On Ovarian Cancer

October 10, 2011

Reports indicate that approximately two million women develop breast or cervical cancer each year, and these rates continue to increase. Though not as common, ovarian cancer – the fifth most common cancer in women – causes more deaths than any other type of female reproductive cancer. According to the National Cancer Institute, to date in 2011 there have been an estimated 21,990 new cases of ovarian cancer, and 15,460 deaths due to the disease. Making women aware of the possible symptoms of ovarian cancer and encouraging them to have routine gynecological appointments may help to improve rates of diagnosis of the condition.

While nearly one in three women will develop breast cancer in their lifetime, one in seven will develop ovarian cancer, but detection and diagnosis is significantly more difficult in ovarian cancer. The symptoms associated with ovarian cancer are often vague, and are commonly associated with other common conditions. According to experts, women should see their doctor if they experience bloating, difficulty eating or feeling full quickly, and pelvic or abdominal pain on a daily basis for more than a few weeks. Because of the difficulty detecting ovarian cancer, it is frequently not detected until it has spread within the pelvis and abdomen. In its late stages it is often fatal, but if diagnosis is made early and treatment is received before the cancer spreads outside of the ovary, the 5-year survival rate is very high. In order to combat difficulties diagnosing ovarian cancer, researchers are working to develop new flureoscence-guided techniques that may make it possible to identify very small tumors that may have been missed using traditional detection methods.

All women are at risk of developing ovarian cancer, but approximately 90 percent of women who get the disease are 40 years of age or older, with the greatest number of cases occurring in women aged 60 and older. Women who have children earlier in life have a decreased risk of developing ovarian cancer, while those who have a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk. Once ovarian cancer has been positively diagnosed, as with other cancers, it is most often treated surgically. This frequently involves the removal of the uterus, both ovaries and fallopian tubes, and/or removal of the lymph nodes. In addition to the surgical removal of tumors, individuals with ovarian cancer may undergo chemotherapy, however radiation therapy is seldom used in the United States to treat ovarian cancer.

Though difficult to diagnose, if treated quickly ovarian cancer can be beaten. By encouraging women to monitor their health and communicate any concerns to their physician, it may be possible to identify cases more quickly and improve treatment outcomes.

 

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On Chickenpox Worldwide

August 29, 2011

Chickenpox was once considered a rite of passage for most children, but since the establishment of routine vaccination programs, complications from the virus have seriously decreased. While the condition very seldom leads to secondary infections or other issues, it is highly contagious and can be problematic in some individuals. It is important that parents ensure their children receive vaccinations for chickenpox and other common childhood illnesses, and remain mindful when interacting with infected individuals.

In the 16th century, the varicella zoster virus (VZV), the virus that causes chickenpox was identified, but it was not until the end of the 19th century that physicians were able to reliably distinguish chickenpox from smallpox. VZV is a member of the herpes virus group, and like other herpes viruses, it has the capacity to persist in the body after the first infection as a latent infection and can reappear as shingles. Shingles, which manifests as a painful rash on one side of the body, occurs in approximately one in 10 adults. It is the result of re-activation of the VZV virus which persists as a latent infection in sensory nerve ganglia and can occur in any individual who has recovered from chickenpox, but it is most common in individuals over 60.

Spread through direct contact with the rash or droplets dispersed into the air by coughing or sneezing, chickenpox manifests as a red, itchy rash which first appears on the face, trunk, or scalp. The rash usually appears 10 to 21 days after infection, and may be accompanied by a fever, abdominal pain, headache, and a general feeling of unease and discomfort. If scratching the rash is not discouraged through the use of oatmeal or baking soda baths, the application of calamine lotion, or antihistamines, individuals may contract a bacterial infection of the skin. Other complications that can result from chickenpox include viral pneumonia, bleeding problems, and infection of the brain (encephalitis).

Before the introduction of a vaccine, approximately 10,600 people were hospitalized and 100 to 150 died as a result of chickenpox in the U.S. every year. Vaccination became routine practice in the U.S. in 1995, and there are now two live, attenuated VZV-containing vaccines available for use. Recent studies have shown that in children, two doses of the chickenpox vaccine is 98 percent effective in preventing infection, compared with 86 percent effectiveness for a single dose. Recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics indicate that children should receive their first shot at 12 to 15 months, and the second at four to six years to ensure the maximum benefit. While a reported 15 to 20 percent of vaccinated individuals do still become infected with chickenpox if they are exposed to it, their condition is significantly milder and lasts for a shorter period of time.

