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Wang J, Wang C, Li X, Guo J, Dove A, Cui Z, Xu W. Association of Anemia with Cognitive Function and Dementia Among Older Adults: The Role of Inflammation. J Alzheimers Dis 2023; 96:125-134. [PMID: 37742647 PMCID: PMC10657670 DOI: 10.3233/jad-230483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The association of anemia with cognitive function and dementia remains unclear. OBJECTIVE We aimed to investigate the association of anemia with cognitive function and dementia risk and to explore the role of inflammation in these associations. METHODS Within the UK Biobank, 207,203 dementia-free participants aged 60+ were followed for up to 16 years. Hemoglobin (HGB) and C-creative protein (CRP) were measured from blood samples taken at baseline. Anemia was defined as HGB <13 g/dL for males and <12 g/dL for females. Inflammation was categorized as low or high according to the median CRP level (1.50 mg/L). A subset of 18,211 participants underwent cognitive assessments (including global and domain-specific cognitive). Data were analyzed using linear mixed-effects model, Cox regression, and Laplace regression. RESULTS Anemia was associated with faster declines in global cognition (β= -0.08, 95% confidence interval [CI]: -0.14, -0.01) and processing speed (β= -0.10, 95% CI: -0.19, -0.01). During the follow-up of 9.76 years (interquartile range 7.55 to 11.39), 6,272 developed dementia. The hazard ratio of dementia was 1.57 (95% CI: 1.38, 1.78) for people with anemia, and anemia accelerated dementia onset by 1.53 (95% CI: 1.08, 1.97) years. The risk of dementia tended to be higher in people with both anemia and high CRP (1.89, 95% CI: 1.60, 2.22). There was a statistically significant interaction between anemia and CRP on dementia risk (p-interaction = 0.032). CONCLUSIONS Anemia is associated with cognitive decline (specifically for processing speed) and increased risk of dementia, especially in people with high inflammation.
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Affiliation(s)
- Jiao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Department of Epidemiology, College of Preventive Medicine, The Army Medical University (Third Military Medical University), Chongqing, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Chun Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jie Guo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Abigail Dove
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Aziz Ali S, Feroz A, Abbasi Z, Aziz Ali S, Allana A, Hambidge KM, Krebs NF, Westcott JE, McClure EM, Goldenberg RL, Saleem S. Perceptions of women, their husbands and healthcare providers about anemia in rural Pakistan: Findings from a qualitative exploratory study. PLoS One 2021; 16:e0249360. [PMID: 33905421 PMCID: PMC8078764 DOI: 10.1371/journal.pone.0249360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. METHODS A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women's health behavior. We analyzed the data through thematic analysis using NVivo 10 software. RESULTS Most community members were not aware of the term anemia but described anemia as a condition characterized by 'blood deficiency' in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia. CONCLUSION The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Savera Aziz Ali
- Department of Nursing, University of Alberta, Edmonton, Canada
| | - Ahreen Allana
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K. Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jamie E. Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Elizabeth M. McClure
- Regional Triangulate Institute International, Research Triangle Park, North Carolina, United States of America
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, New York, United States of America
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Spinowitz B, Pecoits-Filho R, Winkelmayer WC, Pergola PE, Rochette S, Thompson-Leduc P, Lefebvre P, Shafai G, Bozas A, Sanon M, Krasa HB. Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review. J Med Econ 2019; 22:593-604. [PMID: 30813807 DOI: 10.1080/13696998.2019.1588738] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aims: The overall cost and health-related quality of life (HRQoL) associated with current treatments for chronic kidney disease (CKD)-related anemia are not well characterized. A systematic literature review (SLR) was conducted on the costs and HRQoL associated with current treatments for CKD-related anemia among dialysis-dependent (DD) patients. Materials and methods: The authors searched the Cochrane Library, MEDLINE, EMBASE, NHS EED, and NHS HTA for English-language publications. Original studies published between January 1, 2000 and March 17, 2017 meeting the following criteria were included: adult population; study focus was CKD-related anemia; included results on