CHILDREN & YOUNG ADULTS
Sickle-Cell Transfusions Are
Found Critical
By WARREN E. LEARY
Published: December 5, 2004
ASHINGTON, Dec. 4,2004 - Children with sickle cell disease who are at
high risk of having strokes should continue to be treated with
periodic blood transfusions, according to researchers and federal
experts involved in a major clinical trial.
The National Heart, Lung and Blood Institute is to issue a clinical
alert on Sunday notifying doctors treating young people with sickle
cell anemia and related conditions to continue transfusion therapy for
these high-risk patients.
The trial, intended to see if transfusion treatment could be reduced in
these children, was stopped early last month when researchers found a
return to high risk of stroke in subjects who stopped receiving the
transfusions. The transfusions pose their own potential problems,
including damage to organs from iron overload in the body, adverse
immune system reactions to the foreign blood and increased chance of
exposure to blood-borne infections.
But the alert being sent by the institute, which is part of the
National Institutes of Health, advises doctors and other sickle cell
specialists that stopping transfusions cannot be recommended.
"This important study shows the value of continuing periodic blood
transfusions in preventing the serious and debilitating consequences
of stroke," Dr. Barbara Alving, acting director of the institute,
said.
Details about the Stroke Prevention Trial II, also known as STOP II,
are to be presented Sunday in San Diego at the annual meeting of the
American Society of Hematology. The study, begun in 2000 and expected
to run more than six years, was discontinued two years early after 79
of an expected 100 patients were enrolled at 23 clinical centers in
the United States and two in Canada. Subjects ranged in age from 6 to
20.
Doctors determined stroke risk in sickle cell patients with an
ultrasound technique called transcranial Doppler screening, which
measures the velocity of blood flow through blood vessels in the
brain. High velocity in a major artery is linked to narrowing of the
vessel, which increases the risk of a stroke.
When the study was halted, 14 of the 41 patients randomly assigned to
the group that had stopped getting transfusions reverted to being at
high risk of stroke. In addition, two patients in the group suffered a
stroke, the institute reported. There were no strokes or measurable
increased stroke risk in the group that continued with transfusions.
"It became very clear that you've got to continue to be transfused,"
Dr. Duane R. Bonds, the institute's sickle cell disease coordinator,
said in an interview. "We've learned that we now have to look to other
means to prevent strokes in this group and reduce transfusions and
their risks."
Sickle cell anemia is one of a family of inherited blood disorders
caused by a flaw in the gene that makes hemoglobin, the component of
red blood cells that carries oxygen. When low on oxygen, this flawed
hemoglobin causes blood cells to stiffen and contort into jagged
shapes. These distorted cells block small blood vessels and cause
vascular inflammation, leading to organ damage, stroke and other
problems.
The disease afflicts millions worldwide. In this country, an estimated
80,000 people, mostly African-Americans, have it.
About 10 percent of children with sickle cell disease are at risk from
stroke each year, Dr. Bonds said, a number estimated at 3,000 to
7,200. Results from the first Stroke Prevention Trial for Sickle Cell
Anemia, released in 1997, showed that administrating blood
transfusions every three to four weeks to children at high risk of
stroke reduced the rate of a first-time event by 90 percent.
The transfusions reduce the amount of abnormal, sickle hemoglobin to
less than 30 percent of the total, which cuts the stroke risk.
Dr. Robert J. Adams of the Medical College of Georgia, in Atlanta, the
lead center in the latest trial, said that while the first study
showed that transfusion therapy could prevent strokes and subsequent
brain damage, it did not show whether transfusions could be safely
stopped at some point, reducing risks of the therapy.
Source: New York Times
Minority Children Get Less
Sleep, Study Finds
Mon Oct 4, 2004
CHICAGO - Black children are less likely to get enough sleep than their white
counterparts, which makes them susceptible to poorer school performance and behavioral
problems, a study said on Monday.
The survey of 755 children found nearly half of 10- and 11-year-old minority boys -- most of whom were black -- got less than the nine hours of sleep a night recommended for the 8- to 11-year-old age group. Roughly one out of 10 minority boys got less than eight hours of
sleep.
Many more black children than whites in the study went to bed later at night, with nearly one-third having bedtimes after 11 p.m., wrote study author James Spilsbury of Case Western Reserve University in Cleveland. On
average, minority boys went to bed about a half-hour later than their nonminority counterparts but got up at about the same time -- 7:40 a.m.
The study did not specify a reason for the curtailed sleep, though it noted that minority boys in particular were
"often subjected to a number of adverse socioeconomic influences" that might play a
role.
Roughly one in eight U.S. elementary school children experience daytime sleepiness and about one in five are fatigued during the school
day, the report published in The Archives of Pediatric Adolescent Medicine
said.
Sleepiness can impair classroom performance and lead to aggressive
behavior, it said. Also, younger children who do not get enough sleep often go on to become sleep-deprived adolescents and
adults.
Health
- Reuters
The
Facts:
Unfit and obese children in
third and fourth grades who participated in exercise and nutrition
education classes reduced their cholesterol levels by 5 percent in
eight weeks.
Three of the most popular anti-drug
programs taught in schools have not been effective in stopping drug
use among children, a 2000 study suggests.
More than 5,000 elementary school
children who participated in an intensive health education program to
improve their diet and exercise maintained those improvements up to
three years later.
In a recent survey, nearly 90
percent of parents agreed that “teaching kids about how to keep
themselves healthy is as important as teaching them about reading,
writing and arithmetic.”
In the same survey, more than 80
percent of parents said that it was important for schools to offer
alcohol and drug abuse education, age-appropriate sex education and
nutrition and exercise education.
Health education is required in 86
percent of elementary school districts and 89 percent of middle and
high school districts, but only 64 percent of all districts employ
someone who oversees or coordinates health education.
Classroom programs to help
children manage asthma can also indirectly improve how their mothers
treat the condition at home, according to a 2001 study.
A 1999 study in South Carolina found
that 68 percent of high school students risked expulsion for smoking
on campus more than once, but only 6 percent of the schools offered
smoking-cessation programs for them.
Alcohol, tobacco or other drug use
prevention are among the most commonly required health education
topics in U.S. schools. Pregnancy and suicide prevention are among the
least required.
In 1999, 23 percent of high school
sex education teachers taught abstinence as the only method for
preventing pregnancy and sexually transmitted diseases, compared with
2 percent of teachers in 1988.
On average, public schools, urban
schools and schools with larger enrollments offer more
health-promoting programs, policies and facilities than smaller,
private and rural and suburban schools.
Teenagers who enroll in high school
driver education courses have the same number of speeding tickets and
motor vehicle-related crashes and deaths as those who do not take the
safety classes ###
