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Comorbidities are frequent in patients with lung cancer, who are often treated with systemic anticancer therapy. The purpose of the present review is to report the adaptations recommended for the various drugs used in lung cancer treatment, in the context of a specific comorbidity. The literature was reviewed for neurologic, endocrine, hepatic, renal, digestive, cardiovascular, pulmonary, blood and systemic diseases. The comorbidities impact on the systemic anticancer treatment is poorly assessed. There are no good data with a high level of evidence and literature is often limited to experts' opinion and to case reports. We need to improve our knowledge about those patients by adequate multicentric and prospective studies and registries in order to offer them better care in term of evidence-based medicine.

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OBJECTIVES: Consumption of vegetables and fruits, physical activity, obesity and caloric intake are all strongly related to the risk of colorectal cancer (CRC). The association between dietary intake of carotenoids from vegetables/fruits and risk of CRC in the context of cigarette smoking was studied in a nutritionally diverse population. METHODS: The study included 1,817 age sex residence-matched case-control pairs from a population-based study in Northern Israel. Data were acquired by food-frequency questionnaire. Individual intake of carotenoid isomers was calculated using an Israeli food content database. Odds ratios (ORs) were calculated using conditional logistic regression models adjusted for known risk factors. RESULTS: Strong inverse associations were found with consumption of 9-cis-beta-carotene (OR = 0.35, 0.26-0.47), all-trans-beta-carotene (OR = 0.58, 0.44-0.76), cis-beta-cryptoxanthin (OR = 0.67, 0.50-0.90), all-trans-zeaxanthin (OR = 0.64, 0.48-0.86), and lutein (OR = 0.74, 0.57-0.96). Lycopene (OR = 2.22, 1.71-2.89) and all-trans-beta-cryptoxanthin (OR = 2.01, 1.48-2.73) were associated with increased risk of CRC. Inverse associations of most carotenoids with CRC, demonstrated in non-smokers, were much attenuated or reversed in past or current smokers with a highly significant interaction term. CONCLUSIONS: Consumption of most dietary carotenoids was found to be strongly associated with reduced risk of CRC. However, smoking significantly attenuated or reversed this observed protective effect on CRC occurrence. Smokers should be advised that smoking also hampers the potential health promoting effects of high fruit and vegetable consumption.

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Cleft uvula occurs in approximately 20% of Athabaskan Indians. The association of cleft uvula with otitis media was examined in a cohort of 175 Apache Indian children followed up prospectively from birth. No association was found between the occurrence of cleft uvula and the rate, frequency, or timing of otitis media attacks.

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The association of bifid uvula with otitis media and scarred tympanic membrane was studied in White Mountain Apache Indians at Canyon Day, Arizona. Of 349 persons seen during a survey for otitis media, 13.5 percent had clinical otitis media, and 64.2 percent had scarring of the tympanic membrane of the otoscopically worse ear; 20.3 percent had bifid uvula. Bifid uvula was not associated with clinical otitis media or scarred tympanic membrane.

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Language performance was evaluated in 167 healthy Apache Indian children aged 6 to 8 years, who had contrasting histories of otitis media and who had been followed since birth. All children received pneumatic otoscopy, tympanometry, pure tone audiometry, and a battery of language measures. Groups were similar with respect to age, sex, school experience, family income, housing, primary language spoken, and nonverbal intelligence. No statistically or clinically significant differences in language performance were observed between groups of children with frequent episodes of otitis media and those from the same cohort with infrequent otitis. While frequent otitis media was associated with abnormalities on tympanometry and otoscopy, bilateral hearing loss (greater than 25 dB) was observed in only 1% of the children.

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A retrospective study of 60 Navajo children with developmental disabilities was conducted to evaluate the quality and comprehensiveness of health services provided. Descriptive analysis by a multidisciplinary panel included medical record reviews, family interviews, and site visits to local health, educational, and family support services. Findings included timely and appropriate management of "medical" problems but a general neglect of "developmental" issues, such as hearing, speech/language, cognitive, and behavioral functioning, and attention to family understanding and adjustment toward caring for a handicapped child. Primary prevention and screening efforts were judged generally adequate, although not utilized by the majority of mothers of disabled children. Diagnostic assessments, family counseling, and referrals for treatment were incomplete, fragmented, and poorly coordinated. These problems resulted in potentially harmful delays in making referrals to available treatment programs. The majority of families interviewed tended to focus on the "medical" problems, had a poor understanding of the "developmental" components, and rarely participated actively in treatment.

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Child abuse and neglect have recently been found to occur among American Indians at rates comparable to other American population groups. Little is known about the clinical spectrum of Indian maltreatment, the psychodynamics and effective treatment modalities. Cultural misunderstanding, modernization, poverty, situational stress, poor parenting skills because of early break-up of Indian families, alcoholism, unusual perceptions of children, handicapped children, and divorce constitute factors associated with maltreatment in cases cited. Old solutions of removing children from families were largely inappropriate and ineffective and are being replaced by local efforts to develop foster homes, supportive family services, and legal procedures to protect children. Communication between agencies involved and mistrust of outsiders plus a lack of trained personnel and available community resources continue to pose major barriers to effective treatment and prevention efforts. Recent federal policies and laws clearly place the responsibility for child welfare in the hands of Indian tribes and tribal courts. The non-Indian health professional has an important but limited role in providing technical expertise and in aiding development of community resources, taking care to support but not usurp the emerging leadership of Indian people.

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The pediatric role in the management of child abuse and neglect has been largely limited to detecting and reporting cases, with little involvement in long-term treatment and follow-up. A review of published clinical experience indicates that customary protective services' "treatment" strategies are all too often ineffective at preventing reabuse, improving child health and developmental status, and improving family functioning. When foster care is used as a treatment modality, children run the added risk of never returning home, nor being freed for adoption, and they may suffer the emotional harm of repeated foster placements. This situation is likely to worsen, in the light of recent cutbacks in social service programs, at a time of rising reports of maltreatment. The pediatrician is widely recognized as an expert in children's health and development, and he can effectively use his position to influence the management of cases and thereby the outcome, by actively participating in treatment decision making and providing close follow-up in a limited but important way. In order to do this, he must first become acquainted with the effects of maltreatment upon children's health and development and with the general principles and available modalities of treatment. He must be sympathetic and supportive of the difficult role of the protective service worker who must make treatment decisions. His role is to assist the worker by making medical resources available in order to adequately define the child's needs and the capacity of the family to meet those needs. Essential to answering these questions is the availability of a child development clinic and mental health resources.(ABSTRACT TRUNCATED AT 250 WORDS)

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Over the past ten years the needs and rights of handicapped persons have been widely emphasized, leading to major changes in their care. The primary physician has an important role in identification of handicapped children and in counseling and educating families. Training for physicians in these areas has only recently been introduced in some medical schools, residency programs, continuing medical education courses, and journals. The results of a survey of Arizona family physicians and pediatricians and parents of handicapped children confirm that primary physicians see handicapped children with regularity and generally have a clear perception of their role. Screening and counseling families about their child's disability appear to be major problem areas leading to parental dissatisfaction. The implications of these findings for future training efforts are discussed.

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Poisoning has been added to the spectrum of child maltreatment. The range of clinical manifestations is broad, and the degree of family dysfunction varies. Mechanisms include impulsive acts under stress, lack of appropriate supervision, bizarre child-rearing practices and the rare Munchausen's syndrome by proxy. The physician must be adept at detecting and reporting such cases.

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