More U.S. Kids May Be at Risk for High Blood Pressure

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Study looked at rise in body fat, waist size and salt intake over 13-year period

By Steven Reinberg

HealthDay Reporter

MONDAY, July 15 (HealthDay News) -- The risk for high blood pressure in American teens and children increased 27 percent over 13 years, a new study finds, as waistlines thickened and kids consumed more salt in their diets.

"High blood pressure is the predominant risk factor for stroke, and stroke rates have been rising in children in the U.S. over recent years," said Dr. David Katz, director of the Yale University Prevention Research Center. He was not involved with the study.

Harvard researchers collected data on more than 3,200 children aged 8 to 17 who took part in the National Health and Nutrition Examination Survey from 1988 to 1994, comparing them to more than 8,300 kids in the same survey from 1999 to 2008.

Although children in the study had elevated blood pressure, they could not be classified as hypertensive, because readings must be high three times in a row to make that diagnosis, the researchers noted.

As the obesity epidemic continues, doctors are seeing more children with high blood pressure, an expert said.

"Today alone I will see 10 to 15 [patients], mostly teenagers, that are overweight with hypertension," said Dr. Ana Paredes, a pediatric nephrologist at Miami Children's Hospital.

The first step in treating these children is to change their diet and increase the amount of exercise they do, Paredes said. "I give them a plan they can follow," she said. "I tell them to try to lose a pound a week."

Paredes also counsels her patients to reduce the salt in their diet. Much of the salt that children consume comes from processed foods and drinks like sodas, she said. "If you are drinking Gatorade while watching TV or working on the computer, you're just intoxicating yourself with salt," she said.

Katz said that the new study adds to the weight of evidence that sodium intake affects blood pressure in children as well as adults.

"The pathway from increased sodium intake to elevated blood pressure to rising incidence of stroke is cause for both concern and corrective action," Katz said.

Americans eat an average 3,400 milligrams (mg) of salt every day -- that's more than twice the American Heart Association's recommendation of 1,500 mg or less. Two-thirds of the salt is from processed foods and restaurant meals.

The association between body-mass index -- a measure of body fat -- and blood pressure is even stronger than the association with sodium, Katz noted. "As obesity rates rise in our kids, so, too, does their blood pressure," Katz said.

The high salt content of processed food is correctable as are the influences making children obese, he said. "If we needed another reason to take action, this study provides one. As our kids' blood pressure rises, so does the pressure on us all to do what's necessary to put a stop to these trends."

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Aspirin Every Other Day May Lower Women's Colon Cancer Risk

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Benefit must be weighed against GI bleeding, other risks, however, experts say

By Kathleen Doheny

HealthDay Reporter

MONDAY, July 15 (HealthDay News) -- Taking a low-dose aspirin every other day may reduce the risk of colorectal cancer, according to a study that focused on nearly 40,000 women aged 45 and older.

The protection does seem to take some time to surface, said researcher Nancy Cook, a professor of medicine at Brigham and Women's Hospital and Harvard Medical School. "After 10 years, we started to see an effect," she noted.

"After 18 years of follow-up, we saw a 20 percent reduction in colon cancer over the whole time period," she said. When they looked at the 10-to-18 year mark, the reduction was 42 percent, she said.

However, risks linked with aspirin, such as gastrointestinal bleeding, must be considered, Cook said.

The study, funded by the U.S. National Cancer Institute and U.S. National Heart, Lung, and Blood Institute, is published July 16 in the Annals of Internal Medicine.

Aspirin has been long known for its protective effects on heart health, but the protective effect of aspirin on colon and rectal cancer has only been found more recently. "In the past three years, analyses of trials conducted for cardiovascular health have begun to show an effect on colon cancer as well," Cook said.

Cook and her team followed women enrolled in the Women's Health Study, a trial that evaluated the benefits and risks of low-dose aspirin and vitamin E in preventing both cardiovascular disease and cancers.

The study began in 1993 and ended in 2004. The women had no history of cancer (except nonmelanoma skin cancer), cardiovascular disease or other major chronic illness when they enrolled.

The women assigned to the aspirin group were told to take a low dose -- 100 milligrams -- of aspirin every other day. The comparison group took placebo pills on alternate days.

After the study ended, the researchers continued to follow more than 33,000 women through March 2012. The women were told to continue the regimen, although the researchers no longer provided the pills.

The researchers tracked colorectal cancer, along with other cancers. They found the 20 percent lower colorectal cancer incidence over the entire 18-year follow-up.

They did not find a difference with cancer deaths between groups, but Cook said there may not have been enough women to show a comparative difference from a statistical point of view.

Cook found no difference in colorectal polyps between groups. Polyps are removed when they are found on colonoscopy as they can progress to cancer.

The aspirin group had more gastrointestinal bleeding, a known side effect, and more peptic ulcers. While 8.3 percent of the aspirin group had GI bleeding, 7.3 percent of the placebo group did. Peptic ulcers affected 7.3 percent of the aspirin group but only 6.2 percent of the placebo group.

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Scientists Detail Alzheimer's Progression, Step by Step

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As researchers learn more, therapy might someday address brain changes much sooner

By Barbara Bronson Gray

HealthDay Reporter

TUESDAY, July 16 (HealthDay News) -- New research seeks to delineate just how Alzheimer's disease unfolds in the human brain.

Biological changes may happen earlier than scientists had previously thought, according to a new disease model. This suggests that early signs of risk could potentially become treatment targets long before symptoms of Alzheimer's begin to appear, the researchers said.

"We're getting a better idea of what is happening during the asymptomatic [symptomless] phases of the disease," said Dean Hartley, director of science initiatives at the Alzheimer's Association, who was not involved with the new research.

The scientists behind the new research identified distinct but overlapping phases in the course of Alzheimer's disease, each detectable by biological "markers" showing physical changes in the brain. They also have refined their model to distinguish between these "biomarkers" of Alzheimer's disease and those of normal aging.

In the first phase of Alzheimer's, brain markers signaling changes in beta-amyloid protein show up first, the model suggests. Beta-amyloid plaques are protein pieces from the fatty membrane surrounding nerve cells that clump together, contributing to nerve dysfunction.

In the second phase of the disease, signs of degeneration and death of brain cells occur.

Symptoms of dementia are seen in the third phase of Alzheimer's disease, according to the new model.

The refined model should help researchers design better research, guide the selection of study participants, suggest the ideal time to begin treatment and help measure the impact of treatment, said Dr. Clifford Jack Jr.

Jack is lead author of one of three related studies to be presented Tuesday at the Alzheimer's Association International Conference, in Boston. He said his research has been accepted for publication in the journal Neurology.

In addition to beta-amyloid proteins, "tau" -- another protein -- also plays a role in Alzheimer's, creating what are called "neurofibrillary tangles." Jack said the changes in the brain created by tau seem to occur first, but amyloid aggregation, or clumping, accelerates the changes in tau and causes it to spread.

The central message is that tau and beta-amyloid plaque interact with each other in a synergistic way, said Jack, a professor of radiology and a neuroradiologist at the Mayo Clinic College of Medicine, in Rochester, Minn.

Alzheimer's disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills. Symptoms typically appear after age 60, and about 5 million Americans may have the disease, according to the U.S. National Institute on Aging.

Jack and his team published a hypothetical model of the major Alzheimer's disease biomarkers in Neurology in 2010, describing how the biomarkers changed over time and were related to the beginning and progression of symptoms. For this study, the team reviewed studies that tested and evaluated that model, spurring them to further refine it.

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Oregon Sets Affordable Care Act Insurance Rates

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July 16, 2013 -- After 2 months of review, the state of Oregon has approved rates for health insurance sold through Cover Oregon, the state-operated Marketplace created under the Affordable Care Act.

Cover Oregon will have 11 carriers, says spokeswoman Lisa Morawski. Rates and coverage will go into effect Jan. 1, 2014.

Insurance premiums will vary by age, geography, family size, and tobacco use. Four levels of plans -- bronze, silver, gold, and platinum -- will be available. 

Here are some examples of premiums:

A single, 21-year-old nonsmoker in Portland could choose a silver plan (which pays 70% of medical costs) that ranges from $168 to $257 a month.A single, 40-year-old nonsmoker in Portland could choose a silver plan that costs from $215 to $329 a month.A single, 21-year-old nonsmoker in the Bend area could choose a silver plan that costs from $173 to $265 a month.A single, 40-year-old nonsmoker in the Bend area could choose a silver plan that costs from $221 to $339 a month.

By October, Cover Oregon will show side-by-side plan comparisons. Its carriers include two consumer operated and oriented plans (CO-OPs). CO-OPs are nonprofit health insurers that give you another choice if you're looking for health insurance you can afford.

About 217,000 people are expected to sign up through the Marketplace, Morawski said. That includes individuals and people under small-group plans, but not those on Medicaid.

Subsidies (or financial aid) will be available based on personal income. A family of four can make up to $94,200 a year and still qualify for some type of financial assistance. For instance, a family of four making less than $36,000 a year will pay a maximum of $118 a month; a family of four making $94,200 would pay a maximum of $746 a month.

Twelve insurance companies and two CO-OPs submitted rates for approval for either individual or small-employer markets, according to the Oregon Department of Consumer & Business Services.

Oregon's Insurance Division lowered some of the rate requests for individual plans by up to 30%.

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Kidney Failure a Possible Risk of Prostate Cancer Hormone Treatment: Study

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Review looked at side effect from androgen deprivation therapy

By Dennis Thompson

HealthDay Reporter

TUESDAY, July 16 (HealthDay News) -- Hormone therapy for prostate cancer may dramatically increase a man's risk of kidney failure, according to a new study.

