Thalassemias and Cyprus

Junior (College 3rd year) ・Healthcare&Medicine ・APA ・35 Sources

Thalassemia is one of the most well-known and common Mediterranean disease and it is quite literally a disease of the blood. In this essay I will look at the difficulties and facilities that Thalassemia can have on children’s health in both Cyprus and the UK. The choice of the country of Cyprus is because of how common it is in that country and therefore there is a sense of more experience when it comes to the fields of health services, policies, as well as the social, environmental, economic and political influences that it can impact on a child’s health and life.
Thalassemia is an inherited blood condition, and like most genetic conditions there are many types and levels to a disease. There are two major types of Thalassemia known as and alpha and beta, and each type is then categorised into the severity of each strand or strain of the condition; there are of course mild thalassemia types which are called thalassemia traits, or thalassemia minor, and there are beta severe types known as, BTM (beta thalassemia major), BTI (beta thalassemia intermedia), and alpha severe types known as, Hb Barts and Hbh (moderate).
For children who have this disease and self-development can definitely be a major challenge as a lifelong issue, depending on the strand or type of thalassemia an individual, in this case, a child, may have. If the disease is one of the severe cases, then a child will most definitely have to go through blood transfusions, regenerations and chelation therapies. However, although the quality of life may be challenging, if not difficult, a child may easily adapt to the process this transfusion of blood. A healthy lifestyle must also be a set in place, such as avoiding smoking or drinking of alcohol, plenty of exercise, good nutrition and vitamins such as vitamin D, zinc and folic acid.
A variety of evaluations for thalassaemia happen to be derived for the distinct ethnic groups residing in the U.K., representing uncertainty over the true population value in specific states and the heterogeneity within and between countries of origin consisting of the same ethnic group. These were validated using the estimated range accurately forecasting the amount of affected births found by the programmes, against six community screening programmes. In England around 3000 affected infants (0.47%) take sickle cell trait and 2800 (0.44%) take β thalassaemia trait per annum; with about 178 (0.28 per 1000 concepts) affected by sickle cell disease (SCD) and 43 (0.07 per 1000) by β thalassaemia major/intermedia. Permitting for conclusion, about 140–175 (0.22–0.28 per 1000) affected babies are born yearly with SCD and from 10 to 25 (0.02–0.04 per 1000) with β thalassaemia major/intermedia.
All these are the primary evidence-based rates for sickle cell and β thalassaemia to be used in the U.K., and should underpin the future planning of services. The long term treatment for tracking changes in the speeds of disorder and characteristic in the people would be to introduce a standardized device for gathering ethnicity for a great many community screening programmes. The haemoglobinopathies (thalassaemias and sickle cell disease) are seen in several people and areas of the planet initially related to malarial endemicity and therefore are among the commonest inherited disorders in North-West Europe as an effect of migration (Fleming, 1992; W.H.O., 1987). Despite recent progress, individuals with one of these states endure significant morbidity (Charache et al, 1995; Modell & Petrou, 1983; Davies & Oni, 1997) and possess a shorter life expectancy (Zurlo et al, 1989; Modell et al, 1982; Platt et al, 1994) than the overall public.
In 1993 the U.K. Standing Medical Advisory Committee (Department of Health, 1993) advocated that pre-conceptual carrier identification for the states should be supported, and that antenatal and neonatal screening should be universal in districts where >15% of the population is from ethnic minorities. On the other hand, the SMAC report, although usually welcomed (Davies, 1993), got little attention. On the other hand, the Sickle Cell Disease Guideline Panel (1993) convened in the U.S.A. urged that all states carry out universal neonatal screening for sickle cell, because of the ethical and practical issues raised by targeting.
Present policy on screening in the U.K. was summarized by the Chief Medical Officer in 1994 (Calman, 1994), suggesting that the introduction of future programmes should depend on the signs that specific standards were satisfied, as described by Wilson & Jungner (1968) and updated by the National Screening Committee (1998). These stressed the health problem ought to be significant, okay screening tests successful, accessible and satisfactory interventions accessible, and also the cost effectiveness of screening shown. Previous research demonstrate that screening evaluations for haemoglobinopathies are dependable and relatively inexpensive (Lorey et al, 1994; U.S. Department of Health and Human Services, 1993), that for people affected by thalassaemia antenatal screening and following termination of affected pregnancies is okay (Modell & Bulyzhenkov, 1988), and that there are clear advantages conferred by screening and finding babies with sickle cell in order to begin life-going prophylactic penicillin (Gaston et al, 1986). Nevertheless, there is little economic evaluation of some great benefits of universal versus targeted haemoglobinopathy screening and also the U.K. service remains patchy (Streetly et al, 1993).
