Adult ADHD
Attention-deficit hyperactivity disorder (ADHD) has classically been known as a disorder of childhood, but it also affects an estimated 2%–6% of adults. Adults with ADHD are at a higher risk than those without the disorder of dropping out of school, losing their jobs and having marital problems. They typically have poor social skills and experience higher levels of anxiety and depression than the general population. Stimulant medications have been shown to produce clinically significant responses in adults with ADHD in placebo-controlled studies, and new medications and psychotherapeutic approaches are being developed to treat this patient group. Margaret Weiss and Candice Murray review the developmental course of ADHD in adults and discuss the literature on diagnostic assessment and management.
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See page 715
Banking umbilical cord blood
Umbilical cord blood is drawing increasing attention as a source of stem cells for the treatment of a wide range of disorders and as a possible means of increasing the donor pool and decreasing the waiting period for unrelated-donor bone marrow programs. The ethics of cord blood use have been extensively discussed in medical circles, but little is known about the views of parents. Conrad Fernandez and colleagues probed the knowledge and attitudes of 443 pregnant women on this subject. One of their key findings was that most of the women supported the donation of cord blood to public cord blood banks for potential transplantation and research.
See page 695
HIV screening
Mandatory reporting of HIV infection to public health authorities may deter people from undergoing testing. Gayatri Jayaraman and colleagues examined the frequency of HIV testing in Alberta before and after mandatory testing was implemented. They also examined the effect on testing rates among pregnant women in Alberta of an “opt-out” approach, whereby HIV testing is carried out routinely for all pregnant women who seek prenatal care unless they specifically choose not to be tested. They found that the introduction of mandatory reporting of HIV infection did not appear to decrease rates of testing. They also found that the opt-out prenatal HIV testing policy resulted in a dramatic increase in the number of females being tested for HIV infection. In a related commentary, Sharon Walmsley discusses the advantages and disadvantages of the opt-out approach to prenatal screening for HIV infection.
Poverty and hunger
Poverty affects about 1 in 5 children in Canada, and 41% of all poor children live in households headed by single mothers. Women with children who live in disadvantaged circumstances in Canada exhibit dietary intakes below recommended levels, but their children often do not. In a study carried out in Atlantic Canada, Lynn McIntyre and colleagues surveyed low- income lone mothers to determine whether they compromise their own diets to feed their children. They found that mothers' intakes failed to meet their requirements for total energy intake and a number of essential nutrients. In contrast, the children's intakes were consistently more adequate, except for folate and zinc. In a related commentary, Valerie Tarasuk describes how inadequate welfare incomes jeopardize the nutritional health and well-being of those Canadians who must rely on these programs.
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