Doctors and nurses in Harare protest at the state of Zimbabwe's collapsing health system.

Doctors and nurses in Harare protest at the state of Zimbabwe’s collapsing health system.

The failure of medical services has forced doctors to turn away pregnant women and the sick. And with a cholera epidemic sweeping through the capital city of Harare and surrounding areas, medical officials say they fear they will be faced with hundreds of normally preventable deaths in the coming days.

The four main hospitals in Harare have stopped admitting patients because of a medicine shortage, said the Zimbabwe Association of Doctors for Human Rights. Another hospital in the second largest city of Bulawayo — 439 km (272 miles) from Harare — is facing a similar shortage.

“Sick people in need of attention are being turned away,” the group said.

In many hospitals, maternity services have been scaled back — meaning women who need to deliver babies by Caesarian section “will needlessly die during childbirth,” it said.

The hospitals, like everything else in the country, are a victim of the country’s collapsing economy under President Robert Mugabe, the group said.

With the political crisis showing no signs of abating, the country’s inflation rate has skyrocketed to the world’s highest: 230 million percent. Independent analysts put the figure in billions.

Doctors and nurses are reluctant to come to work because of the poor pay and poor equipment. Those who can are leaving Zimbabwe for neighboring countries or to Europe and Australia, the group said.

The group held Mugabe’s government responsible for the cholera epidemic that broke out early last month in the capital city and has since spread to other parts of the country.

The government has not been able to dispose of sewage properly, nor has it been able to provide chemicals to treat water to make it potable, the group said.

Dr. Barbara L. Andersen and colleagues at the Ohio State University followed 227 breast cancer patients for an average of 11 years. At the start of the study, all had undergone breast surgery, but the cancer had not spread. All patients received their usual medical treatment, but half were also randomly assigned to psychological intervention groups. Led by a psychologist, the 26 sessions were held over the course of a year and included relaxation techniques, advice on how to avoid becoming too tired and how to approach family and friends for support. The sessions also included some diet and exercise advice and information on how to cope with the side effects of cancer treatment.

Overall, by the end of the follow-up period, cancer had recurred in 62 of the 212 women for whom data was available and 54 of the total group had died. Patients receiving counseling had about half, 55 percent, the risk of recurrence compared with the control group. Those who did suffer a recurrence had been cancer-free for an average of six months longer than the patients in the control group, a 45 percent risk reduction. And among the 54 women who died, those who took part in the counseling sessions lived longer than the others. The study also found patients receiving counseling had less than half the risk, 44 percent, of death from breast cancer compared to those who did not receive the intervention, as well as a reduced risk of death from all causes, not just cancer. “Many of the strategies patients learned in the intervention program, such as stress reduction, may have protected them from heart disease and other causes of death,” Dr. Andersen said.

In a follow-up analysis, the researchers excluded people who were put in the intervention group, but who attended fewer that 20 percent of the sessions (16 of 114 participants fit this requirement). When the infrequent attendees were excluded, the remainder had a 68 percent reduced risk of breast cancer death, compared to the 55 percent risk reduction for the whole participant group.

Cancer patients undergo a great deal of stress before, during and after treatment. The researchers theorize that psychological interventions may affect immune system changes that are secondary to stress hormones and that may promote cancer growth or metastasis. They recommend that, in addition to powerful antitumor medications, cancer patients should be treated for psychological distress as well. “If efficacious psychological interventions to reduce stress are delivered early, they will improve mental health, health and treatment-relevant behaviors, and potentially, biologic outcomes,” the authors wrote. “If so there is the possibility for improved survivorship and survival for cancer patients.”

However, other experts are wary. Dr. Michael Stefanek, of the American Cancer Society, said other studies had come to the opposite conclusion. “Psychological interventions have been found in the majority of well-controlled studies to enhance quality of life and reduce distress. It would not be reasonable for patients to participate in psychological interventions with the goal of extending survival,” he said in a statement. “We should not conclude that psychological interventions increase survival among women with early stage breast cancer,” he added.