Certainly, knowledge of percentage as well as the amount of girls who take a haemoglobinopathy and of infants with clinically important disorder must help commissioners and haematologists strategy and assess the potency of screening programmes and services. Formerly, ethnic-specific estimates weren't accessible for the U.K.; present screening programmes didn't gather ethnic group reliably or consistently, and the evidence supporting earlier point approximations (W.H.O., 1987, 1985) was neither clear or directly transferable to people in the U.K.
Discussion continues within the capacity of policy to deal with inequalities that come from structural socioeconomic inequalities in a level that is broader. Whitehead et al (2000) claim that preventative and curative health services possess a part to play in boosting the health of deprived groups. In the exact same time, the relationship between the broader policy context as well as health is increasingly viewed as critical to understanding and tackling health inequalities. The World Health Organisation (WHO) maintains that reducing inequalities demands inter-sectoral actions to cure the small effect of actions within health services (WHO, 1996).
Policies to cut back inequalities in health in great britain happen to be created in the context of widening societal and economic inequalities during the 1980s and 1990s. The current UK government has established quite a few initiatives on schooling, employment and social security that target focus especially on poverty in youth and help to the weakest segments of society. On the flip side, other UK social security measures could be observed to get the contrary effect. Townsend (2000) points, by way of example, to the abolition of the connection between social security benefits and income, restraints on the worth of Child Benefit, the abolition of single parent allowances and making-related add-on to Incapacity Benefit and also the promotion of means-tested benefits over worldwide social insurance and non-contributory benefits. He claims that policies impacting income needs to be analyzed for his or her effect on the structural distribution of income as well as the results for folks’s health (Townsend, 2000, pxvii).
A further point that is significant is the results of inter-sectoral actions to handle the root factors behind health inequalities tend to be long-term. There's evidence that strategies to boost equity in health care supply may make a difference in the shorter period, especially where resources are directed at specific groups (Abel Smith et al, 1995; Whitehead et al, 2000). For instance, strategies to boost accessibility of groups that are specific to pregnancy or child health services might possess a somewhat short term effect on health status.
A third stage is the fact that services can be incorporated by strategies inside the healthcare system . A more powerful public health orientation in health policy empowers the broader determinants of health to be considered in the deployment of resources (Raphael, 2000). Commissioning powers in public health can be utilized to fix, by way of example, environmental or community services.
Facets of inequalities. Inequalities in access to health care as well as in health are experienced otherwise between and within classes and social groups. Key aspects include:
Geographic: Included in these are rural and urban versions as well as the kind and amounts of inequalities within areas. Geographic variables will also be related to policies on decentralisation of decision making along with the participation of local people within the policy process.
Socioeconomic: Various measures of socioeconomic standing, including schooling and home, happen to be created to enlarge on work-related class differences revealed in the 1980 Black Report (Townsend and Davidson, 1982). Ethnic/ethnic: Included in these are observation of variations in health of and using services by different ethnic and cultural groups, enhancing race equality strategies and cultural consciousness in the healthcare system and measures to enhance services of concern to specific minority groups like sickle cell anaemia and thalassaemia. Sex-based variations in gender equity and health status in health care are essential factors. At a broader level, the effect of developments in employment patterns and family structure on the healthiness of women and men must be considered.
Morbidity and demographic trends across Europe have resulted in a concentration of higher levels of chronic illness and mortality in elderly age groups among elderly individuals, resulting in concern over escalating prices and demand. There's evidence of discrimination against old individuals and of rationing on the grounds old of specific services.