Use of androgen deprivation therapy was tied to a 250 percent increase in a man's chances of suffering acute kidney injury, Canadian researchers found in a review of more than 10,000 men receiving treatment for early stage prostate cancer.

The study appears in the July 17 issue of the Journal of the American Medical Association.

Androgen deprivation therapy uses medication or surgery to reduce the amount of male hormones in a man's body, which can then cause prostate cancer cells to shrink or grow more slowly.

It is a therapy usually reserved for advanced cases of prostate cancer, said study co-author Laurent Azoulay, a pharmacoepidemiologist at Jewish General Hospital's Lady Davis Institute, in Montreal. Previous research already has linked androgen deprivation therapy to a possible increased risk of heart attack.

These new findings tying hormone therapy to acute kidney injury -- a rapid loss of kidney function with a 50 percent mortality rate -- should prompt doctors to think twice before using androgen deprivation therapy to treat prostate cancer patients at little risk of dying from the disease, said Azoulay, also an assistant professor in McGill University's department of oncology.

"There is a big debate over who should receive androgen deprivation therapy, and the timing of use," he said. "In patients whose prostate cancer has spread, the benefits outweigh the risk, but now there's this jump to using [androgen deprivation therapy] in patients who would not typically die from prostate cancer. In that subgroup of patients, the risks might outweigh the benefit."

Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society, called the Canadian study "intriguing."

"They did find what would appear to be a fairly strong association between androgen deprivation treatment and acute kidney injury," Brooks said. "This is something that men and their clinicians need to be aware of and watching out for if they choose to go with androgen deprivation therapy as part of their treatment plan for prostate cancer."

However, Brooks also noted that the study relied on past medical data and did not involve current prostate cancer patients compared against a control group.

"These results are suggestive that an association may exist, but they are not definitive," Brooks said. "There will need to be other research looking at this."

For the new study, the research team identified 10,250 men who had been diagnosed with nonmetastatic (not spreading) prostate cancer between 1997 and 2008, using patient data maintained by the United Kingdom. Researchers then tracked whether each patient had been hospitalized with acute kidney injury, and whether their kidney failure occurred during or after the hormone treatment.

Prostate cancer patients who received androgen deprivation therapy were 2.5 times more likely to suffer kidney failure, the study found. Their risk of acute kidney injury particularly increased if they received a combined androgen blockade, a therapy that uses different hormone-suppression methods to drastically decrease male and female hormone levels in the body.

Both male and female hormones play a large role in kidney function, Azoulay said, which could explain why androgen deprivation therapy can cause such drastic damage to the organ.

"Testosterone and estrogen have been shown to play an important role in renal [kidney] function," he said. "It seems that testosterone has vessel-dilating effects, and estrogen has a protective effect against renal injury."

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2 New Alzheimer's Drugs Show Promise in Early Studies

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Experts caution that expectations are low in field littered with drug failures

By Brenda Goodman

HealthDay Reporter

SUNDAY, July 14 (HealthDay News) -- Researchers say two new drugs for Alzheimer's disease have shown promise in early experiments and will likely progress to the next round of clinical trials.

One drug, called a BACE inhibitor, has been in development for more than 10 years. In very early tests, it dramatically reduced levels of beta amyloid, a sticky protein that forms plaques in the brains of Alzheimer's patients.

The second drug is thought to reduce damaging inflammation. Patients with mild mental impairment who took the drug for over a year saw significant improvements in some measures of memory and thinking.

The results of the studies, both sponsored by companies hoping to market the medications, are scheduled to be presented Sunday at the Alzheimer's Association International Conference, in Boston.

Normally, those reports would be cause for optimism in a disease that affects 5 million people and currently has no effective treatments.

But Alzheimer's experts have been through this dance before, and they say they're not holding their breaths that the new drugs will make it to patients.

"It's like that movie '27 Dresses,'" said Dr. Paul Rosenberg, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, in Baltimore. "We've been bridesmaids in this field so many times."

So far, the search for a drug that might slow or stop the relentless march of Alzheimer's disease through the brain has proved fruitless.

In the past year alone, three closely watched new agents failed in late-stage clinical trials. In May, a Massachusetts pharmaceutical company announced it would close after its experimental Alzheimer's drug ran into unexpected safety problems. In June, Eli Lilly stopped a study of a different BACE inhibitor when patients who were taking the drug showed signs of liver problems.

Those disappointments come on top of years of trying -- and failing -- at other promising approaches. The plaques that clog the brains of Alzheimer's patients seem to be accelerated by high cholesterol in the blood. So researchers tried cholesterol-lowering drugs in Alzheimer's patients. That didn't work. Doctors noticed that the brains of people with Alzheimer's are very inflamed, so researchers mounted large trials to test over-the-counter anti-inflammatory medications against memory loss. They were of no help.

Indeed, most drugs in development face long odds of success. Only about 8 percent of drugs that reach human trials will eventually make it to market, according to the U.S. Food and Drug Administration.

"In the Alzheimer's field, it can be said to be zero, because we haven't a new drug in 10 years," said Rosenberg, who was not involved in the studies.

Hard as it is to hold out hope, Rosenberg said he probably would attend the presentation of the latest trials because, as he put it, "This is way new stuff."

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Diabetes Drug May Protect the Brain

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Study found patients taking metformin were 20 percent less likely to develop dementia

By Serena Gordon

HealthDay Reporter

MONDAY, July 15 (HealthDay News) -- The diabetes drug metformin may do more than help control blood sugar levels: New research suggests it may also reduce the risk of dementia.

Compared to people taking another class of diabetes medications called sulfonylureas, those taking metformin had a 20 percent reduced risk of developing dementia over the five-year study period.

"Metformin could have a possible neuroprotective effect in the brain," said study author Dr. Rachel Whitmer, an epidemiologist in the division of research at Kaiser Permanente in Oakland, Calif.

Whitmer, however, added a caveat: "This was an observational, retrospective, population-based study. We found an association, but didn't prove cause and effect."

Whitmer is scheduled to present the findings Monday at the Alzheimer's Association International Conference in Boston. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

People with type 2 diabetes have double the risk of developing dementia compared to someone without diabetes, according to background information in the study. But, even though diabetes is such a significant risk factor for dementia, the researchers found that there was little research on the effect of diabetes medications on dementia risk.

To see if any therapies might offer some protection against dementia, Whitmer and her colleagues reviewed data on nearly 15,000 people with type 2 diabetes who were just starting single-drug therapy for their disease.

All of those included in the study were aged 55 or older, and all had been diagnosed with type 2 diabetes. Whitmer said none of them were newly diagnosed; some had even been diagnosed with type 2 diabetes as long as 10 years earlier. But none had been taking medications for their disease when the study began.

"They initiated one of four single-agent therapies: metformin, sulfonylureas, thiazolidinediones (TZDs) or insulin," Whitmer said.

All of these treatments lower blood sugar levels, but they work in slightly different ways.

Metformin makes muscle tissue more receptive to insulin, a hormone necessary for sugar (glucose) to get into the body's cells and tissues to provide fuel. It also decreases the amount of glucose made in the liver. Sulfonylureas stimulate the production of insulin. TZDs make muscle and fat tissue more receptive to insulin, and they decrease the amount of glucose made in the liver. Insulin injections are used to help cover the increased need for more insulin because people with type 2 diabetes aren't able to use insulin produced by the body as efficiently.

During the study, nearly 10 percent of the patients were diagnosed with dementia. (The study was not able to differentiate between Alzheimer's disease and other forms of dementia, Whitmer said.)

Compared to people taking sulfonylureas, those on metformin had a 20 percent decreased risk of developing dementia, according to the study. There was no difference in dementia risk for those on TZDs or insulin compared to those on sulfonylureas.

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Just Cutting Back on Smoking May Not Boost Lifespan

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Quitting entirely is only way to extend longevity, study contends

By Randy Dotinga

HealthDay Reporter

FRIDAY, July 12 (HealthDay News) -- In recent years, researchers have suggested that smokers can boost their lifespans by cutting down instead of quitting.

But now, a new Scottish study that followed people for decades suggests that many smokers won't gain extra years by limiting -- but not eliminating -- their bad habit.

"You may be fooling yourself if you think that reducing the number of daily cigarettes will protect you from the health risk of smoking," said Dr. Steve Schroeder, a professor of medicine at the University of California, San Francisco, who studies how to convince smokers to quit.

However, the study isn't definitive, and another tobacco-use researcher said it has several potential weaknesses.

"It is not possible to know the detailed smoking history of every subject, and there's a myriad of subtle differences in consumption. There is little doubt that there is a difference in risk between one cigarette per day and 20, but it is not possible to measure all gradations in between," said Brad Rodu, a professor of medicine at the University of Louisville. "The other problem is reliability. Smokers who report fewer cigarettes might be underreporting, or they might be compensating by smoking more intensely."

Why does this kind of research matter? Because "there is an emerging trend for smokers to smoke fewer cigarettes, and some don't even smoke daily," Schroeder said.

Earlier this year, Great Britain's National Institute for Health and Clinical Excellence made news by urging some smokers to cut down -- with the help of nicotine gum and other alternatives -- instead of giving up. But there's controversy because people who smoke fewer cigarettes may smoke them more intensely.

The authors of the new study say medical officials shouldn't promote cutting down unless they understand its potential benefits. Previous research has been mixed, with some studies showing that smoking fewer cigarettes didn't affect lifespan.

