Racial and ethnic variation in ADHD, comorbid illnesses, and parental strain

Our objective was to understand the racial and ethnic variation in parental strain for non-Latino White, African American, and Latino parents of children with ADHD and other comorbid diagnoses. We selected 5,397 children with a current diagnosis of ADHD from the 2007 National Survey of Child Health (NSCH) and identified comorbid conditions that could cause additional parental strain. Multivariate regression analyses of parental strain, from ADHD plus comorbid physical and mental health conditions, varied by race and ethnicity in our sample. Additionally we found variables such as mother's mental health, family structure and social support to play significant roles in parental strain. These findings indicate a need for greater understanding of the family mechanisms in place that affect parental strain for these varying populations of families. Interventions to reduce parental strain also need to be tailored to the specific needs of racially and ethnically diverse parents of children with ADHD.     

Growth hormone and adrenal response to intramuscular glucagon test and its relationship to IGF-1 production and left ventricular ejection fraction in adult B-thalassemia major patients

In patients with b-thalassemia major (TM), the anterior pituitary gland is particularly sensitive to free radical stresses. It has been reported that the GH deficiency (GHD) may be secondary to either pituitary or hypothalamic dysfunction. The duration of the disease, the patient's age and the severity of iron overload are the most important factors responsible for the defect of growth hormone (GH) secretion. Recent reports have documented a frequency of severe growth hormone deficiency in 13%-32% of patients with b-thalassemia major. All of these patients underwent GH-releasing hormone (GH-RH) plus arginine (ARG) testing. We undertook the present study to evaluate the GH and adrenal response during glucagon stimulation test (GST) in patients with TM because the GH-RH plus ARG test in patients with hypothalamic GHD may be misleading. Thirty-three adult TM patients were recruited (mean age 36.6 years). Fifty four percent were included in the severe GHD group (GH peak below 3mg/l). The IGF-1 level in TM patients was consistently low (60.3 ± 35.3 mg/l) and 86.6% of patients with a normal GH response to GST had a low IGF-1 level. These findings are also indicative of a relative resistance to GH. In eight out of 18 TM patients (44.4%), the GHD was associated with hypogonadotropic hypogonadism. A positive correlation was found between GH peak after GST and IGF-1 level (r = 0.8, p: 0.003) and a negative correlation between the age of female TM patients and GH peak (r = 0.711, p: 0.007). All patients but one had no evidence of cardiac iron overload (mean T2* 30.4 ± 8.2 ms; range 14-44 ms). The mean LVEF (%) in TM patients was no different when compared to healthy controls. However, three patients with severe GHD and normal T2*were found to have reduced LVEF.One patient (4%) had a peak cortisol response to GST compatible to adrenal insufficiency. Nausea, headache and\or hypoglycemia occurred in 3 patients (12%) during GST. In conclusion, our study demonstrates that the presence of GHD is frequent in adult TM patients. According to the international guidelines for medical practice, we believe that before considering hormone replacement therapy, a second test to confirm the diagnosis of GHD and adrenal insufficiency is required.     

Twins and socioeconomic factors: changes in the last 20 years

Background: Socioeconomic factors associated with twins/multiples have been sparsely studied. Methods: Data, regarding twin out of total births from 1996 to 2015, were extracted from databases of the Hellenic Statistical Authority and analyzed.

Results: Twinning rate in Greece has increased from 1996 and onwards, in parallel with advanced maternal age and decline in total births. Higher twin rates are associated with higher maternal education, better paid parental occupations, and thus wealthier families, married maternal status, while immigrants present a lower twinning rate than Greeks. Lastly, the years of the economic crisis, starting in the year 2008 and still continuing, are characterized by a higher percentage of twins.

Conclusions: Our findings should be mainly attributed to the postponement of fertility, as well as the treatment of infertility with transfer of multiple embryos, when assisted reproductive technologies are applied.