Anemia Control Research Articles

Study to Evaluate Efficacy of Vajravatakmaņdura in Iron Deficiency Anemia in Adolescent Girls: A Randomized Controlled Trial

Background: Anemia in adolescent girls possess greatest burden on their health as it leads to poor cognitive development, poor reproductive health and if not treated may lead to intrauterine growth retardation in their developing fetus. The prevalence of anemia among adolescent is 27% in developing country and 6% in developed country. The Government of India has launched National Anemia Control Programme, to prevent and control anaemia in children and adolescents. But the problem is still persisting because of many issues like - poor palatability, intolerance to the drug used, poor absorption of the drugs used, constipation, discoloration of stool, unpleasant odor and taste etc. result in poor compliance and therefore non adherence to the therapy which finally results in poor improvement. By looking at the magnitude of the problem, an Ayurveda drug Vajravatakmandura has been selected for the study and the present study was undertaken to evaluate the efficacy of the trial drug in iron deficiency anemia in adolescent girls. Material and methods: 100 subjects satisfying inclusion and exclusion criteria were selected and were randomly divided in two groups. In group A, the trial drug Vajravatakmaņdura was administered and in group B, IFA tablets were given for two month of duration with follow up at every fortnight. Result: Both the trial and control groups showed extremely significant result over subjective parameters. Trial drug Vajravatakmaņdura in group A was found more effective over the subjective parameters - weakness, palpitation, pallor and loss of appetite with % gain of 39.77%, 39.39%, 39.17%, 38.09% respectively. Statistical analysis between before and after treatment findings of objective parameters, extremely significant (P less than 0.0001) improvement was found in both groups in all parameters, except for RBC count in group A, which was significant. No adverse effects were reported during entire period of study by any of the patients in trial group treated with trial drug. Conclusion: The trial drug “Vajravatakmandura” is effective, safe and palatable for the management of iron deficiency anemia in adolescent girls.

Condições socioeconômicas e saúde das famílias portadoras de anemia falciforme

A anemia falciforme é doença hereditária caracterizada pela alteração dos glóbulos vermelhos do sangue, tornando-os parecidos com uma meia lua. A pesquisa teve como objetivo mostrar as condiçoes socioeconômicas das famílias com doença falciforme moradoras na comunidade quilombola Negros do Riacho, no município de Currais Novos, Rio Grande do Norte. Adotou-se uma abordagem qualiquantitativa. Os dados foram coletados através de entrevistas semiestruturadas realizadas no domicílio dos participantes, após a assinatura do TCLE. Os resultados mostraram que a proporção de mulheres é maior. Aqueles que se situam entre os 26 e os 35 anos somam 38,8%. A maioria é casada, possui o ensino fundamental e ganha até um salário mínimo. A água consumida não recebe qualquer tratamento.É oriunda exclusivamente de poço. Por não existir coleta pública de lixo, o depósito é feito a céu aberto e apenas 5,6% incinerado. Apenas 11,2% dos doentes já fizeram ou fazem algum tipo de tratamento. Conclui-se que há relação entre as condições socioeconômicas e a incidência e prevalência da anemia falciforme. Sugerem-se apoio financeiro e logístico para o desenvolvimento de estudos/diagnósticos nessa comunidade, alertando as autoridades para que intervenham de forma contínua e sistemática na prevenção, tratamento e controle de anemia falciforme.

PENENTUAN DEFISIENSI BESI ANEMIA PENYAKIT KRONIS MENGGUNAKAN PERAN INDEKS sTfR-F

Background: The highest prevalence of nutrition problem due to nutrition deficiency is iron deficiency. Chronic disease anemia often occurs coincide with iron deficiency and both show of low iron serum appearance. Difficulty occurs when iron deficiency determined in chronic disease anemia by routine parameters. Bone marrow stainning can indicate iron store, but it is invasive. Therefore it needs another more practical parameter that has higher diagnostic value. Objective: To know the more practical parameter that can determine iron deficiency in chronic disease anemia Discussion: Ferritin serum indicates iron store in the body, whereas transferin receptor indicates functional of iron uptake in the erythrocyte. Changes of ferritin level due to inflammation process are varies. Recent evidence shows different changes of transferin receptor between iron deficiency anemia and those in chronic disease anemia. In chronic disease anemia, receptor transferin level increase but not as high as in those who suffer from pure iron deficiency anemia. Studies on groups of iron deficiency anemia, iron deficiency with acute inflammation, chronic disease anemia and healthy control population showed significance differences of receptor transferin among them. sTrF-R index is an index derived from the calculation of transferin receptor level divided by logarithmic of the ferritin level. The usage of sTfR-F index indicates more significance difference as compared to transferin receptor. Its sensitivity and specificity increase when it is applied to diagnose iron deficiency in elderly group. Conclusions: sTfR-F index is more sensitive and specific for the determination of iron deficiency in chronic disease anemia

