While surviving cancer should be an occasion for rejoicing, many people who have undergone the standard or high-dose chemotherapy to defeat the disease unfortunately suffer from a physical and mental ailment known as “chemobrain.” This cognitively dysfunctional symptom ranges from fatigue and memory loss to serious learning impairment due to possible brain damage. In CHEMOBRAIN: HOW CANCER THERAPIES CAN AFFECT YOUR MIND (Prometheus Books, $18.98), a clear, concise guide for cancer patients, survivors, families, friends, and caregivers, noted science journalist Ellen Clegg provides the latest information on this much-discussed but poorly understood side effect of chemotherapy treatment, while also – in an objective journalistic fashion – giving voice to those medical professionals who remain skeptical of chemobrain.

Based on extensive and candid interviews with both those suffering from chemobrain and the physicians and scientists who have treated and studied this problem, Clegg cuts through the scientific jargon and explains in understandable terms how chemotherapy works at the most basic biological level. In doing so, she provides cancer survivors with the knowledge to understand what is happening to them and practical tips for coping with the aftermath of chemotherapy treatment.

Clegg’s extensive cross-analysis of chemotherapy survivors’ stories with the opinions of doctors who recognize the symptoms will provide the affirmation that so many who suffer from chemobrain so desperately need. She includes tactics for dealing with cognitive problems and other lingering side effects, strategies for multitasking at home and reentering the workforce, and even ways to deal with health insurance.

In addition to personal strategies and stories, Clegg also provides the history of the patient empowerment movement that brought chemobrain to the attention of the medical establishment in the first place. She also addresses the future of cancer research and the search for treatments that do less harm, and looks at chemobrain’s implications for the mental health of developing children.

Stewart B. Fleishman, MD, Director, Supportive Services, Continuum Cancer Centers of New York: Beth Israel and St. Luke’s-Roosevelt Hospitals, is a doctor at the forefront of a new movement to treat cognitive dysfunction as a real symptom with real potential solutions. “We will learn more about the causes of cognitive impairment soon, asking future patient generations to invest less of their quality of life to not only survive, but also thrive after diagnosis of cancer and its treatment,” he writes in the book’s foreword. “Many questions have yet to be answered. Further studies are now underway to do so.”

While survivor circles have acknowledged and debated chemobrain for years, this is the first and only book to delve into the cognitive problems many patients endure when they undergo chemotherapy. CHEMOBRAIN brings together cutting-edge science, the compelling stories of adults and children who have struggled for years with cognitive dysfunction, and the coping strategies being developed on the front lines of patient care. Clegg’s investigative study of chemobrain is both a required read for today’s upcoming medical professionals and a gospel for those suffering with this widespread symptom as well as for caring family members.

Notes:

About the Author: Ellen Clegg (Boston, MA) is a deputy managing editor of news operations at the Boston Globe, in charge of the Sunday paper. Her previous positions at the same paper include health and science editor, night news editor, and city editor.

The American Cancer Society estimates 183,000 new cases of breast cancer were diagnosed in the United States last year with more than 40,000 deaths. In New Jersey alone there were 6,300 new cases and 1,400 deaths. It is those statistics on which researchers at The Cancer Institute of New Jersey (CINJ) hope to have impact with a newly opened clinical trial, which has global implications. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

Along with other cancer centers across the world, CINJ will offer a unique study targeted at patients diagnosed with HER2 positive breast cancer. The HER2 positive gene is believed to help in the reproduction of cancer cells and accounts for up to 25 percent of all breast cancers. It is considered an aggressive form of the disease and is associated with a greater risk for breast cancer recurrence and death.

The standard treatment for HER2 positive breast cancer includes a drug known as trastuzumab. Research has shown that many patients respond well to this treatment; however, some do not, because of a build up of acquired resistance to this particular drug. Investigators aim to find out why that is by examining four different treatment combinations of trastuzumab with that of a drug known as lapatinib, which has not been approved by the Food and Drug Administration as a treatment for early breast cancer.

The study — known as the ALTTO (Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization) trial — is sponsored by Glaxo Smith Kline, North Central Cancer Treatment Group, Breast International Group, the National Cancer Institute and the National Cancer Institute of Canada and aims to enroll 8,000 patients worldwide. The collection of data and the way care is given in the study will be exactly the same no matter where patients are participating in the trial.

