Medicine Man

Although some teenagers and young adults become infertile following cancer treatment, physicians are hesitant to discuss options to preserve fertility with patients, according to a new Florida study.

In their discussions with 24 pediatric oncologists, researchers at the Moffitt Cancer Center found that some physicians did not want to bring up the topic for fear of worrying their patients about the expense of egg and sperm storage. Other doctors cited a lack of appropriate resources and guidelines to help their patients with this difficult decision.

Several doctors said they felt the topic was not one to bring up when patients' and their parents' primary concern was surviving cancer, noted study co-authors Gwendolyn Quinn, Ph.D., and Susan Vadaparampil, Ph.D.

Their study appears online in the Journal of Adolescent Health.

"About half of the physicians said the cancer diagnosis is such a shock that an issue like fertility is often put on the back burner," Quinn said.

Talking with young cancer patients about fertility can be a challenge, in part because physicians are used to speaking with teens in a "jocular manner" in an attempt to "ease the pain of an ill child," the researchers found. Yet, this manner of speaking might not be the best way to broach the sensitive topic of fertility with the patients, they said.

Moreover, the parents of children with cancer "tend to be more focused on treatment options and survival, and discussions of fertility often do not arise," the researchers noted.

Physicians who participated in the study "commented that the discussion could be awkward because the parents and the patient are essentially discussing reproduction and sexuality, with parents making decisions about the reproductive future of their child," Quinn said.

Many physicians interviewed for the study said they did not bring up egg or sperm banking because patients and their families usually pay for such procedures out of pocket. As one doctor said, "Our policy is that we offer them the possibility of banking, but since it is not paid for by insurance, it is expensive and a big hassle for them, and they often end up not doing it."

Still, the study authors point to surveys suggesting that patients do not see cost as a barrier, at least for sperm banking. National nonprofit organizations such as FertileHope offer fertility preservation discounts to cancer patients and, "perhaps more importantly, the American Society of Clinical Oncologists suggests all patients should be informed about these options," Quinn said.

The 2006 ASCO guidelines acknowledge that the first visit after a patient's diagnosis might not be the best time to talk about fertility preservation, but they recommend that the discussion take place "at the earliest possible opportunity."

"It may be impossible for physicians to know how important fertility preservation is to their patients unless they ask, since many patients may not bring up the topic," said Kutluk Oktay, M.D., the medical director of the Institute for Fertility Preservation at the Center for Human Reproduction, who worked on the 2006 guidelines.

http://www.hbns.org

Who: The Centers for Disease Prevention and Control's Injury Center is launching a new web resource that provides violence prevention data from 16 funded states.

What: The new on-line tool, WISQARS(tm) NVDRS (Web-based Injury Statistics Query and Reporting System National Violent Death Reporting System) provides data on violent deaths from the National Violent Death Reporting System so that it is easily accessible to researchers, public health practitioners, decision makers and the media. The new tool is a component of the currently available interactive WISQARS(tm) (Web-based Injury Statistics Query and Reporting System, pronounced "whiskers") tool which provides customized reports of injury-related data.

WISQARS(tm) NVDRS links information from multiple sources-death certificates, law enforcement reports, medical examiner and coroner reports and crime laboratories-to more fully understand the circumstances of violent deaths. It includes data on homicides, suicides, legal intervention deaths, unintentional firearm deaths, and deaths of undetermined intent.

Additionally, the new tool also provides data on important public health problems like intimate partner homicides, suicides among youth, and suicides among persons with military service and infant/child deaths. The system also links information across victims to better understand events where there may be more than one victim (e.g. a school or workplace shooting) or where homicides may be followed by suicides.

Users will be able to customize their search based on a variety of data fields including: demographics, victim/suspect relationships, method of injury, and precipitating circumstances.

When: WISQARS(tm) NVDRS will be available online November 18.

Where: You can access WISQARS(tm) NVDRS online, at http://www.cdc.gov/ncipc/wisqars/.

How: Currently, CDC receives Congressional funding to support data collection from 16 states. The CDC Foundation and the Joyce Foundation provided support for the development of the WISQARS(tm) NVDRS module.

http://www.cdc.gov/

They are also a way to give nursing home residents some privacy for sexual expression, according to Kansas State University aging experts.

"By law you can't always lock a room, but you can offer residents some privacy," said Gayle Doll, who directs K-State's Center on Aging.

She said semi-private rooms pose a problem for nursing home residents who want to engage in sexual activity, either alone or with a partner. That's why two of the center's researchers are looking at ways to make nursing home staff more comfortable accommodating the sexual needs of residents.

Doll said that because nursing home staff don't receive any education in this area, they tend to either ignore or condemn these needs.

"We just want people to start talking about these issues," she said. "Once you start talking about it with nursing home staff, everyone has a story."

Majka Jankowiak and Laci Cornelison, research assistants at the Center on Aging, studied nursing home staff attitudes about sexuality in three Kansas nursing homes. The research was presented in October at the American Association of Homes and Services for the Aging conference.

The researchers surveyed the staff before and after a workshop they presented. The surveys, as well as anecdotal feedback from the participants, showed a marked change in attitudes.

"They really felt this was a topic that they needed to be educated on," Jankowiak said. "Part of it is that American society is not supportive of older people and sex. It's been a taboo, and it's an even bigger taboo in nursing homes. After the presentation, the participants felt more confident talking about it and dealing with sexual expression of residents."

