is called microalbuminuria. The kidney’s filtration function usually remains normal during this period.
As the disease progresses, more albumin leaks into the urine. This stage may be called macroalbuminuria or proteinuria. As the amount of albumin in the urine increases, the kidneys’ filtering function usually begins to drop. The body retains various wastes as filtration falls. As kidney damage develops, blood pressure often rises as well.
Overall, kidney damage rarely occurs in the first 10 years of diabetes, and usually 15 to 25 years will pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases.
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Diagnosis of CKD
People with diabetes should be screened regularly for kidney disease. The two key markers for kidney disease are eGFR and urine albumin.
eGFR. eGFR stands for estimated glomerular filtration rate. Each kidney contains about 1 million tiny filters made up of blood vessels. These filters are called glomeruli. Kidney function can be checked by estimating how much blood the glomeruli filter in a minute. The calculation of eGFR is based on the amount of creatinine, a waste product, found in a blood sample. As the level of creatinine goes up, the eGFR goes down.
Kidney disease is present when eGFR is less than 60 milliliters per minute.
The American Diabetes Association (ADA) and the National Institutes of Health (NIH) recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes.
Urine albumin. Urine albumin is measured by comparing the amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amounts of creatinine but almost no albumin. Even a small increase in the ratio of albumin to creatinine is a sign of kidney damage.
Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine, with or without decreased eGFR.
The ADA and the NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more.
Chronic Kidney Disease: A Family Affair
Chronic kidney disease (CKD) is the permanent loss of kidney function. CKD may be the result of physical injury or a disease that damages the kidneys, such as diabetes or high blood pressure. When the kidneys are damaged, they do not remove wastes and extra water from the blood as well as they should.
CKD is a family affair because you may be at risk if you have a blood relative with kidney failure.
CKD is a silent condition. In the early stages, you will not notice any symptoms. CKD often develops so slowly that many people don't realize they're sick until the disease is advanced and they are rushed to the hospital for life-saving dialysis.
A Growing Problem
CKD is a growing problem in the United States. Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation virtually doubled to 380,000. If this trend continues, the number of people with kidney failure will approach 700,000 by 2010. The annual cost of treating kidney failure in the United States has already topped $20 billion.
Kidney failure is only a part of the picture. Experts estimate that 20 million Americans have significantly reduced kidney function, and even a small loss of kidney function can double a person's risk of developing cardiovascular disease. Many of these people will experience heart attacks or strokes before they become aware of their kidney disease. So identifying and treating CKD early can help prevent heart problems as well as postpone kidney failure.
Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation more than doubled.
Who is at risk?
Risk factors are conditions that make you more likely to develop a disease. The leading risk factors for CKD are
- diabetes
- high blood pressure
- family history of kidney failure
Having diabetes increases your risk of developing CKD. In fact, diabetes is the leading cause of kidney failure. High blood pressure is the second leading cause.
CKD runs in families, so you may have an increased risk if your mother, father, sister, or brother has kidney failure.
Some racial groups are also at increased risk for CKD.
- African Americans are nearly four times as likely to develop kidney failure as white Americans.
- American Indians have nearly three times the risk compared to whites.
- Hispanic Americans have nearly twice the risk of non-Hispanic whites.
Screening for kidney disease includes simple blood and urine tests.
If you have diabetes or high blood pressure, or a close family member with kidney failure, you should get checked for kidney disease, especially if you're a member of one of the racial or ethnic groups at higher risk for CKD.
Chronic Kidney Disease: A Family Affair
Chronic kidney disease (CKD) is the permanent loss of kidney function. CKD may be the result of physical injury or a disease that damages the kidneys, such as diabetes or high blood pressure. When the kidneys are damaged, they do not remove wastes and extra water from the blood as well as they should.
CKD is a family affair because you may be at risk if you have a blood relative with kidney failure.
CKD is a silent condition. In the early stages, you will not notice any symptoms. CKD often develops so slowly that many people don't realize they're sick until the disease is advanced and they are rushed to the hospital for life-saving dialysis.
A Growing Problem
CKD is a growing problem in the United States. Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation virtually doubled to 380,000. If this trend continues, the number of people with kidney failure will approach 700,000 by 2010. The annual cost of treating kidney failure in the United States has already topped $20 billion.
Kidney failure is only a part of the picture. Experts estimate that 20 million Americans have significantly reduced kidney function, and even a small loss of kidney function can double a person's risk of developing cardiovascular disease. Many of these people will experience heart attacks or strokes before they become aware of their kidney disease. So identifying and treating CKD early can help prevent heart problems as well as postpone kidney failure.
Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation more than doubled.
Who is at risk?
