Awareness Of Anemia Research Articles

Knowledge, Cultural, and Structural Barriers to Thalassemia Screening in Migrant Populations in Thailand

BACKGROUNDThalassemia syndromes are inherited hemoglobin (Hb) disorders that most severely affect Southeast Asia (SEA). As a result of population migration, thalassemia has grown into a global health issue, posing challenges to health services in many host countries. However, little attention has been paid to mass migration within SEA and its implications for regional prevention and control of Hb disorders. Thailand, with one of the highest burdens of thalassemia in the world, has a successful national prevention and control program, but ~4 million migrants living in Thailand, largely from neighboring countries, are excluded. Lack of thalassemia screening and diagnosis for migrants may undermine national efforts to prevent new births with severe thalassemia. Strategies for thalassemia screening in migrants are needed. Therefore, we sought to characterize the burden of disease, as well as the knowledge, attitudes, and practices (KAP) of migrants surrounding thalassemia in Thailand. METHODSWe surveyed Myanmar and Cambodian migrant workers (age 18-49 years) presenting for health registration and Thai subjects presenting for outpatient care at Laem Chabang Hospital (Chonburi, Thailand). Demographic and KAP surveys were developed and assessed for face and ethnographic validity. Demographic surveys were completed by all subjects. Only subjects with awareness of thalassemia completed the 31-question KAP survey. We offered thalassemia testing to all migrants and compared frequency of Hb variants in our migrant cohort to a Thai cohort. Statistical analysis was performed using SAS 9.4 (SAS Systems, Cary, NC). The study was approved by ethical review boards at Mahidol and Duke Universities. RESULTSMedian age was similar in the three nationalities (Table 1). Migrants were more likely to be married (p=0.003). Only 33.9% of migrants had entered secondary education, compared to 87.6% of Thai. ~30% of migrants did not speak any Thai. Fewer migrants attended doctor visits and used health insurance compared to Thai (both p<0.0001), but migrants showed a stronger preference for health education from doctors (p=0.01). Interestingly, migrants reported residing in Thailand for a median of 5 years, and the majority had never moved within Thailand. Nonetheless, 24.5% of migrants were still unregistered, and unregistered status was associated with a shorter residence in Thailand (p=0.01) and fewer doctor visits (p=0.0003).Only 4.1% of migrants had awareness of thalassemia, compared to 79.6% of Thai; a large knowledge gap also existed for awareness of anemia (Table 1). Female gender (OR 2.12 [95% CI 1.05-4.29]; p=0.03), secondary education (OR 2.69 [95% CI 1.08-6.71]; p=0.03), and awareness of anemia (OR 11.07 [95% CI 4.82-25.44]; p<0.0001) predicted thalassemia awareness in Thai, whereas only anemia awareness (OR 4.89 [95% CI 4.89-72.84]; p<0.0001) and length of residence in Thailand (p=0.0002) predicted awareness in migrants.Among subjects aware of thalassemia, the KAP survey identified important misconceptions in both migrant and Thai populations that may lead to stigmatization of thalassemia carriers and decreased screening uptake. For example, 45.4% and 62.7% of migrants believe that thalassemia is an infectious disease and is rare in Asia, respectively. Though migrants had a lower median knowledge score than Thai (p=0.002), their median attitude score was similar (p=0.21). Both groups generally held positive attitudes towards thalassemia testing, but migrants held particularly negative attitudes towards abortion.Of those migrants offered thalassemia testing who had available blood samples (n=286), 96.9% consented; 3.1% declined. Interestingly, α- and β-globin variants and Hb E were more common in our migrant cohort than in a Thai cohort characterized separately (Table 2). DISCUSSIONWe conclude that the burden of thalassemia in migrant populations is at least as high as in the Thai population and that thalassemia screening is highly acceptable to migrants. However, a tremendous gap in awareness of thalassemia exists between Thai and migrants, suggesting that public education targeted to migrant populations is desperately needed. Other issues identified, including language barriers, lack of insurance, low healthcare utilization, and negative attitudes toward abortion, merit further consideration when designing future health programs for migrants in Thailand and globally. [Display omitted] DisclosuresTelen:Pfizer, Inc.: Consultancy, Research Funding. Viprakasit:F. Hoffmann-La Roche Ltd: Consultancy, Research Funding; Protagonist Therapeutics: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Agios: Consultancy, Research Funding.

