Compared to glasses, contact lenses improve how children feel about their appearance, their ability to play sports and their acceptance among friends, a study of 484 nearsighted children finds.

“Many studies have examined the effect of spectacle wear on self-perception and the perception of others, but the majority of this research has been conducted on adults,” study leader Jeffrey J. Walline, from Ohio State University’s College of Optometry, said in an American Academy of Optometry news release. “Research shows spectacles to be associated with poorer self-perception in adults if they were first worn during childhood.”

The children in this study, aged 8 to 11, were randomly assigned to wear either glasses (237) or contact lenses (247) for three years. Over that time, the researchers checked for changes in the children’s self-perception in areas such as social acceptance, academic competence, athletic competence, physical appearance and behavioral conduct.

By the end of the study, children with contact lenses had significantly higher scores of self-perceived physical appearance, athletic competence and social acceptance. Academic confidence was higher for contact lens wearers who initially disliked wearing glasses.

The study, published in the March issue of Optometry and Vision Science, received funding from Johnson & Johnson Vision Care Inc. and The Vision Care Institute, LLC, a Johnson & Johnson Co.

“Published studies have shown glasses to be associated with negative attributes in areas of self-perception and attractiveness, so it was not surprising that children’s physical appearance self-perception benefits from contact lens wear,” study co-author Mitchell J. Prinstein, director of clinical physiology at the University of North Carolina at Chapel Hill, said in the news release.

The finding that children wearing contact lenses felt better about their athletic ability “are consistent with the growing body of research in this area demonstrating that contact lenses significantly improve how children feel about participating in activities such as sports,” Walline noted.

“Anecdotally, children may participate in recreational activities without vision correction rather than risk breaking their glasses. Unlike glasses, contact lenses provide clear vision without impairing peripheral vision, so children may feel that their athletic competence improves, because they can see more clearly while participating in recreational activities,” he said.

Stress may play a key role in the development of type 2 diabetes in obese black women, U.S. researchers say.

“Much attention has been given to the role of obesity in the development of type 2 diabetes, but stress may be as important in this at-risk population,” study co-author Anastasia Georgiades, of Duke University in Durham, N.C., said in a news release.

The study included 62 healthy, non-diabetic black women who were asked to recall stressful life events. As they did, the researchers measured the women’s levels of blood sugar and epinephrine, the “fight or flight” hormone that’s released in reaction to stress.

Women with high epinephrine levels (25 picograms or more per milliliter of blood) while recalling stressful events and with more belly fat (33 percent or more of total body fat) had significantly higher fasting glucose scores (about 100 milligrams per deciliter) than women with lower epinephrine levels and less belly fat (85 mg/dl). A fasting blood glucose level of 100 mg/dl is considered within the low range of pre-diabetes, and a level of 125 mg/dl is the benchmark for type 2 diabetes.

Women with high epinephrine levels and more belly fat also had bigger increases in blood sugar levels during the stress test.

The findings were to be presented this week at the annual scientific meeting of the American Psychosomatic Society.

“While we don’t fully understand the nature of the association, women with abdominal obesity may be more vulnerable to the impact of stress — causing their body to increase blood sugar production and elevating their risk for diabetes,” Georgiades said.

Further research is needed to determine exactly how epinephrine production affects blood sugar levels in black women. Nearly one in four black women in the United States has type 2 diabetes, according to the American Diabetes Association.

In a long-awaited legal decision, the U.S. Supreme Court ruled Wednesday that patients who are injured by a drug can sue the drug’s manufacturer for damages, even if the drug has been granted FDA approval.

The decision, in the lawsuit Wyeth v. Levine, upheld $6.7 million in damages to a Vermont musician named Diana Levine who had to have her arm amputated after Wyeth’s Phenergan anti-nausea drug hit an artery and caused gangrene.

The complication is a rare one but is acknowledged on the drug’s labeling. Wyeth had argued that the U.S. Food and Drug Administration warning carried on the drug was sufficient.

