CONCEPTS OF SCHOOL HEALTH

For the effective care of a school child with either physical or mental handicaps a complete diagnostic picture is essential. It cannot be provided by the parent or the physician or the teacher separately, for each sees different aspects of the child's problem. Various ways of bringing together the necessary information are here described. A school medical adviser can review the available data with the school psychologist and then discuss the findings with the private physician. In communities where there are medical schools, diagnostic evaluation centers can be set up and their findings interpreted to the family by the general practitioner or the pediatrician. In any case, the diversity of health, behavior, and learning problems is such that the school health program must be viewed as a teamwork project with emphasis on the role of private medical practice.

What Does Your Eye Colour Say About You?

What Does Your Eye Colour Say 

About You?

They say that your eyes are the window to your soul, but new research has found that the colour of your eyes might actually be the window to your health. So how is that possible?

A number of studies have found that the colour of our eyes affect how we feel pain, how well we can hold our drink and even our skill level when it comes to sport and hobbies.

Carried out at Pittsburgh University, the study found that women with lighter coloured eyes experienced less pain during childbirth compared to those with darker eyes, while the women with lighter eyes were also able to tolerate more alcohol. But don't run to buy contact lenses, these differences boil down to one thing: your genes.

A senior lecturer in biomolecular sciences at Liverpool John Moores University has explained that eye colour is based on 12 to 13 individual variations in genes, and these genes also affect other parts of the body.

Take melanin, for example. This chemical not only makes eyes darker but also makes people more susceptible to alcohol. Not to worry though, according to scientists people with darker eyes also have increased reaction time, so they're generally better at fast-moving sports.

And people with lighter eyes? Well the University of Louisville found that the slower reaction times in lighter eyed people helped with activities that require more planning, so although you have no excuse next time you study, you also have a wonderful reason to get down the golf club when you're in need of some physical activity!

Diabetes Home Tests Explained

What Are Diabetes Home Tests?

Testing blood glucose (sugar) is an essential part of your diabetes care plan. Depending on your current condition, you may need to visit your doctor several times a year for formal testing. You may also need to go to your doctor for preventive testing, such as cholesterol checks and eye exams. While staying in touch with your doctor is important for staying on top of your treatment plan, you can and should test your blood sugar on your own, as long as your healthcare team advises you to.

Self-monitoring your blood glucose may be vital to your treatment. Testing your own levels allows you to learn your blood sugar and manage it no matter the time of day or where you are.

Learn how these tests work and talk to your doctor about the benefits of self-monitoring.

Part 2 of 6: Who It’s For

Who Should Use Diabetes Home Tests?

Your doctor will help you decide if you need to test your blood sugar at home. If you do, your doctor will help you determine how often and what times of day you should test. Your doctor will also tell you what your blood sugar targets are. You may consider diabetes home tests if you have:

• Type 1 diabetes
• Type 2 diabetes
• prediabetes
• symptoms of diabetes

By keeping track of blood glucose, you can discover problems in your current diabetes care. According to the Centers for Disease Control and Prevention (CDC), normal blood glucose ranges between 70 and 140 milligrams per deciliter (mg/dL). Low blood sugar (hypoglycemia) is below 70 mg/dL, and high blood sugar (hyperglycemia) is well above the normal range. By maintaining glucose at a normal range, you may help prevent diabetes complications such as:

• diabetic coma
• eye disease
• gum disease
• kidney damage
• nerve damage

Part 3 of 6: Testing

Performing the Test

Blood glucose tests come in varying forms, but they all have the same purpose: to tell you what your blood sugar level is at that point in time. Most home tests come with:

• a lancet (small needle)
• a lancing, or lancet, device (to hold the needle)
• test strips
• a glucose meter
• portable cases
• cords to download data (if needed)

Start by washing your hands, and then put the lancet into the lancet device so it is ready to go.  Before using the lancet, place a new test strip into the meter. Prick your finger with the lancet in the protective lancing device. Next, carefully place the subsequent drop of blood onto the test strip and wait for the results. Results should generally show up within seconds.

With some meters, you need to be sure the code on the strip matches the code on the meter. Also, be sure to check the date on the strips every once in a while to make sure they aren’t out of date. Finally, most meters now have a way to use an alternative site for testing, such as your forearm. Talk to your doctor to decide what is best for you.