Life style risk factors of Iron deficiency Anemia among adolescents’ girls

Adolescence is a journey from the world of the child to the world of the adult. Adolescence is very important since it is the time in life when major physical, psychological and behavioural changes take place. The potential synergistic effects of unhealthy lifestyle behaviours on the risk of chronic conditions as iron deficiency anaemia and health outcomes among adolescents’ girls are a key issue for their health. Aim: this study aimed to identify the life style risk factors of iron deficiency anemia among adolescents’ girls. Design: A case control study design Setting: The study was accompanied at one school from urban and eight from rural preparatory school girls. Subjects: The total number of the randomly selected girls was 240 preparatory school girls (120 girl students as cases who have anemia and the same number of non-anemic girls recruited in control group). Tool: data was collected using one toolentitled adolescent girl's structured interview questionnaire Results: according to multivariate analysis logistic regression the factors which showed significant relation to students with iron deficiency anemia were many.Concerning factors related to demographic characteristic, father's occupation, Underachiever students, Mother’s education, Place of residence, and low monthly family income.Moreover factors related to sleeping pattern and activity practices included physical inactivity, absence of nap sleep hours. With respect to risk factors related to student's feeding practices, the observable risk factor for iron deficiency anemia was not consumed snacks. Additionally other factors were found as not eating daily breakfast, eating less than 2 meals/day and time of drinkingtea. Conclusions & Recommendations: There is significant association of iron deficiency anemia with adolescents’ girls’some socio-demographic characteristics and their activities related to life style. Subsequently, there is requisite to increase awareness of anemia among adolescent girls and their parents.

Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis.

In the past, iron-deficiency anemia in children has had a widespread presence in rural China. Given the recent economic growth in China, it is unclear if anemia among infants/toddlers remains a problem. The objective of this study is to measure the anemia rate in rural Chinese infants/toddlers across four major subpopulations and attempt to discover the sources of anemia. We use a mixed-methods approach combining quantitative data on 2909 rural Chinese infants/toddlers and their families with qualitative interviews with 84 caregivers of infants aged 6 to 30 months. Quantitative analysis indicates that the overall prevalence of anemia (43%) within sampled infants/toddlers was high, especially in comparison to the low rates of stunting (2–5%), being underweight (2%), and wasting (2–4%). These findings suggest that in rural China, anemia stems from the poor quality of the diets of infants/toddlers, rather than insufficient quantities of food being consumed. Qualitative analysis illustrates the factors that are contributing to anemia. Caregivers do not understand the causes of this condition, the symptoms that would lead one to recognize this condition, or the steps needed to treat their child with this condition. The findings offer a comprehensive understanding of the limited awareness of anemia among rural Chinese caregivers.

The effect of the \u201cFollow in my Green Food Steps\u201d programme on cooking behaviours for improved iron intake: a quasi-experimental randomized community study