At a press conference after the decision was announced, Levine, who was injured in April 2000, said: “I’m on the ceiling, I’m just so high about this, I’m so glad, it’s such a good decision and, next to getting my hand, it’s the best they could do, and it’s the least they could do. I’m in a state of almost shock and almost unrestrained joy.”

The court decision was hailed as a triumph by Public Citizen, a consumer watchdog group.

“It’s a terrific decision, because it understands both the importance of compensation for people who are harmed by defective or mislabeled drugs and also understands that the tort system is a complement to the federal regulatory system, that it is not an obstacle to that system,” said Brian Wolfman, director of the litigation group at Public Citizen in Washington, D.C.

Wolfman served as one of Levine’s attorneys.

Bert Rein, an attorney for Wyeth, said the company “fully complied with federal law” in its labeling, and that the FDA “is in the best position to weigh the risks and benefits of a medicine,” The New York Times reported.

In a news release, the Pharmaceutical Research and Manufacturers of America (PhRMA), said the group “is still reviewing the various opinions in the Wyeth v. Levine case. We continue to believe that the expert scientists and medical professionals at the Food and Drug Administration are in the best position to evaluate voluminous information about a medicine’s benefits and risks and to determine which safety information to include in the drug label.”

The high court’s decision is likely to unleash a torrent of similar lawsuits around the country.

“The court opinion not only declined to tell pharmaceutical companies that they could have this kind of immunity, it, in fact, pushed somewhat in the other direction,” said Benjamin C. Zipursky, professor of law at Fordham Law School in New York City and visiting professor at Harvard Law School in Boston.

“Some trial lawyers who had been hesitant to bring claims against pharmaceutical companies are now going to be more willing to do so,” Zipursky said. “A number of cases that were stayed in state and federal court pending this decision will now go forward and go forward with a more plaintiff-oriented posture. This is going to change the balance of incentives for lawyers who are thinking about suing pharmaceutical companies to make them more willing to sue and make trial judges and appellate courts less willing to throw out weak cases.”

Wolfman added: “In general, it’s going to mean that these claims are not pre-empted and that people with drug and injury claims are going to be able to sue for damages and get to a jury and, if the jury agrees, be compensated for that.”

The high court’s 6-3 decision essentially upended moves by the Bush administration to protect drug makers from lawsuits as long as the product was FDA-approved.

Many watchers had predicted that the court would decide the other way, Zipursky said.

“It was a surprise in two respects,” he said. People had believed “that whatever the court did, it would rule narrowly and, in fact, the decision is quite broad.”

Despite some improvements, U.S. school meal programs are still laden with unhealthy fat, salt and sugar, nutrition experts contend.

Students also have limited choices in foods available in vending machines, á la carte in cafeterias, at school stores and snack bars and for fund-raisers, they say in a series of articles in a supplement to the February issue of the Journal of the American Dietetic Association.

Echoing these sentiments, a Chicago chef brought to the White House to cook for the Obamas has said that too much of the food available at schools also is high in additives and preservatives.

Unhealthy eating at school, these food experts believe, is contributing to the surge in obesity rates among U.S. children. Obesity rates have more than doubled among infants and toddlers aged 2 to 5, quadrupled in children aged 6 to 11 and more than tripled among adolescents aged 12 to 19, according to an editorial in the journal.

The rising rates have health experts concerned about a nascent epidemic of obesity-related diseases, including cardiovascular disease and type 2 diabetes, in young people.

“Of course, school meals are only one part of the problem,” said Anne R. Gordon, a senior researcher at Mathematica Policy Research in Princeton, N.J., and co-author of a paper on school lunches in the supplement. “Kids don’t eat well throughout the day. But, we do find at least some evidence that in some of the schools that restrict the availability of sugar-sweetened beverages, you don’t see the kids going and drinking more sugar-sweetened at other times of day. It really does decrease intake, so that’s encouraging.”

Gordon’s paper described and assessed data from the third School Nutrition Dietary Assessment, sponsored by the U.S. Department of Agriculture and conducted by Mathematica, as well as findings from other studies that used the same data. The USDA-backed analysis covered both the National School Lunch Program, which provides subsidized meals to about 30 million children daily, and the School Breakfast Program, which provides meals to about 10 million children a day.