Part 4 of 6: Tips

Tips for Accurate Testing

The fingers traditionally offer the most accurate results. Some tests allow you to prick your thigh or arm, but you need to check with your doctor before doing so.

The CDC recommends two to four tests per day if you are on insulin. You may consider testing before and after meals to see how your diet affects blood glucose. It’s especially important to test after eating simple carbohydrates or sugary foods to make sure your glucose isn’t too high. It’s also important to test whenever you make a change to your treatment plan or if you feel you’re getting sick.

A blood glucose chart is essential for tracking your results. Whether you keep track of your readings on paper or electronically, having this information can help you identify patterns and potential problems. You should save your charts and take them to your next doctor’s visit. When writing down your results, also be sure to log:

• the date and time of the test
• any medications you’re taking, as well as the dosage
• Whether it was before or after a meal
• foods you ate (if after a meal, note the carbohydrate content of that meal)
• any workouts you did that day and when you did them

Part 5 of 6: Home vs. Medical

Home Testing vs. Medical Testing

Self-monitoring your blood sugar is crucial in determining how your diabetes is doing on a daily basis. It’s unreasonable to assume that a few tests a year at the doctor’s office can give an accurate portrayal of your condition because glucose levels fluctuate throughout the day. However, this doesn’t mean that home tests should replace your regular preventive testing either.

In addition to self-monitoring at home, your doctor will likely recommend an A1C test. It measures how your blood glucose has been averaging over the last two to three months. According to the American Association for Clinical Chemistry, A1C tests are ordered up to four times per year. Getting regular lab tests can also help you determine how well you are controlling your diabetes. They will also help you and your healthcare team to decide how often to use your home test, as well as what your target reading should be.

Part 6 of 6: Know Your Numbers

Know Your Numbers

Self-monitoring your blood sugar is essential to maintaining your health. If your readings are unusually low or high, call your doctor right away. The CDC recommends seeking emergency medical attention if your readings are below 60 mg/dL or above 300 mg/dL. 

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Article Sources:

• A1C: The test. (2014, July 8). Retrieved from http://labtestsonline.org/understanding/analytes/a1c/tab/test
• Blood sugar testing. (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/diabetes/multimedia/blood-sugar/sls-20076114?s=1
• Comparing tests for diabetes and prediabetes. (2014, June 18). Retrieved fromhttp://diabetes.niddk.nih.gov/dm/pubs/comparingtests/index.aspx

Running Tips: 3 Essential Quad Stretches

Should you stretch before you run? The answer to that question used to be a simple “yes,” but recently health experts have questioned its effectiveness. Some recent research urges avoiding it altogether, while others who recommend it argue that you should only stretch for short spurts of time.

The overall benefits of stretching are indisputable, according to theUniversity of Rochester Medical Center, and they’re still in popular use among professional coaches and physical therapists. Stretching helps increase the range of motion around a joint and also loosens up the stiffness in the muscles. Muscles that are warmed up before a stress such as exercise are better able to deal with it when it hits you.

We spoke to Dr. Alice Holland, a physical therapist from Side Strong Physical Therapy, for her take on stretching and a few essential quad exercises.

Treating runners for nearly eight years at the Portland-based clinic where she is director, Holland says that anatomy knowledge and form are essential for you to get the most out of your run. Running involves your quadriceps or “quads,” which is the group of muscles at the front of your thigh, attached at the top of the kneecap. “When the leg strikes the ground, the quads control the deceleration,” Holland explains. “Without them, you’d basically fall.”

Can a stretch ever tear or damage your muscle? “There shouldn’t be any tearing damage in a stretch — no injury,” says Holland. Stretching merely involves fibers gliding over one another. What’s important is knowing when to stop: “You’ve stretched enough when you don’t feel any tightness as you take your first few steps.” It helps to warm up a bit before you stretch your muscles; simply walking for five or ten minutes will do. Also, avoid bouncing when you stretch.

The Stretches You Need

Holland recommends the following three stretches for both before and after a run, to help you gain and maintain flexibility in the quads:

Kneeling Stretch

1. Kneel on your right knee and curve your pelvis under like a "scared dog."
2. Flatten out your lower back and keep shoulders and chest upright.
3. Bend forward from the hip to the knee even more to stretch the right hip and quad.
4. Hold for 30 seconds and then switch knees.

