Kids With Migraine Usually OK Psychologically

NEW YORK (Reuters Health) Jul 15 - Contrary to common belief, children treated for migraine are not more likely to be psychologically maladjusted, according to a systematic review published online July 5th in Pediatrics.

They do tend to have more somatic complaints, however, and to show more internalizing behavior, which is likely due to their symptoms and not the consequence of psychological dysfunction, the researchers say.

In their search of Medline, Embase, PsycINFO, and the Cochrane Database, first author Dr. Jacques Bruijn from Vlietland Hospital, Schiedam, the Netherlands, and colleagues identified seven case-controlled studies of psychological functioning and/or psychiatric comorbidity in children or adolescents with migraine. Altogether the studies involved 268 migraine patients (mean age, 11.7 years).

The authors grouped the 26 different standardized outcome measures according to the 10 outcome fields in the Child Behavior Check List (i.e., withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, aggressive behavior, internalizing behavior, and externalizing behavior).

While the investigators reported that children with migraines had more somatic complaints and internalizing behavior compared to controls, they also found strong evidence that these children do not have more thought problems, social problems, or exhibit more withdrawn, delinquent or aggressive behavior than healthy children.

Evidence for anxiety, depression, attention problems, or externalizing behavior was inconclusive.

Pediatric migraine seemed to be associated with more frequent diagnoses of oppositional defiant disorder, but not attention deficit/hyperactivity disorder, conduct disorder, or dysthymia - but this evidence was limited.

Five of the studies were high-quality, but the authors note that all seven were small, and none used a random selection strategy.

The researchers conclude that in general, children with migraine don't need referral to a child psychologist or psychiatrist. If psychological or psychiatric problems do exist, however, they believe mental health referral is likely to have long-term benefits for the children's migraines as well.

SOURCE: http://link.reuters.com/xak47m

Pediatrics 2010.

Morning Prep Leaves Cleaner Gut for Afternoon Colonoscopy

July 16, 2010 — For colonoscopies performed in the afternoon, having patients drink the full gallon of a polyethylene glycol (PEG) bowel prep solution in the morning rather than the evening before results in better bowel cleansing, physicians in the U.S. report.

In their study, the right, middle, and left colon in the morning group were 3, 8 and 3 times more likely, respectively, to have a "good prep" than the evening group.

Patients also found the morning regimen easier to tolerate, with less bloating and better sleep quality.

"So doing the bowel prep on the morning of the procedure worked well for both the colonoscopists and for the patients," senior author Dr. Fernando J. Castro, from Cleveland Clinic Florida in Weston, told Reuters Health.

In 2009, the American College of Gastroenterology endorsed "split-PEG" as the optimal bowel prep regimen, with two liters taken the evening before and two liters the morning of the procedure.

Earlier this year, researchers in Philadelphia found that morning-dosing was clinically equivalent to the split-PEG schedule for afternoon colonoscopies, while a team in Korea reported "excellent" results with a split-dose regimen for morning procedures. (See Reuters Health stories of May 12 and June 24, 2010.)

The current study, published online July 6th in the American Journal of Gastroenterology, included 136 patients, mean age 52 years. Fifty-four percent were undergoing screening colonoscopy; the rest had altered bowel habits, abdominal pain or rectal bleeding. Dr. Castro's team excluded patients with a history of colon resection or suspicion of bowel obstruction.

They randomly assigned 68 patients to drink the solution between 5 and 9 PM the evening before colonoscopy, with nothing else but clear fluids that day. The other 68 were to drink the solution between 6 and 10 AM the same day of the procedure; they were allowed to eat breakfast the day before, followed by clear liquids for the rest of the day.

The eight endoscopists, unaware of the patient's protocol, assessed bowel cleansing using the Ottawa scale, which assigns a score of 0 (no liquid) to 4 (solid stool, not washable) to each part of the colon — right, middle, and left — as well as 0 to 2 points for overall quantity of fluid.

