Posted by James
INTRODUCTION
Sickle cell disease (SCD) is the term used to describe the symptomatic disorders associated with hemoglobin S, an abnormal hemoglobin mutation, and is one of the most common genetic diseases among African Americans. The term “sickle cell disease” includes sickle cell anemia, sickle hemoglobin-C disease and the sickle-6 thalassemias and does not usually refer to sickle cell trait. The most prevalent types are sickle cell anemia and sickle-hemoglobin-C disease. Approximately one out of every 500 and one out of every 6,000 African Americans have sickle cell anemia and sickle hemoglobin-C disease, respectively. SCD is characterized by painful sickle cell crisis episodes that often require hospitalization for the symptomatic relief of pain. These crisis episodes may last for up to several days at a time and are the most frequent cause of hospital admission in patients with SCD. Previous studies have found elevated depressive symptoms in 43-56% of SCD patients. Those who report more frequent painful sickle cell episodes are more likely to be depressed. Depression has also been associated with an increased number of hospital emergency room visits for sickle cell crisis episodes. One limitation of prior studies of depression in SCD subjects was that a non-SCD group was not used for comparison purposes, making it more difficult to interpret the results.
Read the rest of this entry »
Posted by James
This is a small retrospective study in a private hospital and should be interpreted with caution. Type-1 and -2 errors are possible, and our findings should not be generalized to represent other patients in different settings.
We anticipated African Americans to be older at the time of diagnosis, due to lack of symptom recognition or lack of access to care. This was not thecase, and we suspect that it has more to do with bias of the sample coming from pediatric psychiatry and neurology rather than general pediatrics. Better educated and financially stable families could predict referral to subspecialists. Significant treatment resistance disconcerting to primary care physicians and teachers might also predict these referrals. Even if referred, African Americans have great difficulty in accessing subspecialty care. We do not feel our sample treated by psychiatrists and neurologists is necessarily representative of children treated in primary care settings. Our sample may represent children with more comorbidities, treatment resistance or better insurance. Read the rest of this entry »
Posted by James
There was no significant difference in the mean age of diagnosis (African Americans: 7.36 years; Caucasians: 7.25 years) or the mean age of symptom onset (African Americans: 4.0 years; Caucasians: 4.4 years). The comorbidities reported were similar for both groups (Table 1). There were fewer African-American parents (n=4) who could identify a relative with ADHD than Caucasian parents (n=12; %2=5.31, p<0.03), We found no differences between the two groups for pharmacological treatments recommended, outcomes or compliance (Tables 2-4). The average number of days between visits for African-American patients (74.02) was significantly longer than that for Caucasians (50.23) (SD 26, p<0.05).
Read the rest of this entry »
Posted by James
Using the mean age of diagnosis (9.2 ± 1.8) and the mean age of symptom impairment (3.5 years) in other reports, our biostatistician recommended >28 subjects in each group to demonstrate statistical significance in age points for our study. We reconfirmed statistical power for the mean length of time between sessions for the two groups to assure an appropriate confidence interval. Over a one-month period, we age-matched charts of 5-17-year-old African Americans until we had met that number.
Read the rest of this entry »
Posted by James
Children with unaddressed ADHD are at a greater risk for learning difficulties than children treated for ADHD or those children without ADHD. ADHD may be associated with a number of comorbid psychiatric conditions and an increase in both patient and family emotional distress. Parental beliefs about a child’s behavioral problems will influence the decision to seek medical care. If a parent’s belief, for example, is that poor diet is the etiology of ADHD, then they will be less likely to expend time and resources in therapy and medication.
Read the rest of this entry »
Posted by James
Attention-deficit/hyperactivity disorder (ADHD) is a syndrome of childhood onset characterized by symptoms of inattention, hyperactivity and impulsiveness. There is no one defining test used for ADHD—rather the diagnosis comes through a comprehensive history from patient, parents, other caregivers and teachers. Family history of ADHD can be a valuable contribution in helping to differentiate ADHD from other diagnoses.
Read the rest of this entry »
Posted by James
Cheaper Malaria Treatment from Silkwood
Andrew M. Porterfield
Every year, malaria kills more than 750,000 African children under the age of five. But an effort by the World Health Organization and Novartis Pharmaceuticals may provide an inexpensive treatment derived from Chinese silk-wood. The treatment, known as ACT (artemisinin-combination therapy) is effective against falciparum malaria (the most common in Africa). However, most formulations of the drug are designed for adults. Recently, WHO, Novartis and other groups started work to provide a pediatric formulation to developing countries at a cost of $ 1 a treatment, which now totals $3 for a three-day course. This new class of therapy is transforming the global campaign against malaria, said Jack Chow, MD, a special envoy of WHO based in Washington, DC. “With ACTs, along with the wide distribution of long-lasting insecticide-treated mosquito nets, there is a clear and present opportunity to sharply lower the number of malaria outbreaks and deaths in Africa and beyond.”
Read the rest of this entry »
