Study: Dialysis 3 times weekly might not be enough (AP)

LOS ANGELES � A major study challenges the way diabetics and others with failing kidneys have been treated for half a century, finding that three-times-a-week dialysis to cleanse the blood of toxins may not be enough.

Deaths, heart attacks and hospitalizations were much higher on the day after the two-day interval between treatments each week than at other times, the federally funded study found.

The president of the National Kidney Foundation said she was "very troubled" by the results published in Thursday's New England Journal of Medicine.

"We could be doing a better job for our dialysis patients" and that might mean doing it more often, said Dr. Lynda Szczech, a Duke University kidney specialist who had no role in the study.

Kidneys rid the body of waste and fluids. Most of the 400,000 Americans with failing kidneys stay alive by getting their blood purified by a machine three days a week at dialysis clinics � usually on Mondays, Wednesdays and Fridays or on Tuesdays, Thursdays and Saturdays. In both cases, there's a two-day break between the last session of the week and the next one.

The three-day dialysis schedule has been around since the mid-1960s and gives patients a weekend break from the grueling hours of being hooked up to a machine.

However, doctors have suspected that the two-day hiatus between treatments was risky, and smaller studies have found more heart-related deaths on the day after the gap.

"All the fluids and toxins are built up to the highest extent on Monday morning right before dialysis," said Dr. Anthony Bleyer of Wake Forest Baptist Medical Center in North Carolina, who has done similar studies.

The latest research, funded by the National Institutes of Health, is the largest yet. It was done by Dr. Robert Foley of the University of Minnesota and colleagues. All reported receiving fees from dialysis clinics and suppliers.

The team analyzed medical records of 32,000 people who had in-center dialysis three times a week from 2005 through 2008. The average age was 62 and a quarter had been on dialysis for a year or less. After about two years of follow-up, 41 percent had died, including 17 percent from heart-related causes.

Monday was the riskiest day for people on a Monday-Wednesday-Friday schedule. For those on a Tuesday-Thursday-Saturday schedule, the riskiest day was Tuesday.

Researchers found a 22 percent higher risk of death on the day after a long break compared with other days of the week. Put another way: For every 100 people on dialysis for a year, 22 would die on the day after the long interval versus 18 on other days.

Hospital admissions for stroke and heart-related problems more than doubled on the day after a long break than on other days � 44 versus 20 for every 100 people treated.

Fixing this problem, however, could be daunting for patients, busy dialysis centers and insurers and it would require a rethinking of how dialysis is currently delivered.

Medicare covers the cost of dialysis, regardless of age, spending about $77,000 annually per person. It covers thrice-weekly treatment, but people can get a fourth session if needed.

Dr. Paul Eggers of the National Institute of Diabetes and Digestive and Kidney Diseases said adjusting how dialysis is done "would require some fairly convincing evidence. I'm not sure this one study would be sufficient to change" standard practice.

Kidney expert Dr. Eli Friedman of SUNY Downstate Medical Center in New York, said he's in favor of every-other-day dialysis or even daily dialysis. But it would mean "a multibillion dollar change," said Friedman, who launched the country's first federally funded dialysis center.

A clinic operator said increasing treatments would require additional staff. And patients also would have to be willing to come in more often.

"They don't even like coming in three times a week. It's completely understandable. It's not fun," said Dr. Allen Nissenson, chief medical officer at DaVita, which runs more than 1,600 clinics around the country.

There has been recent interest in more frequent dialysis after studies hinted that it made people feel healthier.

This year, Medicare started giving clinics a financial incentive to teach patients to do dialysis at home, allowing them to cleanse their blood more often. But this option is not for everyone. It requires intense training and patients need a helper at home.

Unless rules change, Wake Forest's Bleyer said people can take simple steps to reduce their risk by not drinking too much fluid between long dialysis breaks and eating a healthy diet.

"Patients must be a little more careful on the weekend than on other days of the week," he said.

Carol Thomas, who has been on dialysis since 2007, watches her water intake especially on weekends and avoids dairy, beans and nuts, which are high in certain nutrients that can cause complications.

Thomas, of Sacramento, Calif., said home dialysis is not an option because she doesn't have someone to help her. Would she make the trip for dialysis more often if given the choice?

"It's an inconvenience, but probably if it meant lengthening my life," the 69-year-old said.

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Online:

New England Journal: http://www.nejm.org

Kidney disease information: http://kidney.niddk.nih.gov

National Kidney Foundation: http://www.kidney.org

American Association of Kidney Patients: http://www.aakp.org

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Alicia Chang can be followed at: http://twitter.com/SciWriAlicia

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Million young adults get health coverage under law (AP)

WASHINGTON � At least one part of President Barack Obama's health care overhaul has proven popular. With the economy sputtering, the number of young adults covered by health insurance grew by about a million as families flocked to take advantage of a new benefit in the law.