There are many approaches to outpatient psychological counseling and various ways for it to take place, including individual, group or family sessions. But regardless of where it takes place, sessions that concentrate on mood improvement, effective coping and health behavioral changes appear to reduce stress and help breast cancer patients live longer. “The results suggest that we can help breast cancer patients make positive steps that may help them live longer and make recurrence less likely,” Dr. Andersen said in a prepared statement. “We already knew a psychological intervention program could help breast cancer patients to handle their stress, function more effectively, and improve their health. Now we know it does even more.”

The study will be published in the December 15 issue of the journal Cancer, and is currently available to subscribers online.

Initially, Cambridge University scientists tried treating patients suffering from advanced multiple sclerosis with Alemtuzumab, but they had little success. However, patients suffering from early relapsing-remitting MS who were treated with Alemtuzumab experienced significantly fewer relapses as well as a reduced the number of episodes of fatigue and physical impairments that indicate progression of the disease when compared with those patients treated with the currently approved treatment known as interferon beta-1a.

Surprisingly, three years after entry into the study, some patients who received the experimental drug suffered from less disabilities associated with MS than they were experiencing prior to the beginning of the study. This finding offers hope that the treatment may play a role in stopping the progression of the disease and preventing victims from ever reaching its crippling late stages. According to study co-author Alasdair Coles, Ph.D., “The ability of an MS drug to promote brain repair is unprecedented.” He went on to explain, “We are witnessing a drug which, if given early enough, might effectively stop the advancement of the disease and also restore lost function by promoting repair of the damaged brain tissue.”

The success of Alemtuzumab in fighting against MS does not come with out risks. Almost one in four of the patients treated with Alemtuzumab developed thyroid complications, and the disabilities of some patients worsened. In addition, 3 percent of the patients treated with the drug developed a potentially life-threatening autoimmune condition, resulting in the loss of one of the patient’s lives.

According to Genzyme Medical Director Susan Moran, M.D., the patient who passed away during the study died from an autoimmune-mediated blood condition known as idiopathic thrombocytopenic purpura (ITP). Moran said the death could have been avoided if the condition had been recognized as an adverse effect of the treatment. She stated, “Unfortunately, the patient had symptoms of ITP but did not seek medical attention prior to diagnosis because this was not recognized as an adverse event.” The five additional cases were identified and managed with treatment due to close monitoring of study patients once the risk was known.

Coles said that Phase III trials will soon begin and will determine if the benefits of Alemtuzumab outweigh the risks for MS patients. Eighty-five percent of people who are first diagnosed with MS suffer from relapsing-remitting MS according to the National MS Society. Coles noted, “The Phase II results are very exciting, but this is not ready for routine use.” He also acknowledged, “We need to know more about the long-term effectiveness and adverse effects. That is our challenge over the next few years.”

MS has no cure and affects about 400,000 people in the United States as well as almost 100,000 in Britain and millions around the world. The disease is caused by the body’s immune system attacking nerve fibers in the central nervous system. Few effective treatments exist for MS. Symptoms of the disease may include depression, fatigue, cognitive problems and loss of sight and mobility.

According to a report from U.S. Centers for Disease Control and Prevention (CDC), children conceived through ART have a greater likelihood of having heart wall defects, gastrointestinal defects and a condition known as cleft lip.  ART refers to any procedure involving the surgical removal of eggs from a woman’s womb followed by combining the eggs with sperm in a lab, and then returning them to the woman’s body or donating them to another woman.

The study centered on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and the effects were observed solely in single births. This could be due the fact that high risks for birth defects are already associated with multiple births, according to the researchers led by Jennita Reefhuis, Ph.D., of the CDC’s National Center on Birth Defects and Developmental Disabilities. The findings of the CDC study were recently published in the advance online edition of Human Reproduction.