The lunch program began in 1946 to help ensure that U.S. children were receiving enough nutritious food. The breakfast program was institutionalized in 1975. Both offer free or low-cost meals to eligible students.

“It’s very clear that USDA needs to update the standards of schools” related to nutrition, Gordon said. “They know what they’re aiming for, but … having standards is not enough.”

“We need to explore other ways of making change, which could include items such as providing more training and technical assistance to schools, providing more funding for nutrition education,” she said. “It also may be worth considering more laws or regulations to limit the availability of certain types of food, such as whole or 2 percent milk.”

Mary Ford, a registered dietitian and professor in the School of Public Health at the University of Minnesota, and author of the journal editorial, urged such action.

“Schools need to do even more to reduce the availability of high-calorie, low-nutrient foods and make school meals more nutritious,” she wrote. Foods available by choice to students — in vending machines, á la carte and the like — “should include only fruits, vegetables, whole grains and non-fat and low-fat dairy products,” she wrote.

The editorial also suggested that the federal government withhold funding for meal programs from school systems that don’t comply with stepped-up nutrition expectations.

Sam Kass, the chef who followed the Obamas to the White House, also has put the school lunch program under fire. According to a report in The New York Times in January, Cass attributes the nutritional shortcomings in school lunches, at least in part, to the use of donated surplus agricultural commodities that result from government subsidies.

“As a result, he says, meals served to students are low in vegetables and disproportionately high in fat, additives, preservatives and high-fructose corn syrup,” the Times report said.

The School Nutrition Dietary Assessment included information from 398 public schools in 130 districts across the United States, including 2,314 students in first through 12th grade during the 2004-05 school year.

It found that more than 70 percent of the schools served meals that met the standards for critical nutrients such as protein, vitamins A and C, calcium and iron.

But a mere 6 to 7 percent of subsidized meals met all nutritional standards, the study found. Most had too much saturated fat or fat overall, and not enough calories.

About 42 percent of the schools surveyed offered no fresh fruits or raw vegetables in their lunch programs.

Fat tended to come from salad dressings, condiments and spreads, pizza products, peanut butter sandwiches and french fries. Saturated fat tended to come from pizza products, condiments and spreads, 2-percent milk, salad plates or salad bars and hamburgers or cheeseburgers.

Foods in vending machines and offered á la carte and in snack bars were most often high in calories and low in nutrients: candy, french fries, donuts, sweetened drinks and salty snacks.

The study found that low-income children fared worse, nutritionally, than those from higher-income homes, although school-lunch-program participants generally got more nutrients in their meals than kids responsible for their own lunches.

As for remedies, Gordon and the other researchers offered some. “Innovative preparation methods or improvements in the presentation of fruits and vegetables could make these items more appealing to children,” they wrote. The study suggested that school cooks use whole-grain flours to prepare pizza crusts and mix whole-grain and regular pasta in pasta-based entrees and that school lunchrooms control the available portions of condiments such as ketchup, mustard and barbeque sauce to control sodium intake.

Gordon noted that schools have made progress in improving meal offerings, but more needs to be done.

“Part of it is getting kids to eat healthier foods, part of it is providing schools with more support,” she said.

Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

More dangerous, or malignant, tumors form when two things occur:

1. a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion
2. that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

In 2007, cancer claimed the lives of about 7.6 million people in the world. Physicians and researchers who specialize in the study, diagnosis, treatment, and prevention of cancer are called oncologists.

What causes cancer?

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.

What is cancer? – Video

A short, 3D, animated introduction to cancer. This was originally created by BioDigital Systems and used in the Stand Up 2 Cancer telethon.

3D Medical Animation – What is Cancer?

Genes – the DNA type

Cells can experience uncontrolled growth if there are damages or mutations to DNA, and therefore, damage to the genes involved in cell division. Four key types of gene are responsible for the cell division process: oncogenes tell cells when to divide, tumor suppressor genes tell cells when not to divide, suicide genes control apoptosis and tell the cell to kill itself if something goes wrong, and DNA-repair genes instruct a cell to repair damaged DNA.