By increasing awareness about the importance of vaccination, it may be possible to further decrease rates of infection and complications associated with chickenpox. Vaccination against chickenpox and other childhood illnesses can not only protect the individual receiving the vaccination, but can help to protect individuals who may not be able to receive vaccinations due to health conditions by contributing to the herd immunity of their community

 

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HIV/AIDS Progress

July 4, 2011

In the 30 years since it was first identified, the global response to AIDS has achieved significant results. More people than ever before have access to treatment, allowing them to manage their condition, and according to the United Nations rates of new HIV infections are falling by nearly 25 percent. In spite of these successes, it is important that efforts continue to ensure that progress is made towards further improving treatment options and outcomes.

Since 1981, a reported 25 million people worldwide have died from AIDS and an additional 34 million are infected with HIV. According to a recent United Nations report, in the 33 worst-affected countries, the rate of new HIV infections fell by 25 percent between 2001 and 2009, and in India and South Africa, the countries with the largest populations of individuals living with HIV, new infections fell by 50 percent and 35 percent, respectively.  According to Michel Sidibé, Executive Director of UNAIDS, through the use of antiretroviral therapy (ART), “AIDS has moved from what was effectively a death sentence to a chronic disease…Antiretroviral therapy is a bigger game-changer than ever before – it not only stops people from dying, but also prevents the transmission of HIV to women, men and children.”

A decade ago, half of the population of several nations in southern Africa were expected to die of AIDS-related causes, but as ART has become more widely available, the death rate is dropping. An estimated 6.6 million people in low- and middle-income countries were receiving ART at the end of 2010 – a nearly 22-fold increase since 2001. In spite of this increase, reports indicate that there are 16 million people worldwide living with HIV/AIDS who could benefit from these medications but many do not receive them. Even in the United States and other developed nations, individuals living with HIV/AIDS are frequently put on long waiting lists to gain access to these life-saving drugs as the supply is not able to meet the demand for them.

While expanded access to ART can help to improve the lives of individuals with HIV/AIDS and help to prevent new infection, a major gap in treatment still exists. Access to treatment for children is significantly lower than for adults, and only 28 percent of all eligible children were receiving treatment in 2009, compared with 36 percent for people of all ages. In addition, while the rate of new HIV infections globally has declined, the total number of individuals with HIV remains high and certain groups, including women of reproductive age, remain at increased risk of infection. By ensuring that antiretroviral medications and education and treatment programs are widely available, it may be possible to further decrease the number of new HIV/AIDS infections worldwide as researchers continue to work to track the spread of the disease and find a cure.

 

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On Measles Worldwide

May 23, 2011

The World Health Organization reports that in 2008, there were 164,000 measles deaths globally, more that 95 percent of which were in low-income countries with weak health infrastructures. This rate equates to nearly 450 a day or 18 per hour. In recent years, targeted vaccination campaigns have greatly reduced the number of measles deaths each year, though in developing nations with weak health infrastructures complications or deaths related to measles infection are still not uncommon. By increasing awareness about the importance of vaccination and making vaccines available in regions where they are needed, the virus that causes measles could be eradicated.

Measles, also called rubeola, is a common and preventable childhood disease, also sometimes seen in individuals with compromised immune systems. Most frequently, infection is marked by a fever lasting a couple of days, followed by a cough, runny nose, and conjunctivitis.  Soon after, patients exhibit a rash on the face and upper neck, spreading down the back and trunk to the arms and legs. Reports indicate that 30 percent of people infected with measles will experience complications, ranging from ear infections to pneumonia. Further, one in every 1,000 people will develop inflammation of the brain. If left untreated, the complications associated with measles infection can be life threatening. In regions without widespread access to medical care, an estimated five percent of children die of measles-related causes.

According to William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine, the measles virus infects more than 80 percent of unvaccinated people exposed to it. Though the transmission of endemic measles was declared eliminated in the U.S. in 2000, the disease remains common in other regions and can be imported by travelers. Reports from the Centers for Disease Control and Prevention (CDC) indicate that during 2008, nearly 90 percent of measles cases in the U.S. were either acquired abroad or linked to imported cases. While a safe and cost-effective vaccine is available, more than 20 million people are affected by measles each year and the majority live in developing nations and/or countries with low per capita incomes and weak health infrastructures.

Though measles outbreaks continue to be problematic in some developing regions, the World Health Organization reports that between 2000 and 2007, 576 million children were vaccinated against measles, resulting in a 74 percent decrease in measles-related deaths worldwide. By increasing awareness about the importance of vaccinations and ensuring that vaccines for measles are available, rates of infection, complications due to infection, and death could be even further reduced.