Deborah Toppmeyer, MD, director of the New Jersey Comprehensive Breast Cancer Center at CINJ and associate professor of medicine at UMDNJ-Robert Wood Johnson Medical School, is the lead researcher for the study at CINJ. She notes, “We have entered into an age of cancer research in which we know that collaboration is key. By being a part of this global initiative, we have an opportunity to help develop a model, by which research in this area of breast cancer will be measured in the future.”

For one year, selected patients will undergo one of four treatments, which include taking the drugs paclitaxel and trastuzumab through a needle into a vein, taking a lapatinib pill by mouth, or a combination of the two. Patients will have routine blood and/or urine tests, physical exams and other tests during that time. They also will be required to have follow-up visits on a regular basis until they have been in the study for ten years.

Patients at or over the age of 18 with the diagnosis of early stage HER2 positive breast cancer that has been removed by surgery are eligible to take part in the trial, although other criteria must be met.

Clinical trials, often called cancer research studies, test new treatments and new ways of using existing treatments for cancer. At CINJ, researchers use these studies to answer questions about how a treatment affects the human body and to make sure it is safe and effective. There are several types of clinical trials that are currently underway at CINJ, including those that diagnose, treat, prevent, and manage symptoms of cancer. Many treatments used today — whether it is drugs or vaccines; ways to do surgery or give radiation therapy; or combinations of treatments — are the results of past clinical trials.

As New Jersey’s only National Cancer Institute-designated Comprehensive Cancer Center, CINJ provides patients with access to treatment options not available at other institutions within the state. CINJ currently enrolls more than 1,000 patients on clinical trials, including approximately 15 percent of all new adult cancer patients and approximately 70 percent of all pediatric cancer patients. Enrollment in clinical trials nationwide is fewer than five percent of all adult cancer patients.

About The Cancer Institute of New Jersey

The Cancer Institute of New Jersey (http://www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center, and is dedicated to improving the prevention, detection, treatment and care of patients with cancer. CINJ’s physician-scientists engage in translational research, transforming their laboratory discoveries into clinical practice quite literally bringing research to life. The Cancer Institute of New Jersey is a center of excellence of UMDNJ-Robert Wood Johnson Medical School.

The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides a mechanism to rapidly disseminate important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. Affiliate Hospitals: Bayshore Community Hospital, Carol G. Simon Cancer Center at Morristown Memorial Hospital, Carol G. Simon Cancer Center at Overlook Hospital, CentraState Healthcare System, Cooper University Hospital, Jersey Shore University Medical Center, JFK Medical Center, Raritan Bay Medical Center, Robert Wood Johnson University Hospital at Hamilton (CINJ at Hamilton), Saint Peter’s University Hospital, Somerset Medical Center, Southern Ocean County Hospital, The University Hospital/UMDNJ-New Jersey Medical School, and University Medical Center at Princeton.

Cancer Institute of New Jersey
New Brunswick
NJ 08901
United States
http://www.cinj.org

It’s a question that confronts parents and teachers everywhere- what is the best method of teaching kids new skills? Is it better for children to learn gradually, starting with easy examples and slowly progressing to more challenging problems? Or is it more effective to just dive-in head first with difficult problems, and then move on to easier examples? Although conventional wisdom suggests that the best way to learn a difficult skill is to progress from easier problems to more difficult ones, research examining this issue has resulted in mixed outcomes.

University of California, Santa Barbara psychologists Brain J. Spiering and F. Gregory Ashby wanted to pinpoint the best strategies for learning new information. In their study, a group of volunteers were taught a new task in which they had to categorize items. The volunteers were trained to complete the task by one of three methods – starting with easy problems, starting with harder problems then moving on to easier examples or being shown examples in random order.