Epoetin beta pegol for treatment of anemia ameliorates deterioration of erythrocyte quality associated with chronic kidney disease

BackgroundEpoetin beta pegol (continuous erythropoietin receptor activator; C.E.R.A.) is currently widely used for the treatment of anemia associated with chronic kidney disease (CKD). Therapeutic control of anemia is assessed by monitoring haemoglobin (Hb) levels. However, certain qualitative aspects of erythrocytes are also impaired in CKD, including loss of deformability and shortened life-span. Therefore, monitoring Hb alone could potentially fail to reveal pathological changes in erythrocytes. Focusing on erythrocyte quality in CKD may lead to more effective anemia therapy with C.E.R.A.MethodsA CKD rat model was induced by uninephrectomy followed by anti-Thy1.1 antibody injection. From 5 weeks after the operation, C.E.R.A. (0.6 μg/kg) or vehicle was administered every 2 weeks. Erythrocyte deformability was quantified with ektacytometry and erythrocyte turnover was estimated by biotin labeling. Intracellular calcium level was assessed by Fluo-3/AM.ResultsErythrocyte deformability progressively declined in CKD rats. Furthermore, erythrocyte turnover in the circulation drastically accelerated in CKD rats. With administration of C.E.R.A. at a dose sufficient to adequately control Hb, deterioration of erythrocyte deformability and turnover in CKD rats were significantly improved. Intracellular calcium, which plays a pivotal role in the mediation of erythrocyte quality, was significantly increased in CKD and was normalized by C.E.R.A. treatment.ConclusionC.E.R.A. treatment exerted a favorable effect not only on anemia but also on the improvement of erythrocyte quality. C.E.R.A. administered for the treatment of CKD-associated anemia may confer therapeutic benefits on erythrocytes.

Analysis of anaemia in pregnancy surveillance data, upper west Akim district, Ghana, 2016

Introduction: anaemia is defined as blood haemoglobin level 11g/dl. Worldwide, anaemia affects more than 50% of pregnant women with rate between 23% and 52%. Anaemia control is an intervention towards achieving Sustainable Development Goals 3; which is to reduce maternal and child mortality. In 2011, anaemia accounted for 20% of maternal deaths in Ghana. We reviewed anaemia in pregnancy surveillance data to assess its magnitude and distribution in the Upper West Akim district from 2011-2015.

Association between prevalence of anaemia and sedentary time among women

This study aimed to assess the associations between prevalence of anaemia and sedentary time among women. Data of women aged ≥ 10 y who were included in the 6th Korea National Health and Nutrition Examination Survey (2014-2015) were analyzed (n=3, 593). Self-reported sedentary time was dichotomized into ≥ 7.5 h/d or <7.5 h/d. Sampling weights were generated based on the complex sample to ensure the representativeness of the sample to the Korean population. Logistic regression was used to identify the associations between prevalence of anaemia and sedentary time. The prevalence of anaemia among women aged ≥ 10 y was 9.8%. After adjusting for age, results showed that women with a prevalence of anaemia had a 31% lower odds of sitting for ≥ 7.5 h/d (odds ratios (OR), 0.69; 95% confidence interval (CI), 0.52-0.91) than those without prevalence of anaemia. Women aged between 10-14 y were 7.19 times (CI, 4.28-12.14) more likely to sit for ≥ 7.5 h/d than those aged over 50 y. These findings imply that anaemia control in women aged 10-14 y is necessary to reduce excessive sedentary time.