The kneeling stretch is especially useful for older people and pregnant women. You can use a soft cushion or pillow under the knee for more comfort.

Standing Stretch

1. Stand on your left foot and grab your right shin behind you.
2. Tuck your pelvis in, pull your shin towards your glutes, making sure your knee is pointing to the ground.
3. Hold for 30 seconds and then switch sides.

Ground Stretch

1. Lie on your back at the corner of your bed (where it is the firmest), making sure that your tailbone is at the edge of the bed.
2. Grab one thigh and pull it towards your chest. Make sure that your back is flat and not arched. Let gravity pull down on the leg that is dangling.
3. Relax into the stretch so as not to tense up the muscles. Hold for 1 to 2 minutes and then switch sides. 

Form is Vital

It’s not just the stretches you do and the amount of time you spend doing them that keep your quads flexible, says Holland: “If you’re not doing it properly, you’re just wasting your time.”

Her biggest tip for runners is maintaining good form while stretching, as bad technique can make it less effective. She emphasizes keeping the back straight — to not arch. As Holland explains it, arching the back “decreases the amount of stretch” in the muscle. When you arch your back, the muscle is looser and gets less of a stretch.

In addition to properly stretching the quad muscles, the calf muscles are also involved in running and should be warmed up appropriately for 30 seconds.

When muscles and tendons aren’t warmed up, they don’t work as well. This can increase the chances of you getting a strain or partial tear. If you think you have a severe muscle injury, see your doctor. But as a general rule, if your pain is bearable, remember to RICE: rest, ice, compression, and elevation. You should also avoid running until the pain goes away.

Trials for New Cancer Treatments Reach Only a Tiny Fraction of Patients - See more at: http://www.healthline.com/health/cancer/trials-for-new-teatments-reach-few-patients#sthash.uXdPCic4.dpuf

linical trials, which give perilously ill patients a chance to live, often go unfilled in a disconnect that hurts patients and researchers alike.

If you’ve heard about clinical trials for cancer treatments in the past, you’ve probably heard stories like Evan Rose’s. Rose was diagnosed with a rare form of sarcoma in San Francisco in 2007. With few conventional treatment options, Rose, a 49-year-old urban designer, researched clinical trials.

He learned about a trial to investigate a process called TumorGraft. Researchers take pieces of a patient’s tumor, implant them in lab mice, and screen a number of drug regimens on the mice in hopes of finding a combination likely to work on that particular patient.

“I thought, let’s have the mice be the guinea pigs for a change, not me,” Rose said.

Rose persuaded his doctors, who were skeptical at first, to help him participate in the trial. (They had to provide a tumor sample and help devise the list of medications to be tested.) Rose paid for the process out of pocket, at no small expense, eventually moving to New York to be closer to one supportive doctor.

It paid off.

“One of my doctors told me frankly that I wasn’t going to make it through the year” — 2013 — “unless we could find a chemo that would work. And, voila, the early results on one of the combos were very promising,” Rose said.

“One of my doctors told me frankly that I wasn’t going to make it through the year unless we could find a chemo that would work. And, voila, the early results on one of the combos were very promising.”

—Evan Rose

The drug combination shrank Rose’s tumors enough to make surgery on one of his lungs possible. Rose’s sarcoma eventually became resistant to the drugs, which is not unusual for sarcoma patients. He has signed up for a second round of tests to see if another regimen might shrink the drug-resistant tumors.

“Compared to where we were in January 2013, this is a pretty remarkable place to be,” he said.

Healthline interviewed eight people who participated in cancer research trials, and all gave the experience glowing reviews. Patients described feeling like VIPs, getting top-of-the-line healthcare as study participants.

But the vast majority of patients do not participate in clinical trials; less than 5 percent of adults with cancer do. It’s not because there are too few trials to go around. More than 2 in 10 cancer trials sponsored by the National Cancer Institute between 2000 and 2007 failed to meet their patient recruitment goals.

One in 10 trials must shut down due to lack of participation. Almost 40 percent of all cancer trials that don’t run to completion are cancelled because of low patient participation.