In the new study, researchers tracked two groups of Scottish smokers. One included 1,524 working people who were tracked from the 1970s (when they were in their 40s, 50s and 60s) to 2010. The other group included 3,730 people from the general population who were tracked for about the same period of time.

The researchers found no difference overall in death rates between those who smoked and those who only cut down. In one of the studies, they found a lifespan benefit for those who cut down, but only among those who smoked 21 or more cigarettes per day. In the United States, that would be about a pack-a-day habit.

"These inconclusive results support the view that reducing cigarette consumption should not be promoted as a means of reducing mortality, although it may have a valuable role as a step toward smoking cessation," the researchers wrote.

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Memory Worries May Be Early Sign of Alzheimer's

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Although studies didn't prove connection, expert says concerns are worth mentioning to a doctor

By Amy Norton

HealthDay Reporter

WEDNESDAY, July 17 (HealthDay News) -- Older adults who notice new problems with balancing the checkbook or reading the newspaper may be at increased risk of dementia in the coming years, according to four new studies.

The research, being presented this week at the Alzheimer's Association International Conference in Boston, suggests that older adults' concerns about their memory could serve as an early warning sign of future dementia.

That may not sound surprising. But it has not been clear whether people's subjective perceptions of memory slips are a reliable predictor of more-severe problems down the road.

Older adults who complain of memory issues, but test "normal" on standard cognitive (thinking) tests, have often been dismissed as the "worried well," said Rebecca Amariglio, a neuropsychologist with Brigham and Women's Hospital in Boston who led one of the new studies.

Her team found evidence that older adults' concerns may be more significant.

The study included 131 adults who were 73 years old, on average, and had normal scores on formal tests of memory and thinking. To get at the participants' subjective perceptions, the researchers gave them a separate, detailed questionnaire that asked them to rate any problems they had with everyday tasks, like remembering things they've just read or been told. It also asked them how well they thought their mental skills measured up compared with a decade ago.

Next, the researchers used PET scans to image participants' brains.

It turned out that people with bigger subjective concerns about their mental sharpness had a higher level of beta-amyloid proteins in the brain. Beta-amyloid buildup is considered a risk factor for Alzheimer's.

It's not known yet whether the study participants who were worried about their memories actually face a greater Alzheimer's risk, Amariglio said.

She also stressed that older adults need not be alarmed by the "senior moments" that crop up as you age -- like walking into a room and forgetting why you went there, or having trouble remembering an unfamiliar person's name.

An expert not involved in the study agreed.

"We're not talking about those times you walk out of your house and realize you've forgotten your keys," said Heather Snyder, director of medical and scientific operations for the Alzheimer's Association.

"We're talking about cases where you identify a change over time -- you've always been able to balance your checkbook with no problem, but now you're having difficulty," she explained.

Even those issues do not necessarily mean you are on a course to develop Alzheimer's or other forms of dementia. But if you notice such changes, it is something to bring up to your doctor, Snyder said.

Three other studies presented at the meeting uncovered evidence that subjective memory concerns may serve as red flags:

In a study of nearly 3,900 U.S. women aged 70 and up, those with memory concerns were more likely to show declining scores on objective memory tests over the next six years. The link was most clear among women who carried the ApoE4 gene variant -- the strongest known genetic risk factor for Alzheimer's.Another study followed 531 older adults who took annual cognitive tests for a decade. Before each test, they were asked if they'd noticed changes in their mental abilities in the past year. Those who said they had were twice as likely to be diagnosed with mild cognitive impairment or dementia at some point during the study. On average, participants noticed changes six to nine years before their diagnosis.German researchers found that of 2,230 elderly adults who were free of obvious impairment, those who thought their memories were getting worse showed a steeper decline in objective memory tests over the next eight years.

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Health Highlights: July 16, 2013

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The U.S. Food and Drug Administration on Monday approved the first brain test that could help doctors diagnose attention-deficit hyperactivity disorder (ADHD) using biological evidence, and not just the results of psychiatric evaluations.

The device, called the NEBA System, is a 20-minute test that uses an electroencephalogram (EEG) test to look at a patient's brain waves. Specifically, it measures the ratio between beta and theta brain wave frequencies, which studies have shown is higher in children and teens with ADHD.

"Diagnosing ADHD is a multi-step process based on a complete medical and psychiatric exam," Christy Foreman, director of the Office of Device Evaluation at the FDA's Center for Devices and Radiological Health, said in an agency statement. "The NEBA System, along with other clinical information, may help health care providers more accurately determine if ADHD is the cause of a behavioral problem."

The test is already used to assess sleep issues, measure unconsciousness, diagnose side effects from head injuries and monitor the brain during surgery, according to CBS News.

A company-funded study of almost 300 children and teens with behavior problems showed that the test, when coupled with standard diagnostic criteria, helped physicians more accurately diagnose ADHD than a doctor's exam alone.

ADHD affects nearly 7 percent of children between the ages of 3 and 17, and a recent government report found that 11 percent of all school-aged children have been diagnosed with the disorder, the FDA statement said.

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Following Blood Pressure-Drug Schedule May Be Critical to Survival

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Risk of stroke, death increased for patients who weren't compliant, study finds

By Robert Preidt

HealthDay Reporter

WEDNESDAY, July 17 (HealthDay News) -- Failure to take blood pressure-lowering medicines as directed greatly increases the risk of stroke and death in patients with high blood pressure, a new study finds.

"These results emphasize the importance of hypertensive [high blood pressure] patients taking their antihypertensive medications correctly in order to minimize their risk of serious complications such as fatal and non-fatal strokes," said study first author Dr. Kimmo Herttua, a senior fellow in the Population Research Unit at the University of Helsinki in Finland.

"Non-adherent patients have a greater risk even 10 years before they suffer a stroke. We have also found that there is a dose-response relationship, and the worse someone is at taking their antihypertensive therapy, the greater their risk," Herttua said.

For the study, published online July 17 in the European Heart Journal, researchers followed more than 73,000 hypertensive Finnish patients, aged 30 and up, from 1995 through 2007. They looked at how often prescriptions were filled for these patients each year to determine if they followed their medication regimens. During this time, more than 2,100 died from stroke and more than 24,500 were hospitalized with a stroke.

Compared to those who followed their medication schedule, patients who did not adhere to the schedule had nearly four times the risk of dying from a stroke in the second year after being prescribed their medicines and three times the risk in the 10th year.

In the actual year that non-adherent patients died from stroke, they had a 5.7-fold higher risk than adherent patients, the study found.

Patients who didn't take their blood pressure-lowering medications correctly had a 2.7-fold higher risk of hospitalization in the second year after being prescribed the drugs, and a nearly 1.7-fold higher risk in the tenth year, the study also found.

In the actual year that non-adherent patients were hospitalized with stroke, they had nearly twice the risk compared to adherent patients.

"As far as we know, this study is unique as it is the first study to follow patients over a long period of time, repeatedly checking how correctly they are taking their medications, and linking the trajectory of adherence with the risk of fatal and non-fatal stroke," Herttua said in a journal news release.

Blood pressure refers to the force of blood pushing against your artery walls. Over time, elevated blood pressure can cause serious problems.

The study had some limitations. The researchers couldn't be sure that patients were actually taking their drugs even though they had picked them up, and the registries did not offer information on body mass index (a calculation of body fat), smoking, alcohol consumption and resting blood pressure.

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Cancer, Chemo May Lower Alzheimer's Risk, Study Suggests

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Results, if confirmed, might point to new treatments

By Alan Mozes

HealthDay Reporter

MONDAY, July 15 (HealthDay News) -- If battling a deadly disease can be said to have a silver lining, this might be it: Many forms of cancer appear to lower the risk for developing Alzheimer's disease, new research suggests.

After sifting through the health records of nearly 3.5 million patients, investigators concluded that most kinds of cancer seem to confer some degree of protection against Alzheimer's, reducing risk of the age-related brain disorder by anywhere from 9 percent to 51 percent.

And they have also linked a common form of cancer treatment -- chemotherapy -- to a lower risk for developing Alzheimer's-related dementia.

"We found that the majority of cancers were associated with a decreased risk of [Alzheimer's disease]," said study lead author Dr. Laura Frain, a geriatrician with the VA Boston Healthcare System. "This does not mean that if you have cancer you won't get [Alzheimer's], but that you may have a decreased risk, depending on the cancer type."

Chemotherapy conferred additional protection against Alzheimer's in most cancers, with the exception of prostate cancers, Frain said. "Our findings suggest that some chemotherapies may have a neuroprotective action. Further studies are needed to confirm this," she added.

Frain and colleagues are scheduled to present their findings Tuesday at the Alzheimer's Association international conference in Boston. The research uncovered an association between some cancers and possible protection from Alzheimer's, but it did not prove the existence of a cause-and-effect relationship.

Frain's findings come on the heels of another large study published online July 10 in Neurology, in which an Italian team also unearthed a potential protective link between cancer and Alzheimer's disease.

In that case, investigators identified an inverse relationship between cancer and Alzheimer's disease, in which having cancer appeared to lower the risk for Alzheimer's by 35 percent, while having the progressive brain disease lowered the risk for cancer by 43 percent.

For the current effort, Frain's team pored through the medical paperwork of millions of American veterans who moved through the VA health care systems between 1996 and 2011.

All the patients were over 65 and dementia-free when they first sought medical attention.

On average the veterans were tracked for just shy of six years, during which time more than 82,000 were diagnosed with Alzheimer's. About one-quarter of these patients also had one of 19 different types of cancer. However, roughly three-quarters did not.