patients receiving iron supplementation, red blood cell transfusion, or erythropoiesis stimulating agents (ESAs); reported results on HRQoL and/or costs. Studies which included patients with DD-CKD, did not directly compare different treatments, and had designs relevant to the objective were retained. HRQoL and cost outcomes, including healthcare resource utilization (HRU), were extracted and summarized in a narrative synthesis. Results: A total of 1,625 publications were retrieved, 15 of which met all inclusion criteria. All identified studies included ESAs as a treatment of interest. Two randomized controlled trials reported that ESA treatment improves HRQoL relative to placebo. Across eight studies comparing HRQoL of patients achieving high vs low hemoglobin (Hb) targets, aiming for higher Hb targets with ESAs generally led to modest HRQoL improvements. Two studies reported that ESA-treated patients had lower costs and HRU compared to untreated patients. One study found that aiming for higher vs lower Hb targets led to reduced HRU, while two other reported that this led to a reduction in cost-effectiveness. Limitations: Heterogeneity of study designs and outcomes; a meta-analysis could not be performed. Conclusions: ESA-treated patients undergoing dialysis incurred lower costs, lower HRU, and had better HRQoL relative to ESA-untreated patients. However, treatment to higher Hb targets led to modest HRQoL improvements compared to lower Hb targets.
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Affiliation(s)
| | - Roberto Pecoits-Filho
- b George Institute for Global Health , Newtown , NSW , Australia
- c School of Medicine Pontificia Universidade Catolica do Parana , Curitiba , PR , Brazil
| | | | | | | | | | | | - Gigi Shafai
- g Akebia Therapeutics , Cambridge , MA , USA
| | - Ana Bozas
- g Akebia Therapeutics , Cambridge , MA , USA
| | - Myrlene Sanon
- h Otsuka Pharmaceutical Development & Commercialization , Rockville , MD , USA
| | - Holly B Krasa
- h Otsuka Pharmaceutical Development & Commercialization , Rockville , MD , USA
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Finkelstein FO, van Nooten F, Wiklund I, Trundell D, Cella D. Measurement properties of the Short Form-36 (SF-36) and the Functional Assessment of Cancer Therapy - Anemia (FACT-An) in patients with anemia associated with chronic kidney disease. Health Qual Life Outcomes 2018; 16:111. [PMID: 29855366 PMCID: PMC5984470 DOI: 10.1186/s12955-018-0933-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/13/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Anemia is a common and debilitating manifestation of chronic kidney disease (CKD). Data from two clinical trials in patients with anemia of CKD were used to assess the measurement properties of the Medical Outcomes Survey Short Form-36 version 2 (hereafter SF-36) and the Functional Assessment of Cancer Therapy-Anemia (FACT-An). The Vitality and Physical functioning domains of the SF-36 and the FACT-An Total, Fatigue and Anemia subscales were identified as domains relevant to CKD-associated anemia. METHODS A total of 204 patients aged 18-80 years were included in the analyses that included internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficients [ICCs]), convergent and known-groups validity, responsiveness, and estimates of important change. RESULTS Both the SF-36 and the FACT-An had strong psychometric properties with high internal consistency (Cronbach's alpha: 0.69-0.93 and 0.79-0.95), and test-retest reliability (ICCs: 0.64-0.83 and 0.72-0.88). Convergent validity, measured by correlation coefficients between similar concepts in SF-36 and FACT-An, ranged from 0.52 to 0.77. Correlations with hemoglobin (Hb) levels were modest at baseline; by Week 9, the correlations with Hb were somewhat higher, r = 0.23 (p < 0.05) for SF-36 Vitality, r = 0.22 (p < 0.05) for FACT-An Total, r = 0.26 (p < 0.001) for FACT-Fatigue and r = 0.22 (p < 0.01) for Anemia. Correlations with Hb at Week 13/17 were r = 0.28 (p < 0.001) for SF-36 Vitality and r = 0.25 (p < 0.05) for Role Physical; FACT-An Total correlation was r = 0.33 (p < 0.0001), Anemia was r = 0.28 (p < 0.001), and Fatigue was r = 0.30 (p < 0.001). The SF-36 domains and Component Summary scores (p < 0.05-p < 0.0001) demonstrated ability to detect change. For the FACT-An, significant differences (p < 0.05-p < 0.0001) were observed between responder and non-responder change scores: important change score estimates ranged from 2 to 4 for Vitality and 2-3 for Physical functioning. Important change scores were also estimated for the FACT-An Total score (6-9), the Anemia (3-5), and Fatigue subscale (2-4). CONCLUSIONS Both the SF-36 Vitality and Physical function scales and the FACT-An Total, Fatigue and Anemia scales, are reliable and valid measures for assessing health-related quality of life in anemia associated with CKD.