Association between variables

There's a significant measure of overlap between the preceding variables. As an example, policies on enhancing maternal health should consider equity of access to health care for women in girls as well as minority ethnic groups who live in housing estates inhabited mostly by poorer families. Consequently, the development of tactical actions to accomplish quantifiable and tangible results is a complicated job, requiring both long-term and brief views. Additionally, there are strains involving the aforementioned variables when it comes to policy precedence and differences within. By way of example, the Acheson Report advocates putting a higher priority on policies geared toward improving health and reducing inequalities between girls of childbearing age, expectant mothers and young kids (DoH, 1998b). In precisely the same time, there's increasing demand to satisfy with the wants of elderly, individuals that are chronically ill.

Life course views

A further significant problem to think about is the influence of variables within the complete life lessons – for example, the impact of poverty and deprivation in youth on well-being in old age. The association between socio-economic health and variables on the life class is complicated and also a snapshot of socio-economic well-being and status in maturity creates only a partial image. Benzeval et al (2000) identify ‘income possibility’ and ‘health capital’ as possible mechanisms that link youth and adult well-being. Income possibility contains the collection of education and skills that impact adult employment capability and, therefore, socioeconomic standing. Health capital comprises physical and psycho-social resources acquired and inherited in youth that effect well-being in later life. The long term effects of youth and early adulthood encounters, including proper schooling and family and community life, should be taken into consideration in developing policies to cut back inequalities within the life lessons (Benzeval et al, 2000).

The global policy context

The World Health Organisation’s definition (WHO, 1974) of health as “… not just the lack of disorder, however a state of complete physical, mental, religious and societal wellbeing” whilst receptive to criticism as utopian, reminds us that inequalities in health is unable to be understood by reference to mortality and morbidity data alone. It begs the inquiry of how health measured is understood and identified in policy making. The WHO has later developed its social model of health, referring to well-being as a “resource for ordinary life” and as “a positive concept emphasising social and personal resources in addition to physical abilities” (WHO, 1984). The fundamental guiding principles of the Healthy Cities Programme, by way of example, would be the decrease in inequalities in health, working to attain social development along with a dedication to sustainable development (WHO, 1997).
Equity, encouraging equal opportunities for health and health care, including actions to fight the wellness of minority ethnic groups to increase,
• Community involvement, boosting the ability of local individuals to take part in their communities impacting,
• Intersectoral cooperation, including actions for health with a variety of governmental and non-governmental organisations, the commercial and private sectors
• Sustainable development, including environmental strategies, like home and energy efficient transportation.

European health policies

The Health for All 2000 programme has affected policy in several states and there's now widespread acceptance of its own fundamental philosophical strategy among authorities in Europe (see for example Saving Lives: Our Healthier Nation, 1999, in the UK). Additionally it is vital that you consider also how the thoughts of the Health for All 2000 programme may continue to affect policy through community groups and voluntary organisations which are active in health and environmental -related tasks. The Healthy Cities network, for instance, has major influence on community health jobs that goes past the cities that are participating.
European authorities differ when it comes to the precedence given to reducing inequalities. Germany, for instance, revealed little excitement for the Well-Being for All 2000 initiative. Primary care is still in a comparatively poor position in Germany, although there's a higher priority among policy makers as well as people on availability to services. In Norway, a similarly high priority is put on enhancing use of healthcare. Especially, investment has enlarged the variety of services accessible to elderly individuals, people who have mental health difficulties and people who have learning disabilities have (European Observatory on Health Care Systems, 2000).

Macroeconomic policies in all European states are geared towards keeping tight controls on public spending, including spending on healthcare and developing economical competitiveness. The WHO’s Regional Office for Europe notes the pressures on health care reform as well as the challenge of balancing the moral imperative of “keeping solidarity as well as the societal good character of health care” on the one hand and also the financial imperative of “pursuing cost control” about the other (WHO, 1996, p4).
As the expectations of the people for improved health services and equity of access must be balanced contrary to the economic imperative of controlling costs, these pressures are reflected by British health policy. But in which a high priority is set on reducing inequalities it might be asserted that added costs shouldn't be thought of as inefficiency but as an essential facet of achieving a policy aim.

Common tendencies in health policies

• Reexamination of the construction of administration in health care systems and also the relationship between market and state.
• Decentralisation of service supply both geographically and from state.
• Greater selection and participation of citizens and service users in healthcare supply and planning.
• The evolving role of health boosting action outside health care systems of public health and knowledge.
(WHO, 1996)
Although they affect the variety of potential approaches for handling them, not one of the tendencies expressly addresses inequalities in well-being. As an example, the shifting function of the private sector influences the promotion of local ventures. The promotion of primary and public health care interests is firmly related to reducing inequalities. Nevertheless, policy aspirations and statements on developing principal-directed health services and strengthening public health functions are often not matched by actions (Barker and Chalmers, 2000).
Differences can be found between states in the extent to which health policies plan to improve overall standards of well-being as an alternative to focus on inequalities in particular (Shaw et al, 1999). Reaching a balance between these two objectives can be debatable, specially in the context of increasing consumer sway in health supply. Policies may also have surprising results, by way of example, encouraging screening and immunisation programmes across the board may in fact bring about increased rates of inequalities since higher income groups may make greater use of them (Abel Smith et al, 1995).

