More Americans than ever lack health insurance-more than 46 million, up 1.3 million from 2005, according to the Henry J. Kaiser Family Foundation. (See page 40 for a report on the uninsured and underinsured.) And that number may increase with Medicaid's new policy requiring proof of citizenship before it will insure the U.S.-born children of undocumented immigrants. Previously, any infant born in the United States was automatically granted Medicaid coverage for one year. Under the new policy, parents must apply for coverage for the child and provide documents, such as a birth certificate, proving the child's U.S. citizenship. This may deter parents who fear deportation, leaving infants without immunization and monitoring during a critical time.

Family caregivers. The graying of baby boomers is creating a need for services that will be increasingly difficult to fill. There's already a shortage of caregivers for nursing homes and in-home care. About 20% of Americans now care for relatives or friends, but the stress of doing so often leads them to neglect their own health-and prevents them from providing the best care. A recent report (available online at http://www.ilcusa.org/_lib/pdf/Caregiving%20in%20America-%20Final.pdf) surveyed caregivers in fair or poor health who said their health had declined as a result of caregiving; they reported depression, anxiety, stress, hypertension, arthritis flare-ups, and reflux. To ease the burden, nurses can identify caregivers who are overstressed, help them find respite, and coordinate relatives to assist with care.

Some insurance plans now pay for geriatrics case managers, whose services range from answering questions to supervising home care visits, and in September the U.S. Department of Health and Human Services announced that it would invest more than $13 million in community prevention programs for older adults in 16 states.

"Diabesity." Despite spending $30 billion yearly on diet products, two-thirds of Americans are overweight or obese-double the percentage of 25 years ago. And in children and teens, the prevalence of abdominal obesity increased by 65% in boys and 69% in girls between 1988 and 2004, Centers for Disease Control and Prevention researchers reported in the November 2006 issue of Pediatrics. Obesity leads to not only heart disease but also diabetes, the nation's sixth leading cause of death in 2003. Now, one in every 523 U.S. children and teens has diabetes, according to an October 2006 report in Pediatrics.

In New York City, where diabetes is the fourth leading cause of death, the Board of Health now requires laboratories to report test results for hemoglobin A_Ic-a measure of the average glucose level in the blood during the two to three months before testing-to the city's Department of Health and Mental Hygiene. It is the first government program to track a chronic, noninfectious illness. In addition, the city voted last month to ban the use of artery-clogging trans fats at all city restaurants.

Carol Potera

Figure. Florence "Tubby" Parsons, age 93, and Penny Walsh, age 41, in Parson's apartment in Winooski, Vermont, last October. Walsh, a former tenant of Parson's, now works as her in-home caregiver under the state's year-old Choices for Care program, which has made home care as available as nursing-home care for older adults on Medicaid.

Maureen Shawn Kennedy, MA, RN

news director