By Elizabeth Cooney, Globe Correspondent

Uninsured people are also more likely to have undiagnosed and undertreated medical conditions, according to a new study comparing chronic illnesses among Americans with and without health coverage. The results offer possible clues to a recently reported higher death rate among people who lack insurance.

Researchers from Cambridge Health Alliance and Boston Medical Center tracked diabetes, high blood pressure, and high cholesterol in a national survey of more than 15,000 working-age adults. Based on questionnaires, medical exams, and lab test results, they found that about half of uninsured people who had diabetes or high cholesterol were unaware of it, compared with just under one-quarter of insured people who did not know they had these conditions. High blood pressure, however, was undiagnosed in about a quarter of both uninsured and insured people.

Once diagnosed, hypertension was poorly controlled in 58 percent of uninsured people and 51 percent of those with insurance. The treatment gap was larger for high cholesterol: 77 percent of uninsured versus 60 percent of insured people had inadequately treated levels.

For diabetes control, the difference in treatment was not as clear. Insurance status did not matter in achieving good diabetes control, as defined by the national survey conducted by the US Centers for Disease Control and Prevention. But using less stringent measures that the authors say are more commonly used by physicians, 31 percent of uninsured diabetics were in poor control of their blood sugar levels, compared with 25 percent of insured diabetics.

"The diagnosis and control of chronic illness is substandard even in people with insurance," Dr. Steffie Woolhandler, co-author of the article appearing online today in Health Affairs, said in an interview. "But it's much, much worse for the uninsured."

Five members of a national physicians organization led about 30 people in a rally outside Massachusetts General Hospital today protesting the use of live animals in a training program for trauma treatment.

The Physicians Committee for Responsible Medicine said it targeted Mass. General because the hospital uses live, anesthetized sheep to teach trainees how to insert tubes and needles into the animals’ chests or cut into their throats. The animals are later killed, according to the group, a nonprofit organization that advocates preventive medicine and ethical research practices.

The hospital defended its use of animals in Advanced Trauma Life Support training.

"We have long been committed to conducting all activities according to the highest standards of quality, safety and excellence," the hospital said in a statement emailed to the Globe. "This commitment includes delivering the highest quality care to laboratory animals that are used for research and education purposes. The animals are anesthetized and treated in the most humane manner possible. We take this responsibility very seriously."

Most hospitals, including Boston Medical Center, use human patient simulators to teach these skills, the physicians' group said. Ten out of 207 trauma hospitals in the United States and Canada use live animals, Dallas cardiologist Dr. John Pippin said outside Mass. General today. Mass. General has simulators but also uses sheep, the hospital confirmed.

"Since June, five programs have ended the use of animals and two more will do so as soon as they get simulators," he said. "This is disappearing from the landscape, but Mass. General is lagging behind."

Boston Medical Center is reducing its intensive care beds by eight and consolidating the remaining 66 beds in two inpatient buildings as part of a plan to control costs in the face of significant financial losses, the hospital confirmed today.

"These actions are part of Boston Medical Center’s ongoing efforts to reduce costs and provide efficient, quality care," hospital spokeswoman Ellen Berlin said in an e-mailed statement. "Since BMC’s inception, we have managed critical care patients in two inpatient buildings, with ICUs on both sides of our campus. We will continue to provide the same level of care in both inpatient buildings."

Forty nurses, certified nurse assistants, and support staffers are affected by the move, but seniority provisions in their union contract will dictate whether they will lose their jobs or move to other positions in the hospital.

Boston Medical Center, which before the cuts expected to lose $178 million in the fiscal year that started Oct. 1, filed a lawsuit against Massachusetts in July, accusing the state of illegally cutting payments made to the hospital for treating thousands of poor patients. After the state passed its landmark law mandating near-universal health insurance coverage, it phased out special payments to Boston Medical Center and Cambridge Hospital, another safety-net hospital. The state has said its actions comply with applicable laws.