These shifting attitudes translated into a positive experience for one particular couple, Cornelison said. A married couple moved into a nursing home room with two hospital beds. One spouse had to have a leg elevated, but it was on the same side as the partner's bed, which made it hard for them to hold hands. Some staff members didn't see the importance of allowing the couple intimacy and said the problem couldn't be fixed.

"But someone who had been to our presentation encouraged everyone to move the furniture," Cornelison said.

The researchers said that sexuality and nursing home residents brings up issues beyond just acknowledging and accommodating sexual expression. HIV and other sexually transmitted diseases can be concerns for a generation that may have not have the same awareness that younger people do.

Also, adult children may have concerns about their parent's safety or how a new relationship will affect the family or their inheritance. The researchers are developing materials to help family members deal with these questions.

"What they fear is exploitation or that the role the parent played will go away," Doll said.

In addition, Alzheimer's and dementia raise questions about the ability to consent, and these conditions also may spur sexual behavior that's inappropriate.

"Even though we advocate for residents' rights, there are things that are inappropriate," Doll said. "But staff must be able handle this without residents feeling embarrassed. Inappropriate behavior can just come from people needing relationships, not necessarily sexual ones."

Doll said the researchers hope to see federal guidelines developed to help all nursing homes deal with sexuality in a positive way, especially as baby boomers age and bring their attitudes about sex with them to the nursing home.

"Nursing homes are the second most regulated industry next to nuclear power, and yet these regulations don't address sexuality," Doll said.

http://www.k-state.edu/

Many women separated from abusive partners still experience high-disability chronic pain after almost two years, according to Canadian researchers writing in The Journal of Pain , the peer review journal of the American Pain Society.

Despite ample evidence that chronic pain is a serious problem in women with a history of abuse, little is known about the severity and patterns of chronic pain in this population. The authors studied 292 abused women who had been separated for at least 20 months. They sought to describe patterns of chronic pain severity, define the relationship between chronic pain severity and disability, and document the pattern of use of select pain medications.

In the study, 35 percent of the women who survived intimate partner violence (IPV) showed high disability chronic pain and they experienced pain, on average, at three or more sites. Nearly half of those with chronic pain in the sample said they had swollen and painful joints. The authors noted that chronic stress caused by IPV may inhibit how the body naturally adapts to stress and causes imbalances in cortisol levels. Also, proinflammatory cytokines may lead to an increased autoimmune/inflammatory response and eventually cause chronic pain. Since IPV involves repeated trauma, many women sustain serial injuries before previous trauma can heal. Chronic pain also can be exacerbated by post-traumatic stress syndrome and elevated anxiety that interferes with cognitive skills for managing pain.

More than half of the women studied were unemployed, suggesting that chronic pain hampers the ability to maintain employment regardless of age or level of education. The authors reported that less than 25 percent of women with high-disability pain were taking opioids and, despite the prevalence of high-disability pain in this sample, opioid use in this group was the same as women in the general population.

They concluded these findings combined with high rates of unemployment and PTSD "raise questions about how well chronic pain is being managed" among victims of IPV."

http://www.ampainsoc.org/

Raging wildfires that engulfed Southern California earlier this decade not only destroyed neighborhoods laying in their path, they also caused significant health problems for many who lived outside the fires' reach.

An analysis of hospital and emergency department admissions directly before, during and after the 2003 Southern California wildfires shows a dramatic increase in treatment for those with asthma, bronchitis and other respiratory disorders. Data points to the importance of educating people with existing respiratory ailments to react quickly to symptom onset and take precautionary measures. Results suggest that those at risk face similar health issues during current Southern California firestorm activity.

Heavy smoke conditions were associated with:

• 34 percent increase in asthma admissions;
• 67 percent increase in acute bronchitis admissions;
• 48 percent increase in chronic obstructive pulmonary disease admissions; and
• 45 percent increase in pneumonia admissions.

The hardest hit patients were young children and the elderly. Teens with asthma also were affected.

UC Irvine environmental epidemiologist Dr. Ralph Delfino led the study, which analyzed more than 40,000 admissions to Southern California hospitals in a month-and-a-half period surrounding raging wildfires in October 2003 that burned nearly three-quarters of a million acres and destroyed approximately 5,000 buildings.

According to study findings, public health officials need to increase preventive measures - such as advising people to avoid outdoor activities and advocating use of anti-inflammatory medications at the first sign of a wildfire for people who have asthma.

"It's important to learn from this study that large-scale wildfires can have wide-ranging effects on human health. It will be vital to educate those at risk with existing respiratory conditions to react quickly at the earliest signs of symptoms with preventive interventions," Delfino said. "This data has broad policy implications, as the health impact of wildfires will probably increase worldwide due to the effects of global warming."

The study has been presented to the South Coast Air Quality Management District and will appear in the online version of Occupational and Environmental Medicine . To aid their analysis, investigators used sophisticated models including NASA satellite images to link hospital data to daily air-particle concentrations at the ZIP codes of patients' homes throughout Southern California.

Delfino worked with statisticians, public health officials and environmental health researchers from UCI, UCLA, the California Department of Health Services and the California Office of Environmental Health Hazard Assessment. Hospital admissions data were obtained from the California State Office of Statewide Health Planning and Development.

Delfino studies air pollutants' effects on respiratory and cardiovascular health and leads one of the nation's first public health studies on how ultrafine particles in urban air contribute to coronary heart disease in the elderly. In 2005, Delfino won an award from the South Coast Air Quality Management District for his contributions to cleaner air.

http://www.uci.edu/