BackgroundNutritional iron deficiency is one of the leading factors for disease, disability and death. A quasi-experimental randomized community study in South-West Nigeria explored whether a branded behaviour change programme increased the use of green leafy vegetables (greens) and iron-fortified bouillon cubes in stews for improved iron intake.MethodsA coinflip assigned the intervention to Ile-Ife (Intervention town). Osogbo (Control town) received no information. At baseline 602 mother-daughter pairs (daughters aged 12–18) were enrolled (Intervention: 300; Control: 302). A Food Frequency Questionnaire assessed the addition of cubes and greens to stews, the primary outcome. Secondary outcomes were the addition of cubes and greens to soups and changes in behavioural determinants measured using the Theory of Planned Behaviour. Structural Equation Modelling (SEM) evaluated the impact of the intervention on behavioural determinants and behaviour.ResultsThe data of 527 pairs was used (Intervention: 240; Control: 287). The increase in greens added to stews was larger in the Intervention town compared to the Control town (MIntervention = 0.3 [SE = 0.03]; MControl = 0.0 [SE = 0.04], p < 0.001, r = 0.36). Change in iron-fortified cubes added to stews did not differ between towns (p = 0.07). The increase in cubes added to soups was larger in the Intervention town compared to the Control Town (MIntervention = 0.9 [SE = 0.2] vs MControl = 0.4 [SE = 0.1], p < .0001, r = 0.20). Unexpectedly, change in greens added to soups was larger in the Control town compared to the Intervention town (MIntervention = − 0.1 [SE = 0.1]; MControl = 0.5 [SE = 0.1], p = 0.003, r = 0.15). The intervention positively influenced awareness of anaemia and the determinants of behaviour in the Intervention town, with hardly any change in the Control town. Baseline SEMs could not be established, so no mediation analyses were done. Post-intervention SEMs highlighted the role of habit in cooking stews.ConclusionsThe behaviour change programme increased the amount of green leafy vegetables added to stews and iron-fortified cubes added to soups. Future research should assess the long-term impact and the efficacy of the programme as it is scaled up and rolled out.

Awareness of anaemia during pregnancy among the pregnant women attending a health facility in District Srinagar

Awareness of anaemia during pregnancy among the pregnant women attending a health facility in District Srinagar

Management of Iron Deficiency Anemia in Pregnancy in India.

Iron deficiency anemia (IDA) continues to be the commonest etiology of anemia in pregnancy. The prevalence of iron deficiency (ID) in pregnant Indian women is amongst the highest in the world. Untreated iron deficiency (ID) has significant adverse feto-maternal consequences. Plethora of investigations are available for diagnosis of IDA, each having specific advantages and disadvantages when used in the pregnancy setting. Therapy for ID includes dietary modification, oral iron supplementation, intravenous iron and blood transfusion. Newer parenteral iron preparations are safe and there is mounting evidence to suggest their use in frontline settings for pregnancy associated IDA in the second and third trimester. Through this review, we suggest an algorithm for diagnosis and treatment of IDA in pregnancy depending on the severity of anemia and period of gestation suited for widespread use in resource limited settings. Also, we recommend ways for increasing public awareness and tackling this health issue including the observance of "National Anemia Awareness and Treatment Day."

Ethiopian women's perspectives on antenatal care and iron-folic acid supplementation: Insights for translating global antenatal calcium guidelines into practice.

After decades of global response to iron-deficiency anemia, lessons learned from antenatal iron-folic acid (IFA) supplementation can inform new micronutrient supplementation efforts. The World Health Organization recommends calcium supplementation for the prevention of preeclampsia; however, little is documented on how to design programs to integrate calcium into the standard of care. Twenty interviews with pregnant women and 22 interviews with health providers and volunteers in two districts in Ethiopia were conducted to examine how barriers and facilitators to antenatal care, IFA supplementation, and initial reactions to calcium supplements and regimen might influence adherence and inform future programs. Women viewed supplementation positively but cited lack of information on benefits and risks, forgetfulness, and inconsistent IFA supply as challenges. Though knowledge and awareness of anemia and IFA supplements were widespread, preeclampsia was mostly unknown. Some symptoms of preeclampsia were viewed as normal in pregnancy, making it difficult to convey risk to motivate supplement use. Some women viewed co-consumption of IFA and calcium as potentially harmful and were confused regarding the simultaneous risks of anemia and hypertension, understood as "low" and "high" blood levels in pregnancy. However, most said they would take both IFA and calcium supplements if provided with supplements and counseling on purpose and benefits. Strategies such as social support from families, stronger community-based counseling, and increased health care provider and community awareness of preeclampsia are critical for women to understand the benefits of supplementation and resolve confusion caused by current descriptors used for anemia and hypertension.

Anaemia - a pale ale?

