Time for action

Article Abstract:

Although many research reports concerning the purported increased vulnerability of African-Americans to kidney disease can be criticized on methodological grounds, evidence does seem to support the notion that blacks are at increased risk for kidney failure. While study of the separate effects on kidney disease of clinical, demographic, and social factors for this population group may be needed, the problem demands attention now. Blacks have a higher prevalence of high blood pressure (hypertension) than whites, but whether this is the cause or the result of kidney failure is not known. Some of the known physiologic differences between blacks and whites are discussed. When kidney disease appears, it seems to progress in blacks even when treatment is instituted. Treatment should aim at improving patient compliance and removing the cultural and economic barriers that often prevent blacks from seeking care. Additional funding for research concerning severe kidney disease in blacks can be justified, in part because dialysis (in which the patient's blood is filtered to remove waste products), the treatment for irreversible kidney failure, is very expensive. Blacks who undergo dialysis have poorer survival rates than whites, and the treatment itself impairs the quality of life. Hypertension and diabetes mellitus are two conditions that put patients at high risk for kidney failure; as long as health care continues to be difficult for blacks to obtain, these conditions will remain untreated among this group. The health care goals for blacks elaborated in the 'Healthy People 2000' program by the Department of Health and Human Services fall below the current status of health care for whites in the US. Kidney disease costs money in direct patient care, in lost tax revenues from people who can no longer work, and in Social Security disability insurance payments for patients who are not yet on dialysis. The time to act is now, and such action will necessitate cooperation between several levels of health care agencies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, African Americans, Diseases, Kidney diseases, Chronic kidney failure, editorial

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Anonymous human immunodeficiency virus surveillance and clinically directed testing in a Newark, NJ, hospital

Article Abstract:

Although more than 100,000 cases of AIDS had been reported in the United States by mid-1989, the number of people in the US who are infected with the human immunodeficiency virus (HIV, the agent that causes AIDS) may be as high as 1.5 million. To better understand what proportion of hospitalized patients tests positive for HIV, the Centers for Disease Control has started the Sentinel Hospital Surveillance System (SHSS) on a nationwide basis. Under SHSS, blood samples from patients whose admitting diagnoses are not associated with HIV infection are anonymously tested. Results from a one-year study in a university hospital in Newark, New Jersey (a state with a high number of AIDS cases) showed that 269 (7.6 percent) of 3,529 samples tested positive for HIV type 1 using two different kinds of test. The proportion of men who tested positive was higher than the proportion of women (10.3 percent versus 4.8 percent). A greater proportion of black patients (9.9 percent) than of Hispanics (3.8 percent) or whites (1.8 percent) tested positive. The rates of HIV infection among this group of hospitalized patients are higher (according to published studies) than rates among patients attending clinics for sexually transmitted diseases in Boston, and indicate a very high prevalence of HIV infection in poor inner-city residents. Furthermore, these rates represent an underestimation since SHSS guidelines deliberately exclude patients with many diseases from testing. The results indicate that more efforts should be made to identify HIV-infected people, particularly in regions where the number of AIDS cases is high. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Statistics, HIV infection, HIV infections, Medical screening, Health screening, Hospital patients, AIDS (Disease)

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