Patient satisfaction and aggressive care don't necessarily go hand in hand, according to new hospital ratings prepared by Consumer Reports.

Drawing on government surveys compiled on the Hospital Compare web site and the Dartmouth Atlas of Health Care intensity index, the consumer ratings publisher has ranked the nation's more than 3,000 hospitals on its online health site, using the same red and black blobs familiar from ratings of cars or digital cameras.

Patient satisfaction covered eight categories, from cleanliness to communication, and intensity was measured by the number of tests conducted, doctors' visits made, procedures performed, and days spent in the hospital. Consumer Reports reverses how Dartmouth reports intensity, instead presenting aggressive care at the low end and conservative care at the high end of a spectrum from 1 to 100.

The top 28 teaching hospitals -- those that ranked significantly above the national average in patient satisfaction -- on average practiced more conservative medicine than 59 percent of hospitals, according to Dartmouth benchmarks for chronic care.

Brigham and Women's Hospital and Massachusetts General Hospital, the only two hospitals in the state to make the highest performers' list, were among the exceptions. The Brigham's Dartmouth score says it is more conservative than 29 percent of hospitals and Mass. General is more conservative than 18 percent on a spectrum where aggressive scores are low and conservative scores are high.

That stands in contrast to the Dartmouth-affiliated Mary Hitchcock Memorial Hospital in Lebanon, NH. Its overall patient satisfaction score of 81 is one point ahead of the Brigham and one point below Mass. General, but its Dartmouth score says its care is more conservative than 88 percent of hospitals.

"Mass. General does very well and so does the Brigham among better-performing hospitals. They are more toward the aggressive end of the spectrum, but what we try to communicate to folks is a more conservative approach doesn't lessen patient satisfaction," Dr. John Santa, director of the Consumer Reports Health Ratings Center, said in an interview. "It actually appears to be associated with a better experience."

Elaine Ullian, head of Boston Medical Center since its creation, will retire in January, she said today.

Ullian, 61, was chosen to lead the hospital when Boston City Hospital and Boston University Medical Center Hospital merged in 1996, becoming the first medical center in the country to combine a public hospital and an academic medical center.

The hospital now serves as a safety net for many of the city's poorest residents. It has more than 6,000 employees, 1,400 physicians, and an annual operating budget of about $2.5 billion.

Earlier this month the hospital said it expects to lose $175 million in the fiscal year starting Oct. 1, and will close this year $38 million in the red, its first loss in five years. It blames the deficits partly on changes that started with the state's groundbreaking mandatory health insurance law.

"The years have flown by, and together, we built an important, effective and extraordinary medical center that is a national model of an academic medical center committed to the most vulnerable populations," she wrote in a message to staff. "Your commitment to our mission -- coupled with your extraordinary competence and loving kindness -- has inspired me each day for sixteen years."

Ted English, chair of the hospital's board of trustees, will lead the search for a new president.

Boston hospitals made a strong showing in the newest US News & World Report rankings.

Massachusetts General Hospital and Brigham and Women's Hospital both scored high on the honor roll for hospitals with top scores in at least six of the 16 specialties rated. Mass. General was fifth and the Brigham was 10th on the 21-member list.

The rankings are based on patient outcomes, reputation, and care-related measures. Out of 4,861 hospitals in the country, 174 scored high enough to be included on the specialty lists.

Beth Israel Deaconess Medical Center made the top 50 in eight specialties and Boston Medical Center was ranked in three.

The video is short, simple, and powerful.

A woman with advanced dementia -- wearing lipstick, beads and a white shawl -- stares blankly at the camera while her daughters ask her questions. A man's voice describes what she and others at this stage cannot do: communicate, walk or sit alone, feed themselves. She does not respond when her daughter asks her how many daughters she has, and she needs help to keep her spoonfuls of pureed food in her mouth.