Great Britain circumstance

Health policy in great Britain level proceeds to emphasize effectiveness and efficiency in the NHS whilst putting renewed emphasis on equity. Klein (2000) claims the results of current policy will probably incorporate heightened public expectations that'll be hard to balance against pressure to keep prices down. This strain is apparent in the UK NHS Strategy that stresses the need for meeting with public expectations for health care but stops short of covering the expense of long term care for elderly individuals. This conclusion continues to be roundly condemned by organizations of and for elderly individuals, for example Age Concern, and is contrary to the recommendations of the Royal commission on Long Term Care (Royal Commission on Long Term Care, 1999). In addition, it compares using the conclusion of the Scottish Parliament on long term care for elderly individuals (Pollock, 2001).
The introduction of Trusts and Primary Care Groups is a vital initiative to advertise a principal-directed service also to improve the functions of an assortment of professionals in the working level. In once the decreased function of Health Authorities shows a centralisation of standards of tracking and strategic planning. These organisational reforms have consequences for the execution of strategies to tackle the range of activity along with inequalities in medical care in the neighborhood level.

Signs of inequalities

Modern health policies draw on evidence from numerous studies from your Black Report (1979) to the Acheson report (1998). Key findings include:
• The power of the signs of the connections between socio-economic loss and disadvantage and poor health
• The comprehensive range of policies to reducing inequalities related
• The need for long- and short term strategies
• The purpose of primary health services in enhancing the well-being of the worst away.
• The inadequacy of focus to medical needs of ethnic minority groups
• The significance of up to date and precise data on well-being in the neighborhood grade.
Therefore, the significant link between socioeconomic and health inequalities is firmly established. Talking at the Royal College of Physicians in February 2001, the Secretary of State for Health, Alan Milburn claimed for the vicious cycle of ill health, unemployment and poverty to be busted (DoH, 2001). The European Observatory on health care systems notices the British strategy as an important shift (European Observatory on Health, 1999).