To enroll in a trial, patients must clear a series of hurdles. They must learn about the experimental treatment, meet eligibility criteria to receive it, decide that the potential benefits outweigh the costs and risks, and travel to the trial site for a series of appointments. At each of these stages, the field of would-be participants thins.

part 2

Doctors Fail to Mention Trials

Many patients never hear about trials because their doctors don’t recommend them. Among the patients Healthline interviewed, most found out about clinical trials through their own research. The only patients who heard about trials through their doctors were referred to trials those doctors were running themselves.

Advocates say patients are better served with more information, whether or not they decide to participate in trials. But doctors aren’t being callous.

“Cancer is a devastating disease. Doctors are doing the best they can and for whatever reason they don’t know about trials,” said Dr. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society.

The clinical trials system puts the burden on already over-busy medical practices to stay informed about ongoing trials, screen patients for eligibility, and walk them through daunting consent forms, doctors told Healthline.

The Mount Sinai Hospital oncologist Dr. Ajai Chari juggles clinical practice and research. He explained that educating patients about clinical trials — and going over consent forms that often exceed 30 pages — slows down the practice’s carefully choreographed flow of patients through timeslots and exam rooms.

“Unless you have a vested interest as a clinician, you’re not going to find the time,” he said.

“The reasons [doctors don’t refer patients to trials] are manifold. One is financial; referring a patient out of practice does not help the bottom line. But one is simply based on wanting to continue to care for that patient.”

—Dr. Matthew Galsky, The Mount Sinai Hospital

But skewed financial incentives also help explain why so few doctors refer patients to clinical trials. If doctors provide radiation or chemotherapy, they can bill for it.

“Physicians are generally unlikely to refer their patients to another provider to enroll in clinical trial when they can offer them a standard treatment,” said Dr. Matthew Galsky, a Mount Sinai oncologist who has researched recruiting barriers for clinical trials.

Lichtenfeld agreed that financial incentives are part of the problem.

“People receive third- and fourth-line chemotherapy and may receive chemo within weeks of death when it’s obvious that the drugs aren’t going to work,” Lichtenfeld said, referring to egregious cases he has heard about. “That issue of financial self-interest is always on the table.”

Doctors likely do not consciously consider finances. Economic incentives may simply tip the scales when doctors are already inclined to believe they can provide the best care for their patients.

“The reasons are manifold. One is financial; referring a patient out of practice does not help the bottom line. But one is simply based on wanting to continue to care for that patient,” Galsky said.

part 3

Patients Misunderstand Scientific Processes

The public’s spotty understanding of how medical research works compounds doctors’ challenges.

For example, researchers and patient advocacy groups have said that many patients are reluctant to participate in trials because they fear they will receive a sugar pill.

In fact, placebos are generally only used in early stage trials, and never when a life-saving treatment is already available. Trials typically compare the best available treatment to the same treatment plus the new drug or protocol that’s being studied.

Alice Gordon, a 62-year-old retired New Jersey teacher, was first diagnosed with breast cancer in 2002. She declined at first to participate in a study mentioned by her doctor because she was scared.

“People think that, ‘If I don’t get the trial medicine, I’m going to get a sugar pill.’ That’s not well explained,” she said. Gordon later participated in a different clinical trial.

“I have heard patients say they don’t want to be a guinea pig and possibly die just to try out a new drug,” said Fran Kamin, a graduate student in the social sciences at Florida Atlantic University. She participated in a national clinical trial for advanced breast cancer in 2011.

“I have heard patients say they don’t want to be a guinea pig and possibly die just to try out a new drug.”

—Fran Kamin

“Maybe because I understand how the process works in general, I didn’t find it that daunting,” Kamin added. “I had nothing to lose.”

But even patients who, like Kamin, understand how trials work may not feel comfortable approaching their own health through the dispassionate lens of science.

“It’s one thing to think of it in the abstract and quite another when you have received a potentially life-threatening diagnosis and are thinking about the ways in which you’re going to treat your disease,” said Meghan Gutierrez, chief program, policy, and communications officer at the Lymphoma Research Foundation. The foundation runs a hotline to educate patients about clinical trials.

Method drives researchers, but passions drive patients. The two don’t always mix well.