Although not all cancers were associated with lower Alzheimer's risk, many were. Having liver cancer was linked to a 51 percent drop in Alzheimer's risk, while pancreatic cancer was linked to a 44 percent drop. Esophageal cancer, myeloma, lung cancer and leukemia were also associated with a lower risk for Alzheimer's, in the range of 33 percent to 23 percent. What's more, such risk reduction could not be explained by the premature death of cancer patients, the study authors said.

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Divorce in Early Childhood May Harm Adult Ties With Parents: Study

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If split happened when kids were young, they were less likely to feel secure later, particularly with fathers

By Kathleen Doheny

HealthDay Reporter

TUESDAY, July 16 (HealthDay News) -- If parents divorce when their children are young, the split can affect how secure these children will feel about their relationship with their parents as adults, new research shows.

"The disruptive consequences of parental divorce on the security of parent-child relationships are more acute when parental divorce takes place early versus later in a child's life," said study author R. Chris Fraley, a professor of psychology at the university of Illinois at Urbana-Champaign.

Fraley analyzed data from 7,335 of men and women, average age 24, who participated in a survey about personality and close relationships online. More than one-third of the participants' parents had divorced.

On average, the children were aged 9 at the time of the divorce.

Men and women from divorced families were less likely to see their current relationship with their parents as secure. Those who parents divorced when they were under 5 were more insecure than those whose parents divorced when they were older.

When a person feels they have a secure relationship with a parent, Fraley said, they feel they can trust them and depend on them and that the parent will be available psychologically.

In the study, published online recently in the journal Personality and Social Psychology Bulletin, feelings of insecurity were much greater for the adult children's relationships with their fathers.

The divorce did not have an substantial effect on the adult children's views of their romantic partners, Fraley found.

"This research suggests that the consequences of parental divorce are selective," he said, "Undermining the security that people have in their parental relationships more so than their romantic ones."

Fraley repeated the analysis with another group of 7,500 adults. These men and women, if their parents divorced, told which parent had primary custody. While 74 percent lived with mothers, 11 percent lived with their fathers. The rest lived with other caretakers.

Participants were most likely to have an insecure adult relationship with the parent they did not live with, Fraley found.

Fraley won't make recommendations based on the study. In the paper, however, he writes that ''something as basic as the amount of time that one spends with a parent or one's living arrangements can have the potential to shape the quality of the attachment relationship that one has with a parent."

The new results echo some found earlier by Jennifer Vendemia, an associate professor of psychology at the University of South Carolina. She was not involved with the latest study.

While the study new has strengths, she said one potential weakness is the questionnaire used, which is not yet well known in the field.

However, she said the take-home from the new study is that "Fathers need to make an effort to stay involved in a child's life."

Another expert said the new study shows divorce has long-term effects. "But at the same time, these effects are potentially limited -- that is, likely to be most influential on one's relationship with his or her parents," said Omri Gillath, an associate professor of social psychology at the University of Kansas.

While not minimizing the effect, he noted that the study found divorce does not seem to affect all relationships as an adult.

"It is also important to keep in mind that although divorce can have many negative consequences, sometimes staying together rather than getting a divorce is actually worse for the child."

His advice for divorcing parents? Be as civilized as possible, he said, acknowledging that can be difficult.

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Electronic Health Records May Slow Rise of Health-Care Costs

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Study found small but measurable savings in 3 Mass. communities that have embraced the technology

By Robert Preidt

HealthDay Reporter

TUESDAY, July 16 (HealthDay News) -- The use of electronic health records can cut the costs of outpatient care by about 3 percent, compared with traditional paper records, a new study suggests.

Outpatient care includes doctor's visits, and laboratory, pharmacy and radiology services typically ordered during those visits.

University of Michigan researchers compared the health-care costs of 179,000 patients in three Massachusetts communities where electronic health records were widely adopted and six communities where that was not the case.

On average, health-care costs in the three communities -- Brockton, Newburyport and North Adams -- where electronic health records were widely used were $5.14 less per patient per month than in those communities that still relied on paper records, the study found.

Most of the savings were in radiology. This may be because doctors ordered fewer medical imaging tests since electronic health records gave them better access to patients' medical histories, according to study leader Julia Adler-Milstein, an assistant professor in the U-M School of Information and School of Public Health.

"To me, this is good news. We found 3 percent savings and while that might not sound huge, if it could be sustained or even increased, it would be a substantial amount," she said in a university news release.

"That said, when we talk about cost savings, it does not mean that the costs went down, but that the costs did not go up as quickly in the intervention communities. This suggests that adopting electronic records helped slow the rise in health-care costs," Adler-Milstein added.

The study findings were published in the July 16 issue of the journal Annals of Internal Medicine.

Opponents of the use of taxpayer dollars to fund electronic health records contend that these systems might boost costs by making it easier to order tests and could be used to justify higher reimbursement.

"I think our findings are significant because we provide evidence to support the use of taxpayer dollars to invest in electronic health records," Adler-Milstein said. "We really have not had compelling evidence that proved that they would save money. It was assumed, but there are a lot of skeptics. This study helps clarify whether there are cost savings and what the magnitude of those are in the near-term."

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As Years Spent Obese Rise, So Do Heart Risks

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Study strengthens link between excess pounds and cardiovascular troubles

By Steven Reinberg

HealthDay Reporter

TUESDAY, July 16 (HealthDay News) -- There's more bad news for overweight Americans: A 30-year study finds the risk for heart disease rises the longer someone is obese.

"Each year of obesity was associated with about a 2 to 4 percent higher risk of subclinical coronary heart disease," said study lead author Jared Reis, an epidemiologist with the U.S. National Heart, Lung, and Blood Institute.

"Subclinical" heart disease means damage to arteries that shows up in markers such as calcium buildup on arterial walls, but has not yet developed into symptomatic illness.

"Those with longest duration of both overall obesity and abdominal obesity tended to have the highest risk" for subclinical disease, Reis said.

The report was published in the July 17 issue of the Journal of the American Medical Association.

In the new study, Reis' team used scans to track calcium buildup in the heart arteries in almost 3,300 adults 18 to 30 years old. When the study began in the mid-1980s, none of the participants were obese.

During the course of the study, however, more than 40 percent became obese and 41 percent developed abdominal obesity (excess belly fat). Those who became obese tended to stay obese for years, the researchers noted.

The investigators found that 27.5 percent of these long-term obese participants showed signs of heart disease, and the problem got worse the longer the individual had been obese.

More than 38 percent of those with more than 20 years spent obese had calcified arteries compared with only about a quarter of those who never put on that level of excess weight, the findings showed.

Among those with overall obesity, 6.5 percent had more dangerous "extensive" arterial calcification, as did 9 percent of those with obesity centered around the belly area. In contrast, only about 5 percent of those who were not obese had this extensive calcification, the researchers found.

Reis said the findings could have dire implications as Americans age.

"With the increased prevalence of obesity over the last 30 years, younger individuals are becoming more obese at a younger age than in previous generations," he noted. "This longer duration of obesity may have important implications on the future burden of subclinical heart disease and potentially rates of clinical heart disease in the United States."

Another heart expert agreed.

"Obesity rates in adults and children have increased markedly in the United States over the last 25 years," said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles. "This is particularly concerning as obesity is associated with an increased risk of diabetes, premature cardiovascular disease, and mortality."

Dr. David Katz, director of Yale University's Prevention Research Center, said he also worries about rising obesity rates among the young.

"I have long feared that in an age of increasingly prevalent type 2 diabetes among children, the day may dawn when angina is an adolescent rite of passage alongside acne," Katz said.

This new study compounds that worry, he said. "It demonstrates just what common sense would suggest: That the longer the exposure to the adverse effects of obesity, the greater the harm to the coronary arteries."

According to Katz, "this study is yet another reason -- as if we needed one -- to devote all possible effort to the prevention, control and reversal of rampant obesity in childhood."

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Could a Gene Help Make You Obese?

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Certain DNA might keep people hungry, study suggests

By Dennis Thompson

HealthDay Reporter

MONDAY, July 15 (HealthDay News) -- Researchers have discovered a potential genetic explanation for why some people overeat and run a greater risk for obesity.

People who carry two copies of a variant form of the "FTO" gene are more likely to feel hungry soon after eating a meal, because they carry higher levels of the hunger-producing hormone ghrelin in their bloodstream, an international team of scientists found.

What's more, brain scans revealed this double FTO gene variant changes the way in which the brain reacts to food and ghrelin. People with the double variant displayed different neural responses in the brain region known to regulate appetite and the pleasure/reward center that normally responds to alcohol and recreational drug use.

About one in every six people carries two copies of this FTO gene variant. These folks are 70 percent more likely to become obese than people who carry other versions of FTO gene, according to background information in the study published July 15 in the Journal of Clinical Investigation.

"We've known for a while that variations in the FTO gene are strongly linked with obesity, but until now we didn't know why," said lead author Dr. Rachel Batterham. "What this study shows us is that individuals with two copies of the obesity-risk FTO variant are biologically programmed to eat more."

Evolution may be responsible for the existence of this double variant in so many people.

"For the majority of the time that humans have existed food has been scarce. Having this genetic variant would have conferred a survival advantage," said Batterham, head of obesity and bariatric services and director of Center for Obesity Research at University College London Hospitals.

The researchers first asked a group of 20 men -- 10 with the double variant, and 10 with a version of the FTO gene linked to lower obesity risk -- to rate their hunger before and after a meal. Blood samples were taken to test their levels of ghrelin, a hormone secreted by the stomach that stimulates appetite.