The results, published in Psychological Science, a journal of the Association for Psychological Science, showed that the effects of the different training methods depended on the type of categories that the participants were learning. When the categories could be easily described (i.e. was the line horizontal or vertical?), all three of the training procedures were equally effective. However, when the categories could not be described easily, starting with the harder problems then moving to easier ones produced the best results. The volunteers in the easy-to-hard group were able to come up with simple rules and category descriptions which worked for the easy problems, but were not applicable to more complicated problems. As a result, these participants ended up doing poorly on the task because they were unable to think abstractly to solve the problem. On the other hand, the participants who began with harder problems very quickly stopped trying to come up ways to describe the categories and thought about the problems in a more abstract way; this strategy helped them to perform well throughout the task.

These findings have important implications for teachers and educators and suggest that materials should be presented to students in a specific order, depending on what is being taught.

Notes:

Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. For a copy of the article “Initial Training With Difficult Items Facilitates Information Integration, but Not Rule-Based Category Learning” and access to other Psychological Science research findings, please contact Barbara Isanski

Researchers from Boston University’s Slone Epidemiology Center have found that exposure to pseudoephedrine, a decongestant found in many cough-and-cold and allergy medications, has been common among U.S. children, especially those under the age of two years who are at the highest risk for toxicity and for whom safe dosing recommendations are lacking. These findings appear in the December issue of the journal Pediatrics.

Pseudoephedrine has been associated with deaths and adverse events in young children. However, the absolute risks of pediatric pseudoephedrine use are difficult to determine because the number of children exposed to this medication and typical patterns of use are unknown. In addition, use may be changing because of the Combat Methamphetamine Act of 2005, a law which limited availability of pseudoephedrine-containing products.

To define the frequency and patterns of use, the researchers analyzed data from 1999 through 2006 on pseudoephedrine use among 4,267 children, aged 0 to 17 years, who were enrolled in the Slone Survey, a national random-digit-dial telephone survey of medication use in the U.S.

The researchers found 4.9 percent of children took pseudoephedrine in a given week. Use was highest in children under two years of age (8.1 percent). Sixteen children (7.5 percent of users) took more than one pseudoephedrine-containing product within the same week, including six children under two years old. Of the pseudoephedrine products used, most were multiple-ingredient liquids (58.9 percent) and multiple-ingredient tablets (24.7 percent). Fifty-two subjects (25 percent of users) took pseudoephedrine for longer than one week, including seven children under two years of age. Perhaps reflecting reduced availability, use in 2006 (2.9 percent) was significantly lower than in 1999-2005 (5.2 percent).

Concerning patterns of use identified in the study include taking more than one pseudoephedrine-containing product at the same time and using pseudoephedrine for long periods of time. Pediatric pseudoephedrine use appears to be declining since the institution of the 2005 Combat Methamphetamine Act. “Pseudoephedrine exposure, mostly in the form of multiple-ingredient products, is common among U.S. children and needs to be monitored closely because of the potential for this medication to cause harm, particularly to children under two” said lead author Louis Vernacchio, MD, MSc, an assistant professor of epidemiology and pediatrics at Boston University School of Medicine

Babies born via cesarean section are more likely to be asthmatic in comparison to babies delivered naturally, according to an article released on December 2, 2008 in Thorax, one of the BMJ Specialist journals.

In the past decades, asthma rates have increased dramatically, paralleling an increase in cesarean section births. The proportion of these procedures has increased from 5% in the 1970s to more than 30% in 2000. However, studies examining the potential link between asthma and cesarean delivery have been inconclusive.

About 3,000 children were followed until the age of 8 years with regard to respiratory health, and this data was compared to the methods of birth. At age 8, 12.4% (362) had been diagnosed with asthma and thus prescribed inhaled steroids. While only 8.5% (247) of the children were born by cesarean, but these children were nearly 80% more likely to have a diagnosis of asthma, in comparison to the children delivered naturally. This association between cesarean section and asthma was strengthened by the presence of two allergic parents, indicating a hereditary predisposition to asthma. In children with two allergic parents, cesarean-born children were 200% times more likely to be asthmatic, in comparison with children without allergic parents, who were 36% more likely.

The authors suggest that this association may be linked to the development of the immune system at birth. That is, a cesarean may prevent the baby from being exposed to certain microbes earlier in life. They also suggest that their findings are quite robust given the sample size, long period of followup, and the strict definition of asthma.