Despite some modest improvements described recently, anaemia remains a significant global public health concern affecting both developed and developing countries. It affects a quarter of the global population, including 293 million (47%) children who are younger than five years of age. A prevalence of 42% and 30% has been described in pregnant and non-pregnant women, respectively. Children and women of reproductive age are at high risk, partly because of physiological vulnerability, followed by the elderly. Africa and Asia are the most heavily affected regions, accounting for 85% of the absolute anaemia burden in highrisk groups. According to the World Health Organization global database on anaemia (1993–2005), this disorder was considered to be a moderate public health problem in South African preschool children, pregnant women and non-pregnant women of reproductive age. &#x0D; &#x0D; There has been an increased awareness of anaemia and its consequences on the health and development of women and children in the past few decades. The many underlying causes of the various types of anaemia seen in general practice means it is essential that practitioners’ clinical decisions be underpinned by a sound knowledge of the pathological processes involved. Thorough history-taking will guide practitioners to request specific tests to confirm or refute differential diagnoses. Management must be developed around the specific type of anaemia and the potential physical and psychological effects it may have on the individual.

Awareness of Anemia and Associated Factors among Pregnant Women Attending Antenatal Care, South Ethiopia

Background: Anemia affects around half a billion women of reproductive age worldwide, women; especially pregnant women are at high risk of contracting anemia. The aim of this study was to asses’ awareness of anemia among pregnant women and identifies associated factors with the level of awareness. Methods: Institutional based cross-sectional study was conducted from April to June 2016 at Yrga Cheffe health center, South Ethiopia. Data were gathered using structured questionnaire. Simple random sampling technique was used to select participants. Sample frame was prepared from secondary data at antenatal care service unit. SPSS version 20 was used to analyze the data. Results: Among 244 study participants about 94.3% (230) pregnant women were responsive and only 44.3% (102) of the women have comprehensive awareness of anemia. Awareness of anemia was significantly associated with number of ANC visit {AOR=7.407, CI=95% [3.247-16.895]}, occupational status {AOR=1.970, CI=95% [1.092-3.555]} and educational status {AOR=6.141, CI=95% [2.781-13.562]} of respondents. Conclusion: Promoting the benefits of early and frequent ANC, enhancing the quality of ANC and counseling on the ad knowledge of women on anemia are essential elements for improving the awareness of anemia.

Translating formative research findings into a behaviour change strategy to promote antenatal calcium and iron and folic acid supplementation in western Kenya.

The World Health Organization now recommends integrating calcium supplements into antenatal micronutrient supplementation programmes to prevent pre-eclampsia, a leading cause of maternal mortality. As countries consider integrating calcium supplementation into antenatal care (ANC), it is important to identify context-specific barriers and facilitators to delivery and adherence. Such insights can be gained from women's and health workers' experiences with iron and folic acid (IFA) supplements. We conducted in-depth interviews with 22 pregnant and post-partum women and 20 community-based and facility-based health workers in Kenya to inform a calcium and IFA supplementation programme. Interviews assessed awareness of anaemia, pre-eclampsia and eclampsia; ANC attendance; and barriers and facilitators to IFA supplement delivery and adherence. We analyzed interviews inductively using the constant comparative method. Women and health workers identified poor diet quality in pregnancy as a major health concern. Neither women nor health workers identified pre-eclampsia, eclampsia, anaemia or related symptoms as serious health threats. Women and community-based health workers were unfamiliar with pre-eclampsia and eclampsia and considered anaemia symptoms normal. Most women had not received IFA supplements, and those who had received insufficient amounts and little information about supplement benefits. We then developed a multi-level (health facility, community, household and individual) behaviour change strategy to promote antenatal calcium and IFA supplementation. Formative research is an essential first step in guiding implementation of antenatal calcium supplementation programmes to reduce pre-eclampsia. Because evidence on how to implement successful calcium supplementation programmes is limited, experiences with antenatal IFA supplementation can be used to guide programme development.

The Karnataka Anemia Project 2--design and evaluation of a community-based parental intervention to improve childhood anemia cure rates: study protocol for a cluster randomized controlled trial.