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Affiliation(s)
| | - Floortje van Nooten
- Formerly with Astellas Pharma BV, Sylviusweg 62, 2333 BE Leiden, The Netherlands
| | - Ingela Wiklund
- Evidera, Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL UK
| | - Dylan Trundell
- Formerly with Evidera, Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL UK
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Evanston, IL USA
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Eckerdal P, Kollia N, Löfblad J, Hellgren C, Karlsson L, Högberg U, Wikström AK, Skalkidou A. Delineating the Association between Heavy Postpartum Haemorrhage and Postpartum Depression. PLoS One 2016; 11:e0144274. [PMID: 26807799 PMCID: PMC4726585 DOI: 10.1371/journal.pone.0144274] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/16/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the association between postpartum haemorrhage (PPH) and postpartum depression (PPD), taking into account the role of postpartum anaemia, delivery experience and psychiatric history. METHODS A nested cohort study (n = 446), based on two population-based cohorts in Uppsala, Sweden. Exposed individuals were defined as having a bleeding of ≥1000 ml (n = 196) at delivery, and non-exposed individuals as having bleeding of <650 ml (n = 250). Logistic regression models with PPD symptoms (Edinburgh Postnatal Depression scale (EPDS) score ≥ 12) as the outcome variable and PPH, anaemia, experience of delivery, mood during pregnancy and other confounders as exposure variables were undertaken. Path analysis using Structural Equation Modeling was also conducted. RESULTS There was no association between PPH and PPD symptoms. A positive association was shown between anaemia at discharge from the maternity ward and the development of PPD symptoms, even after controlling for plausible confounders (OR = 2.29, 95%CI = 1.15-4.58). Path analysis revealed significant roles for anaemia at discharge, negative self-reported delivery experience, depressed mood during pregnancy and postpartum stressors in increasing the risk for PPD. CONCLUSION This study proposes important roles for postpartum anaemia, negative experience of delivery and mood during pregnancy in explaining the development of depressive symptoms after PPH.
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Affiliation(s)
- Patricia Eckerdal
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Natasa Kollia
- Department of Biostatistics, Harokopio University, Athens, Greece
| | - Johanna Löfblad
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Hellgren
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Linnea Karlsson
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Ulf Högberg
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
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Widyawati W, Jans S, Utomo S, van Dillen J, Janssen ALML. A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives. BMC Pregnancy Childbirth 2015; 15:47. [PMID: 25886505 PMCID: PMC4348154 DOI: 10.1186/s12884-015-0478-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 02/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with anaemia in Public Health Centres. METHODS We conducted a qualitative study with semi-structured face to face interviews from November 2011 to February 2012 with 23 nurse-midwives in five districts in Yogyakarta Special Province. Data analysis was thematic, using the constant comparison method, making comparison between participants and supported by ATLAS.ti software. RESULTS Twelve nurse-midwives included in the interviews had less than or equal to 10 years' working experience (junior nurse-midwives) and 11 nurse-midwives had more than 10 years' working experience (senior nurse-midwives) in Public Health Centres. The senior nurse-midwives mostly worked as coordinators in Public Health Centres. Three main themes emerged: 1) the lack of competence and clinical skill; 2) cultural beliefs and low participation of family in antenatal care programme; 3) insufficient facilities and skilled support staff in Public Health Centres. The nurse-midwives realized that they need to improve their communication and clinical skills to manage pregnant women with anaemia. The husband and family involvement in antenatal care was constrained by the strength of cultural beliefs and lack of health information. Moreover, unfavourable work environment of the Public Health Centres made it difficult to apply antenatal care the pregnant womens' need. CONCLUSIONS The availability of facilities and skilled staffs in Public Health Centre as well as pregnant women's husbands or family members contribute to the success of managing anaemia in pregnancy. Nurse-midwives and pregnant women need to be empowered to achieve the optimum result of anaemia management. We recommend a more comprehensive approach in managing pregnant women with anaemia, which synergizes the available resources and empowers nurse-midwives and pregnant women.