They say: “The increased rate of caesarean section is partly due to maternal demand without medical reason.” The authors continue: “In this situation the mother should be informed of the risk of asthma for her child, especially when the parents have a history of allergy or asthma.”

Asthma at 8 years of age in children born by caesarean section
C Roduit, S Scholtens, J C de Jongste, A H Wijga, J Gerritsen, DS Postma, B Brunekreef, MO Hoekstra, R Aalberse, H A Smit
Online First Thorax 2008;
doi 10.1136/thx.2008.100875

Cryptorchidism, the congenital birth defect in which one or both testicles fail to descend into the scrotum, has been associated with certain genetic mutations, including a syndrome which is also a common cause of infertility, according to a study released on November 19, 2008 in JAMA.

As the most common congenital birth defect in male children, cryptorchidism may occur in 2-4% of all full-term male births. However, its cause is largely unknown, and the authors point out that, “although cryptorchidism is often considered a mild malformation, it can seriously affect men’s health, representing the best characterized risk factor for infertility and testicular cancer in adulthood.”

To investigate the potential cause of cryptorchidism, Alberto Ferlin, Ph.D., of the University of Padova, Italy, and colleagues performed a case-control study evaluating the frequency of genetic alterations in 600 male children with and 300 male children without the disease. the children were followed up for 2 to 3 years for persistence of the malformation.

In the genetic examination, abnormalities were low even in the group of cases (2.8%), but statistically significantly higher than those of the controls. This was true in for children with persistent cryptochidism (5.3%) and bilateral cryptorchidism (8.3%) in which both testes fail to descend at once. The odds of a genetic alteration in children with persistent cryptorchidism was 17 times that of controls; the odds of a genetic alteration in children with bilateral persistent cryptorchidism was 27 times that of controls.

The types of genetic mutation were varied. In the small proportion of cases with genetic abnormalities, the most common was Klinefelter syndrome, the most common genetic cause of male infertility. Additionally, several cases had mutations in the INSL3 receptor gene, which affects descent of the testes. Genetic alterations were found exclusively in children with normal weights and gestational ages.

The authors point out the exclusive presence of Klinefelter syndrome: “We found that chromosomal aberrations represent the most frequent genetic alteration in participants with isolated cryptorchidism, particularly in those with persistent cryptorchidism (1.6 percent in the unilateral forms and 4.2 percent in the bilateral forms), and that chromosomal alterations were exclusively represented by Klinefelter syndrome.”

They continue, summarizing the results of the study: “In this study, we found genetic alterations in a small percentage of boys with cryptorchidism. We found a significant association between bilateral and persistent cryptorchidism and genetic alterations, including mutations in the INSL3 receptor gene and Klinefelter syndrome. Genetic alterations were not found in participants with low birth weight or low gestational age …”

However, the authors finally caution against strong generalization of these results, noting the limitations of their study. “Our findings have the limitations of a case-control study, and the main limitation is the small number of genetic abnormalities found. Future studies involving a higher number of participants are necessary to confirm our findings. This study should therefore be considered preliminary, and strong conclusions about association cannot be drawn,” they write.

Latest figures show that roughly 135 000 African-born physicians and professional nurses practice overseas in developed countries. This finding, published in the online open access journal Human Resources for Health, suggests that approximately one-fifth of doctors and 10% of nurses born in any of the 27 African states are currently working in a developed nation.

The fraction of health professionals abroad varies enormously across African countries, from 1% to over 70% according to the occupation and country. For example, for every Liberian physician working in Liberia, about two live abroad in developed countries. Countries that experienced recent civil war (e.g. Mozambique, Sierra Leone) or economic stagnation (e.g. Cameroon) see about half their home-born doctors working in a developed country.

The numbers were calculated using the most recent census data from the nine most important destination countries for African health professional emigrants. They are the first standardized, systematic and occupation-specific measure of skilled professionals working in developed countries who were born in a developing country. The numbers have almost certainly increased since the censuses were conducted between 1999-2001.

“The lack of systematic data on the extent of African health workers’ international movements has hampered any study into the causes and effects of African health professional migration,” explained author Michael Clemens, from the Center for Global Development, Washington DC. The fear that health services in developed countries are poaching medical expertise from developing countries is a highly emotive and political issue. South Africa’s health minister, Dr Manto Tshabalala-Msimang, claimed in 2002 that “if there is a single major threat to our overall health effort, it is the continued outward migration of key health professionals, particularly nurses.”