Cancer occurs when a cell’s gene mutations make the cell unable to correct DNA damage and unable to commit suicide. Similarly, cancer is a result of mutations that inhibit oncogene and tumor suppressor gene function, leading to uncontrollable cell growth.

Carcinogens

Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes are all examples of carcinogens. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. Theses free radicals damage cells and affect their ability to function normally.

Genes – the family type

Cancer can be the result of a genetic predisposition that is inherited from family members. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life.

Other medical factors
As we age, there is an increase in the number of possible cancer-causing mutations in our DNA. This makes age an important risk factor for cancer. Several viruses have also been linked to cancer such as: human papillomavirus (a cause of cervical cancer), hepatitis B and C (causes of liver cancer), and Epstein-Barr virus (a cause of some childhood cancers). Human immunodeficiency virus (HIV) – and anything else that suppresses or weakens the immune system – inhibits the body’s ability to fight infections and increases the chance of developing cancer.

What are the symptoms of cancer?

Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Some cancers can be felt or seen through the skin – a lump on the breast or testicle can be an indicator of cancer in those locations. Skin cancer (melanoma) is often noted by a change in a wart or mole on the skin. Some oral cancers present white patches inside the mouth or white spots on the tongue.

Other cancers have symptoms that are less physically apparent. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. Pancreas cancers are usually too small to cause symptoms until they cause pain by pushing against nearby nerves or interfere with liver function to cause a yellowing of the skin and eyes called jaundice. Symptoms also can be created as a tumor grows and pushes against organs and blood vessels. For example, colon cancers lead to symptoms such as constipation, diarrhea, and changes in stool size. Bladder or prostate cancers cause changes in bladder function such as more frequent or infrequent urination.

As cancer cells use the body’s energy and interfere with normal hormone function, it is possible to present symptoms such as fever, fatigue, excessive sweating, anemia, and unexplained weight loss. However, these symptoms are common in several other maladies as well. For example, coughing and hoarseness can point to lung or throat cancer as well as several other conditions.

When cancer spreads, or metastasizes, additional symptoms can present themselves in the newly affected area. Swollen or enlarged lymph nodes are common and likely to be present early. If cancer spreads to the brain, patients may experience vertigo, headaches, or seizures. Spreading to the lungs may cause coughing and shortness of breath. In addition, the liver may become enlarged and cause jaundice and bones can become painful, brittle, and break easily. Symptoms of metastasis ultimately depend on the location to which the cancer has spread.

How is cancer classified?

There are five broad groups that are used to classify cancer.

1. Carcinomas are characterized by cells that cover internal and external parts of the body such as lung, breast, and colon cancer.
2. Sarcomas are characterized by cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues.
3. Lymphomas are cancers that begin in the lymph nodes and immune system tissues.
4. Leukemias are cancers that begin in the bone marrow and often accumulate in the bloodstream.
5. Adenomas are cancers that arise in the thyroid, the pituitary gland, the adrenal gland, and other glandular tissues.

Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common prefixes include:

* Adeno- = gland
* Chondro- = cartilage
* Erythro- = red blood cell
* Hemangio- = blood vessels
* Hepato- = liver
* Lipo- = fat
* Lympho- = white blood cell
* Melano- = pigment cell
* Myelo- = bone marrow
* Myo- = muscle
* Osteo- = bone
* Uro- = bladder
* Retino- = eye
* Neuro- = brain

How is cancer diagnosed and staged?

Early detection of cancer can greatly improve the odds of successful treatment and survival. Physicians use information from symptoms and several other procedures to diagnose cancer. Imaging techniques such as X-rays, CT scans, MRI scans, PET scans, and ultrasound scans are used regularly in order to detect where a tumor is located and what organs may be affected by it. Doctors may also conduct an endoscopy, which is a procedure that uses a thin tube with a camera and light at one end, to look for abnormalities inside the body.

Extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose cancer. This procedure is called a biopsy. Other types of molecular diagnostic tests are frequently employed as well. Physicians will analyze your body’s sugars, fats, proteins, and DNA at the molecular level. For example, cancerous prostate cells release a higher level of a chemical called PSA (prostate-specific antigen) into the bloodstream that can be detected by a blood test. Molecular diagnostics, biopsies, and imaging techniques are all used together to diagnose cancer.