For instance, some trials feature experimental treatments that have gotten buzz in the media and within the patient community. These trials generate a lot of interest, but would-be participants sometimes refuse to enroll in randomized trials because they can’t be guaranteed to get the new therapy. Other trials test treatments that few have ever heard of, and patients may see no reason to go through the extra effort to sign up. Randomized trials are the final step before the FDA considers a drug for approval.

“If it’s a life-and-death situation, I’d be way more prone to give it a shot, but for those who are like, ‘Well, we could help out for the benefit of science,’ that’s a tougher choice,” said Dale Smith, a 67-year-old retired Philadelphia resident. Smith participated in a double-blind trial to test a drug on patients who would normally just be monitored.

Andrea Denicoff, R.N., the head of operations for the National Clinical Trials Network at the National Cancer Institute, said both too much hype and too little can make it difficult to enroll trial participants. It’s especially tough when the new treatments have been approved for other uses and patients can get access to them “off-label” to treat their disease.

For instance, said Denicoff, for a time women with breast cancer were so convinced that bone marrow transplants would cure them — even suing insurance companies to cover the surgeries — that it was difficult to complete the studies that eventually showed the risky surgeries did not improve survival rates.

part 4

Trial Eligibility Rules Too Strict

Regulatory requirements designed to protect patients can sometimes be overly rigid.

For instance, the first patients to take an experimental drug must have healthy organs to make sure they can flush out drugs that prove unexpectedly toxic. But, Galsky said, the same criteria may be too limiting in later studies to explore additional uses for the same drug.

Researchers may also lock in narrow eligibility criteria in hopes of producing definitive results for publication. Those trial results may help the drugs get approved. However, they may also make oncologists less likely to prescribe the treatments to patients whose medical histories are more complicated and whose prognoses are bleaker, Galsky said.

Sergei German, 54, researched clinical trials online after being diagnosed with lymphoma in early 2013. A New Yorker, German had access to a number of trial locations nearby. But finding a trial for which he qualified took some finesse.

“You have to be sick, but not too sick,” German said.

“Often times by the time patients feel like they should be seeking clinical trials, they are no longer eligible.”

—Dr. Matthew Galsky, The Mount Sinai Hospital

The strictness of criteria for the ongoing Mount Sinai-based trial he eventually joined — testing an immunotherapy for lymphoma — is a case in point.

“You have to have a tumor which is available for biopsy, close to the surface of the skin, and another that’s available for injection, and you have to have at least one more tumor which is a control,” German said.

“Often times by the time patients feel like they should be seeking clinical trials, they are no longer eligible,” Galsky said.

part 5

Urban Research Centers Leave Rural Residents Hanging

Some patients are excluded from trials based on geography. Most trials take place in major cancer centers, which are most often found in big cities.

Almost half of all cancer patients live more than an hour away from the nearest clinical trial, according to Galsky’s research. How far away patients live also affects their treatment outcomes.

The prospect of commuting to regular, physically taxing medical appointments can play a major role in a patient’s decision-making process. Patients who travel for experimental treatments sometimes, but not always, receive financial help to cover travel and lodging. The prospect of those travel costs may deter others, according to patients Healthline interviewed.

When Zoe Beck, a 74-year-old resident of Shelton, Connecticut, began to educate herself about bladder cancer after receiving the diagnosis, she chose to go to New York’s Memorial Sloan Kettering Cancer Center partly because of its proximity.

“I saw that a center for excellence was just 70 miles away in New York,” she said. Beck never got experimental treatments, but she provided samples for a study testing new ways to track how well chemotherapy drugs are working.

“They always did it on the days when I was already scheduled for something so I wouldn’t have to schlep in from Connecticut to New York,” Beck said.

After all, time is a cancer patient’s most valuable resource. And chemotherapy is grueling enough that even a relatively short trip like Beck’s can be an ordeal.

“If you have a disease like this, you do not want to have to travel. That to me was a major, major part of my decision. You need the least amount of trauma and distress in your treatment,” said Alice Gordon. She has remained in New Jersey for all of her treatments except for two surgeries performed in New York City.

“If you have a disease like this, you do not want to have to travel. You need the least amount of trauma and distress in your treatment.”

—Alice Gordon

Denicoff, of the National Cancer Institute, underscored just how much some patients want to stay close to home. Some women with breast cancer opt to have their affected breast removed in a mastectomy. If there is a radiation center close by, they could have just the tumor removed, in what’s called a lumpectomy, followed by radiation.