The mean total Ottawa scale score was 7.10 in the evening group and 4.73 in the morning group, and scores for each colon segment were consistently lower in the morning group (p < 0.01 for each comparison). In addition, patients in the morning group were twice as likely to receive the lowest (i.e., the best) score for overall fluid quantity in the colon.

One reason why the morning bowel prep results in better cleansing, Dr. Castro said, is that "as the patient finishes drinking the solution, bile starts to accumulate in the colon, staining the bowel so the colonoscopist can see less. The closer the colonoscopy to the time of the prep, the better the visibility is."

The number of patients with polyps and adenomas were similar for the two protocols. Likewise, withdrawal time, time to reach the cecum, and total duration of colonoscopy did not differ significantly between groups.

Patient questionnaires showed that those in the morning group were 58% less likely to lose sleep (p = 0.038) and 55% less likely to have bloating (p = 0.027) compared with the evening group.

Dr. Castro recommends either the split-dose strategy or using the whole gallon of solution on the morning preceding afternoon colonoscopies.

As to whether patients could cut the dose of the prep solution — which many find unpleasant — that will require head-to-head trials, he added.

Am J Gastroenterol. Published online July 6, 2010.

Report: HIV Prevention Research Enters New Era

A new report warns that promising developments in HIV prevention could be undermined by funding gaps and a lack of political will. The report’s being released in conjunction with the 18th International AIDS Conference in Vienna.



Mitchell Warren, head of the AIDS Vaccine Advocacy Coalition, says the new report is called "Turning the Page."

“Turning the Page for us refers to the HIV prevention research world really entering a new period in its activity,” he says.

That new period comes 30 years into the HIV/AIDS epidemic.

Good news, bad news

“We’re at a point now where some really important recent discoveries have not answered all our questions, but have certainly helped take us into some new directions and really open up a new chapter in the search for additional options to prevent HIV,” says Warren.



AVAC
AVAC report released at 18 International AIDS Conference
Those recent discoveries include anti-bodies found in some HIV positive people that prevent the AIDS virus from entering cells. Then there’s last September’s results of the Thai vaccine trial, which proved a vaccine can offer some protection from infection.

But Warren says the good news comes at a time when researchers are facing a big obstacle – limited funding.

“Well, isn’t that just the way science is? Just as we’re getting some of the most exciting results, just as we’re getting new concepts to test, we’re reaching a point in the global environment where the economy just can’t support everything…. Clearly, this is all happening in the context of severe economic crisis,” he says.

It’s time to be “smarter,” he says, about research as funding levels off or decreases.

“We’re seeing a lot of competition for resources, which is inevitable in periods of scarcity. People saying we can’t afford to have disease specific programs. We need public health. We need good health systems. Other people saying the treatment programs that have been scaled-up over the last number of years have been the best investments in building health systems, while also dealing with the AIDS epidemic,” says Warren

A microbicide that works against HIV?

One of the major announcements expected at the 18th International AIDS conference is about a microbicide gel called CAPRISA 004.

“It’s a fascinating program. CAPRISA is the center of AIDS program of research in South Africa at the University of KwaZulu-Natal. And KwaZulu-Natal is one of the provinces of South Africa and it’s the one with the highest rates of HIV. And it’s been really the epicenter of the epidemic there,” he says

The research is funded by the South African government and USAID. Clinical trial results for CAPRISA 004, which contains HIV fighting drugs, will be released on July 20.

“Whether that result is positive or if is a flat result or something in between – something that we’re not quite sure what it is – it is the first ever anti-retroviral containing product. So it really does open up a new world of learning,” he says.

Warren says when it comes to HIV/AIDS, people must be ready to be surprised. He adds, “The greatest advances…have come about because people and institutions refused to accept conventional wisdom about what was possible.”

Antibiotics Might Protect Against Malaria

People at high risk of contracting malaria might be protected by taking a combination of simple, inexpensive antibiotics. That is the finding of a new study by researchers who say the drugs rally the body's immune system against the mosquito-borne parasite.

Malaria infects an estimated three million people around the world each year and causes as many as one million deaths - most of them children in sub-Saharan Africa.