Ghrelin levels normally increase before meals and fall afterward, but researchers found the men with the double FTO variant had much higher ghrelin levels after a meal and felt hungrier after eating than men who had the variation that carries lower obesity risk.

In the next step, the research team used functional MRI to measure how the brain responds to food images and ghrelin levels before and after a meal, using a different group of 24 men.

MRI scans revealed altered brain activity in the double-variant men, both in the appetite-controlling hypothalamus and the brain's "reward" regions, which are known to respond to alcohol and recreational drugs. The altered activity occurred in response to food images and to the ghrelin in their bloodstream.

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Too Little Vitamin D May Hasten Disability as You Age

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Stair-climbing, other everyday tasks were harder for those with deficiency, researchers found

By Robert Preidt

HealthDay Reporter

WEDNESDAY, July 17 (HealthDay News) -- Older people with vitamin D deficiency may struggle with daily physical activities such as dressing or climbing stairs, a new study shows.

It's estimated that as many as 90 percent of older people are vitamin D-deficient. The vitamin, usually absorbed through sunlight or diet, plays a key role in bone and muscle health, and a deficiency can lead to reduced bone density, muscle weakness, osteoporosis and broken bones.

The study included more than 1,300 people, aged 55 to 88, in the Netherlands who were followed for six years. Participants' vitamin D levels were checked and they were asked about their ability to do routine tasks, such as sitting down and standing up from a chair or walking outside for five minutes without resting.

Among participants aged 65 to 88, those with the lowest vitamin D levels were 1.7 times as likely to have at least one physical limitation as those with the highest vitamin D levels. Among participants aged 55 to 65, those with the lowest vitamin D levels were twice as likely to have at least one physical limitation as those with the highest vitamin D levels.

In the older age group, 70 percent of those with the lowest vitamin D levels had at least one physical limitation, while most of those with moderate or high vitamin D levels had no physical limitations, according to the study, published July 17 in the Journal of Clinical Endocrinology & Metabolism.

The researchers also found that people with vitamin D deficiency were more likely to develop additional physical limitations over time. This occurred over three years among people in the older age group and over six years among those in the younger age group.

"Seniors who have low levels of vitamin D are more likely to have mobility limitations and to see their physical functioning decline over time," study author Evelien Sohl, of VU University Medical Center in Amsterdam, said in a journal news release. "Older individuals with these limitations are more likely to be admitted to nursing homes and face a higher risk of mortality."

The findings indicate low vitamin D levels in older individuals may contribute to the declining ability to live independently, Sohl said. "Vitamin D supplementation could provide a way to prevent physical decline, but the idea needs to be explored further with additional studies," she said.

While the study found an association between low vitamin D levels and limited mobility, it did not establish a cause-and-effect relationship.

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Putting Off Retirement May Help Stave Off Alzheimer's

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Study looked at self-employed workers in France

By Maureen Salamon

HealthDay Reporter

MONDAY, July 15 (HealthDay News) -- As Americans increasingly delay retirement, a new French study indicates this scenario may have a silver lining: a lower risk of developing Alzheimer's disease.

Researchers analyzing health and insurance records of more than 429,000 self-employed workers found a 3 percent reduction in dementia risk for each extra year at the age of retirement. Workers evaluated had been retired for an average of more than 12 years, and 2.65 percent of the group had dementia.

"There's increasing evidence that lifestyle factors such as exercise, mental activities, social engagement, positive outlook and a heart-healthy diet may reduce the risk of developing Alzheimer's disease and other forms of dementia," said Dr. James Galvin. "Now we can add staying in the workforce to this list of potential protective factors."

Galvin, director of the Pearl Barlow Center for Memory Evaluation and Treatment at the NYU Langone School of Medicine, was not involved with the new research.

The study, led by Carole Dufouil, director of research in neuroepidemiology at the French National Institute of Health and Medical Research, is scheduled to be presented Monday at an Alzheimer's Association conference in Boston. Research presented at scientific conferences typically has not been peer-reviewed or published and results are considered preliminary.

About 5.2 million Americans have been diagnosed with Alzheimer's disease, which is the sixth leading cause of death in the United States, according to the Alzheimer's Association.

Americans are increasingly putting off retirement, especially those in the middle class. According to a 2012 Wells Fargo survey of 1,000 Americans earning less than $100,000 annually, almost one-third said they'd need to work until age 80 to live comfortably in retirement.

But Dufouil's research, which linked health and pension databases of self-employed workers who were retired as of 2010, puts a positive spin on that choice. In study background materials, she said the data is in line with the "use it or lose it" hypothesis of brain health. The study showed an association between higher retirement age and lower dementia risk, but not a cause-and-effect relationship.

One Alzheimer's disease expert was not surprised by the new findings.

"There seems to be growing evidence that staying cognitively [mentally] active is really important to reducing a person's risk, and perhaps professional activity may be one of those cognitive activities," said Heather Snyder, director of medical and scientific operations for the Alzheimer's Association, based in Chicago. "What we know is that things that promote lifelong learning seem to be beneficial. But that may mean different things for different people . . . and exactly what that is, we can't define at this point in time."

For his part, Galvin noted several caveats to keep in mind when interpreting the study's meaning. First, he said, self-employed workers may be inherently different than company-employed workers, with differences in skill sets, work environment, stress and social mobility that might affect the study's results.

Also, the prevalence of dementia was based on a review of either an existing dementia diagnosis or prescription for dementia-related medication, he noted.

"There is no way of knowing about those individuals who did not seek medical attention, did not have access to health care or who were not properly diagnosed," Galvin added. "Nonetheless, the study supports the concept that keeping oneself mentally, physically and socially active over the span of a lifetime may have important effects on both physical and mental health."

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Top Acne Treatment Mistakes: Popping Pimples, Overdoing Products, and More

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Common ways people go wrong in treating their acne.

For the nearly 50 million Americans affected by acne, the many available medications and treatments can be confusing and overwhelming.

It's easy to make mistakes treating acne or even make it worse, despite the best intentions.

Alternative Treatments for Acne

Often people with acne turn to complementary or alternative treatments. These may include gels, creams, and lotions; dietary supplements and herbs; and special dietary routines. Many people swear by alternative acne treatments. But the American Academy of Dermatology (AAD) that "all-natural supplements" have not been shown to be effective, and some may even be harmful. For example, the group cites an over-the-counter (OTC) acne supplement that contained more than 200 times the amount of selenium...

Read the Alternative Treatments for Acne article > >

Here, experts list the most common mistakes. In most cases, a dermatologist can help undo the damage.

Skin reacts slowly to treatment. Even if the acne came on fast, it still requires time to heal. That usually takes between 6 to 12 weeks, says Barbara R. Reed, MD, a dermatology professor at the University of Colorado Hospital in Denver.

April W. Armstrong, MD, MPH, is an assistant professor of dermatology at the University of California Davis Health System. She tells patients to give a product 1 month and keep using it if they notice any improvement.

In some cases, your skin might feel a bit irritated the first couple of weeks of treatment, says Diane S. Berson, MD. She is an assistant clinical professor of dermatology at Weill Medical College of Cornell University, Ithaca.

“It's not an infection, it's an inflammation. It can even get worse before it gets better,” Berson says.

People usually layer on products when they don't get results in the first few days of treatment, Reed says.

“What then happens is that they start trying different products, abandoning them very quickly if they do not see results in a day or two. They also add one product to another. Sometimes the products can cause irritation of the skin and add further insult to the owner,” she says.

When someone self-treats their acne, they may accidentally distress their skin. This can make the acne lesions bigger, more likely to pigment, and heal with spots and scars, Berson says.

Scrubbing the skin will actually worsen acne, as it can compromise the skin's protective barrier and increase irritation, Berson says.

Instead, gently wash with a nonirritating, pH-balanced cleanser to lessen inflammation. It's also important to thoroughly rinse off the cleanser, because the residue can be irritating, she says.

“Acne is not from dirt," Reed says. "Many people tend to over-wash and over-scrub when they get acne. As one of my teachers used to say, 'If acne were from dirt, you would have it on your feet!'"

Harsh cleansers, alkaline bar soaps, and alcohol-based products may worsen acne, says Berson, who has consulted for skin care product-makers Galderma Stiefel, Procter & Gamble, and Neutrogena.

Reed says she advises patients to look for “noncomedogenic” or “for acne-prone skin” products. Noncomedogenic products don't contain ingredients that tend to clog pores in people with acne-prone skin.

Certain ingredients found in products such as cosmetics, sunscreen, and moisturizers are more likely to clog pores. They include isopropyl palmitate, isopropyl myristate, butyl stearate, isopropyl isostearate, decyl oleate, isostearyl neopentanoate, isocetyl stearate, myristle myristate, cocoa butter, acetylated lanolin, and D & C red dyes. Products containing oil can clog pores and lead to breakouts.

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Community Health Centers – In Every State – Get Obamacare Outreach Funds

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WebMD News from Kaiser Health NewsBy Phil Galewitz

The nation’s community health centers — which treat the poor and uninsured– apparently know a good deal when they see one.

Nearly all 1,200 federally funded community health centers applied for and will be getting a piece of $150 million in federal health law money to enroll patients in new online health insurance marketplaces starting Oct.1.

Federal health officials on Wednesday said 1,159 centers will be getting the new money offered in May to provide in-person enrollment assistance to uninsured individuals across the nation.  The centers, which operate nearly 9,000 service delivery sites nationwide and serve approximately 21 million patients each year, will each get from $59,000 to $500,000. Health centers in every state, even those that have governors opposing the health law, will be getting some of the funding. The money will allow health centers to hire an additional 2,900 outreach and eligibility assistance workers to assist millions of people nationwide with enrollment into the exchanges.