Role of point of care Hb diagnostic devices in getting the right picture of anemia control: Tangi Rural Anemia Diagnostic Accuracy Study

Objectives: To study the accuracy and reliability of two point of care devices (Hemocue 201 [HC201]) and Hemoglobin Colour Scale (HCS) with reference to automated laboratory analyser Sysmex XP 100 (LabSXP) and determine factors influencing their performances. To discuss certain design issues while ascertaining these parameters for its judicious use in both clinical context and disease burden studies.Methods: Reliability and accuracy statistics were calculated for four population subgroups that were selected randomly using cluster sampling in a rural community of eastern India. Appropriate measures were taken to reduce biases in the study. Bland Altmann Plot was used to determine Bias and ROC curve analysis was used to suggest new cut-offs for HCS method.Results: True prevalence varied across subgroups ranging from 12.56% in adolescent boys to 40.71% in adult women. Sensitivity for HC201 was lowest among boys (80.39%) and highest among adult females (92.82%), while specificity was highest among adult males (86.94%) and lowest among adult females (75.00%). The variation across subgroups was due to differences in distribution of underlying Hb values. HC201 has potential for use in clinical practice as well as disease burden estimation study. HCS was not suitable for use in clinical setting as the bias (−4.1 g/dl) was unacceptable. However, ROC analysis suggested certain cut-offs for different age groups and can be employed in poor resource settings for disease burden estimation study.Conclusions: HC201 is better than HCS as per the study. However, accuracy parameters are likely to vary depending on the distribution of underlying Hb distribution. Thus, same machines can demonstrate different accuracy parameters in different settings. There is need for designing studies that could help estimate these parameters each time on a subsample which would go a long way in efficiently using technology be it for guiding clinical decisions or public health actions.

Packed cell volume and bone marrow cytological responses in Trypanosoma vivax-induced acute trypanosomosis in Nigerian Sokoto Red goats

Bone marrow responses have been identified as key determinants of trypanotolerance in cattle as they determine the ability for hemopoietic cell regeneration and control of anemia. However, not much is known about such responses in Nigerian breed of goats known to show different susceptibilities to trypanosome infections. Early bone marrow events associated with pathogenesis of Sokoto Red goats to Trypanosoma vivax were investigated in six goats to assess their role in susceptibility of this goat breed to trypanosomiasis. A total of six Sokoto Red goats of mixed sexes were used. While four of the goats randomly selected were infected with Trypanosoma vivax, the remaining two served as control. The parameters examined included packed cell volume (PCV) and differential bone marrow cytology. Cytological changes in the bone marrow of goats with acute trypanosomosis were compared to the controls. T. vivax caused an acute disease course in the goats resulting to mild drop in PCV and death 2–3 weeks post infection (PI). Associated bone marrow (BM) cytological changes were characterized by moderate erythroid hyperplasia with a resultant lower myeloid:erythroid (M:E) ratio, while the granulocytic maturation rate was 3.15 ± 0.6 and 2.42 ± 0.0 for infected and control animals, respectively. However, significant macrophage (MC) numbers (hyperplasia) were detected in the BM of the infected group. Most of the MCs phagocytized mature red blood cells (RBC) and band or mature white blood cells (WBC) only while no MC phagocytized immature cells. The MCs in BM of control goats phagocytized no blood cells. The study confirmed that mature blood cells form the first cell types to be phagocytized by MCs of BM in the pathogenesis of anemia in T. vivax-infected Sokoto Red goats while early onset of MC hyperplasia and erythrophagocytosis are indicators of susceptibility to trypanosomosis in this breed of goats and perhaps other susceptible ruminants.

Primary total knee arthroplasty for acute fracture around the knee.

Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high, especially following complex femoral fractures in the elderly.

Malaria Is More Prevalent Than Iron Deficiency among Anemic Pregnant Women at the First Antenatal Visit in Rural South Kivu.

Anemia is common during pregnancy and is associated with poor outcomes. Objectives were not only 1) to determine the prevalence of anemia and iron deficiency (ID) but also 2) to identify other factors associated with anemia in pregnant women from South Kivu province, in the eastern Democratic Republic of Congo. Between December 2013 and March 2014, 531 women attending the first antenatal visit in their second trimester of pregnancy were recruited. Sociodemographic, clinical, and biological data were collected. Hemoglobin (Hb) was determined by a portable photometer (Hemocue® Hb201+), and anemia was defined as altitude-adjusted Hb < 110 g/L. ID was defined as serum ferritin < 15 μg/L adjusted for inflammation status (C-reactive protein [CRP] > 5 mg/L and/or α-1-acid glycoprotein > 1 g/L) whereas hypoalbuminemia was defined as serum albumin < 35 g/L. A Giemsa-stained blood smear was used to diagnose malaria. The median age (interquartile range ) was 25.5 (21.1-31.3) years, with anemia in 17.6% and ID in 8%. Malaria was present in 7.5% and hypoalbuminemia among 44%. Soluble transferrin receptor concentration was higher in the presence of inflammation and/or malaria. In the final logistic regression model, factors independently associated with anemia were malaria (adjusted odds ratio [aOR]: 11.24 (4.98-25.37) P < 0.001), hypoalbuminemia [aOR: 2.14 (1.27-3.59); P = 0.004] and elevated CRP [aOR: 1.94 (1.10-3.45); P = 0.022]. ID was not highly prevalent and not associated with anemia in our population. Effective control of anemia during pregnancy in this region should consider fighting malaria and other infectious diseases in combination with measures to improve women's nutrition, both before and during pregnancy.

Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study

BackgroundLay health workers (LHWs) are increasingly used to complement health services internationally. Their perceptions of the interventions they implement and their experiences in delivering community based interventions in India have been infrequently studied. We developed a novel LHW led intervention to improve anemia cure rates in rural community dwelling children attending village day care centers in South India. Since the intervention is delivered by the village day care center LHW, we sought to understand participating LHWs’ acceptance of and perspectives regarding the intervention, particularly in relation to factors affecting daily implementation.MethodsWe conducted a qualitative study alongside a cluster randomized controlled trial evaluating a complex community intervention for childhood anemia control in Karnataka, South India. Focus group discussions (FGDs) were conducted with trained LHWs assigned to deliver the educational intervention. These were complemented by non-participant observations of LHWs delivering the intervention. Transcripts of the FGDs were translated and analyzed using the framework analysis method.ResultsSeveral factors made the intervention acceptable to the LHWs and facilitated its implementation including pre-implementation training modules, intervention simplicity, and ability to incorporate the intervention into the routine work schedule. LHWs felt that the intervention impacted negatively on their preexisting workload. Fluctuating relationships with mothers weakened the LHWs position as providers of the intervention and hampered efficient implementation, despite the LHWs’ highly valued position in the community. Modifiable barriers to the successful implementation of this intervention were seen at two levels. At a broader contextual level, hindering factors included the LHW being overburdened, inadequately reimbursed, and receiving insufficient employer support. At the health system level, lack of streamlining of LHW duties, inability of LHWs to diagnose anemia and temporary shortfalls in the availability of iron supplements constituted potentially modifiable barriers.ConclusionThis qualitative study identified some of the practical challenges as experienced by LHWs while delivering a community health intervention in India. Methodologically, it highlights the value of qualitative research in understanding implementation of complex community interventions. On the contextual level, the results indicate that efficient delivery of community interventions will require streamlining of LHW workloads and improved health system infrastructure support.Trial registrationThis trial was registered with ISRCTN.com (identifier: ISRCTN68413407) on 23 September 2013.

A cross-sectional study of complementary and alternative medicine use in patients with coagulation disorders in Southern Iran

ObjectiveComplementary and alternative medicine (CAM) use has an increasing trend around the world. Despite the wild application of CAM in patients with coagulation disorders, its efficacy is still questioned by many studies. The aim of this study was to determine the frequency and types of CAM usage, and the factors affecting CAM use among patients with bleeding disorders. MethodsThis cross-sectional study investigated the usage of CAM with a standard validated questionnaire in coagulopathic patients who were referred to Dastgheib Hospital, an educational therapeutic center affiliated to the Shiraz University of Medical Sciences in Shiraz, Southern Iran. ResultsBetween December 2015 and May 2016, 75 patients were included in this survey. Severe hemophilia A and rare bleeding disorders were the most frequent among our participants. Overall, nearly half of the studied population (49.3%) used at least one CAM product or practices. The most common products were multivitamin (29.3%), followed by folic acid (21.3%) and chamomile (12%). 32% of the patients resorted to faith healing. The main reasons of using CAM were reported to be increased general health, correction of anemia and thrombocytopenia and control of bleeding tendency. ConclusionCAM is being used frequently in patients with coagulation disorders like many other chronic illnesses all around the world. Due to emerging concern regarding the safety and possible interaction with the conventional medicine, it is necessary to develop basic data about the hematologic effects of these methods in order to use them more safely.