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Affiliation(s)
- Widyawati Widyawati
- School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center, 117, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Suze Jans
- Royal Dutch Organisation of Midwives (KNOV), Nijmegen, Netherlands.
| | - Sutarti Utomo
- Provincial Health Office of Yogyakarta Special Province, Yogyakarta, Indonesia.
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - A L M Lagro Janssen
- Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center, 117, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Orlov YP, Lukach VN, Govorova NV, Baytugaeva GA. [Fear of anemia or why don't we afraid of blood transfusion?]. Khirurgiia (Mosk) 2015:88-94. [PMID: 27010036 DOI: 10.17116/hirurgia20151188-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Yu P Orlov
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
| | - V N Lukach
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
| | - N V Govorova
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
| | - G A Baytugaeva
- Chair of Anesthesiology and Intensive Care of Omsk State Medical Academy, Russian Ministry of Health, Omsk, Russia
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Kedir H, Berhane Y, Worku A. Khat chewing and restrictive dietary behaviors are associated with anemia among pregnant women in high prevalence rural communities in eastern Ethiopia. PLoS One 2013; 8:e78601. [PMID: 24223828 PMCID: PMC3817221 DOI: 10.1371/journal.pone.0078601] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 09/22/2013] [Indexed: 11/18/2022] Open
Abstract
Background Anemia affects a high proportion of pregnant women in the developing countries. Factors associated with it vary in context. This study aimed to determine the prevalence and predictors of anemia among pregnant women in the rural eastern Ethiopia. Methods A community-based cross-sectional study was done on 1678 pregnant women who were selected by a cluster random sampling technique. A pregnant woman was identified as anemic if her hemoglobin concentration was <11 g/dl. Data were collected in a community-based setting. Multilevel mixed effect logistic regression was used to determine the adjusted odds ratios (AOR) with 95% confidence intervals (CI) for the predictors of anemia. Results Anemia was observed among 737(43.9%) of the 1678 pregnant women studied (95% CI 41.5%–46.3%). After controlling for the confounders, the risk of anemia was 29% higher in the women who chewed khat daily than those who sometimes or never did so (AOR, 1.29; 95% CI, 1.02–1.62). The study subjects with restrictive dietary behavior (reduced either meal size or frequency) had a 39% higher risk of anemia compared to those without restrictive dietary behavior (AOR, 1.39; 95% CI, 1.02–1.88). The risk of anemia was increased by 68% (AOR, 1.68; 95% CI, 1.15–2.47), and 60% (AOR, 1.60; 95% CI, 1.08–2.37) in parity levels of 2 births and 3 births, respectively. Compared to the first trimester, the risk of anemia was higher by two-fold (AOR, 2.09; 95% CI, 1.46–3.00) in the second trimester and by four-fold (AOR, 4.23; 95% CI, 2.97–6.02) in the third trimester. Conclusion In this study, two out of five women were anemic. Chewing khat and restrictive dietary habits that are associated with anemia in the setting should be addressed through public education programs. Interventions should also focus on the women at higher parity levels and those who are in advanced stages of pregnancy.