So far, experimental vaccines offer only partial protection against malaria, which causes high fever, chills, body aches and at worst, brain complications leading to death.

But a team of researchers has found that a combination of two widely available and inexpensive antibiotics - clindamycin and azithromycin - provided laboratory mice with protection against the parasitic illness.

Researchers say the antibiotic cocktail, given once a week at the height of malaria season, has the potential to protect people living in endemic areas and may even offer life-long protection the same way a vaccine would.

Steffen Borrmann is with the Heidelberg University School of Medicine in Germany and the Kenya Medical Research Institute in Kilifi.

"Here we would only give a drug periodically, as in peak transmission seasons in malaria endemic areas," said Steffen Borrmann. "And the hope is that this would generate protection for subsequent reinfections."

The antibiotics stimulate a strong protective immune response against the malaria parasite while it is in the liver of an infected individual, the symptomless first stage in the parasite's life cycle.

Borrmann says the immune reaction causes cellular changes that make it impossible for parasitic spores released into the bloodstream to infect red blood cells, the second stage of the life-cycle that causes life-threatening malaria symptoms.

The parasite then dies because it cannot infect the red blood cells it needs for sustenance.

Borrmann says that in an experiment with mice, those treated with antibiotics were protected when scientists exposed them to the parasite.

"It prevented [the conversion] to the pathogenic [the symptomatic] blood stage," he said. "That's the one thing that's been known for some time. We have established that this is the mode of action. But secondly, for subsequent reinfections again via the mosquito route, the animals are protected."

Borrmann says he is not concerned that frequent and widespread use of the antibiotics, including azithromycin, might lead to drug resistant strains of malaria. He points to the use of the drug in the treatment of trachoma, a serious bacterial infection of the eye.

"So far, when, for instance, azithromycin has been used for mass treatment of trachoma in African countries over a year, there wasn't any evidence for the emergence of bacterial resistance," said Borrmann. "But that has yet to be seen, of course. That will be seen as part of one of the first clinical studies."

Borrmann says the trials could begin almost immediately because the drugs are easily available at very little cost.

The study demonstrating antibiotic protection against malaria is published in the journal Science Translational Medicine.

Genes Predict Who Will Live to Age 100

Researchers at Boston University have identified a kind of genetic signature in people who are likely to live to age 100 or older. The technique may also help doctors predict whether you're likely to get a disease, decades before the symptoms show up.

Living a long, healthy life tends to run in families. If your grandparents and parents lived into their 90s and remained relatively healthy until the end, there's a pretty good chance you will, too.

So it's pretty clear genetics plays some role in longevity.

In this study, the research team developed a new statistical way of analyzing the genetic code of people who had reached age 100 as compared with people who had a more typical lifespan. Tom Perls, who heads the New England Centenarian Study, explains what they found.

"We discovered 150 or so genetic markers that can highly predict whether or not a person has the genetic propensity to live to extreme old age."

Using just that large number of genetic markers, the team was able to predict in almost four out of five cases whether a person would live to be 100.

Perls says the key to successfully predicting long life was the sophisticated statistical analysis of many different gene variations that each played some role.

"And that's what this method does - it captures the complexity of the puzzle and the interaction of all these genes together to produce exceptional longevity."

Perls and his colleagues publish their study in the online edition of the journal Science.

The Boston University researcher says this kind of analysis could play a role, not just in predicting who will live longest, but in actually helping people live longer and healthier lives.

In an interview via Skype, Tom Perls said the same technique used to predict long life may also be used to predict whether a person might eventually develop certain diseases. He gave the example of Alzheimer's Disease as one in which genetics plays a role.

"And we think that this methodology can very much be used to capture the bunch of genes that are playing an important role in one's susceptibility to that disease," he said. "And the same can be true, perhaps, for looking at adult-onset diabetes, or cardiovascular disease, or stroke. Again, where I think there is at least a moderate impact from genetic variation."