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Healthcare Shortages in the U.S.

January 18, 2011

In remote areas worldwide, the availability of trained medical personnel continues to be problematic, but new research shows that there are also shortages of healthcare providers in the United States. Recent reports indicate that approximately 65 million Americans live in federally-designated primary-care health-professional shortage areas (HPSAs), defined as regions with 2,000 or more residents per primary-care doctor. A recent study in the journal Academic Emergency Medicine found that three-quarters of U.S. emergency department directors indicated that they did not have adequate on-call trauma surgeon coverage. In addition to a lack of emergency department personnel, some regions of the U.S. are experiencing shortages of ophthalmologists, pediatricians, nurses, and dentists, all of which result in a lack of quality healthcare services. Treatment outcomes can be improved by finding alternative means of ensuring that patients have access to specialty healthcare.

Nearly a quarter of the U.S. hospital emergency departments that participated in a recent study reported an increase in the number of patients who left the facility before being seen by a specialist. According to the study’s lead author Dr. Mitesh Rao, 21 percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Further, more than 70 percent of participating emergency departments noted staff shortages in neurosurgery and hand surgery, and for patients with traumatic brain or hand injuries, the resulting delays in care could significantly increase the risk of lifetime disability, and according to Dr. Rao, the study’s lead author, “Transferring patients significant distances to an available specialist is sometimes the only option.”

In regions with a dearth of a particular type of medical professionals, availability of general treatment may also be significantly limited. Reports indicate that 14 of 81 counties in Kansas have no dentists, leaving residents with few options. Without appropriate dental care, patients’ risk of developing infections detrimental to the heart and lungs can increase, as can the risk of other conditions. Pediatricians and family care physicians are also lacking in some areas of the U.S. According to a recent study, nearly one million children live in areas with no local doctor. Nurses are also in short supply in many areas, and according to experts, by 2020 the nation will have 29 percent fewer nurses than are needed to provide care.

To ensure the provision of care to patients in areas that lack clinical staff, some experts suggest the use of telemedicine and remote screening programs. Through these programs, specialists can provide clinical advice to clinicians remotely and improve the level of care provided without requiring transport of the patient. Remote screening and diagnosis have been proven effective for diabetic retinopathy in areas where expert ophthalmologists are not available. Using a special camera, clinical staff and technicians captured a picture of a patient’s eye and send it to a trained professional. Eighty-three percent of individuals with retinopathy were diagnosed correctly using this remote screening technique regardless of the level of medical training of the individual taking the photograph. Teleradiology programs have also been implemented in some areas, a number of which are now utilizing fourth-generation wireless networks to allow radiologists to transfer images more and make preliminary evaluations more quickly.

Comprehensive telemedicine programs can help to ensure the delivery of specialty healthcare in underserved areas of the U.S. and worldwide. The iCons in Medicine program is an global telehealth and humanitarian medicine volunteer alliance that serves to connect volunteer healthcare providers with individuals and clinics requesting assistance on challenging cases. Membership in the iCons in Medicine network includes nearly 400 individuals in 12 countries around the world. These individuals represent 35 academic and medical centers, and include renowned experts in telemedicine, e-health, and global health disparities. Over 130 physicians with expertise in 35 medical specialties are available to respond to teleconsultation requests from individuals representing over 20 organizations in 10 countries. Through the use of telemedicine and remote diagnosis and screening programs, the delivery of specialty care in remote areas and treatment outcomes can be improved.

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On Polio Worldwide

January 3, 2011

Though cases of polio worldwide have been reduced by 99 percent since 1988, it continues to be a major public health concern in Afghanistan, India, Nigeria, and Pakistan. Recent outbreaks have also been seen in the Congo Republic. Vaccination programs have been put in place in the hopes of eradicating the disease, but according to experts, infection in even one individual can put an entire population at risk. Though previous vaccination efforts helped to reduce the number of cases in many regions, in Nigeria and some other African nations the social stigma and fear associated with vaccinations must be overcome. By utilizing a newly developed, more effective polio vaccine and working to educate individuals about the importance of getting vaccinated, it may be possible to meet the Global Polio Eradication Initiative’s (GPEI) goal of eradication polio worldwide by 2013.