Health and Human Services Secretary Kathleen Sebelius said the funding will help the centers enroll 3.7 million people into the Obamacare exchanges as well as Medicaid and Children’s Health Insurace Program.

Among activities planned:

-In Florida, a health center is hosting learning sessions at local libraries, churches and civic organizations.

–In Washington State, health centers are coordinating with local schools and libraries to let families know that they may be eligible for new insurance options.

–A health center in Michigan is coordinating with a coalition of over 30 African American churches to get the word out and help sign people up.

In New Mexico and South Dakota, health centers will be reaching individuals at summer and fall county fairs and rodeos to make sure they know about and sign up for the opportunities they qualify for in the new marketplace.

Health centers have long helped patients sign up for Medicaid and the Children’s Health Insurance Program (CHIP). Now, they’ll also be helping patients sign up for coverage and apply for the subsidies available to individuals and families earning less than 400 percent of the federal poverty level to buy private health insurance coverage on the exchanges.

About 60 percent of the patients who visit health centers are minorities, who are much more likely  to be uninsured. Many  are healthy and come to the centers for primary and preventive care. Officials are eager to get these people to join the insurance risk pools to help keep premiums low in the exchanges.

The new funds will double the resources available to community health centers for enrollment efforts.  There are currently 4,000 community health center employees nationwide focused on enrollment. HHS hopes to nearly double that.

With these new funds, health centers will be able to hire new staff, train existing staff, and conduct community outreach events and other educational activities.  Health center staff will provide consumers information about the new health insurance marketplaces and help them understand their coverage options so they can enroll in a plan. They can also answer questions about Medicaid and CHIP.

For a list of health centers receiving this funding, visit: http://www.hrsa.gov/about/news/2013tables/outreachandenrollment/

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

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Chemicals in Carpets, Cosmetics Tied to Thyroid Problems

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PFCs linger in the body for long periods, study author says

By Robert Preidt

HealthDay Reporter

WEDNESDAY, July 17 (HealthDay News) -- Exposure to a class of chemicals used to make a wide range of consumer products can cause changes in thyroid function, according to a new study.

People have widespread exposure to perfluorinated chemicals (PFCs), which are used to manufacture items such as fabrics, carpets, cosmetics and paper coatings. These chemicals break down very slowly and take a long time to leave the body.

For this study, researchers analyzed data from more than 1,100 people who took part in the 2007-2008 and 2009-2010 U.S. National Health and Nutrition Examination Survey. The study looked at levels of four different PFCs as well as participants' thyroid function.

Along with finding that having higher levels of PFCs in the body can alter thyroid function in both men and women, the researchers also found that PFCs may increase the risk of mild hypothyroidism in women.

Hypothyroidism occurs when the thyroid gland does not produce enough hormones. This can lead to symptoms such as fatigue, mental depression, weight gain, feeling cold, dry skin and hair, constipation and menstrual irregularities.

The study was published online July 17 in the Journal of Clinical Endocrinology & Metabolism.

"Our study is the first to link PFC levels in the blood with changes in thyroid function using a nationally representative survey of American adults," study co-author Dr. Chien-Yu Lin, of En Chu Kong Hospital in Taiwan, said in a journal news release.

"Although some PFCs . . . have been phased out of production by major manufacturers, these endocrine-disrupting chemicals remain a concern because they linger in the body for extended periods," Lin said. "Too little information is available about the possible long-term effects these chemicals could have on human health."

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Q & A With Jane Lynch

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By Elizabeth B. Krieger
WebMD Magazine - Feature

Famous for playing tough (even mean) characters, actress and comedian Jane Lynch has starred in a wide range of movies and TV shows, including Talladega Nights,Two and a Half Men, The 40 Year Old Virgin, Role Models, Alvin and the Chipmunks, Ice Age, and The Three Stooges, as well as the "mockumentary" Best in Show. Her portrayal of Sue Sylvester in Glee has garnered her numerous awards, including a Primetime Emmy Award, Golden Globe Award, Screen Actors Guild Award, and People's Choice Award. The actress, who turns 53 this month, will host Hollywood Game Night starting July 11, 2013, on NBC. She talked to WebMD Magazine about her passion for animals, her best and worst health habits, and what doing improv has taught her about love, conflict, and the importance of listening.

You’re supervising the festivities of the new Hollywood Game Night, but would you also be a fearsome player?

How I Stopped Complaining for a Week

By Ann Hodgman One woman's diary I said to my daughter, "You know what I just can't stand about this book? The long passages with no dialogue." - She paused, then said, "Mom, are there any books you like ?" Now it was my turn to pause. How could she ask that, when everyone knows how much I love to read? But then again, when had I last complimented a book — even one I admired? Come to think of it, how often did I say anything without a negative twist? I don't want my tombstone...

Read the How I Stopped Complaining for a Week article > >

Oh, yeah, and I can be really competitive. But what I love most about game nights is all the teamwork and the togetherness aspect of games -- the jumping up and down and cheering for each other. This show is a raucous party, really, and everyone will just be having so much fun. My favorite games aren’t board games; they’re the ones that are sort of pop-culture based, like playing "Celebrity." That’s what this show is about.

Sue Sylvester, the love-to-hate-her character you play on Glee, is similar to a few other "mean teacher" roles you’ve played in the past. And until mid-July you play the über-mean role of Miss Hannigan in Annie on Broadway, too. Does this sort of repeat typecasting bother you at all?

Oh no, I don't mind! I like having the work, for one thing. And I also sort of love extreme characters. It lets me explore that wacky side of things and have fun expressing extreme opinions.

You acted with Second City Improv in Chicago and have been a key player in many of Christopher Guest’s movies, where much of the dialogue is improvised. Do these skills affect your life outside of acting? 

There’s no question that improv can help you in every realm of life. You learn to think fast on your feet, but most important, you learn to listen really well and be comfortable with silences in conversations. Because you can't do improv if you aren't listening to other people. I also find it helps you in conflicts, although I don't like to argue at all. I can’t say it comes naturally -- it’s something you have to hone.

You often play characters who sing -- but in fact, you’re deaf in one ear! How do you account for your musicality?

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Cancer Patients Less Likely to Get Alzheimer's, Study Finds

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Risk for malignancy was also lower in seniors with Alzheimer's, researchers report

By Alan Mozes

HealthDay Reporter

WEDNESDAY, July 10 (HealthDay News) -- Gaining insight into two big health concerns, Italian researchers have found that seniors with cancer have a lower risk for Alzheimer's disease and vice versa.

Studying more than 200,000 older adults in northern Italy, the research team concluded that cancer patients bear a 35 percent lower risk for developing Alzheimer's, while people with Alzheimer's have nearly half the risk of getting cancer compared to the general population.

The investigators suggested that the findings could help guide researchers toward better treatments for both illnesses over the long term.

"Practically, our results [indicated that] some genes that have been demonstrated to act in cancer growth and control might also be involved in the [development] of Alzheimer's disease," said study lead author Dr. Massimo Musicco, of the National Research Council of Italy's Institute of Advanced Biomedical Technologies. "And this represents a promising [observation] for the struggle against this devastating neurodegenerative disorder."

For the study, which was published online July 10 in the journal Neurology, the research team spent six years (2004 to 2009) tracking the health status of more than 204,000 Italians aged 60 and older. During that period, nearly 21,500 men and women developed cancer, while more than 2,800 developed Alzheimer's disease.

Although 161 patients developed both diseases, the authors said that known incidence rates among the general population had predicted a higher dual-disease figure.

After crunching the numbers, the team found that having one disease seemed to have a considerable protective effect in terms of lowering the risk for the other.

The researchers also determined that the reduced-risk linkage could not be explained by fatalities from either disease. This meant that a lower risk for developing Alzheimer's could not simply be explained away by the premature death (and therefore shorter lifespan) of cancer patients, or vice versa.

Dr. James Galvin, a professor of neurology, psychiatry, nursing and nutrition at the NYU Langone School of Medicine in New York City, said that the observed linkage between cancer and Alzheimer's, while important, may not apply to less common forms of dementia.

"Interestingly, nearly all investigations have found that cancer and cancer treatment does not seem to alter the risk of developing other forms of dementia, such as vascular dementia caused by multiple strokes," he said.

"This suggests common pathways exist between most cancers and Alzheimer's disease, but these relationships do not appear to exist with other causes of dementia," Galvin said.

Given such a potentially unique connection between cancer and Alzheimer's, Galvin said, more research is now needed "to examine whether drugs used to treat cancers such as lung, leukemia, liver and pancreas may also be used to treat Alzheimer's."

In an editorial accompanying the Italian study, Catherine Roe, an instructor in neurology at the Washington University School of Medicine, in St. Louis, said the study's large size makes the findings exciting.

"Like previous studies, they have shown that people with Alzheimer's disease are less likely to get cancer, and people with cancer are less likely to get Alzheimer's disease," she said.

"But because they looked at so many people, they were also able to test whether Alzheimer's is associated with some kinds of cancers, but not other kinds," she said. "This may help in eventually pinpointing why there is this opposite relationship between Alzheimer's and cancer."

Although the study found a link between the risks of cancer and Alzheimer's, it did not prove a cause-and-effect relationship.

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Solving Your Diaper Dilemma

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Cloth vs. disposable: It's the great diaper debate, but is one type of diaper really better for baby and the environment? Experts weigh in.