“Here we’ve come up with this successful way to have less morbid care but, due to sheer distance, some patients will choose mastectomy anyway because it’s just easier,” Denicoff said.

part 6

Change Comes Slowly

Elizabeth Naylor, a 25-year-old middle-school teacher living in a suburb of Boston when she was diagnosed in 2009, had everything going for her and still almost didn’t get the experimental treatment that saved her life.

Boston is home to several of the most highly regarded medical centers in the country. Naylor went for chemotherapy for her non-Hodgkin lymphoma at one of the best cancer treatment and research centers in the world, the Dana-Farber Cancer Institute.

Because she was young and otherwise healthy, the team of doctors that oversaw her care expected chemotherapy to work quickly. But her tumors continued to grow through two rounds of chemotherapy. As Naylor braced for the third round, her primary doctor sat her down and let her know just how dire her situation had become.

“He was upfront with me that he wasn’t giving up on me, but it was really bad,” Naylor said. He gave her about a month to live.

But even as Naylor’s doctor prescribed a difficult treatment with little chance of success, he never mentioned clinical trials, Naylor said. He likely knew that clinical trials were an option: Dana-Farber is currently home to more than 400 cancer trials for adults. Naylor’s doctor is currently leading three trials for non-Hodgkin lymphoma patients.

Naylor and her husband are educated and financially stable. And they had personal connections to leverage. It was Naylor’s father-in-law who came up with the idea of a trial after reaching out to every doctor and nurse he had ever met in several dozen phone calls over a 12-hour period.

Naylor’s father-in-law, Reverend Robert Naylor, managed to get the cell phone number of Dr. Wyndham Wilson, a lymphoma researcher at the National Institutes of Health (NIH) in Bethesda, Maryland. The two called him on a Saturday, and, to Naylor’s surprise, he answered. On Monday she had an appointment.

By a strict accounting of the eligibility criteria for the trial she participated in, Naylor was too sick to qualify. However, the doctors had some wiggle room in determining who was too sick and, seeing her age, they enrolled her anyway.

At the NIH, Naylor received stem cells donated by her sister that were used to make T-cells specially trained to recognize lymphoma cells as intruders. The treatment almost certainly saved her life. She is now cancer free, with withering scars where grapefruit-sized tumors had been.

Throughout the trial, the oncologist Naylor had seen at Dana-Farber spent hours on the phone with her husband, painstakingly explaining the procedures described in the NIH paperwork. He was not lazy or ill informed, by Naylor’s account.

Naylor’s care team at Dana-Farber declined numerous requests for comment.

After Naylor’s Lazarus-like recovery, she met a neighbor facing lymphoma and receiving treatment from the same medical team at Dana-Farber. The team had not referred her to a clinical trial either. Naylor encouraged her neighbor to look for a trial at the NIH, and the she later enrolled in one, Naylor said.

There is no clear bad guy in this story. But with blame spread around, a simple solution will also be hard to find. The challenges will only grow in the coming years as both patients and their cancers are divided into more specific categories based on their genetic traits. Each new potential treatment will have to pass muster in a series of clinical trials.

Still, some efforts have successfully brought together patients, advocacy groups, community doctors, government agencies, and leading researchers to expand patients’ access to cutting-edge treatments. Healthline will explore those trends in upcoming investigative articles. 

About the Author:

Cameron Scott is a Healthline news staff reporter. Prior to joining Healthline in 2014, Cameron wrote about robotic prosthetics and stem cell research for a tech blog and about the environment for SFGate.com. Cameron has also had work published in SF Weekly, Mother Jones, and California Lawyer.

Before landing in journalism, Cameron earned a doctorate in comparative literature from Cornell University (cold) and a master’s degree in creative writing from the University of Texas (hot).

In the perfectly mild climes of the Bay Area, Cameron enjoys hiking, running, biking, and swimming in fresh water. He has recently discovered that he can put most these together and called it a triathlon. At rest, Cameron enjoys reading, writing creatively, and the company of well-behaved children and poorly behaved canines.

To offer feedback about this story, please email hrl@healthline.com.

- See more at: http://www.healthline.com/health/cancer/trials-for-new-teatments-reach-few-patients#sthash.uXdPCic4.dpuf