Sickle Cell Disease from a Public Health Perspective: Lessons from the National Heart,Lung and Blood Institute (NHLBI)

This is a second topic I am sure many have heard about. Yes, we are talking about Sickle Cell Disease ( SCD). Sickle Cell Disease is caused by a genetic abnormality in the gene for hemoglobin, which results in the production of sickle haemoglobin. Hemoglobin is a protein that carries oxygen. Once oxygen is released from a sickle hemoglobin it sticks together and forms long rods which damage the shape of the red blood cells (WebMD). Abnormal hemoglobin is called haemoglobin S, this causes sickle cell disease (SCD).

SCD, is passed on from parents to children, it is not contagious and no one can catch like they catch a cold or an infection. People with SCD inherit one abnormal gene from both parents. When the person has inherited one abnormal gene then they are said to have an abnormal hemoglobin S. When they inherit both genes they are then said to have hemoglobin SS. Hemoglobin SS is called Sickle Cell Anemia. This is the most severe and most common SCD.

June 19th of every year, is set aside as the National Sickle Cell Day.  This year ( 2015) Dr. Gary H. Gibbons of the  National Heart, Lung and Blood Institute (NHLBI), shared the story of  Afia Donkor who is one of a handful of people to have undergone a successful bone marrow transplant to cure her disease.

The NHLBI also set the stage for an opportunity at the campus of the National Institutes of Health in Bethesda, Md., that will brought together diverse members of the sickle cell disease community, including patients and their families, advocates, health care professionals, professional societies, government agencies, and others.  As a community, we will discuss and strategize about the future of sickle cell disease research.  The forum will include panel sessions and discussions that focus on issues affecting those living with sickle cell disease, including sickle cell research, pain management, disease treatment, and other timely topics.

According to the NHLBI Website, in the United States, most people with sickle cell disease (SCD) are of African ancestry or identify themselves as black.

• About 1 in 13 African American babies is born with sickle cell trait.
• About 1 in every 365 black children is born with sickle cell disease.

There are also many people with this disease who come from Hispanic, southern European, Middle Eastern, or Asian Indian backgrounds. Approximately 100,000 Americans have SCD.

SCD can manifest in many forms: blockage of blood vessels, known as vaso-occlusive crisis; obstruction of smaller vessels by sickled red blood cells; pain crisis; injury to internal organs due to blockage of blood flowing to them which can cause ischemic injury. There are 6- more episodes per person annually. Other forms of pain and complication are :  malaria exacerbates effects of SCD; dactylitis; avascular necrosis; acute joint necrosis; abdominal pain; liver infarction; papillary necrosis; inability to concentrate urine ( isosthenuria); deep bone pain; fevers; acidosis; dehydration and chirped lips.  What does this inform us?

Some suggestions to make life better:

1. Improve on reception services for those in acute pain or crisis.

2. Establishing community and national awareness drives addressing SCD.

3. Anti-malaria drives such as universal practices ensuring no mosquito bites.

4. Provision of mosquito repellants and insecticides.
5. Provision of Folic Acid Supplements.
6. Translating literature on SCD in format that is understandable.
7. Providing education on partner testing for abnormal genes.
8. Training resource persons to provide care, management and interventions.
9. Establishing cultures fr testimony giving following Bone Marrow Transplants.
10. Provide opportunities for community engagement

SOURCES:

1. NHLBI

2. WebMD

3. NIH

Diesel from a Public Health Perspective: Lessons from California

I am sure you are a writer or someone who enjoys discussions about matters of everyday or not so everyday concern. In this series called "from a Public health Perspective," I hope to bring to the forefront themes, subjects and materials that have not been common in the dialogue or ethos of our realm of everyday life.

This will be part of doctoral and postdoctoral level works combining research, community health education, immunology, health and public health.

In the series I shall write a short narrative geared at provoking deeper understanding and critiquing. I hope you join in and help make this an educative platform. We need to bring more subjects into the conversational arena if we want to contribute to a critical mass of practices that engender care for others and the Earth.

This is the first of the series: Diesel from a Public Health Perspective!

Diesel is a product of Crude Oil, a mineral occurring naturally. When crude oil is processed at refineries, it can be separated into several different kinds of fuels, including gasoline, jet fuel, kerosene ( paraffin), grease, vaseline and diesel. A scientist called Rudolf Diesel contributed to the science of separating these fuels. Hence the name diesel. Diesel is heavier, corrosive, evaporates more slowly and has a higher boiling point than water. it is a popular product in that it has a higher energy density than gasoline (petrol).

Imagine, 1 gallon ( 3.8L) of diesel fuel contains about 155X10,000,000 joules. 1 gallon of gasoline contains 132X10,000,000 joules. Diesel engines get better mileage than equivalent gasoline engines.

Diesel engines are around us:  freight ship, vehicles, construction, generators, trucks, school buses, city buses, trains, cranes, farming equipments and emergency response vehicles. We rely on diesel to ship bulk goods.

Diesel emits very small amounts of carbon monoxide, hydrocarbons and carbon dioxide. These emissions lead to global warming. From this observation, we see it does not contribute to global warming. However, it produces very high amounts of nitrogen compounds and matter in particle form for example soot and sulphur. These lead to acid rain, smog and health hazards. According to the office of Environmental Health Hazard Assessment  (OEHHA) of California, exhaust from diesel engines contains substances that can pose a risk to human health. Diesel, is a complex mixture of thousands of gases and fine particles that contain over 40 toxic air contaminants some of which are suspected to cause cancer. These substances are:  nickel, benzene, arsenic, formaldehyde and harmful pollutants such as nitrogen.

People, animals, fish, birds and plants are exposed to toxic gases. It is more severe for organisms near or around objects that produce the exhaust. In humans, this particle pollution causes: emphysema, asthma, chronic heart and lung diseases, childhood illnesses and allergies.

So, we see that diesel is good in that it has been behind the development boom and increase in built infrastructure which is so central to our life. But, we have also seen the risky side of it to our life. What does this inform us?

Some suggestions to make life better:

1. Improve engines to reduce emissions.

2. Retrofitting  cars with particle-trapping filters.

3. Vigilance in tracking defaulters.

4. Use of alternative fuels ( propane, electricity, natural gas
5. Reduce idling time of engines.
6. Street cleaning.
7. Providing education to people about risk factors.
8. Putting up notices for the public as well as alerts.
9. Establishing Walking and cycling zones in cities or built urban areas
10. Pollution taxes/penalties.

SOURCES:

1. California Air Resources Board ( ARB) 

2. Energy Information Administration 

3. EUROPA

4. OEHHA (oehha.ca.gov)

5. The American Lung Association of California ( ALAC)