What else besides lack of sleep and feeding after feeding does a parent have to look forward to during baby's first year?

Diapers. Mounds and mounds of them.

Some moms and dads know from the get-go that they'll love the convenience of disposable diapers. And some know there's something just right about the fluffy feel of cotton nappies against their newborn's skin.

But other parents find themselves in a quandary. Are cloth diapers more eco-friendly? Are there worrisome chemicals in disposable diapers? Which diapers will keep Junior drier and hence, less prone to diaper rash?

WebMD asked experts to weigh in on the diaper dilemma.

Most U.S. families -- by some estimates, up to 95% -- use disposable diapers. But there are some parents who are convinced that cloth diapers are more Earth-friendly. Experts, though, say the answer isn't clear-cut.

Research has suggested that both disposable and cloth diapers affect the environment negatively -- just in different ways. For example, disposable diapers require more raw materials to manufacture. And they generate more landfill solid waste that can take an extremely long time to degrade. But cloth diapers use up large amounts of electricity and water for washing and drying. Plus, commercial diaper service delivery trucks consume fuel and create air pollution.

Nebraska pediatrician Laura A. Jana, MD, FAAP, agrees that there's no clear winner in the diaper debate. She researched the controversy while co-writing the American Academy of Pediatrics book, Heading Home with Your Newborn: From Birth to Reality. "When we were writing the book, we tried to get to the bottom of [the debate]. And -- with a sort of pun intended -- it kind of came out a wash," Jana says. "More power to parents who are trying to do the right thing," she adds. "But I'm not convinced from an environmental standpoint that there's a huge benefit to cloth diapers."

Ultimately, parents are left to make their own personal choice. The American Academy of Pediatrics takes no position on cloth vs. disposable diapers.

Nor does the Environmental Protection Agency (EPA). While proponents of cloth diapers worry that germs in disposable diapers might leach from landfills to contaminate ground water, an EPA spokesperson told WebMD in an email that the agency didn't consider them a hazard: "Disposable diapers fall under the category of municipal solid waste, which means the material is safe to be disposed of in a U.S. municipal solid waste landfill. In the U.S., modern landfills are well-engineered facilities that are located, designed, operated, and monitored to ensure compliance with federal regulations which aim to protect the environment from contaminants which may be present in the solid waste stream."

Despite the lack of consensus, parents can still go green. Some buy a flushable hybrid diaper. The soiled, biodegradable liner is flushed down the toilet into the sewage system, rather than sending yet another diaper to the landfill. Then parents insert a new liner into the reusable cloth pants.

Others parents prefer chlorine-free disposable diapers, which cut down on toxic dioxin. Dioxin is the result of using chlorine to bleach disposables white. Parents can also buy organic cotton diapers. Organic cotton uses no pesticides during growing.

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5 Things Kids Should Tell Their Asthma Doctor

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Experts list key topics to discuss for optimum care

By Robert Preidt

HealthDay Reporter

WEDNESDAY, July 10 (HealthDay News) -- Children, not their parents, should do most of the talking about their asthma symptoms when seeing an allergist, according to a new study.

Researchers looked at about 80 children with asthma and their parents. Although parents can provide useful information, it's important for allergists to ask both parents and children about symptoms, activity limitations and use of medications to better understand and treat the child's asthma, the researchers found.

The importance of listening to children with asthma is highlighted by the fact that they report having a better quality of life in terms of activity limitations than their parents believe, according to the study, which was published in the July issue of the journal Annals of Allergy, Asthma & Immunology.

"Our research shows that physicians should ask parents and children about the effects asthma is having on the child's daily life," said study lead author Margaret Burks, of the pediatrics department of the University of Texas Health Science Center at San Antonio.

"Parents can often think symptoms are better or worse than what the child is really experiencing, especially if they are not with their children all day," Burks said in a news release from the American College of Allergy, Asthma & Immunology.

Asthma is a serious condition that leads to more than 10.5 million missed school days a year, Dr. James Sublett, chairman of the college's public relations committee, said in the news release. "It is important for children to tell their allergist about their symptoms so the best treatment can be provided and over-treating doesn't occur," he said.

The asthma experts list these five topics that children with asthma and their parents should discuss with their allergist:

If a child can't play sports or participate in gym class and recess activities. This can indicate that the asthma isn't properly controlled. It's also important to tell the allergist if a child can participate in physical activities because it shows the condition is well managed.When a child's asthma symptoms get worse outside or at home. Sixty percent to 80 percent of children with asthma also have an allergy. If common allergens such as pollen, mold, dust and pet dander are triggering your child's asthma symptoms, an allergist may include allergy shots (immunotherapy) as part of a treatment plan.If a child often feels sad or different from other kids because of asthma. Nearly half of children with asthma report feeling depressed or left out of activities because of their condition.If a child misses school because of asthma. Research shows that children under the care of a board-certified allergist see a 77 percent reduction in lost time from school.When a child's asthma appears to have gone away. It's important that a child carry and use their inhaler as prescribed, even if asthma symptoms aren't bothersome. Although symptoms are controllable with the proper treatment, there isn't a cure for asthma and it likely won't disappear. An asthma attack can strike at any time.

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Funnyman Chris Rock Is Serious About Parenting

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By Lauren Paige Kennedy
WebMD Magazine - Feature

Chris Rock has built a career mining his childhood in New York City. But the Emmy Award-winning actor and comedian has a new perspective now that he's raising kids of his own. He opens up about bullying, helicopter parents, and why he hasn't had a PB&J in years.

The stand-up sensation has made countless quips over the years about being bullied as a boy in rough-and-tumble Brooklyn, N.Y., depicted on "Everybody Hates Chris," the TV show he created. He's also famous for his rip-roaringly funny (and brutally honest) comments about marriage and parenthood in his Emmy Award-winning specials for HBO. Now, as his new film Grown Ups 2 hits big screens in July, the provocative comic mines more coming-of-age discomforts -- that of kids and the adults who rear them -- for laughs.

These days Rock, 48, views the wonder years from two very different vantage points: as someone who was once tormented at school and as a father of two young daughters (Lola, 11, and Zahra, 9, with wife Malaak Compton-Rock) living in an age of "helicopter" parents.  And, true to form, he's got some wisdom to share.

The bullying began when he was in second grade. "We lived in Bed-Stuy [Bedford-Stuyvesant], one of the most famous ghettos in the world" is how he once described his former stomping grounds. "My mother and father wanted me to go to a better school, so I was bused to this poor, white neighborhood…I was the only black boy in my grade for most of the time. I was a little guy, too, a skinny runt."

Surprisingly, he's prepared to give his former bullies a pass -- sort of. "Of course, I'm against bullying!" Rock says with his trademark intonation. "To-tal-ly, totally against it! But on the other hand…" He pauses for comedic effect. "Who's going to cure cancer? Who's gonna figure out how to advance stem cell research? Someone who got bullied, that's who! You think Bill Gates didn't get bullied? Put the most successful men and women in the world in one room, and ask them to put their hands up to see which ones were bullied." Another beat passes before he shares his own theory: "Most of 'em!"

In 2007 Rock went so far as to tell host James Lipton of Bravo's Inside the Actors Studio that bullying was "the defining moment of my life … it made me who I am." On air, he even profusely thanked the pack of boys who regularly "kicked my a--, spit in my face, and kicked me down the stairs," because the experiences not only forged his quick wit, he insists, but also fueled his drive to succeed.

But Rock is the first to say all that bad has to be tempered with good, or no good can come out of it. "Who's your boss?" he posits, laughing out loud, before answering: "Either somebody whose dad or mom owns the place, or someone who's put up with a lot of adversity and overcome it. But you need love, too," Rock maintains. "Bullying without love? You can be destroyed. …But you know, I was bullied and I had love at home, so that was kind of the perfect storm for me, you know? I just read the Steve Jobs book [the biography by Walter Isaacson]. There's no way you can tell me that guy wasn't beat up in school! And what happened? He used that pain to make sure he'd be in a position where he would never be bullied again."

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Is U.S. Health-Care Reform on Track for 2014?

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Health policy experts weigh in on the fate of the Affordable Care Act

By Karen Pallarito

HealthDay Reporter

THURSDAY, July 11 (HealthDay News) -- At the heart of President Barack Obama's sweeping yet controversial health-reform law is the largest expansion of health insurance in decades, and it's set to take effect on Jan. 1, 2014. But some observers wonder whether it will get off the ground as scheduled.

The law requires most adults to purchase health insurance or face a penalty -- the so-called individual mandate. It seeks to broaden health insurance coverage by:

creating state health insurance exchanges where individuals can buy coverage on their own -- in some cases, with federal subsidies; expanding Medicaid, the government insurance program for poorer Americans;and requiring all but the smallest employers, those with 50 or more workers, to offer health insurance or pay a fine.

But in a surprise announcement last week, the Obama administration delayed the employer mandate, granting companies another year -- until 2015 -- to work through federal rules and reporting requirements.

Could the "individual mandate" be next? Is further upheaval in store?

"It does call into question, 'Is this just a one-time thing or the beginning of more delays and changes,'" said Steve Wojcik, vice president of public policy at the National Business Group on Health, in Washington, D.C.

With the 2014 deadline fast approaching and a lack of definitive guidance from the federal government on implementing some parts of the law, the Affordable Care Act -- dubbed "Obamacare" -- remains a work in progress.

"I'm actually in the middle of still reading proposed regulations for exchanges," said Cristine Vogel, an associate director in the Chicago-based health-care practice of Navigant Consulting, Inc.