Similarly, after the UK National Health Service ended its active recruitment of staff from Sub-Saharan Africa in 2001, the British Medical Association (BMA) and the Royal College of Nursing praised its “strong moral lead.” BMA Chairman of Council James Johnson flatly declared that “the rape of the poorest countries must stop.”

But Clemens says that there is insufficient research to make such categorical judgements. “A Kenyan nurse working in London isn’t taking care of sick people in Kenya,” he says, “but that nurse is pursuing professional possibilities that aren’t available to her at home – something of inherent value. The amount of good she can do at home is often constrained by dazzlingly complex problems in the health system, problems utterly ignored by the blunt coercion of recruitment bans.”

The new data overcome some of the limitations of previous estimates and facilitate efforts to analyse the global impacts of health worker movements.

Notes:

1. New data on African health professionals abroad
Michael A Clemens and Gunilla Pettersson
Human Resources For Health

Human Resources for Health is an Open Access, peer-reviewed, online journal covering all aspects of planning, producing and managing the health workforce – all those who provide health services worldwide.

Human Resources for Health aims to disseminate research on health workforce policy, the health labour market, health workforce practice, development of knowledge tools and implementation mechanisms nationally and internationally; as well as specific features of the health workforce, such as the impact of management of health workers’ performance and its link with health outcomes. The journal encourages debate on health sector reforms and their link with human resources issues, a hitherto-neglected area.

2. BioMed Central is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

BioMed Central

The percentage of teens who report solely positive benefits from not having sex declines precipitously with age, according to a new study by scientists at the University of California, San Francisco.

The finding suggests that adults should give teens guidance in coping with both the negative outcomes of engaging in sexual behaviors, and the negative experiences of refraining from them, the researchers say.

The study, reported in the January 2008 issue of the American Journal of Public Health, studied teens from the fall of their ninth-grade year through the spring of their tenth-grade year.

Among teens who remained sexually inexperienced during the study, the percentage reporting only positive experiences from refraining from sex fell from 46 percent to 24 percent.

Among teens who were sexually experienced at the outset of the study, the percentage reporting only positive experiences from refraining fell from 37 percent to 8 percent.

The greatest change in attitudes was among teens who became sexually experienced during the study period. For those teens, the percentage who said that not having sex resulted in only positive experiences dropped from 40 percent to 6 percent.

A comparison between the groups was also illuminating. Those adolescents who were sexually experienced from the outset were more likely than those who remained sexually inexperienced to value refraining from sex (odds ratio 3.1 to 1.6).

“When we encourage teens to abstain from sex or delay becoming sexually active, we frequently over-focus on the health risks, such as unintended pregnancy or sexually transmitted infections,” said senior study author Bonnie Halpern-Felsher, PhD, a professor of pediatrics in the Division of Adolescent Medicine at UCSF.

“Young teens are aware of the health risks, but this study shows that teens are assessing how they feel about refraining from sexual behaviors based upon how having sex makes them feel – and those feelings become increasingly influential over time,” Halpern-Felsher said.

While research has examined how teens feel about becoming sexually active, the current study is the first to examine how teens feel when they don’t have sex, according to Sonya Brady, PhD, lead study author and a former UCSF post-doctoral fellow.

The study examined the attitudes of approximately 600 Northern California high school students. Study participants were divided into three categories: those who were sexually experienced at the outset of the study, in the fall quarter of the ninth grade; those who had become sexually experienced by the end of the spring quarter of the tenth grade; and those who remained sexually inexperienced throughout the ninth and tenth grades.

The study data was collected between 2002 and 2004 from a racially and ethnically diverse group of high schoolers who were mostly 14 years old at the start of the study. Fifty eight percent of the teens were female. Forty percent were Caucasian, 22 percent were Asian and 17 percent were Hispanic, with the remainder being of other racial groups.