Resource apportionment

Throughout its history, fair apportionment of resources, especially between areas, is a challenge for policy makers virtually considering that the foundation of the NHS. In 1975, the Resource Allocation Working Party (RAWP) created a weighted capitation formula to deal with regional inequalities in health and ensure an equitable distribution of resources according to desire. The Black Report (Townsend and Davidson, 1992) supported the fundamental principles of the RAWP formula but identifies three inadequacies:
1. Inconsistent and insufficient use of both principles and also the methodology of the formula.
2. Short measure of demand itself. Attention was brought to placing indexes, including overcrowding that have been omitted.
3. Insufficient awareness of the amount of resources together with the use allocated in almost any area.
In its evaluation of health inequalities after the Black Report, The Health Divide (Whitehead, 1992) draws focus variations within regions also to sub-regional places of deprivation that were really worse off beneath the revised weighted capitation process introduced underneath the Conservative Government in 1992.
The Review of RAWP created in 1985, thought to fine tune the RAWP formula, marked an important part of developing policy choices on resource allocation according to empirical data on varieties and amounts of demand as opposed to on informed judgements.
The Acheson Report (DOH, 1998b) makes four specific recommendations (38.1-38.4) on resource allocation:
1. A “rate of shift” policy to empower more rapid progress to be furthest from their capitation targets made by health authorities.
2. An extension of the “needs based weighting” principle to non-cash limited GMS resources and an evaluation of effectiveness as well as the size of deprivation payments.
3. A review of effectiveness as well as the size of Community Health Services formula and the Hospital and thought of a stronger focus on health promotion and primary health care.
4. A review of the relationship using a proposition that present inequalities are compounded by this.
The Acheson Report also urges that Directors of Public Health make routine equity profiles that are ‘ triennial and ’ audits of progress towards attaining goals of reducing inequalities in health. In addition, it focuses on local partnerships to lessen inequalities and urges that there needs to be a “duty of venture involving the NHS Executive and regional authorities to make sure that these ventures operate efficiently” (DoH, 1998b Para, 39.1).
Morbidity and mortality associated with thalassemia happen to be reduced significantly with modern clinical treatment, and quality of life (QOL) should now be considered a vital index of efficient healthcare. An evaluation of QOL differs from other sorts of evaluation that is health because it centers around the people' own perspectives of the wellbeing and evaluates other features of life, giving a holistic perspective of wellbeing. There's quite little published work on assessment of QOL in thalassemia. A tool that is proper needs to be reproducible, sensitive to the important options that come with the state that change patients' lives, and appropriate in the number of age, distinct ethnic, and societal settings. This kind of instrument will be useful in comparing health outcomes between different practices as well as in assessing new sorts of treatment. Two devices happen to be evaluated, one derived from your WHOQOL 100 survey, and one designed especially for thalassemia, which evaluates clinical and psychosocial weight, as they change kids, parents, and adult patients. Evaluate and additional studies have to develop such tools to be used in thalassemia. Another tactic is to seek patients' own perspectives of the treatment that is routine as well as the extent to which QOL changes. Results from patient surveys in Cyprus and Great Britain are consistent in finding difficulties with organization of inadequate alternatives with chelation therapy, transfusions, and poor communication. Practical measures might be taken to address these problems.
History Thalassaemia Major (TM) is a critical illness characterized by lifelong reliance on blood transfusions and chelation therapy. Our objective was to ascertain health-related quality of life (HRQOL) in children with TM living in the united kingdom, as well as the effect of caring for a child getting National Health Service treatment on family financing.
Procedures This was a cross sectional evaluation of HRQOL in children (n= 22) with TM aged 8–18 years. Kids were recruited from three UK Paediatric Haematology and Bone Marrow Transplant centers. Moms completed measures in their kid's HRQOL [PedsQL™ 4.0 (Measurement Model for the Pediatric Quality of Life Stock™, James W. Varni PhD, PedMetrics™, Quantifying the Qualitative SM, Copyright 1998–2009)] and behavior (Strengths and Difficulties survey), and the impact of caring for the kid on family financing.
Kid HRQOL was less than population standards although results Kid behavior was within the standard range. Family fiscal concerns connected with TM were correlated with poorer child HRQOL (P= 0.020).
Decisions Thalassaemia Major presents a large challenge to kid HRQOL, nicely recorded in aspects of the world where TM is common. In spite of the accessibility to financial advantages and National Health Service care our study indicates the same weight in great britain.
Important improvement continues to be reached in the control of congenital disorders, the majority of which has helped industrialized nations. Little edge accrued to developing countries, nearly all of which in the same time frame reached a major epidemiological transition, leading to congenital disorders reaching public health importance. The load of congenital disorders in these lower-resource countries is high plus they must come up with medical services that are genetic. The post Medical Genetics In Developing Countries (Christianson & Modell, 2004) presents a new practical strategy for the care and avoidance of congenital disorders in these states, initiated initially from the World Health Organization.