Timothy Jost, a professor at Washington and Lee University School of Law in Lexington, Va., said core parts of the law, including the exchanges and individual mandate, can operate without the employer mandate. "I think the train is still on track, although not moving as quickly as I would like," he said.

Half of states sit out Medicaid expansion

The Affordable Care Act faced its most significant challenge last year when the U.S. Supreme Court considered whether requiring most consumers to have health insurance, or pay a penalty, was constitutional. The high court upheld this individual mandate last June. But it also ruled that states could opt out of expanding Medicaid -- the federal-state health insurance program for the poor and disabled.

Expanding Medicaid to more low- and middle-income people is one of the ways the architects of the health-reform law envisioned reducing the ranks of the nation's uninsured by up to 30 million people.

Under the law, people making up to 138 percent of the federal poverty level may qualify for coverage under the Medicaid expansion. (That's as much as $15,856 for an individual or $32,499 for a family of four.)

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Diapering Baby On the Go

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Heading out for a day with baby? Here are some diaper bag must-haves, with tips for diapering babies in public, too

Going out with your newborn is already a little nerve-wracking: Baby’s so tiny and the world is pretty big. Then there’s the added worry of getting stranded without diapers or other baby care essentials. What can you do?

Don't worry! We talked with pediatricians and parents on WebMD’s parenting message boards and got their tips for diapering baby on the go, what to bring, and how to improvise.

Whether you’re headed out to the park for an hour or going away for the weekend, there’s really only one baby care must-have, says Atlanta pediatrician and mom Jennifer Shu, MD, co-author of Heading Home With Your Newborn: From Birth to Reality. “Diapers. You really can get away without anything else.”

How many baby diapers will you need? That depends on the length of the trip, says Shu, who recommends two to three for an afternoon out, but as many as 12 for an overnight stay. And “overnight diapering needs overnight diapers,” Shu tells WebMD. “They have more absorbency.”

And, because modern diapers are super-absorbent, in a pinch you can even let baby pee in the same diaper twice if you must. Don’t do it too often, however, as it can lead to diaper rash.

Though a handful of baby diapers is all that really stands between you and a day out with your little one, you’ll probably find it practical to have a few more items on hand, say moms and dads. These include:

Baby wipes. Wipes are another component of the on-the-go diapering arsenal for some, especially the travel-pack size. Not only do they make handling messy diaper changes a snap; they’re handy for sticky hands and messy faces, too. If you’ve got a big box of wipes at home, you can make your own travel pack by slipping a few into a zip-top plastic bag. Left the wipes at home? Wing it with a few facial tissues. New mom Amiee Peri also carries a washcloth to back up wipes. ”We just dry our baby off before re-diapering him,” she says. “We think this has really helped us avoid diaper rash.”

Changing pad. A portable changing pad is a big help when you’re out on the town and don’t know where you may end up diapering baby. Although a few cloth diapers, a simple towel, or a baby blanket is all you really need, a diaper bag with a built-in changing pad comes in handy. There are also disposable pads -- similar to the paper sheets used in a doctor’s or dentist’s office. What if you forget to bring anything that can serve as a changing pad? Try using a newspaper or improvise with lavatory paper towels, suggests Shu.

Plastic bags. Those dirty diapers, disposable changing pads, and used baby wipes need to go somewhere when you’re out and about. That’s why lots of parents suggest tucking a few plastic grocery bags in with the diapers and wipes. They take up almost no room and in return provide very useful odor and mess control while out in public.

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Vermont Releases Final Health Insurance Rates

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July 12, 2013 -- Vermonters can expect to pay slightly lower premiums than those initially proposed by the two insurance carriers approved to sell plans on the state’s new health insurance Marketplace, called Vermont Health Connect.

The Green Mountain Care Board -- the regulatory authority for insurance and hospital rates in Vermont -- announced this week that it negotiated 4.3% to 5.3% rate cuts in individual and small-group plans offered by Blue Cross Blue Shield of Vermont and MVP Health Care. The rates go into effect Jan. 1.

Vermont approved six “metal” plans in its health insurance Marketplace, also called an Exchange. There are two bronze, two silver, one gold, and one platinum plan, each with different combinations of copayments, coinsurance rates, and limits on annual out-of-pocket spending. 

Every plan must cover the same services, but the companies pay a bigger share of costs going from the bronze to platinum. Bronze plans pay about 60% of the average person’s health costs. Silver plans pay 70%, gold plans 80%, and platinum plans 90%. Customers pay the remaining costs. (For example, customers pay 40% of the costs under a bronze plan.) Bronze plans have the lowest premiums, while the platinum plans have the highest.  

In Vermont, final rates for mid-range silver plans are from $395 (BCBS) to $410 (MVP) per month for a single person. Family plans range from $1,111 (BCBS) to $1,151 (MVP) per month. About 100,000 state residents are expected to buy insurance through Vermont Health Connect.

Lower-income Vermonters can expect to pay 0.5% to 8% of their income on health insurance premiums, according to Robin Lunge, Vermont’s director of health care reform. Financial aid in the form of state subsidies and federal tax credits are available to ease the financial burden for about 49,500 residents.

Under the Affordable Care Act, signed into law in 2010, each state must have a health insurance Marketplace in place by Oct. 1 for coverage starting Jan. 1, 2014. Most Americans will be required to have health insurance starting Jan. 1. Vermont is one of 17 states, along with the District of Columbia, that will run its own Marketplace.

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Listeria Outbreak Prompts Cheese Recall

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1 person dead, 4 sickened; source seems to be Wisconsin company, CDC says

By Robert Preidt

HealthDay Reporter

MONDAY, July 8 (HealthDay News) -- A recent listeria outbreak that caused one death and sickened four other people seems to be linked to cheeses made by a Wisconsin firm, the U.S. Centers for Disease Control and Prevention reports.

An investigation by federal, state and local health agencies indicates that Les Freres, Petit Frere, and Petit Frere with Truffles cheeses made by Crave Brothers Farmstead Cheese Company of Waterloo are the likely sources of the outbreak, the CDC said.

The five people who became ill were in Illinois, Indiana, Minnesota and Ohio. All had to be hospitalized and one person in Minnesota died. One illness in a pregnant woman resulted in a miscarriage, according to the CDC.

The dates of the illnesses ranged from May 20 to June 17. The patients' median age was 58 and 80 percent of them were women.

On July 3, Crave Brothers recalled its Les Freres, Petit Frere, and Petit Frere with Truffles cheeses with make dates of July 1, 2013 or earlier due to possible Listeria monocytogenes contamination, the CDC said.

The recalled cheeses were sold nationwide at retail and foodservice outlets, as well as by mail order. People who bought any of the recalled cheeses should throw them away. It's especially important that pregnant women, older adults and people with weakened immune systems not eat the recalled cheeses. These people have the highest risk for infection and serious health problems, the CDC noted.

The U.S. Food and Drug Administration is conducting an inspection at Crave Brothers' processing facility in coordination with the Wisconsin Department of Agriculture.

Each year in the United States, about 800 laboratory-confirmed cases of listeriosis are reported and three or four outbreaks are identified and reported to CDC. Foods that have been linked to outbreaks in recent years include Mexican-style soft cheeses, imported ricotta salata cheese, whole cantaloupe, raw sprouts and precut celery, according to the CDC.

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California Unveils Health Plans to Mixed Reactions

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July 10, 2013 -- California, the first state to set up a health insurance Marketplace under the Affordable Care Act, has chosen the state’s health plans and announced proposed rates.

Both the insurance plan selection and rates are subject to final approval by state regulators.

Since the plans were picked in late May, some experts have praised the progress in California while others have predicted ''rate shock." On a swing through the state to promote the sweeping health care reform law, President Barack Obama lauded California's efforts at creating a state-operated Marketplace (also called an Exchange) and urged the uninsured to sign up for the new insurance options starting Oct. 1.

About 5.3 million of the state’s 38 million residents are expected to be eligible for coverage through the Marketplace, known as Covered California. Of those, 2.6 million are expected to be eligible for subsidies to help cover the cost.

The 13 companies that will participate in the health insurance Exchange for individual plans include a mix of large and small companies:

Alameda Alliance for HealthAnthem Blue Cross of CaliforniaBlue Shield of California Chinese Community Health PlanContra Costa Health PlanHealth NetKaiser PermanenteL.A. Care Health PlanMolina HealthcareSharp Health PlanValley Health PlanVentura County Health Care PlanWestern Health Advantage

Most companies will offer four “metal” levels of plans: bronze, silver, gold, and platinum. The platinum plans cover the largest share of expected medical costs, and they also cost the most, according to Anne Gonzales of Covered California.

Platinum plans are expected to pay about 90% of costs, with the consumer’s share about 10%. Under the gold plans, the ratio is 80% to 20%. For silver, it’s 70%/30%. And for bronze plans, which are the least expensive, it's 60%/40%. Not every company offers all four tiers in all of the 19 rating regions of the state.

Catastrophic coverage, for people younger than 30, also will be available.

In the more populated areas, people will have as many as five or six insurance companies to choose from, according to Covered California. In rural areas, people will have a choice of two or three companies.

The number of companies offering plans creates sufficient choice, said Linda Blumberg, PhD, senior fellow at the Urban Institute's Health Policy Center. It’s important to have a range of options, she said, adding that, "I think that's clearly what has happened in California."

The average premium for a California consumer, regardless of location, plan level, or family size, is $321, according to Covered California.

Rates vary by the region of the state, the plan selected, the age of the insured, and family size.

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