Two surveys released Wednesday � one by the government, another by Gallup � found significantly fewer young adults going without coverage even as the overall number of uninsured remained high.

The government's National Center for Health Statistics found that the number of uninsured people ages 19-25 dropped from 10 million last year to 9.1 million in the first three months of this year, a sharp decline over such a brief period.

New data from an ongoing Gallup survey found that the share of adults 18-25 without coverage dropped from 28 percent last fall to 24.2 percent by this summer. That drop translates to roughly 1 million or more young adults gaining coverage.

The new health care law allows young adults to remain on their parents' health plans until they turn 26. Previously, families faced a hodgepodge of policies. Some health plans covered only adult children while they were full-time students. Others applied an age cutoff.

Elizabeth Wilson, an aspiring opera singer who lives near Indianapolis, said her mother's plan dropped her in the midst of a medical crisis because she had turned 23. At the time, Wilson was in the hospital under treatment for an inflammation of the pancreas. Because of the overhaul, she has been able to get back on the policy.

"It means I don't have to spend every penny I make to get health care," said Wilson, now 24. "I can use some of it to further my studies � or buy food."

The two surveys were welcome news for the administration, which is trying to fight off attempts to repeal the law � which some GOP lawmakers and candidates call "Obamacare" � or to overturn it in court.

"It's very disappointing to hear some people in Congress talk about repealing the law and taking away this security," said Health and Human Services Secretary Kathleen Sebelius.

Repealing Obama's law, which Congress approved in March 2010, would end the requirement that health plans cover young adults up to age 26. But some GOP lawmakers say they would include such a mandate in replacement legislation to follow.

While the bleak economy has made it hard for young people to get jobs, fewer are being forced to go without medical care, defying an overall trend of rising numbers of working-age Americans who lack coverage.

"While we did not see a drop-off in any other age group, we did see a drop in this age group," said Frank Newport, Gallup's polling director.

Gallup found that the share of 26- to 64-year-olds uninsured rose from 18.1 percent in the fall of last year to 19.9 percent this summer.

Public opinion remains divided about Obama's overhaul, but coverage for young adults has proven to be a popular and relatively low-cost benefit in these days of prolonged school-to-work transitions. The provision technically took effect last fall but wasn't implemented by most workplace health plans until Jan. 1.

"The big change started in the last quarter of 2010 and continued further in the first two quarters of this year," said Newport. "Bingo, it started going down," he said of the percentage of uninsured young adults.

Those young Americans are still more likely to be uninsured than any other age group.

Some are making the switch from school to work. Others are in low-wage jobs that don't usually offer coverage. And some in this group � sometimes termed the "invincibles"_ pass up workplace health insurance because they don't think they'll use it and would rather get a little extra in their paychecks.

The latest surveys are in line with other findings. Mercer, the benefits consulting firm, found a 2 percentage-point increase in workplace health plan enrollment as a result of extending coverage to young adults.

It's a less expensive group to cover than middle-aged or older adults, and many companies have spread the extra premiums among their workers. Delloite LLP, another major benefits consultant, projects additional costs for covering young adults in the range of 1-2 percent.

Other early coverage expansions in the health care law have not worked as well, including a special program for people with health problems turned away by insurers.

The law's main push to cover the uninsured isn't scheduled until 2014. At that time, more than 30 million people are expected to get coverage through a combination of expanding Medicaid and providing tax credits to make private insurance more affordable. And insurers will no longer be able to turn away people in poor health.

Gallup continuously surveys nearly 1,000 people a day. Its analysis includes 89,857 respondents interviewed between April 1 and June 30. The margin of error for the full sample is plus or minus 1 percentage point; it is higher for subgroups.

The government's National Health Interview Survey is one of the primary sources of information on the U.S. public, relying on detailed household interviews. The latest results are drawn from interviews with more than 20,000 people from January through March. Wednesday's report also found an uptick in public coverage for young adults, but officials said that increase was not statistically significant.

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Associated Press writer Mike Stobbe in Atlanta contributed to this report.

Online:

Gallup survey: http://tinyurl.com/3dy4nrk

HHS report: http://tinyurl.com/3mvc7wg

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Company hires adults with autism to test software (AP)

HIGHLAND PARK, Ill. � The software testers at Aspiritech are a collection of characters. Katie Levin talks nonstop. Brian Tozzo hates driving. Jamie Specht is bothered by bright lights, vacuum cleaners and the feel of carpeting against her skin. Rider Hallenstein draws cartoons of himself as a DeLorean sports car. Rick Alexander finds it unnerving to sit near other people.