Polio (poliomyelitis) is a contagious viral illness that, in its most severe form, can cause paralysis, difficulty breathing, and death. Often contracted through contact with the feces of an infected person, polio can be spread through contaminated food or water, and the risk of contamination is particularly in areas with poor sanitation. Though individuals of all ages can contract polio, children under five years of age, pregnant women, and individuals with weakened immune systems are even more vulnerable. Ninety-five percent of individuals infected with polio have no symptoms, and between four and eight percent experience minor, flu-like symptoms including fever, fatigue, and stiffness or pain in the back, neck, or limbs. Individuals with polio who show no symptoms or only minor symptoms may still spread the virus to others.

Though infection rates of non-paralytic and paralytic polio were significant in the 1950s in the United States and other areas worldwide, in recent years fewer than one percent of individuals who contract polio develop paralytic polio, the most serious form of the disease, which can lead to loss of reflexes, severe muscle aches and spasms, and paralysis. Paralytic polio can manifest in a variety of ways, and is classified by the areas of the body that are most affected. Spinal polio, the most common form of paralytic polio, attacks the motor neurons in the spinal cord and may cause paralysis of the muscles that control breathing and movement of the arms and legs. Bulbar polio affects the motor neurons of the brainstem, impacting an individual’s ability to see, hear, smell, taste, and swallow, and may also affect intestine, heart, and lung function. A combination of both, bulbospinal polio can lead to paralysis of the limbs, as well as affecting breathing, swallowing, and heart function.

The lack of a cure for polio and limited treatment options available underscore the need for effective vaccination campaigns. Inactivated polio vaccine (IPV), an injection given in the arm or leg, has been used in the United States since 2000. Most children in the U.S. are given four doses of IPV, which has been found to be 90 percent effective after two shots, and 99 percent effective after three. The oral polio vaccine (OPV) is used throughout much of the world, but may soon be replaced by the newly developed bivalent oral polio vaccine (bOPV). The bOPV contains two key strains of the virus and thus may provide improved inoculation results. In addition to efforts to increase vaccination rates, improved sanitation and education related to personal hygiene can help to reduce the spread of polio, as well as cholera and other water-borne illnesses.

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Maternal Mortality Worldwide

November 15, 2010

Worldwide, a reported 1,500 women die each day as a result of pregnancy-related causes. According to the World Health Organization’s (WHO) “Trends in Maternal Mortality” report, maternal mortality rates (MMR) worldwide have decreased, but remain a persistent public health concern. As noted in previous WHO reports on women’s health, medical staff and services, educational programs, and information pertaining to pregnancy and childbirth may be lacking in some areas. By ensuring that trained medical personnel are available, and that women are able to access pre- and postnatal care, MMR can be further reduced.

The number of women dying due to complications during pregnancy has decreased from 546,000 in 1990 to 358,000 in 2008 with an estimated 99 percent of these deaths occurring in developing nations. Reports indicate that women in developing nations are 36 times more likely to die from a pregnancy-related cause than those in developed countries. Though rates vary within and between countries due to differences in income and between urban and rural populations, the average risk of maternal mortality in developing nations is one in 75, compared with one in 7,300 in developed areas. According to experts, most maternal deaths are avoidable, and are due to four major causes: severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions. In addition, approximately 20 percent of maternal deaths are due to indirect causes, including diseases that complicate pregnancy or are aggravated by it such as malaria, anemia, and HIV/AIDS.

Many of these deaths are due, at least in part, to a lack of trained medical personnel available to care for pregnant women and new mothers. WHO data show that less than two-thirds of women in developing countries receive assistance from a healthcare worker during childbirth. In addition to care during delivery, antenatal care is often limited in developing regions. In low- and middle-income countries approximately two-thirds of women have at least one antenatal visit, while in high-income nations nearly all women have at least four antenatal visits, receive postnatal care, and are attended by a midwife or doctor during childbirth. According to the WHO’s Colin Mathers, reducing the MMR worldwide will require countries, international organizations, and charities to collaborate to educate and train additional medical personnel to attend to pregnant women. Dr. Margaret Chan, Director-General of the WHO, has also stated that “No woman should die due to inadequate access to family planning and to pregnancy and delivery care.”

In addition to ensuring that trained personnel are available locally, telemedicine initiatives such as the iConsult program may prove beneficial in lowering the MMR. By combining a software application and website, iConsult may enables healthcare providers in remote and medically underserved areas (Requestors) to receive free advice on difficult cases from medical specialists (Volunteers) including Obstetricians and other maternal and fetal health experts. This type of telemedicine program may be employed to improve health outcomes and lower maternal mortality rates in regions where the necessary personnel are not available.

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