After a diagnosis is made, doctors find out how far the cancer has spread and determine the stage of the cancer. The stage determines which choices will be available for treatment and informs prognoses. The most common cancer staging method is called the TNM system. T (1-4) indicates the size and direct extent of the primary tumor, N (0-3) indicates the degree to which the cancer has spread to nearby lymph nodes, and M (0-1) indicates whether the cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph nodes or distant organs may be staged as (T1, N0, M0), for example.

TNM descriptions then lead to a simpler categorization of stages, from 0 to 4, where lower numbers indicate that the cancer has spread less. While most Stage 1 tumors are curable, most Stage 4 tumors are inoperable or untreatable.

How is cancer treated?

Cancer treatment depends on the type of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

Surgery

Surgery is the oldest known treatment for cancer. If a cancer has not metastasized, it is possible to completely cure a patient by surgically removing the cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.

Radiation
Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells (including those associated with leukemia and lymphoma), and it is also used in combination with other cancer treatments.

Chemotherapy

Chemotherapy utilizes chemicals that interfere with the cell division process – damaging proteins or DNA – so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options.

Immunotherapy

Immunotherapy aims to get the body’s immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation (hematopoetic stem cell transplantation) can also be considered immunotherapy because the donor’s immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone therapy

Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone.

Gene therapy

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.

How can cancer be prevented?

Cancers that are closely linked to certain behaviors are the easiest to prevent. For example, choosing not to smoke tobacco or drink alcohol significantly lower the risk of several types of cancer – most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco user, quitting can still greatly reduce your chances of getting cancer.

Skin cancer can be prevented by staying in the shade, protecting yourself with a hat and shirt when in the sun, and using sunscreen. Diet is also an important part of cancer prevention since what we eat has been linked to the disease. Physicians recommend diets that are low in fat and rich in fresh fruits and vegetables and whole grains.

Certain vaccinations have been associated with the prevention of some cancers. For example, many women receive a vaccination for the human papillomavirus because of the virus’s relationship with cervical cancer. Hepatitis B vaccines prevent the hepatitis B virus, which can cause liver cancer.

Some cancer prevention is based on systematic screening in order to detect small irregularities or tumors as early as possible even if there are no clear symptoms present. Breast self-examination, mammograms, testicular self-examination, and Pap smears are common screening methods for various cancers.

How to eat to prevent cancer – Video

A guide to some everyday foods that contain nutrients that may help reduce your risk of getting cancer. Video by Howcast.

How To Eat To Prevent Cancer

Cancer / Oncology news

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Both share a need for quick answers or more detailed information about a broad range of topics involving diagnosis, treatments, or unexpected symptoms.

A new section of the Indiana University Melvin and Bren Simon Cancer Center’s web site, http://www.cancerinfo.cancer.iu.edu, helps patients and their families find information about a variety of topics in an easily accessible format.

In the symptom management section, for example, people can learn about anemia, dry mouth, nausea, and shortness of breath.

Overall, according to Anna McDaniel, DNS, a professor at the IU School of Nursing and a researcher with the IU Simon Cancer Center, the section “makes information more accessible to the public as well as patients. It has been designed so there is a clearly defined way to access quality, or evidence based, information.”

Such information is beneficial for patients. “Research has shown that having access to good information can increase coping in cancer patients and lead to better treatment outcomes,” Dr. McDaniel said.

Dr. McDaniel received a $250,000 grant from Indianapolis-based Walther Cancer Foundation in 2007 for the project. She and others from the IU schools of nursing and informatics and the cancer center worked together to create the section, which made its debut Feb. 23.

The new section is dedicated to Dr. Harold Burdette, a visionary leader committed to eliminating the burden of cancer in Indiana.

Dr. McDaniel and others are now testing the section’s next phase, which takes symptom management to an interactive level.