As the cost of the needed genetic tests continues to decline, he predicts doctors will be able to screen patients for diseases they may not develop until later in life, and recommend ways to avoid them.

Tumors Shrink When Mice Live in Stimulating Environments

New research has found that mice with cancer are better able to fight off the disease when they are in complex, stimulating environments, with lots of toys and other mice that they interact - and compete - with. Although this was an animal study, the scientist behind it thinks it could signal new ways of treating cancer in people.

The study involved genetically-identical mice with cancerous tumors. Some mice were put in standard laboratory cages, in groups of five or so, with plenty of food and water. Another group lived in what the researchers call an enriched environment up to 20 mice per cage, with toys, hiding places, and running wheels.

"And what was surprising to us was that [in] the animals in the enriched environment, the cancers are 40 percent smaller" after just three weeks, said lead author Matthew During of Ohio State University. "When we moved that enrichment to six weeks, now, the cancers were approximately 80 percent smaller - a dramatic effect, and not only that, but 17 percent of those animals had no tumors whatsoever."

It took several years of further experiments and analysis, but During and his colleagues ultimately concluded that the mild stress of all that activity and interaction activated a communication channel that prompts fat cells to stop releasing a hormone called leptin, which accelerates cancer growth.

"The crux of what this study is all about is that we define a new pathway where the brain talks to fat," he said. "And the brain is activated by this challenging environment and signals to the fat to stop the release of this hormone. And this particular hormone stimulates and feeds the cancer growth, essentially. And that's the simplest analysis of what we showed."

During's field is gene therapy, so he's working on a way to recreate that effect by modifying the gene that controls the leptin hormone. But the study also suggests a more low-tech solution might be helpful.

"Being more socially engaged in your community - maybe in environments which aren't always just the same, a little bit more challenging socially - may be a very good thing. So I think this study gives investigators who are working with cancer survivors some ideas as to how best, perhaps, to think about prescribing a lifestyle," said the scientist.

Matthew During's paper on how the mild stress of an enriched environment can change the production of hormones related to cancer growth is published in the journal "Cell."

Low vitamin D levels 'linked to Parkinson's disease'

Having low vitamin D levels may increase a person's risk of developing Parkinson's disease later in life, say Finnish researchers.

Their study of 3,000 people, published in Archives of Neurology, found people with the lowest levels of the sunshine vitamin had a three-fold higher risk.

Vitamin D could be helping to protect the nerve cells gradually lost by people with the disease, experts say.

The charity Parkinson's UK said further research was required.

Parkinson's disease affects several parts of the brain, leading to symptoms like tremor and slow movements.

30-year study

The researchers from Finland's National Institute for Health and Welfare measured vitamin D levels from the study group between 1978 and 1980, using blood samples.

They then followed these people over 30 years to see whether they developed Parkinson's disease.

They found that people with the lowest levels of vitamin D were three times more likely to develop Parkinson's, compared with the group with the highest levels of vitamin D.

Most vitamin D is made by the body when the skin is exposed to sunlight, although some comes from foods like oily fish, milk or cereals.

As people age, however, their skin becomes less able to produce vitamin D.

Doctors have known for many years that vitamin D helps calcium uptake and bone formation.

But research is now showing that it also plays a role in regulating the immune system, as well as in the development of the nervous system.

Vitamin target

Writing in an editorial in the US journal Archives of Neurology, Marian Evatt, assistant professor of neurology at Emory University School of Medicine, says that health authorities should consider raising the target vitamin D level.

"At this point, 30 nanograms per millilitre of blood or more appears optimal for bone health in humans.

"However, researchers don't yet know what level is optimal for brain health or at what point vitamin D becomes toxic for humans, and this is a topic that deserves close examination."

Dr Kieran Breen, director of research at Parkinson's UK, said: "The study provides further clues about the potential environmental factors that may influence or protect against the progression of Parkinson's.

"A balanced healthy diet should provide the recommended levels of vitamin D.

"Further research is required to find out whether taking a dietary supplement, or increased exposure to sunlight, may have an effect on Parkinson's, and at what stage these would be most beneficial."