BackgroundChildhood anemia is highly prevalent worldwide. Improving the hemoglobin level of preschool age children could yield substantial benefits in cognitive and psychosocial development and overall health. While evidence-based recommendations for reducing childhood anemia in high anemia prevalence countries are available, there is no experimental evidence of community centered education and counseling programs, as a route to improved acceptance of iron supplements, demonstrating beneficial effects on anemia outcomes. We report on the evaluation protocol of a complex educational intervention led by the community lay health worker (LHW) and delivered to mothers of 12–59-month-old anemic children living in and visiting village day care centers in a large district of southern India.Methods and designThe study is designed as a cluster randomized controlled trial. The intervention is based on the social cognitive theory and aims to promote among mothers, anemia awareness, dietary modifications to increase iron intake in the child, and recognition of the need for enhanced adherence to supplemental iron in the anemic child. From 270 eligible villages in the study area, a sample of 60 villages will be randomized to intervention [n = 30] or to treatment as usual [n = 30] of the study. LHWs in the intervention arm will be trained to administer the following intervention components to mothers of anemic children: 1] monthly distribution of Iron and folic acid (IFA) supplements to mothers of anemic children, and 2] five monthly counseling sessions of mothers of anemic children covering: a] anemia awareness education b] IFA adherence counseling and assessment, c] dietary modification to improve iron intake, and d] hygiene and sanitation. LHWs in the control arm will distribute IFA to mothers of anemic children as in the intervention arm but will not provide monthly education and counseling support. The primary outcome is the difference between the two experimental groups in anemia cure rates of children found to be anemic at baseline. Secondary outcomes, assessed as differences between all participants in both experimental groups, are: change in mothers’ knowledge regarding anemia; 24 hour dietary iron intake; net improvement in individual hemoglobin values; serum ferritin; and the difference in overall cluster level childhood anemia prevalence. All outcomes will be measured 6 months after the start of the intervention. Multilevel linear and logistic regression models will be used to analyze differences between intervention and control groups in outcome variables.DiscussionThis trial is designed to evaluate the effectiveness of an intervention intended to improve anemia cure rates in anemic children living in villages of Chamarajnagar, Karnataka a large district in south India. The extensive study of secondary endpoints will be used to identify possible weak points in the compliance to intervention delivery and uptake. This evaluation is one of the few large randomized trials evaluating the impact of an education and counseling intervention to reduce childhood anemia prevalence.Trial registrationThis trial was registered with ISRCTN.com (identifier: ISRCTN68413407) on 17 September 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1135-x) contains supplementary material, which is available to authorized users.

An etiologic profile of anemia in 405 geriatric patients.

Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine) in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1%) in a mild form. Anemia was primarily due to iron deficiency (65%), frequently due to underlying chronic infection (62.1%), or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy.

The role of information sources in anemia knowledge in Qassim region, Saudia Arabia

Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. The aim of this study to assess the role of information sources in anemia awareness. This cross-sectional community-based study was conducted throughout the Qassim region which has been divided into 11 provinces were evaluated. A total of 1281Saudi citizens participated in this study. Each participant was asked to answer a total of 18 questions from a pre-piloted questionnaire. 1281 questionnaires were distributed the response rate was 95.7%. Males represented 62.2%. General knowledge of anemia was 89.5% of the study population. Satisfactory, fair, and poor awareness of anemia represented 20.5%, 50.5%, and 29.0% respectively. Friends and relatives were constituted the major information sources while books and journals were the lowest source. We conclude that general awareness of anemia is very good, but still more efforts should be performed through information sources to boost of anemia awareness in Saudi population in Qassim area to reach satisfactory knowledge, which reflect in life style and hygiene behavior.

Understanding Healthcare Workers Perceptions of Iron and Folic Acid Supplementation in Bihar, India