Risk factors are conditions that make you more likely to develop a disease. The leading risk factors for CKD are
- diabetes
- high blood pressure
- family history of kidney failure
Having diabetes increases your risk of developing CKD. In fact, diabetes is the leading cause of kidney failure. High blood pressure is the second leading cause.
CKD runs in families, so you may have an increased risk if your mother, father, sister, or brother has kidney failure.
Some racial groups are also at increased risk for CKD.
- African Americans are nearly four times as likely to develop kidney failure as white Americans.
- American Indians have nearly three times the risk compared to whites.
- Hispanic Americans have nearly twice the risk of non-Hispanic whites.
Screening for kidney disease includes simple blood and urine tests.
If you have diabetes or high blood pressure, or a close family member with kidney failure, you should get checked for kidney disease, especially if you're a member of one of the racial or ethnic groups at higher risk for CKD.
High Blood Pressure and Kidney Disease
What is high blood pressure?
Blood pressure measures the force of blood against the walls of the blood vessels. Extra fluid in the body increases the amount of fluid in blood vessels and makes blood pressure higher. Narrow, stiff, or clogged blood vessels also raise blood pressure.
[d]
Hypertension can result from too much fluid in normal blood vessels or from normal fluid in narrow, stiff, or clogged blood vessels.
People with high blood pressure should see their doctor regularly.
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How does high blood pressure hurt the kidneys?
High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It’s a dangerous cycle.
High blood pressure is one of the leading causes of kidney failure, also called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or have regular blood-cleansing treatments called dialysis. Every year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States.1
1United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.
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What are the signs and symptoms of high blood pressure?
Most people with high blood pressure have no symptoms. The only way to know whether a person’s blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, called the systolic pressure, represents the pressure when the heart is beating. The bottom number, called the diastolic pressure, shows the pressure when the heart is resting between beats. A person’s blood pressure is considered normal if it stays at or below 120/80, which is commonly stated as “120 over 80.” People with a systolic blood pressure of 120 to 139 or a diastolic blood pressure of 80 to 89 are considered prehypertensive and should adopt lifestyle changes to lower their blood pressure and prevent heart and blood vessel diseases. A person whose systolic blood pressure is consistently 140 or higher or whose diastolic pressure is 90 or higher is considered to have high blood pressure and should talk with a doctor about the best ways to lower it.
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What are the signs and symptoms of chronic kidney disease (CKD)?
Early kidney disease is a silent problem, like high blood pressure, and does not have any symptoms. People may have CKD but not know it because they do not feel sick. A person’s glomerular filtration rate (GFR) is a measure of how well the kidneys are filtering wastes from the blood. GFR is estimated from a routine measurement of creatinine in the blood. The result is called the estimated GFR (eGFR).
Creatinine is a waste product formed by the normal breakdown of muscle cells. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.
An eGFR with a value below 60 milliliters per minute (mL/min) suggests some kidney damage has occurred. The score means that a person’s kidneys are not working at full strength.
Another sign of CKD is proteinuria, or protein in the urine. Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of failing kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. CKD is present when more than 30 milligrams of albumin per gram of creatinine is excreted in urine, with or without decreased eGFR.
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How can kidney damage from high blood pressure be prevented?
The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), recommends that people with CKD use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.
High Blood Pressure and Kidney Disease
What is high blood pressure?
Blood pressure measures the force of blood against the walls of the blood vessels. Extra fluid in the body increases the amount of fluid in blood vessels and makes blood pressure higher. Narrow, stiff, or clogged blood vessels also raise blood pressure.
[d]
Hypertension can result from too much fluid in normal blood vessels or from normal fluid in narrow, stiff, or clogged blood vessels.
People with high blood pressure should see their doctor regularly.
[Top]
How does high blood pressure hurt the kidneys?
High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It’s a dangerous cycle.
High blood pressure is one of the leading causes of kidney failure, also called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or have regular blood-cleansing treatments called dialysis. Every year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States.1
1United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.
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What are the signs and symptoms of high blood pressure?
Most people with high blood pressure have no symptoms. The only way to know whether a person’s blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, called the systolic pressure, represents the pressure when the heart is beating. The bottom number, called the diastolic pressure, shows the pressure when the heart is resting between beats. A person’s blood pressure is considered normal if it stays at or below 120/80, which is commonly stated as “120 over 80.” People with a systolic blood pressure of 120 to 139 or a diastolic blood pressure of 80 to 89 are considered prehypertensive and should adopt lifestyle changes to lower their blood pressure and prevent heart and blood vessel diseases. A person whose systolic blood pressure is consistently 140 or higher or whose diastolic pressure is 90 or higher is considered to have high blood pressure and should talk with a doctor about the best ways to lower it.