This is the unusual workforce of a U.S. startup that specializes in finding software bugs by harnessing the talents of young adults with autism.

Traits that make great software testers � intense focus, comfort with repetition, memory for detail � also happen to be characteristics of autism. People with Asperger's syndrome, a mild form of autism, have normal to high intelligence and often are highly skilled with computers.

Aspiritech, a nonprofit in Highland Park, Ill., nurtures these skills while forgiving the quirks that can make adults with autism unemployable: social awkwardness, poor eye contact, being easily overwhelmed. The company's name plays on the words "Asperger's," "spirit" and "technology."

Clients, nine companies in Aspiritech's first two years, have been pleased.

"They exceeded my expectations," said Dan Tedesco of Shelton, Conn.-based HandHold Adaptive, which took a chance on Aspiritech to test an iPhone application. "There is a pride in their product you don't usually see in this type of work."

Aspiritech was founded by Moshe and Brenda Weitzberg after their son, Oran, now 32, was fired from a job bagging groceries. Oran was diagnosed with Asperger's syndrome when he was 14. He now works at Aspiritech.

"He went from failing at bagging groceries to being one of the best software testers on our team," said Brenda Weitzberg.

The Weitzbergs modeled Aspiritech on a successful Danish company called Specialisterne, or "the Specialists." Specialisterne also employs software testers with autism. Its satisfied clients include Oracle and Microsoft.

Other companies in Belgium, Japan and Israel are either hiring or training adults with autism as software testers.

This year, Aspiritech projects $120,000 in revenue, with 60 percent coming from donations and 40 percent from clients. The Weitzbergs hope to raise the client revenue to 50 percent next year.

"There have been a couple of attempts in the U.S. and Aspiritech is the one that's making it," said Scott Standifer of the University of Missouri's Disability Policy and Studies office and the organizer of a national conference on adults with autism and employment.

The exact unemployment rate for adults with autism is unknown, but it's thought to be high, Standifer said.

"We don't know how many adults have autism and, because of that, we don't know their rate of unemployment," he said. "We do know from tracking adults just emerging from high school that they are having great difficulty finding jobs."

A 2009 U.S. Department of Education survey found the employment rate for young adults with autism was on par with that for deaf-and-blind young adults, and well below the rate of those with blindness alone or learning disabilities or traumatic brain injuries, Standifer said.

Since Asperger's syndrome didn't become a standard diagnosis until the early 1990s, many of Aspiritech's software testers were adults when they first learned they were on the autism spectrum. They are pioneers, the first generation of adults with Asperger's.

Katie Levin, 35, was diagnosed in her late 20s with Asperger's. As a child, she'd been labeled as mentally ill.

"Asperger's is not a mental illness," she said. "I definitely feel like I identify with the Asperger's community more than I did with the mental illness community." She tests software and runs Aspiritech's Facebook page and Twitter feed.

Rick Alexander, 24, another tester, has a degree in computer science from the Illinois Institute of Technology and completed an internship developing software for the city of Chicago.

"I have a lot of social anxiety. I don't like meeting new people," said Alexander, who was diagnosed with Asperger's syndrome as a teenager. Like many of the other testers, he lives with his parents.

He'd rather be a software developer than a tester, he said. But selling himself in a job interview is "very difficult for me."

"When you're a child, the school is very concerned with you, the state is very concerned with you," Alexander said. Organizations help adults with autism, he said, but "you need to approach them and for somebody with Asperger's syndrome, it's very difficult to do the approaching."

Most research dollars have gone toward studying children with autism while adults have been neglected, said Molly Losh, an autism researcher at Northwestern University.

"Our vocational structure really isn't suited to funnel people with autism into the workforce," Losh said. Aspiritech "is a magnificent and innovative venture," she said.

Many businesses hire offshore companies to test software. Mike Mestemaker, director of engineering for Schaumburg, Ill.-based ISI Telemanagement Solutions, chose Aspiritech because it offered competitive rates but was based in the United States.

"They dove right in and worked very quickly," Mestemaker said. "They were very detail-oriented people. They really got the job done."

ISI was happy with the work and has hired Aspiritech for a second project, he said.

Aspiritech provides meaningful work (pay is $12 to $15 an hour) in a relaxed environment where bosses never yell if you're late and nobody minds if you need to be alone for a while. What's more, the company is building social skills. The software testers, who are in their 20s and 30s, are trained to work together and they take part in organized outings: miniature golf, bowling, eating at a restaurant.

"We want to improve social skills among people who tend to be socially isolated," said Marc Lazar, Aspiritech's autism specialist. For many of them, software testing is not going to be their lifelong career, Lazar said, "but while they're here they're going to improve their job skills and they're going to learn what kind of behavior is expected on the job and they're going to have more to put on their resumes."

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AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

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