Modell B, ed: Guidelines for the control of haemoglobin disorders. World Health Organization 1994
Cao A, Gabutti V, Galanello R, Masera G, Modell B, Di Palma A, Piga
A, Vullo C, Wonke B: Management protocol for the treatmentof thalassemia patients.Thalassemia International Federation. Nico-sia, Cyprus 1997
Olivieri NF, Nathan DG, MacMillan JH, Wayne AS, Liu PP, McGee A,Martin M, Koren G, Cohen AR: Survival in medically treated patients with homozygous beta-thalassemia.N Engl J Med 1994,331:574-578
Zurlo MG, De Stefano P, Borgna-Pignatti C, Di Palma A, Piga A, Me-levendi C, Di Gregorio F, Burattini MG, Terzoli S: Survival andcauses of death in thalassemia major.Lancet1989, 2:27-30
Blowey DL, Hebert D, Arbus GS, Pool R, Korus M, Koren G: Compliance with cyclosporine in adolescent renal transplant recipients.Pediatr Nephrol1997, 11:547-551
Phipps S, DeCuir-Whalley S: Adherence issues in pediatric bonemarrow transplantation.J Pediatr Psychol1990, 15:459-475
Pidgeon V: Compliance with chronic illness regimens: schoolaged children and adolescents.J Pediatr Nurs1989, 4:36-47
Brittenham G, Griffith PM, Nienhuis AW, McLaren CE, Young NS,Tucker EE, Allen CJ, Farrell DE, Harris JW: Efficacy of deferoxamine in preventing complications of iron overload in patientswith thalassemia major.N Engl J Med1994, 331:567-573BMC Clinical Pharmacology 2002, 2 9 of 9
Gabutti V, Piga A: Results of long term iron chelating therapy.Acta Haematol1996, 95:26-36
Olivieri NF: The beta-thalassemias.N Engl J Med1999, 341:99-109
Hussain MA, Green N, Flynn DM, Hussein S, Hoffbrand AV: Subcutaneous infusion andintramuscular injection of desferriox-amine in patients with transfusional iron overload.Lancet1976, 2:1278-1280
Modell B, Letsky EA, Flynn DM, Peto R, Weatherall DJ: Survival anddesferrioxamine in thalassemia major.BMJ1982, 284:1081-1084
Ehlers KH, Levin AR, Markenson AL, Marcus JR, Klein AA, HilgartnerMW, Engle MA: Longitudinal study of cardiac function in tha-lassemia major.Ann N Y Acad Sci1980, 344:397-404
Cromer B, Tarnowski KJ: Non-compliance in adolescents: a re-view.J Dev Behav Pediatr1989, 10:207-215
Beratis S: Noncompliance with iron chelation therapy in pa-tients with beta thalassaemia.J Psychosom Res1989, 33:739-745
McGee A, Koren G, Liu P, Freedman M, Rose V, Benson L, Olivieri N:Cardiac disease-free survival in patients with thalassemia major treated with subcutaneous deferoxamine: an updateof the Toronto cohort.Blood1989, 74:311a Abstract 1172
Olivieri N: Randomized trial of deferiprone (L1) and deferox-amine (DFO) in thalassemia major.Blood 1996, 88(suppl1):651a Abstract 2593
Modell B, Khan M, Darlison M: Survival in beta-thalassemia major in the UK: data form the UK Thalassemia Register.Lancet2000, 355:2051-2052
Rees L: Compliance with growth hormone therapy in chronicrenal failure and post transplant.PediatrNephrol1997, 11:752-754
Wolff G, Strecker K, Vester U, Latta K, Ehrich JH: Non-compliancefollowing renal transplantation in children and adolescents.Pediatr Nephrol1998, 12:703-708
Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD: Persistencewith treatment for hypertension in actual practice.Can MedAssoc J1999, 160:31-37
Bush S, Mandel FS, Giardina PJ: Future orientation and life expectations of adolescents and young adults with thalassemia major.Ann N Y Acad Sci1998, 850:361-369
Goldbeck L, Baving A, Kohne E: Psychosocial aspects of beta-thalassemia: distress, coping and adherence.Klin Padiatr 2000,212:254-259
Sherman M, Koch D, Giardina P, Hymowitz P, Siegel R, Shapiro T:Thalassemic children'sunderstanding of illness: a study ofcognitive and emotional factors.Ann N Y Acad Sci 1985, 445:327-336
Yamashita R, Foote D, Weissman L: Patient cultures: thalassemia service delivery and patient compliance.Ann N Y Acad Sci1998,850:521-552
Rosenstock IM: The health belief model: explaining health behavior through expectancies.
In: Health Behavior and Health Education(Edited by: Ganz K) New York, Jossey-Bass 1989, 39-62
Willey C, Redding C, Stafford J, Garfield F, Geletko S, Flanigan T, Mel-bourne K, Mitty J, Caro JJ: Stages of change for adherence with medication regimens for chronic diseases: development and validation of a measure.Clin Ther2000, 22:853-871
Koch DA, Giardina PJ, Ryan M, MacQueen M, Hilgartner MW: Behavioral contracting to improve adherence in patients with thalassemia.J Pediatr Nurs1993, 8:106-111
Loukopoulos D: Current status of thalassemia and the sicklecell syndromes in Greece.Semin Hematol 1996, 33:76-86
Pearson HA, Guiliotis DK, Rink L, Wells JA: Patient age distribution in thalassemia major: changes from 1973 to 1985.Pediatrics1987, 80:53-57

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