Derivation and validation of a novel bleeding risk score for elderly patients with venous thromboembolism on extended anticoagulation

Existing clinical scores do not perform well in predicting bleeding in elderly patients with acute venous thromboembolism (VTE). We sought to derive an easy-to-use clinical score to help physicians identify elderly patients with VTE who are at high-risk of bleeding during extended anticoagulation (>3 months). Our derivation sample included 743 patients aged ≥65 years with VTE who were enrolled in a prospective multicenter cohort study. All patients received extended anticoagulation with vitamin K antagonists. We derived our score using competing risk regression, with the time to a first major bleeding up to 36 months of extended anticoagulation as the outcome, and 17 candidate variables as predictors. We used bootstrapping methods for internal validation. Sixty-six (9 %) patients suffered major bleeding. The clinical score is based on seven clinical factors (previous bleeding, active cancer, low physical activity, anemia, thrombocytopenia, antiplatelet drugs/NSAIDs, and poor INR control). Overall, 48 % of patients were classified as low-risk, 37 % as moderate-risk, and 15 % as high-risk of bleeding. The rate of major bleeding was 1.4 events in low-risk, 5.0 events in moderate-risk, and 12.2 events per 100 patient-years in high-risk patients. The c-statistic was 0.78 at 3 months and 0.71 at 36 months of extended anticoagulation. Model calibration was excellent (p=0.93). Internal validation showed similar results. This simple clinical score accurately identified elderly patients with VTE who are at high risk of major bleeding and who may not benefit from extended anticoagulation. Further validation of the score is important before its implementation into practice. The study is registered to https://clinicaltrials.gov as NCT00973596.

Effectiveness of Switch to Erythropoiesis-Stimulating Agent (ESA) Biosimilars versus Maintenance of ESA Originators in the Real-Life Setting: Matched-Control Study in Hemodialysis Patients.

In hemodialysis (HD), switching from erythropoiesis-stimulating agent (ESA) originators to biosimilars is associated with the need for doses approximately 10% higher, according to industry-driven studies. The aim of this study was to evaluate the efficacy on anemia control of switching from ESA originators to biosimilars in daily clinical practice. We retrospectively selected consecutive HD patients receiving stable intravenous ESA doses, and who had not been transfused in the previous 6months, from 12 non-profit Italian centers. Patients switched from originators to biosimilars (n=163) were matched with those maintained on ESA originators (n=163) using a propensity score approach. The study duration was 24weeks, and the primary endpoint was the mean dose difference (MDD), defined as the difference between the switch and control groups of ESA dose changes during the study (time-weighted average ESA dose minus baseline ESA dose). Age (70±13years), male sex (63%), diabetes (29%), history of cardiovascular disease (40%), body weight (68±14kg), vascular access (86% arteriovenous fistula), hemoglobin [Hb] (11.2±0.9g/dL) and ESA dose (8504±6370IU/week) were similar in the two groups. Hb remained unchanged during the study in both groups. Conversely, ESA dose remained unchanged in the control group and progressively increased in the switch group from week8 to 24. The time-weighted average of the ESA dose was higher in the switch group than in the control group (10,503±7389 vs. 7981±5858IU/week; p=0.001), leading to a significant MDD of 2423IU/week (95% confidence interval [CI] 1615-3321), corresponding to a 39.6% (95% CI 24.7-54.6) higher dose of biosimilars compared with originators. The time-weighted average of Hb was 0.2g/dL lower in the switch group, with a more frequent ESA hyporesponsiveness (14.7 vs. 2.5%). Iron parameters and other resistance factors remained unchanged. In stable dialysis patients, switching from ESA originators to biosimilars requires 40% higher doses to maintain anemia control.

A study on occurrence of anemia in primigravida women attending antenatal ward of BPKIHS

Background: Anemia is identified as a very common nutritional problem in developing countries. Prevalence of micro nutrient malnutrition in respect of iron, iodine and vitamin A is more wide spread then protein energy malnutrition. Pregnancy is a serious burden to the women with the disease for the anemia and places them at increased risk of mortality.Objective: To determine the Hb% level of Primigravida women. To classify status of anemia on the basis of level of Hb%. To find out the association between Hb level and selected background factors. To find out the association between the Hb% level and week of gestation and nutritional pattern.Method: A descriptive and exploring Study design was carried out on 300 primigravid women admitted in BPKIHS, Dharan antenatal ward and every alternate admitted case was selected for the study. The instrument was structured questionnaires with close ended, observation check list and observational sheet. Descriptive statistics and inferential statistics were used for data analysis.Result: Overall occurrence of anemia was found to be 42% among the study population. Mild anemia and moderate anemia were found to be 17% and 25% respectively. Greater proportions of 13-19 yr. women were found to be anemic compares to those &gt; 20 years of age. Greater proportions of anemic women were from the nonsedentary groups than the sedentary. Both mild and moderate anemia were more among Primigravid women with &gt;40 gestational week.Conclusion: Understanding the extent and severity of anemia among pregnant women is essential to the development and implementation of effective anemia control for the normal delivery and healthy baby in Nepal. Health Renaissance 2015;13 (3):