High prevalence of anemia and low iron and folic acid (IFA) consumption among pregnant women in Bihar has been identified as an important public health issue. Surveys have shown only 30% of Bihari women indicate receiving IFA and 23% report IFA counseling during their last pregnancy. To address this, we conducted twenty in‐depth interviews and focus group discussions in two districts of Bihar with three key types of frontline healthcare workers (FLWs) to explore their knowledge and awareness of anemia and IFA counseling techniques.FLWs attributed anemia to factors including poor diet, close child spacing, high parity, and lack of rest, which they perceived to stem from poverty, lack of awareness, low priority of women's status, and family tension. Many felt anemia was not a significant issue, estimating its prevalence as 0–20% (compared to survey estimates of 60%). FLWs tended to restrict IFA consumption to the 4th–8th month, and many reported that excess IFA intake can cause harm. In conclusion, Bihari FLWs had high knowledge of anemia causes but did not view it as a common issue in their communities. Further, their views of proper consumption windows may prevent added health benefits of IFA consumption during the 9th month and lactation from being realized. Efforts to allow IFA intake over a longer timeframe may increase the opportunity for women to receive IFA tablets and be a key step to increasing IFA consumption.Grant Funding Source: Funding support provided by a BMGF grant through a subcontract with CARE‐India

Prevalence of anemia and its determinants in urban school-going children of Mumbai

Context: WHO estimates that around two billion people are anemic with approximately 50% of all anemia attributable to iron deficiency. Weekly Iron and Folic Acid Supplementation Program is implemented in school, in various countries to reduce prevalence of anemia in adolescents. Aims: To find out baseline prevalence of anemia and its determinants in urban school-going children of Mumbai. Settings and Design: The cross-sectional study was carried out from August to October 2012 on sample size of 385 school children, selected by systematic random sampling of class VI to X of government-aided school. Materials and Methods: After a written-informed consent, students were interviewed by pre-tested, semi-structured questionnaire and then weight and height were recorded. Hemoglobin was estimated by cyan-methemoglobin method using a colorimeter. Data was analyzed by SPSS version 16. Statistical Analysis Used: Proportion, Chi-square test, Co-relation Co-efficient and Unpaired t test. Results: Mean age was 12.9 years with SD of 1.5 years. Overall prevalence of anemia was 53.2% with prevalence in females and males 56.5% and 50%, respectively. Proportion of mild, moderate and severe anemia was 21.6%, 30.9% and 0.8%, respectively. Age was significantly associated and negatively co-related with mean hemoglobin values with highest prevalence in age group of 15 to 19 years. Anemia was significantly associated with attainment of menarche. Practice of eating green leafy vegetables, groundnuts and egg was significantly higher in males as compared to females. Tiredness and palpitation were significantly higher in females as compared to males. Very few students (2.9%) were aware about anemia. Only 75% of the students were willing to consume weekly iron and folic acid supplementation for a year. Conclusions: Both males and females are susceptible to anemia with highest prevalence in age group of 15 to 19 years. Awareness of anemia was very poor in school-going children.

RESPOND - Raising awareness of anemia in oncology centers through computer algorithm driven guidelines: Assessment of intraclass correlation metrics for the accuracy of algorithmic definitions

19633 Background: Publication of evidence-based (EB) practice guidelines (EBPGs) does not assure their application in patient care. Computerized clinical decision support systems (CDSSs) incorporating EBPGs may promote EB decision-making about individual patients. Most CDSSs are knowledge-, not evidence-based. Effective CDSSs are those integrated into workflow, providing point of care guidance, and offering actionable recommendations. Few are validated in terms of algorithmic operationalization. RESPOND is a CDSS based on the 2006 update of the European Organisation for Research and Treatment of Cancer (EORTC) EBPGs for erythropoietic proteins in cancer-related anemia. Method: Descriptive study. Panel of five experts (three physicians, two nurses) rated the 27 algorithms derived from the EORTC EBPGs in terms of accuracy (binary: yes/no). If not judged accurate, experts were asked to explain and propose correction. Objective was to attain intraclass correlation coefficient (ICC) &gt;0.90 for each operationalization in a maximum of three iterations. Table 1 . Example of operationalization of guideline Hb, hemoglobin Results: In iteration 1, three experts agreed with all 27 sets; one disagreed with one set and one with four sets; therefore ICC = 1.00 for 22 sets; ≤0.90 for five sets. Three sets concerned additional output to be generated, and one a substantive inaccuracy; all were corrected. One set concerned a suggestion not supported by evidence, hence not incorporated. In iteration 2, all five experts agreed with all sets, thus ICC = 1.00 for 27 sets. Conclusions: The RESPOND CDSS being developed and validated is based on algorithms that accurately specify, in the form of conditional dependency rules, the EORTC EBPGs for erythropoietic proteins. [Table: see text] [Table: see text]