[Top]
What are the signs and symptoms of chronic kidney disease (CKD)?
Early kidney disease is a silent problem, like high blood pressure, and does not have any symptoms. People may have CKD but not know it because they do not feel sick. A person’s glomerular filtration rate (GFR) is a measure of how well the kidneys are filtering wastes from the blood. GFR is estimated from a routine measurement of creatinine in the blood. The result is called the estimated GFR (eGFR).
Creatinine is a waste product formed by the normal breakdown of muscle cells. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.
An eGFR with a value below 60 milliliters per minute (mL/min) suggests some kidney damage has occurred. The score means that a person’s kidneys are not working at full strength.
Another sign of CKD is proteinuria, or protein in the urine. Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of failing kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. CKD is present when more than 30 milligrams of albumin per gram of creatinine is excreted in urine, with or without decreased eGFR.
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How can kidney damage from high blood pressure be prevented?
The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), recommends that people with CKD use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.
Kidney Biopsy
What is a kidney biopsy?
A biopsy is a diagnostic test that involves collecting small pieces of tissue, usually through a needle, for examination with a microscope. A kidney biopsy can help in forming a diagnosis and in choosing the best course of treatment. A kidney biopsy may be recommended for any of the following conditions:
- hematuria, which is blood in the urine
- proteinuria, which is excessive protein in the urine
- impaired kidney function, which causes excessive waste products in the blood
A pathologist will look at the kidney tissue samples to check for unusual deposits, scarring, or infecting organisms that would explain a person’s condition. The doctor may find a condition that can be treated and cured. If a person has progressive kidney failure, the biopsy may show how quickly the disease is advancing. A biopsy can also help explain why a transplanted kidney is not working properly.
Patients should talk with their doctors about what information might be learned from the biopsy and the risks involved so the patients can help make a decision about whether a biopsy is worthwhile.
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What are the preparations for a kidney biopsy?
Patients must sign a consent form saying they understand the risks involved in this procedure. The risks are slight, but patients should discuss these risks in detail with their doctors before signing the form.
Doctors should be aware of all the medicines a patient takes and any drug allergies that patient might have. The patient should avoid aspirin and other blood-thinning medicines for 1 to 2 weeks before the procedure. Some doctors advise their patients to avoid food and fluids before the test, while others tell patients to eat a light meal. Shortly before the biopsy, blood and urine samples are taken to make sure the patient doesn’t have a condition that would make doing a biopsy risky.
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What are the procedures for a kidney biopsy?
Kidney biopsies are usually done in a hospital. The patient is fully awake with light sedation. A local anesthetic is given before the needle is inserted.
Patients lie on their stomachs to position the kidneys near the surface of their backs. Patients who have a transplanted kidney lie on their backs. The doctor marks the entry site, cleans the area, and injects a local painkiller. For a biopsy using a needle inserted through the skin, the doctor uses a locating needle and x-ray or ultrasound equipment to find the kidney and then a collecting needle to gather the tissue. Patients are asked to hold their breath as the doctor uses a spring-loaded instrument to insert the biopsy needle and collect the tissue, usually for about 30 seconds or a little longer for each insertion. The spring-loaded instrument makes a sharp clicking noise that can be startling to patients. The doctor may need to insert the needle three or four times to collect the needed samples.
The kidneys filter wastes and extra fluid from the blood and direct them to the bladder as urine.
The entire procedure usually takes about an hour, including time to locate the kidney, clean the biopsy site, inject the local painkiller, and collect the tissue samples.
Patients who are prone to bleeding problems should not have a biopsy through the skin. These patients may still undergo a kidney biopsy through an open operation in which the surgeon makes an incision and can see the kidney to collect tissue samples.
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What happens after a kidney biopsy?
After the test, patients lie on their backs in the hospital for a few hours. Patients who have a transplanted kidney lie on their stomachs. During this time, the staff will monitor blood pressure and pulse and take blood samples to assess for blood loss. On rare occasions when bleeding does not stop on its own, a transfusion may be necessary to replace lost blood. Most patients leave the hospital the same day. Patients may notice some blood in their urine for 24 hours after the test.
A rare complication is infection from the biopsy.
Patients should tell their doctors or nurses if they have any of these problems:
- bloody urine more than 24 hours after the test
- inability to urinate
- fever
- worsening pain in the biopsy site
- faintness or dizziness
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How are kidney biopsy results reported?
After the biopsy, the doctor will inspect the tissue samples in the laboratory using one or more microscopes, perhaps using dyes to identify different substances that may be settled in the tissue. Electron microscopes may be used to see small details. Getting the complete biopsy results usually takes a few days. In urgent cases, a preliminary report may be given within a few hours.
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