Applying Positive Deviance for Improving Compliance to Adolescent Anemia Control Program in Tribal Communities of India.

Positive deviance (PD) is an asset-based social and behavior change communication strategy, utilizing successful outliers within a specific context. It has been applied to tackling major public health problems but not adolescent anemia. The study, first of its kind, used PD to improve compliance to adolescent anemia control program in Jharkhand, India, where anemia prevalence in adolescent girls is 70%, and program compliance is low. With leadership of state government, the study was designed and implemented by a multidisciplinary 42 member PD team, in Khunti district, in 2014. Participatory appraisals were undertaken with 434 adolescent girls, 18 frontline workers, 15 teachers, and 751 community leaders/parents/relatives. Stakeholders were interviewed to identify positive deviants and PD determinants across 17 villages. Perceived benefits of iron folic acid tablet and nutritional care during adolescence are low. Positive deviants exist among adolescent girls (26 of 434), villages (2 of 17), and schools (2 of 17). Positive deviant adolescent girls consumed variety of iron-rich foods and in higher frequency, consumed iron folic acid tablets, and practiced recommended personal hygiene behaviors. Deviant practices in schools included supervision of students during tablet distribution among others. Government-led PD approach uncovered local solutions and provided a forum for government functionaries to listen to and dialogue with, and an opportunity to adapt the program according to the needs of the affected communities, who are missing partners in program design and management.

Antecedents of patient health outcomes in dialysis clinics: a national study

PurposeThe purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and dialysis practice characteristics. The dialysis industry is facing a major transition from a volume-based health care system to a value-based cost-efficient care model, in the USA. Under the bundled Prospective Payment System, the treatment-based payment model is subject to meeting quality thresholds as defined by clinical process measures including dialysis adequacy and anemia management. Few studies have focused on studying these two processes and their association with the quality of patient health outcomes.Design/methodology/approachIn this study, the authors focus on identifying the determinants of patient health outcomes among freestanding dialysis clinics, using a large cross-sectional data set of 4,571 dialysis clinics in the USA. The authors use econometric analyses to estimate the association between dialysis facility characteristics and practice patterns and their association with dialysis process measures and hospitalization risk.FindingsThe authors find that reusing dialyzers and increasing the number of dialysis stations is associated with higher levels of clinical quality. This research indicates that deploying more nurses on-site allows patients to avail adequate dialysis, while increasing the supply of physicians can hurt anemia control process. In addition, the authors report that offering peritoneal dialysis and late night shifts are not beneficial practices in terms of their impact on the hospitalization risk.Research limitations/implicationsWhile early studies of dialysis care mainly focused on the associations between practice patterns and patient outcomes, this research reveals the underlying mechanisms of these relationships by exploring the mediation effects of clinical dialysis processes on patient outcomes. The results indicate that dialysis process measures mediate the impact of the operational characteristics of dialysis centers on patient hospitalization rates.Practical implicationsThis study offers several managerial insights for owners and operators of dialysis clinics with respect to the association between managerial and clinical practices that they deploy within dialysis clinics and their impact on clinical quality measures as well as hospitalization risk of patients. Managers can draw on this study to optimize staffing levels in their dialysis clinics, and implement innovative clinical practices.Social implicationsConsidering the growth in healthcare expenditures in developing and developed countries, and specifically for costly diagnoses such as dialyses, this study offers several insights related to the inter-relationships between dialysis practice patterns and their clinical quality measures.Originality/valueThis study makes several major contributions. First, the authors address the extant gap in the literature on the relationships between dialysis facility and practice characteristics and clinical outcomes, while specifically highlighting the role of clinical process measures as antecedents of patient hospitalization ratio, a key metric used to measure performance of dialysis clinics. Second, this study sheds light on the underlying mechanisms that serve as enablers of the dialysis adequacy and anemia management. To the best of the authors’ knowledge, this is the first study to explore these relationships in the dialysis industry. The authors’ approach provides a new direction for future studies to explore the pathways that may impact clinical quality measures in the delivery of dialysis services.