In the study, researchers asked participants to fill out survey questionnaires that asked about the positive and negative consequences of refraining from sexual activity. Sexual activity was defined as having either oral or vaginal sexual relations. Positive consequences of not having sex included ‘having a good reputation,’ ‘friends were proud,’ and ‘felt responsible.’ Negative consequences included ‘partner became angry,’ ‘felt regret,’ ‘felt left out’ and ‘felt like you let your partner down’. The participants were surveyed every six months.

Those who were sexually experienced were more likely that the other groups to value refraining from sex. By the spring of the tenth grade, these teens were twice as likely to report a positive outcome from not having sex, when compared with adolescents who became sexually experienced during the course of the study.

Although more research is needed to understand why that might be the case, say Brady and Halpern-Felsher, they say that sexually experienced teens may reflect upon their past experiences and come to value selectivity about sexual partners or appropriate occasions for engaging in sex.

“Refraining from sexual behavior should feel rewarding, and engaging in sexual behavior should be based on maturity and readiness,” Brady said.

“We often focus on abstinence in sex education programs. It may be that, when we do this exclusively, we’re not meeting the needs of those adolescents who choose to be sexually active, and may be failing to give them the tools to select the most caring partners for them, the right occasions for engaging in sex, and the best strategies for engaging in safer sexual behavior,” she said.

Experts are warning policy makers that allergic disease might replace infectious disease as a major cause of ill health in cities undergoing rapid demographic changes in developing countries.

New research tracking the number of cases of childhood eczema across the globe has revealed big changes in the prevalence of the condition over the last five to ten years and suggests that environmental factors could be having a significant impact.

Research, by a team of allergy experts across the world, has shown a levelling off in the number of cases of eczema in children aged between 13 to 14 years and a decrease in some countries like the UK and New Zealand where childhood eczema was once highly prevalent. But a continuing rise in younger children aged between six and seven and in the number of cases reported in developing countries is of growing concern.

Their paper, published in the Journal of Allergy and Clinical Immunology, suggests environmental factors are key for eczema expression because it is highly unlikely that genetic factors would change in such a short time.

Hywel Williams, Professor of Dermato-Epidemiology in the Centre of Evidence-Based Dermatology at The University of Nottingham, who led the eczema research, says eczema needs to be tackled at a public health level in many countries.

He says that moderate or severe cases of eczema have a significant impact on family life and carry an economic burden comparable with that of asthma. Constant scratching often leads to sleep deprivation which also affects carers as well as incurring significant financial costs.

Professor Williams and his international team analysed information from two worldwide surveys of asthma and allergy symptoms in children which was carried out by the International Study of Asthma and Allergies in childhood (ISAAC) between 1991 and 2001. ISAAC was formed in 1991 to facilitate research into asthma, allergic rhinitis and eczema by promoting a standardised methodology, and currently holds a Guinness World record for the largest epidemiological study in children.

Professor Williams and his team analysed over 300,000 children aged 13 to 14 years from 105 centres in 55 countries and nearly 190,000 children aged six to seven years from 64 centres in 35 countries.

The largest decreases in children aged between 13 to 14 years were seen in developed countries in northwest Europe, such as the United Kingdom, Ireland, Sweden, Germany and also New Zealand. Professor Williams says this provides some reassurance that an allergic disease epidemic is not increasing inexorably throughout the world, and that a threshold effect may be in operation.

Most of the biggest increases in the 13 to 14 age group were seen in developing countries such as Mexico, Chile, Kenya and Algeria and in seven countries in Southeast Asia.

However, in six to seven year olds most countries showed significant increases over the five to ten year period.

Professor Williams said: “This is the first time we have been able to have a glimpse at what has been happening to eczema symptoms across the world using standardised methods. The results suggest that environmental factors are key to the expression of eczema – if only we could identify those factors so that we could prevent eczema in those countries experiencing significant increases.”

Although no singular environmental or genetic risk factor adequately explains the changes in eczema symptoms described in this paper Professor Williams does have some words of encouragement. He says there is already some evidence that eczema might be preventable to some degree and there is plenty of evidence on effective approaches to managing existing eczema symptoms. The way forward, he suggests, is for all public health responses to the eczema epidemic to ideally include an evaluative component so that others in the world can understand which approaches are more likely to be successful than others in different circumstances.