Patients will log into a secure system to answer questions about any side effects they might be experiencing from chemotherapy. They will rate their symptoms on a scale of zero to 10. Depending on the severity of the symptoms, the patient will be directed to information on the Internet, or his or her oncologist will be notified.

Twenty patients are currently being recruited into this test phase.

“The unique aspect of this is that it will connect the patient and the health-care provider,” Dr. McDaniel said. “Not only does the system give patients useful information about how to help themselves during chemotherapy, it increases communication with oncology doctors and nurses.”

Also Included In: IT / Internet / E-mail; Primary Care / General Practice

Research in a new field called oncofertility has advanced the ability of doctors to preserve the reproductive health of women, men and children who are diagnosed with cancer. Yet, many oncologists aren’t familiar with these new strategies to help their patients.

A leading oncofertility researcher and a breast surgical oncologist from the Northwestern University Feinberg School of Medicine have written a guide to help doctors navigate their patients through the new technologies to preserve their fertility and understand the fertility threats posed by cancer treatments. The guide, based on the latest research, offers strategies based on each kind of cancer, age and gender of the patient.

The article is published in the February 26 issue of the New England Journal of Medicine and is included in the NEJM Audio Summary.

“We hope that physicians who are not used to dealing with fertility threats associated with treatment can now talk confidently with their patients about their options,” said article co-author Teresa Woodruff, chief of fertility preservation and the Thomas J. Watkins Professor of Obstetrics and Gynecology at the Feinberg School. “This is a new tool for them.”

Woodruff and Northwestern colleagues also recently launched www.myoncofertility.org, an interactive web site to educate patients about the potential effect of cancer and treatments on their fertility and options to preserve it.

“Doctors are focused on saving a patient’s life and are not used to thinking about preserving a patient’s fertility and incorporating fertility preservation into her or his care,” said lead author Jacqueline Jeruss, M.D., assistant professor of surgery at Feinberg. Jeruss also is a surgical oncologist at Northwestern Memorial’s Prentice Women’s Hospital and a basic science researcher at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Younger patients in particular are not benefiting from fertility preservation options. A new national survey of pediatric oncologists showed that more than half of them are not using fertility preservation techniques that are available at most medical centers for their adolescent patients. The survey was conducted by Robert Brannigan, M.D., associate professor of urology at the Feinberg School and a physician at Northwestern Memorial Hospital.

“Adolescent oncology patients are at the same risk as adults to become permanently infertile as a result of their cancer or cancer treatment, but they are not getting what they need to save their fertility,” Brannigan said.

When a young patient is diagnosed with cancer, doctors feel like it is a medical emergency, even when there may be time to consider fertility before treatment begins, Jeruss explained. “We aren’t used to taking a step back to look at the big picture of patients’ lives after they survive cancer,” she said.

“Clinicians need to break through old practice patterns,” Jeruss said. “In the past, if I saw a young woman with breast cancer, I would be focused on getting her into surgery and through chemotherapy and radiation. Now we have a better sense that with the improvements we’ve made in cancer management, many of our young patients with cancer are going on to survive and live healthy long lives. We need to do everything possible so patients can look forward to a life that looks as much like the life they had planned on before the day they were diagnosed.”

The survival rate of children with cancer is nearly 80 percent in the United States. Approximately 10,700 children were diagnosed with cancer in 2008. In addition, there are 140,000 young adults (men and women younger than 45 years old) who face a cancer diagnosis each year.

Northwestern has led the emerging field of oncofertility and has provided a template of fertility preservation patient care to other medical centers. Woodruff developed and is principal investigator of the national Oncofertility Consortium, a National Institute of Health- funded network of doctors and scientists working to provide improved fertility preservation options for people diagnosed with cancer and other diseases.

At the Lurie Cancer Center, newly diagnosed men, women and adolescents work with a special Fertility Preservation Patient Navigator to figure out the best options to preserve their reproductive health before starting cancer therapy. The patient navigator then coordinates that plan with the patient’s doctors.

Several fertility preservation techniques are under investigation at Northwestern. One is an entirely new way of growing and preserving a woman’s immature eggs, or young follicles, so they can be fertilized and implanted into the uterus when she is ready to have children. Thus far, this technology has been used successfully in mice to produce live, healthy offspring.