Anemia in Old Age Is Associated With Increased Mortality and Hospitalization

Anemia is common in old age and has been shown to affect older persons' physical function. To more fully understand the detrimental health effects of anemia, we examined the relationship of anemia with death and hospitalization outcomes in a large community-based sample of older persons. Data are from 3607 persons, aged 71 years or older, participating in the National Institute on Aging (NIA)-sponsored Established Populations for Epidemiologic Studies of the Elderly (EPESE) study. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Data on subsequent mortality and hospital admissions over 4 years were obtained from death records and the Medicare database. Anemia was present in 451 of the 3607 (12.5%) participants. During the follow-up period, anemic persons were more likely to die than were nonanemic persons (37.0% vs 22.1%, p<.001). Also, anemic persons were more often hospitalized (65.9% vs 54.6%, p<.001) and spent more days in hospital (25.0 vs 13.7, p<.001). After adjustment for demographics and baseline comorbidities, anemia significantly predicted subsequent mortality and hospitalization (relative risk=1.61, 95% confidence interval, 1.34-1.93; and relative risk=1.27, 95% confidence interval, 1.12-1.45, respectively). After excluding persons with prevalent diseases at baseline, anemia remained significantly associated with increased risks of mortality and hospitalization. A higher hemoglobin level was significantly associated with lower risks of mortality and hospitalization (p for trend<.001 for both). These findings indicate that late-life anemia characterizes persons at risk for important clinical health outcomes, and demonstrate the importance of clinical awareness of anemia even if the person is without apparent clinical disease.

Overview of cancer-related anemia: focus on the potential role of darbepoetin alfa.

Cancer-associated anemia is common and has many causes, including the effects of the underlying disease and cancer treatment. The effect of anemia on patients with cancer was not appreciated fully until relatively recently. Several well-designed studies have demonstrated the relationship between anemia and fatigue, and the effect of fatigue on quality of life. These data have resulted in a greater awareness of anemia in cancer and have increased the use of recombinant human erythropoietin (r-HuEPO, epoetin alfa) therapy for the treatment of anemia. Recombinant HuEPO produces a hemoglobin response in 50-60% of patients with cancer; however, to obtain this response rate, frequent dosing is required. Darbepoetin alfa, a recently developed erythropoietic protein, has a longer half-life than that of r-HuEPO, enabling less frequent dosing, and has a greater in vivo activity. In studies of patients with cancer who develop anemia, darbepoetin alfa has proved to be well tolerated and effective, and its advantages make it a potential improved treatment option for anemia in these patients.

Late awareness of anaemia in a patient receiving clozapine

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.

Socio-economic factors associated with the iron intake of preschoolers in the United States

This study investigated household income, food program participation, and diet awareness and attitudes of the household meal planner as predictors of dietary iron intake of preschoolers in the United States. Non-breastfeeding children, 1 to 5 years of age, with 3 days of dietary data from the 1989–1991 Continuing Survey of Food Intake of Individuals were included in this sample (N=800). Two measures of intake were analyzed: a nutrient adequacy ratio (NAR), defined as iron intake divided by the RDA; and an index of nutritional quality (INQ), or diet density measure, which is the ratio of iron NAR to energy NAR. Data from the concurrent Diet and Health Knowledge Survey were used to create indicator variables for meal planners who were aware of anemia as a health problem related to iron intake and who felt it was important to choose a diet with plenty of grain products. After controlling for age, gender, ethnicity, household size, region, and urbanization, multi-variate regression analyses revealed that household income and participation in the WIC food program were positively associated with both iron intake measures. Participation in the Food Stamp program was positively associated with the iron NAR, but not the INQ. Although anemia awareness was not a significant predictor of intake, children from households whose main meal planners had a positive attitude about the importance of grains, consumed more iron as measured by either index. The findings suggest that dietary iron intakes of preschoolers continue to be affected by economic factors and that food transfer and/or educational interventions may be useful in improving these intakes.