The use of ART is becoming more and more common. In a news release, Reefhuis stated, “Today, more than 1% of infants are conceived through ART and this number may continue to increase.” Reefhuis noted that the chances of birth defects for babies conceived through the use of ART are low yet “it is still important for parents who are considering using ART to think about all of the potential risks and benefits of this technology.” The CDC is not making any recommendations about the use of ART.

According to the CDC, the use of ART in the United States began in 1981 and the number of infants conceived through ART doubled from 1996 through 2004. About 12 percent of U.S. women between the ages of 15 and 44 reported using infertility services in 2002. In 2005, over 134,000 ART procedures were performed in the United States that resulted in about 52,000 births.

During the study, the researchers evaluated data from the mothers of babies born on or after Oct. 1, 1997, and on or before Dec. 31, 2003. About 13,500 of the babies were born with birth defects and just over 5,000 of the babies were born without birth defects. Mothers of the infants were interviewed by telephone between six months and two years after the date of delivery. The infants were born throughout 10 states including Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, Utah, and Texas.

Of the babies who were conceived through ART, 2.4 percent had birth defects while only about 1percent had no birth defects, according to interviews with the mothers. Among the ART babies, Septal heart defects were found to be twice as common, Cleft lip and/or cleft palate was found to be 2.4 times as common, Esophageal atresia (birth defect of the esophagus) was found to be 4.5 times more common and Anorectal atresia (birth defect in the anal/rectal area) was 3.7 times more common than in normally conceived children.

It must be noted that the study does not prove that ART actually causes the birth defects. The authors of the study report acknowledged this by stating, “Sub-fertile women might have a higher risk of having a child with a birth defect regardless of whether infertility treatments are used.” Additional research will be necessary to determine whether or not ART has an impact on birth defect risk.

Today, November 20th, marks the 33rd annual Smokeout where members of the American Cancer Society strive to get as many smokers to quit as they can by offering free resources to make quitting easier. Started in 1976, the Smokeout encourages people to stop smoking for one day out of the year in the hopes that one clean day will inspire smokers to quit for good. ACS has a great success rate with over 44 percent of American smokers who have quit for at least one day in the past year.

By establishing the Quitline* in 2000, people struggling to stop smoking are able to use the toll free hotline to speak to a trained counselor in order to receive educated advice and confidential counseling about their addiction. The Quitline has shown to more than double someone’s chances of quitting and has already given support to more than 380,000 smokers. The ACS website also lays out resources for smokers and their families and loved ones to start a long-term plan to stop the nicotine addiction.

Social networking sites have also proved to be helpful in encouraging smokers to quit by getting friends and family actively involved in their progress and support says a study from the New England Journal of Medicine. A spokesman from ACS says, “…social networks are helpful in quitting smoking…. Friends and family can help the most by being aware and supportive of the struggle to quit, and the American Cancer Society has resources to help them show support for their loved one who is trying to quit.”

Tobacco prices are continuing to rise and the tolerance around cigarette smoke is diminishing because many states have enacted anti-smoking laws inside public places including bars. Though it may seem that smoking is more prevalent in Europe than in the states, our awareness of smoking is heightened and because of the dangers of second hand smoke as well as lung disease, cancer, and early death, a stigma has grown around tobacco in the United States.

The American Cancer Society’s plan includes ways to help smokers transform their entire life from grocery shopping tips to healthy recipes, weight control elements, and ways to keep active. Hours after quitting, former smokers can experience a range of health benefits that accumulate over time such as an immediate drop in heart rate and blood pressure, better circulation and lung function, lower heart disease and stroke risk, and eventually a lowered risk for a lung, throat, mouth, esophagus, pancreas, bladder and cervical cancers. Just smoking 3 cigarettes a day adds up to 1,065 cigarettes or 54 packs smoked and over 200 dollars thrown away per year. Calculate your smoking numbers with the ACS cigarette calculator  and shed some light on your habit. Do yourself and your loved ones a favor and reduce your risk now, join the ACS’ Great American Smokeout and plan on today being your first day as a non-smoker.