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Affiliation(s)
- Haji Kedir
- College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- * E-mail:
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Goshtasebi A, Alizadeh M, Gandevani SB. Association between maternal anaemia and postpartum depression in an urban sample of pregnant women in Iran. J Health Popul Nutr 2013; 31:398-402. [PMID: 24288954 PMCID: PMC3805890 DOI: 10.3329/jhpn.v31i3.16832] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of this prospective study was to determine the relationship between anaemia during pregnancy and postpartum depression. Two hundred eighty-one non-anaemic mothers with singleton and low-risk pregnancy and no history of antidepressant-use were studied. Demographic and reproductive data at week 20 were obtained. Mothers were followed up and haemoglobin (Hb) was checked at delivery. Iranian version of Edinburgh Postpartum Depression Scale (EPDS) was completed 4-6 weeks after delivery. Mean age of the mothers was 26.6+/-4 years. The prevalence of postpartum depression according to EPDS was 5.5%. Binary logistic regression analysis showed that Hb <11 g/dL at delivery would increase the chance of postpartum depression (OR 4.64; 95% CI 1.33-16.08). The results show that diagnosis and treatment of physiologic factors, especially anaemia, would reduce the risk of postpartum depression.
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Affiliation(s)
- Azita Goshtasebi
- Family Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
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Gascón P, Rodríguez CA, Valentín V, Mata JG, Carulla J, Cassinello J, Colomer R, Baró E. Usefulness of the PERFORM questionnaire to measure fatigue in cancer patients with anemia: a prospective, observational study. Support Care Cancer 2013; 21:3039-49. [PMID: 23793142 PMCID: PMC3789890 DOI: 10.1007/s00520-013-1862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PERFORM Questionnaire is a 12-item scale developed for assessing fatigue in cancer patients in the clinical practice. It has advantages over other tools in that it is short and includes beliefs and attitudes of patients about fatigue. It was psychometrically validated in cancer patients with and without anemia. PURPOSE We evaluated the usefulness of the PERFORM scale to measure fatigue in a large study focusing exclusively on anemic patients. METHODS This was an observational, multicenter, prospective, 3-month study in cancer patients with hemoglobin (Hb)≤11 g/dl. Fatigue was assessed using the PERFORM questionnaire. The overall score ranges from 12 (no fatigue) to 60 (maximum fatigue). RESULTS We included 667 patients: 54.1 % women, mean age 60 (standard deviation, 12) years. A highly significant, but mild correlation was observed between low baseline Hb and high patient perception of fatigue (r with PERFORM score=-0.215, p < 0.0001). Of the patients, 65.8 % improved Hb level during follow-up (increase of ≥1 g/dL and/or achieving >11 g/dL), which translated into a significant improvement in the PERFORM score [mean (95 % confidence interval (CI)] change, -1.2 (-0.04 to -2.4), whereas more fatigue was observed in patients without improvement in Hb [change (95 % CI) in PERFORM, +3.3 (1.5 to 5)]. In a multivariate linear regression analysis, the independent factors associated to fatigue at 3 months were a low Hb level, a low Karnofsky index, active chemotherapy, cancer treatment with palliative intention, and transfusion need in the last 3 months. CONCLUSIONS Minimal increases or decreases in Hb of ≥1 g/dL were associated with meaningful changes in patient-perceived fatigue as measured with the PERFORM questionnaire. In addition to anemia severity, other factors such as active chemotherapy and advanced disease contribute to perception of fatigue by cancer patients.