A stem cell therapy for osteoarthritis is to be tested on patients in the UK for the first time.

Survival rates for some cancers have doubled over the past four decades, a charity has said.

People with breast, bowel and ovarian cancers, and non-Hodgkin's lymphoma, are now twice as likely to survive for at least 10 years than in the 1970s.

Cancer Research UK's figures show leukaemia survival is now four times as high, although the charity warned there was still much work to do.

The Department of Health said it was "delighted" by the findings.

Launching a television campaign, the charity said investment in research was key to further boosting survival.

The figures go back to the early 1970s and include estimated survival rates for the latest diagnoses made in 2007.

In breast cancer, 10-year survival has jumped from less than 40% to a predicted 77% currently.

And half of people diagnosed with bowel cancer are now expected to survive at least 10 years compared with 23% in the 1970s.

Continue reading the main story
“
Start Quote
We need to develop even more effective treatments that can prolong life further and we need to ensure that each individual patient has optimal treatment”
End Quote
Harpal Kumar

Cancer Research UK
For ovarian cancer and non-Hodgkin's lymphoma, survival has increased from 18 to 35% and from 22 to 51% respectively.

In cancers such as oesophageal cancer and myeloma, although survival rates are still very poor at below 20%, rates have improved almost threefold over the past few decades, Cancer Research UK said.

However, some other cancers have shown little improvement, most notably lung and pancreatic cancer, the figures show.

'Real progress'

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "There are many reasons for our continuing success in the fight against cancer, including faster diagnosis, better surgery, more effective radiotherapy and many new drugs, all developed using the knowledge that our laboratory research has given us."

He said with further investment in research, he expected the trend to continue.

Professor Michel Coleman, an expert in statistics at the London School of Hygiene and Tropical Medicine, who calculated the figures, said the survival data reflected "real progress" in cancer diagnosis and treatment.

"Ten-year survival figures for patients diagnosed in 2007 are of course predictions, but they are derived from the latest national data on cancer patient survival - and for most cancers, the true 10-year survival for these patients will turn out to be higher than we report."

The figures prompted Professor Mike Richards, the Department of Health's national cancer director, to say: "We are delighted to note these improvements in cancer survival.

"Improving health outcomes is a key priority for the coalition government and will be a major focus of the forthcoming review of the Cancer Reform Strategy."

Harpal Kumar, Cancer Research UK's chief executive, said the improvements being seen in cancer care were "encouraging, but we have to do better".

"We need to develop even more effective treatments that can prolong life further and we need to ensure that each individual patient has optimal treatment."

Stem cell therapy 'first' in trial on arthritic knees

A stem cell therapy for osteoarthritis is to be tested on patients in the UK for the first time.

A year-long trial, funded by Arthritis Research UK, will mix stem cells with cartilage cells in the lab and inject them back into damaged knee joints.

The new treatment could be an alternative to joint replacement surgery, experts hope.

Scientists from Keele University will study up to 70 people from the end of this year.

The trial will be run at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire as part of a five-year research programme.

Three treatments are being tested in a randomised trial of patients with osteoarthritis of the knee.

Cell therapy

Using keyhole surgery, a patient's cartilage cells - also known as chondrocytes - and bone marrow stem cells will be removed and grown in a laboratory for three weeks.

Continue reading the main story
“
Start Quote
We are using the body's own cells to repair damaged joints. The hope is that it will be permanent and long-term”
End Quote
Professor Sally Roberts,

Keele University
They will then be re-implanted separately in some patients, and mixed together in other patients, into the area of damaged or worn cartilage.

Scientists will then test the effectiveness of all three types of cell therapy, based on the quality of the new cartilage formed over a period of 12 months.

Chondrocytes - cartilage cells - have been grown in a lab and re-injected into patients' damaged knees for the last 15 years.

But scientists now want to find out if combining cartilage cells and stem cells in the same process could work better, and specifically if one type of cell stimulates the other.