Local areas will be able to get the support they need from skilled organisations, which will help to make PBC practice more effective and robust across the country. The Department of Health is quite rightly re-invigorating PBC and this framework is a step in the right direction.

NHS Alliance chairman Dr Michael Dixon said:

“This is good news for the NHS Alliance, the NHS and, most of all, for our patients. We have a strong reputation with frontline clinicians and managers. We also have credibility within the NHS as an organisation that has strong values and delivers on its promises. We will do our best so that our work contributes towards a new dawn for PBC.”

Humana Europe CEO Dr Jonathan Lord said:

“This partnership represents the coming together of clinicians and managers with both NHS and international commissioning experience. We are delighted to be offering this unique support and advice to support the development of PBC for the benefit of patients and the wider population”.

The procurement process was tough and the NHS Alliance and Humana are proud of having been among the chosen providers; 107 organisations expressed interest in the work, with only 19 being issued an invitation to tender.

NHS Alliance PBC Federation director Julie Wood said

“We’ve been working with clinicians and managers up and down the country who are successfully delivering or supporting PBC. And we are proud of our strong track record in promoting and improving PBC. The NHS Alliance/Humana PBC Partnership will put us in a unique position to continue this important work with the ‘front line’ for the ‘front line’.

The framework operates on a call off contract basis, with providers supplying support packages that meet specific needs of PCTs and practice-based commissioners.

Notes

1. The NHS Alliance is a collaboration of clinicians, managers and board members who put patients first. It is the independent body that represents NHS primary care. Values based, it is the only organisation that brings together PCTs with GP practices, clinicians with managers and Board members, and NHS primary care with its patients. The Alliance membership and its hard working national executive is fully multi-professional.

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
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Cardiovascular disease and diabetes are associated with lipodystrophy, which results in fat redistribution that can leave the face and lower limbs gaunt, the stomach swollen and the back humped. Lipodystrophy also raises cholesterol levels and causes glucose intolerance, which could be particularly harmful to black people, who are predisposed to heart disease and diabetes. According to the Times, there are no data that compare the incidence, age of onset and cause of aging-related diseases in the general population with long-term survivors of HIV. However, experts say they do not see HIV-negative people in their mid-50s with hip replacements associated with vascular necrosis, heart disease or diabetes related to lipodystrophy, or osteoporosis without the usual risk factors.

The most comprehensive research has come from the AIDS Community Research Initiative of America, which has studied 1,000 long-term survivors in New York City. The ACRIA study, published in 2006, found unusual rates of depression and isolation among older people living with HIV.

The NIH-funded Multi-Site AIDS Cohort Study — which has followed 2,000 subjects nationwide for the past 25 years — will examine the effects of HIV/AIDS and aging over the next five years. MACS investigators and other researchers say the slow pace of research on HIV/AIDS and aging is a result of numbers. They note that the first generation of people diagnosed with HIV/AIDS in the mid-1980s had no effective treatments for 10 years and died in large numbers, leaving few people to participate in studies.

Charles Emlet — an associate professor at the University of Washington-Tacoma and a leading HIV and aging researcher — said HIV/AIDS and aging research has been slow to start because of “the rapid increase in numbers.” CDC’s most recent data, from 33 states that meet certain reporting criteria, showed that the number of people age 50 and older with HIV or AIDS was 115,871 in 2005, compared with 64,445 in 2001. In addition, the “routine exclusion” of older people from drug trials by large pharmaceutical companies has undermined such research, the Times reports. The studies are designed to measure safety and efficacy but not long-term side effects of drugs. The lack of research also limits a patient’s care, the Times reports.

“AIDS is a very serious disease, but longtime survivors have come to grips with it,” Emlet said, noting that although some patients experience unpleasant side effects from the antiretroviral drugs, a vast majority find a regimen they can tolerate. “Then all of a sudden they are bombarded with a whole new round of insults, which complicate their medical regime and have the potential of being life threatening. That undermines their sense of stability and makes it much more difficult to adjust,” he added (Gross, New York Times, 1/6).

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