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Affiliation(s)
- Pere Gascón
- Hospital Clínic de Barcelona, Villarroel 170, ES-08036, Barcelona, Spain,
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Kupper N, Pelle AJ, Szabó BM, Denollet J. The relationship between Type D personality, affective symptoms and hemoglobin levels in chronic heart failure. PLoS One 2013; 8:e58370. [PMID: 23472188 PMCID: PMC3589413 DOI: 10.1371/journal.pone.0058370] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 02/03/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anemia is associated with poor prognosis in heart failure (HF) patients. Contributors to the risk of anemia in HF include hemodilution, renal dysfunction and inflammation. Hemoglobin levels may also be negatively affected by alterations in stress regulatory systems. Therefore, psychological distress characterized by such alterations may adversely affect hemoglobin in HF. The association between hemoglobin and Type D personality and affective symptomatology in the context of HF is poorly understood. AIM To examine the relationship between Type D personality and affective symptomatology with hemoglobin levels at inclusion and 12-month follow-up, controlling for relevant clinical factors. METHODS Plasma levels of hemoglobin and creatinine were assessed in 264 HF patients at inclusion and at 12-month follow-up. Type D personality and affective symptomatology were assessed at inclusion. RESULTS At inclusion, hemoglobin levels were similar for Type D and non-Type D HF patients (p = .23), and were moderately associated with affective symptomatology (r = -.14, p = .02). Multivariable regression showed that Type D personality (β = -.15; p = .02), was independently associated with future hemoglobin levels, while controlling for renal dysfunction, gender, NYHA class, time since diagnosis, BMI, the use of angiotensin-related medication, and levels of affective symptomatology. Change in renal function was associated with Type D personality (β = .20) and hemoglobin at 12 months (β = -.25). Sobel mediation analysis showed significant partial mediation of the Type D - hemoglobin association by renal function deterioration (p = .01). Anemia prevalence increased over time, especially in Type D patients. Female gender, poorer baseline renal function, deterioration of renal function and a longer HF history predicted the observed increase in anemia prevalence over time, while higher baseline hemoglobin was protective. CONCLUSION Type D personality, but not affective symptomatology, was associated with reduced future hemoglobin levels, independent of clinical factors. The relation between Type D personality and future hemoglobin levels was mediated by renal function deterioration.
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Affiliation(s)
- Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, and Department of Cardiology, TweeSteden Hospital, Tilburg, The Netherlands.
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Dearman LR, Musonda P, Roberts FG, Bowles KM, Morris EP. Bonding in women with postnatal anaemia: a pilot case control study looking at postnatal bonding in women who have been diagnosed with anaemia at a University Hospital in the East of England. Arch Gynecol Obstet 2011; 285:1243-8. [PMID: 22127552 DOI: 10.1007/s00404-011-2142-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 11/04/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Anaemia is common postpartum; however, the effect of anaemia on mother-infant bonding is presently unknown. This case controlled study was designed to evaluate the effects of anaemia on mother and baby bonding in the first month following delivery. METHODS 945 consecutive postpartum women who gave birth at home or in the obstetric unit at a university hospital in the East of England were identified from the hospital computer records. Blood counts had been performed on 279 of these women within 48 h of delivery, entirely at the discretion of the clinical team. The women with available blood count data were sent a self-reporting questionnaire which included a validated postpartum bonding questionnaire (PBQ). Data were collected from the 115 (41%) responses and analysed for the evidence of an effect of anaemia on bonding. RESULTS 57 (50%) of women responding to the questionnaire were anaemic (haemoglobin < 10 g/dL). There was no evidence of a difference between maternal, age, parity, mode of delivery, gestational age, baby weight or baby age at the time of completing questionnaire between the anaemic and non-anaemic groups. Moreover, there was no evidence of a difference in maternal perception of mother-infant bonding between the anaemic and non-anaemic groups. CONCLUSION Our study suggested no evidence of an association between postnatal anaemia and the mother's ability to bond with the baby; however a small but significant effect may still exist which we were not able to detect due to a possible lack of power, hence we suggest, further larger studies to be conducted.
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Affiliation(s)
- L R Dearman
- Department of Obstetrics and Gynaecology, NNUH, Colney Lane, Norwich, Norfolk NR4 7UY, UK.