The Columbia Center for Children’s Environmental Health (CCCEH) at Columbia University’s Mailman School of Public Health, has received a $10.4 million grant from the National Institute of Environmental Health Sciences (NIEHS) to study environmental contributors to childhood asthma. The grant was awarded via a new NIEHS initiative called Disease Investigation through Specialized Clinically-Oriented Ventures in Environmental Research, or DISCOVER, that is designed to integrate environmental health research with patient and population-based studies.

CCCEH’s DISCOVER grant was awarded because of groundbreaking research on the effects of early life exposure to common air pollutants the Center has performed since 1998. The new grant will advance the field of asthma research by deepening scientists’ understanding of how prenatal and early postnatal exposure to widespread contaminants in the air alters lung development and the immune system to produce asthma. In four related studies, CCCEH scientists will combine molecular, epidemiologic, experimental and clinical approaches to better prevent childhood asthma and improve clinical treatment of the disease.

CCCEH is one of the first research centers in the nation to receive a DISCOVER grant. Launched by NIEHS in 2006, the DISCOVER program has awarded grants to only three institutions nationwide: CCCEH, Johns Hopkins Bloomberg School of Public Health and the University of Washington, Seattle.

“The DISCOVER centers will help to define the role of environmental agents in the initiation and progression of human disease and develop new ways to both prevent and treat disease,” said Dennis Lang, Ph.D., interim director, NIEHS Division of Extramural Research and Training, as he announced the new awards. “The potential impact of the research that these three centers will be conducting is enormous.”

Since 1998, CCCEH has conducted significant research linking early exposure to ambient air pollution from sources such as diesel and gasoline powered vehicles and power plants to children’s risk for asthma and asthma exacerbation. CCCEH’s research in New York City and internationally in Poland and China finds that in utero and postnatal exposure to particulates and polycyclic aromatic hydrocarbons (PAHs) from diesel exhaust and other urban combustion sources adversely affects children’s neurocognitive development and increases potential cancer risk. The Center has also identified in utero exposure to residential pesticides as harmful to neurocognitive development.

CCCEH’s scientific research is raising public awareness, improving children’s environmental health, and influencing public policies. The Center’s award-winning Healthy Home Healthy Child campaign, developed in collaboration with WE ACT for Environmental Justice, educates inner-city families about practical ways to reduce children’s exposure to pollutants. The Center and WE ACT’s joint translation of scientific research findings to improve environmental policies helped to pass legislation that lowered New York City’s diesel exhaust emissions and neurotoxic pesticide exposure throughout public housing.

The four studies CCCEH will conduct with its DISCOVER funds are as follows:

* Project 1, “Time Windows of Asthma Vulnerability,” directed by CCCEH’s lead asthma expert Dr. Rachel Miller, seeks to determine at what point in their development young inner-city children are most vulnerable to diesel-related and other urban air pollution. The results will serve to clarify the relationship between exposure to air pollution, obesity and an increase in allergy and asthma-related symptoms. Project 1 also will monitor the impact of recent policy changes on children’s exposure to traffic-related air pollution to determine if there is a correlation between reduced urban air pollution and children’s health. CCCEH anticipates that results from the study can be used to advise parents on reducing the risk of childhood asthma, and by physicians to clarify the role of pollutants in asthma.

* Project 2, “New Air Sampling Technology,” directed by Dr. Patrick L. Kinney, will collect data from asthmatic and non-asthmatic children wearing a unique air sampling system in order to monitor how exposure to diesel exhaust can worsen asthma symptoms. Researchers expect the study will uncover usable health information for physicians, parents and communities by identifying specific air pollutants and sources as triggers of asthma.

* Project 3, “Genes and Asthma,” directed by Dr. Frederica Perera in collaboration with Dr. Shuk Mei Ho of the Environmental Health Sciences Laboratory at the University of Cincinnati, will determine whether biomarkers, such as environmentally-related changes in the expression of specific genes in utero, can predict childhood asthma. The goal is to develop clinically relevant biomarkers that would identify children at high risk of asthma. While previous studies conducted by the Center have shown that prenatal exposure to air pollutants can contribute to childhood asthma, exact mechanisms and early warning indicators have not been determined. This project aims to fill this gap in knowledge.