Less invasive

AdvertisementProf Richardson from the Orthopaedic Hospital explains how the trial works
Osteoarthritis affects an estimated 8m people in the UK.

The condition is caused by wear and tear to the surface of joints, leading to stiffness and pain.

At present there is little effective treatment for osteoarthritis patients, apart from pain-relieving drugs and joint replacement.

The trial will focus on knee joints, but the results could have implications for other joints, say the scientists.

The advantage of stem cell treatment is that it's much less invasive than major joint replacement surgery.

Sally Roberts, professor of orthopaedic research at Keele University and lead scientist on the trial, says it's also a more "biological approach".

"We are using the body's own cells to repair damaged joints. The hope is that it will be permanent and long-term repair," she said.

But, even if successful, the treatment won't be used on everyone with osteoarthritis.

"Surgeons don't want to put implants into young patients in their 30s, so we are targeting these people for the use of this cell therapy if we can produce robust new cartilage cells.

"Stem cells certainly have huge potential - we just need to learn how to harness it properly," she added.

Jane Tadman, spokesperson for Arthritis Research UK, said: "This is just the start of developing this technique, and it could be a few years before such treatment will be in routine use."

Syringes beat spoons for children's medicine

Parents should avoid using household teaspoons to give children medicine as sizes can vary widely, leading to both under- and overdoses, a study warns.

US and Greek researchers looked at teaspoons in 25 households and found that the largest was three times the size of the smallest.

They also found that when asked to use 5ml medicine spoons, people poured in varying quantities.

To avoid dosage differences, the team urged parents to use syringes.

The study in the International Journal of Clinical Practice looked at more than 70 teaspoons collected from 25 homes in Greece.

Low risk

The team from the Alfa Institute of Biomedical Sciences in Athens suggested that a parent using the largest domestic teaspoon would be giving their child nearly three times as much medicine as the smallest.

Most households in the study had between one and three different teaspoons, but two women had six.

"We not only found wide variations between households, we also found considerable differences within households," said Professor Matthew Falagas, the lead author.

In addition, when they asked five people to measure out medicine in a calibrated 5ml spoon, they found that only one gave the correct dose.

Syringes are increasingly given out with over-the-counter medicines such as child paracetamol and ibuprofen.

The risks of harm occurring as a result of parents giving too much of these products in a single dose is thought to be very small indeed.
Source:BBC.co.uk