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González-De-Jesús LN, Sánchez-Román S, Morales-Buenrostro LE, Ostrosky-Solís F, Alberú J, García-Ramos G, Marino-Vázquez LA, McClintock SM. Assessment of emotional distress in chronic kidney disease patients and kidney transplant recipients. Rev Invest Clin 2011; 63:558-563. [PMID: 23650668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the presence of emotional distress in patients with chronic kidney disease (CKD), and the effect of kidney transplant on these symptoms. MATERIAL AND METHODS This was a two-part study. Part one was cross-sectional, observational, and descriptive, where 75 patients with CKD were evaluated for emotional distress with the Hospital Anxiety and Depression Scale (HAD) and the Symptom Checklist 90 (SCL-90). In part two, we longitudinally followed 19% of the study cohort to examine symptomatological changes after their kidney transplantation. RESULTS The results of the HAD indicated that 30.7% of the study cohort with End-Stage Renal Disease (ESRD) showed anxious symptoms, and 25.3% showed depressive symptoms. The change in the HAD total score before and after kidney transplant was not significant. However, a significant decrease in total score on the SCL-90 was observed before and after transplantation. CONCLUSION Improvement on emotional distress was found after kidney transplantation.
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Affiliation(s)
- Lorena N González-De-Jesús
- Departamento de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
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Zhai Y, Shi XM, Qian HZ, Fitzgerald SM, Zeng Y, Yin ZX, Xu JW, Liu YZ. [Association of anemia with cognition among senior female in China]. Zhonghua Yu Fang Yi Xue Za Zhi 2011; 45:802-805. [PMID: 22177302 DOI: 10.3760/cma.j..issn.0253-9624.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the relationship between anemia and cognitive function among senior female aged 90 years old and above in longevity regions in China. METHODS 383 senior female in 5 longevity areas from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008 - 2009 were included in the study. The cognitive function was assessed by mini mental state examination (MMSE) scale. All subjects were administered the physical examinations and biochemical testing of blood, including the hemoglobin. The difference of cognitive function between those with and without anemia was analyzed. Logistic regression was used to analyze the relationship between anemia and cognitive function. RESULTS The 383 subjects were divided into two groups, 141 in anemia group and 242 in group without anemia. The total score of cognitive function was 9.65 ± 9.32 in anemia group, and 13.06 ± 10.25 in group without anemia (χ(2) = 5.59, P < 0.05). The percentage of cognition impairment was 84.4% (119/141) in anemia group, and 72.3% (175/242) in group without anemia (χ(2) = 8.08, P < 0.05). In the multivariable logistic regressions, after adjustment for age, education, marital status, smoking and alcohol drinking, the risk for cognition impairment in anemia group was about twice of that in group without anemia (OR = 2.016, 95%CI: 1.185 - 3.431, P = 0.010). CONCLUSION Anemia increases the risk of cognition impairment among senior female in Chinese longevity areas.
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Affiliation(s)
- Yi Zhai
- Division of Chronic Diseases Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing
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Harrow BS, Eaton CB, Roberts MB, Assaf AR, Luo X, Chen Z. Health utilities associated with hemoglobin levels and blood loss in postmenopausal women: the Women's Health Initiative. Value Health 2011; 14:555-563. [PMID: 21669380 DOI: 10.1016/j.jval.2010.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 10/31/2010] [Accepted: 11/03/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of our study was to use health-related quality of life data from the Women's Health Initiative to calculate health-related utility weights and examine differences in these health utility weights across different hemoglobin (Hgb) levels. These utility weights could then be used in future cost-effectiveness studies. METHODS Health utility weights were measured by the Short Form-6D (SF-6D), a health utility index derived from the Short Form Medical Outcomes questionnaire. Adjusted least square means were calculated for each level of Hgb at baseline and in longitudinal regression analysis the relationship between change in Hgb and change in the SF-6D was examined. Both baseline and longitudinal analyses were performed for all postmenopausal women and separately for those with self-reported heart failure, cancer, and osteoarthritis. RESULTS Women with Hgb in the anemic range had lower health utility weights than those with higher Hgb levels. Longitudinally, a loss of of 2 g/dl Hgb or more was associated with a statistically significant and clinically meaningfully decline in SF-6D in all participants and also in the group of participants with cancer and osteoarthritis, but not in those with heart failure. CONCLUSIONS Lower levels of Hgb and a loss of Hgb are associated with a statistically significant and clinically meaningful decrement in health utility in all postmenopausal women we studied and also in those with chronic conditions.