Less than two minutes long, the video was shown to almost 100 elderly people taking part in a study comparing the effects of watching the narrated video of advanced dementia with listening to the verbal narration alone. Just over 100 other participants heard the narration. Both groups were then asked to choose what kind of end-of-life care they would want if they were in the same irreversible condition.

People who viewed the video were more likely to choose comfort care over life-extending measures than people who heard a verbal description alone, Dr. Angelo Volandes of Massachusetts General Hospital and his colleagues report in the British Medical Journal. Those who saw the video were also more knowledgeable about the disease, and more of them remained firm in their choice of end-of-life care six weeks after seeing the video.

"Most of our patients do not have experience with advanced stages of disease nor with the interventions such as CPR," Volandes said in an interview. "Video may be one way of better informing patients about decisions at the end of life. Video makes these conversations quite real."

Boston Medical Center's food is going green.

In an announcement tied to Earth Day celebrations, the hospital said today that CEO Elaine Ullian will sign a Healthy Food in Health Care Pledge. The promise commits Boston Medical Center to serving food that is better for patients, visitors, and employees while helping local farmers and decreasing greenhouse emissions.

The 626-bed hospital will buy local produce from Red Tomato, a Canton nonprofit organization that will sponsor a farmer’s market this summer on the hospital campus. The hospital also said it will purchase meat and dairy products raised without unnecessary antibiotics and hormones.

The Healthy Food in Health Care Pledge is a voluntary program of Health Care without Harm, an international coalition working to reduce the environmental impact of the health care industry. Eight other hospitals in Massachusetts have also joined the effort: Fairview Hospital in Great Barrington, Cooley Dickinson Hospital in Northampton, Baystate Medical Center in Springfield, Spaulding Rehabilitation Hospital in Boston, Berkshire Medical Center in Pittsfield, Milford Regional Medical Center, Shriners Hospital for Children in Boston, and MetroWest Medical Center in Framingham and Natick.

A Boston radiologist studying how well a faster form of ultrasound can detect breast cancer is training the same tool on marathon runners and their tendons.

Dr. Alda Cossi, director of ultrasound in the radiology department at Boston Medical Center, hopes to improve the way both cancer and sports injuries are treated by getting a better picture of them before they get worse.

Typical ultrasound machines, like the ones in an obstetrician's office, send out sound waves, like ripples in a pond. When they meet tissue they compress it slightly, but too fast for the movement to be recorded. A newer kind of ultrasound technology called shear wave elastography borrows software from video games that captures images 10 times as fast, at 3,000 frames per second. That reveals the vibration of the sound waves on the tissue and allows radiologists to measure how stiff the tissue is.

That's important in cancer diagnosis because malignant tissue tends to be harder. That quality is also relevant in for athletes, who know the pain of muscle or tendon stiffness. Or the agony when they rupture, often without warning.

"We're pretty poor at looking at tendons," Cossi said. "You can do an MRI, but all you can tell is is, does a tendon have a hole or a tear? You're not really looking at the behavior of the tendon."

Dr. Steven Parker, a pediatrician and expert in child development at Boston Medical Center, died Monday of complications of cancer. He was 62.

Founder of the Comprehensive Care Program at the hospital, he promoted family-centered care for children with developmental disabilities. He also co-directed Healthy Steps, a national program that includes an early childhood specialist in pediatric practices to foster children’s social, emotional, and cognitive development. He co-authored "Baby and Child Care" with Dr. Benjamin Spock.

"Steven followed in the footsteps of Dr. Spock and his mentor, Dr. [T. Berry] Brazelton, by sharing his wisdom directly with parents as the voice of pediatrics for WebMD," Dr. Barry Zuckerman, Boston Medical Center chief of pediatrics, said in message to hospital staff.

Parker's blog for the online health resource was called Healthy Children. WebMD has posted a video interview with Parker.

"I always liked kids. They're funny, they're interesting, they're hopeful," he tells WebMD. "Kids are just such a kick. I get to work with them every day. It's great."