Undiagnosed Diabetes Patients May Also Have Undiagnosed Kidney Disease

Millions of Americans may have chronic kidney disease (CKD) and not know it, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).
“Our research indicates that much of the CKD burden in the United States is in persons with prediabetes and undiagnosed diabetes, who are not being screened for CKD,” comments Laura C. Plantinga, ScM (University of California, San Francisco). The researchers believe that broader screening may be needed to detect patients with these two “relatively silent yet harmful diseases.”
In a study funded by the Centers for Disease Control and Prevention, Plantinga and colleagues analyzed a nationally representative sample of about 8,200 Americans from the National Health and Nutrition Examination Survey. Standard laboratory tests were used to assess the rate of CKD, focusing on people with undiagnosed diabetes or prediabetes (sometimes called “borderline” diabetes).
Based on lab tests, 42 percent of subjects with undiagnosed diabetes had CKD—similar to the 40 percent rate in those with diagnosed diabetes. “Only a small percentage of participants were aware of the diagnosis of CKD,” says Plantinga.
In addition, CKD was present in nearly 18 percent of subjects with prediabetes. Among participants without diabetes or prediabetes, the rate of CKD was about 11 percent.
“Based on these results, there may be a substantial number of individuals in the United States—up to 13 million—who have undiagnosed diabetes or prediabetes and who already have signs of kidney damage and/or reduced kidney function,” says Plantinga. Such patients would be at high risk for worsening kidney disease and diabetes, and for the poor outcomes associated with both conditions—including cardiovascular disease and death.
Diabetes is the most important risk factor for kidney disease, but the new results suggest that harmful effects on the kidneys may be occurring even before diabetes is diagnosed. “Persons at risk for diabetes and their health care providers should be aware that earlier screening for both diabetes and kidney disease may be warranted,” says Plantinga. “Earlier screening would allow for appropriate, timely medical care to prevent further progression and poor outcomes.”
In an accompanying editorial, Gary C. Curhan, MD, ScD (Brigham and Women’s Hospital, Boston, MA) calls for CKD screening to be extended to patients with prediabetes. Curhan also suggests that it may be time to consider the concept of “pre-CKD”—identifying patients at a very early stage of CKD when the disease may still be preventable or reversible.
Although the study shows an association, it cannot determine whether the development of CKD followed the development of diabetes, or whether CKD was actually caused by diabetes. There is also likely some misclassification of both diseases, although the association remained significant when tested under a range of different assumptions.
Study co-authors include Deidra C. Crews, Josef Coresh, Edgar R. Miller III (Johns Hopkins University, Baltimore, MD), Rajiv Saran, Elizabeth Hedgeman (University of Michigan, Ann Arbor), Jerry Yee (Henry Ford Hospital, Detroit, MI), Meda Pavkov, Mark S. Eberhardt, Desmond E. Williams (Centers for Disease Control and Prevention, Atlanta, GA), and Neil R. Powe (University of California, San Francisco) on behalf of the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team.
Disclosures: The authors reported no financial disclosures.
Source: Clinical Journal of the American Society Nephrology (CJASN), “Prevalence of Chronic Kidney Disease in US Adults with Undiagnosed Diabetes or Prediabetes,” (doi 10.2215/CJN.07891109) and the accompanying editorial,” Pre-Diabetes, Pre-Hypertension…is it time for Pre-CKD?” (doi 10.2215/CJN.01650210)
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Kids with Sickle Cell Disease More Likely to Have Physical and Developmental Health Problems

The first national estimate on the health status of children with sickle cell disease revealed that black children with sickle cell disease are more likely to have intellectual disabilities, hearing deficits, and frequent severe headaches or migraines than black children without sickle cell disease. The study by the Centers for Disease Control and Prevention (CDC), “Health Status and Healthcare Use in a National Sample of Children with Sickle Cell Disease,” was published in the American Journal of Preventive Medicine.
The study found that black children with sickle cell disease are four times more likely to have fair or poor health status, twice as likely to have recently visited a mental health professional and have received special educational or early intervention services more often compared with black children without sickle cell disease.
Sickle cell disease is a group of red blood cell disorders that is inherited, passed from parents to children. In sickle cell disease, the red blood cells become hard and sticky, and take on a sickle shape. When the C-shaped cells travel through small blood vessels, they clog the vessels and can block blood flow. In addition, the sickled cells die earlier than normal blood cells, which creates a constant shortage of red blood cells.
“In the United States, sickle cell disease is one of the most common genetic disorders; more than 20 percent of children with SCD had recently visited a health care provider such as an optometrist or an ophthalmologist, and had more than one visit to the emergency department in the past year,” said Sheree Boulet, DrPH, with CDC’s Division of Blood Disorders. “The findings of this study emphasize the importance of screening children with sickle cell disease for thinking ability, hearing, and vision problems.”
Further, despite the increased use of health care services, the data showed that more parents indicated that they could not get an appointment for their child soon enough (10.5 percent, compared to 3.9 percent of parents whose children did not have SCD), reported waiting too long in the doctor’s office (8.7 percent versus 4 percent), and could not get through to their doctor on the telephone (7.5 percent versus 1.8 percent).
“This study gives a better insight into the types of disabilities children with sickle cell disease have and can help health care providers plan comprehensive treatments for children with the disease,” said Dr. Boulet.
The study analyzed data from the 1997–2005 National Health Interview Surveys (NHIS) to describe health status and health services use among black children 0-17 years of age with SCD. The NHIS has monitored the health of the nation since 1957; it is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). NHIS data on a broad range of health topics are collected through personal household interviews.
Source: Centers for Disease Control (CDC), March 23, 2010