Actualidad del Tratamiento Renal Sustitutivo Pediátrico

Son escasos los datos sobre la incidencia de ERC en los niños y es posible que esté subestimada pues en muchos casos los estadios iniciales no se diagnostican. Los registros europeos muestran en esta población una prevalencia de entre 59-74 por millón de población y el Registro Español Pediátrico de ERC no terminal (REPIR II), que recoge estadios más tempranos, encontró una prevalencia superior a 128 por millón de población. La enfermedad es más frecuente en varones y la causa principal las anomalías estructurales1,2. El paciente renal pediátrico necesita de un seguimiento riguroso por equipos especializados que traten precozmente las alteraciones que se producen en su metabolismo y crecimiento. El control de la enfermedad mineral ósea, de la anemia y del crecimiento se ha de complementar con la intervención nutricional puesto que la malnutrición es muy frecuente, todo ello requiere del seguimiento por unidades especializada

Prevalence of Inherited Hemoglobin Disorders and Relationships with Anemia and Micronutrient Status among Children in Yaoundé and Douala, Cameroon.

Information on the etiology of anemia is necessary to design effective anemia control programs. Our objective was to measure the prevalence of inherited hemoglobin disorders (IHD) in a representative sample of children in urban Cameroon, and examine the relationships between IHD and anemia. In a cluster survey of children 12–59 months of age (n = 291) in Yaoundé and Douala, we assessed hemoglobin (Hb), malaria infection, and plasma indicators of inflammation and micronutrient status. Hb S was detected by HPLC, and α+thalassemia (3.7 kb deletions) by PCR. Anemia (Hb < 110 g/L), inflammation, and malaria were present in 45%, 46%, and 8% of children. A total of 13.7% of children had HbAS, 1.6% had HbSS, and 30.6% and 3.1% had heterozygous and homozygous α+thalassemia. The prevalence of anemia was greater among HbAS compared to HbAA children (60.3 vs. 42.0%, p = 0.038), although mean Hb concentrations did not differ, p = 0.38). Hb and anemia prevalence did not differ among children with or without single gene deletion α+thalassemia. In multi-variable models, anemia was independently predicted by HbAS, HbSS, malaria, iron deficiency (ID; inflammation-adjusted ferritin <12 µg/L), higher C-reactive protein, lower plasma folate, and younger age. Elevated soluble transferrin receptor concentration (>8.3 mg/L) was associated with younger age, malaria, greater mean reticulocyte counts, inflammation, HbSS genotype, and ID. IHD are prevalent but contribute modestly to anemia among children in urban Cameroon.

Research, policy, and programmatic considerations from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project sought to inform the interpretation of iron and vitamin A biomarkers (ferritin, serum transferrin receptor, and retinol binding protein) in settings of prevalent inflammation as well as the prevention of and control strategies to address anemia. Our purpose is to comment on the contributions of the BRINDA to advance global knowledge with regard to iron and vitamin A status assessment in women and preschool children and to analyze the findings in terms of their rigor and usefulness for global nutrition research and programs. BRINDA investigators found that the acute-phase response is so prevalent that it must be assessed in surveys of iron and vitamin A status for valid interpretation of micronutrient biomarkers. Furthermore, they found that C-reactive protein and α-1-acid glycoprotein provide important and different information about these responses and that common survey variables cannot replace the information they provide. Developing a method for adjusting micronutrient biomarkers for the independent influence of inflammation is challenging and complex, and BRINDA has brought greater clarity to this challenge through the use of large and diverse data sets. When comparing approaches, the regression methods appear to perform best when sample sizes are sufficient and adequate statistical capacity is available. Further correction for malaria does not appear to materially alter regression-adjusted prevalence estimates. We suggest that researchers present both adjusted and unadjusted values for the micronutrient biomarkers. BRINDA findings confirm that iron deficiency is a common and consistent risk factor for anemia globally and that anemia control must combine iron interventions with control of infection and inflammation. Anemia control strategies must be informed by local data. By applying the knowledge in these studies, researchers, program planners, and evaluators working in populations with prevalent inflammation can use and interpret biomarkers with more confidence, tempered with necessary caution.