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Lewis EF, Pfeffer MA, Feng A, Uno H, McMurray JJV, Toto R, Gandra SR, Solomon SD, Moustafa M, Macdougall IC, Locatelli F, Parfrey PS. Darbepoetin alfa impact on health status in diabetes patients with kidney disease: a randomized trial. Clin J Am Soc Nephrol 2011; 6:845-55. [PMID: 21212421 PMCID: PMC3069378 DOI: 10.2215/cjn.06450710] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/22/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Quality of life (QOL) is markedly impaired in patients with anemia, diabetes mellitus, and chronic kidney disease. Limited data exist regarding the effect of anemia treatment on patient perceptions. The objectives were to determine the longitudinal impact of anemia treatment on quality of life in patients with diabetes and chronic kidney disease and to determine the predictors of baseline and change in QOL. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a large, double blind study, patients with type 2 diabetes mellitus, nondialysis chronic kidney disease (estimated GFR, 20 to 60 ml/min per 1.73 m(2)), and anemia (hemoglobin 10.4 g/dl) were randomized to darbepoetin alfa or placebo. QOL was measured with Functional Assessment of Cancer Therapy-Fatigue, Short Form-36, and EuroQol scores over 97 weeks. RESULTS Patients randomized to darbepoetin alfa reported significant improvements compared with placebo patients in Functional Assessment of Cancer Therapy-Fatigue, and EuroQol scores visual analog scores, persisting through 97 weeks. No consistent differences in Short Form-36 were noted. Consistent predictors of worse change scores include lower activity level, older age, pulmonary disease, and duration of diabetes. Interim stroke had a substantial negative impact on fatigue and physical function. CONCLUSION Darbepoetin alfa confers a consistent, but small, improvement in fatigue and overall quality of life but not in other domains. These modest QOL benefits must be considered in the context of neutral overall effect and increased risk of stroke in a small proportion of patients. Patient's QOL and potential treatment risk should be considered in any treatment decision.
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Affiliation(s)
- Eldrin F Lewis
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Genadieva-Stavrik S, Georgievski B, Stojanoski Z, Krstveska-Balkanov S, Pivkova A, Trajkova M, Genadieva-Dimitrova M, Serafimoski V. Iron overload in patients with transfusion dependent myelodisplastic syndrome. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2011; 32:295-304. [PMID: 21822196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The myelodisplastic syndrome is a heterogeneous group of diseases, characterised by ineffective and dysplastic haematopoesis and pancytopenia in the peripheral blood, followed by progressive disturbance of differentiation of the haematopoetic stem cell, resulting in evolution of the disease towards acute leukaemia. According to the latest WHO classification, the term myelodisplastic syndrome includes diseases with an indolent course, as well as diseases with a fast evolution towards acute leukaemia. Because of this diversity, haematologists base their therapeutic decisions on prognostic scoring systems which incorporate all the significant factors with an influence on survival in this group of patients with myelodisplastic syndrome. Bearing in mind that anaemia is the most frequent form of cytopenia in patients with myelodisplastic syndrome, it is common that at some point of the disease almost every patient with myelodisplastic syndrome is transfusion-dependent. Frequently applied transfusions secure the correction of anaemia in these patients, giving them a good quality of life, but at the same time endangering them with the potential threat of iron overload, when the physiological mechanisms of iron excretion from the organism become insufficient. There is a clear correlation between transfusion dependence and the overall survival in patients with myelodisplastic syndrome. Chelators secure the lowering of the iron surfeit and are indicated in transfusion-dependant patients with myelodisplastic syndrome ( need for two blood units monthly, during one year ), when the ferritin level increases over 1000, in patients who are candidates for transplantation as well as in patients from good prognostic groups with median survival over one year. The therapy with chelators lasts as long as the patient is transfusion-dependant.
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Brooker S, Okello G, Njagi K, Dubeck MM, Halliday KE, Inyega H, Jukes MCH. Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya. Trials 2010; 11:93. [PMID: 20929566 PMCID: PMC2959045 DOI: 10.1186/1745-6215-11-93] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 10/07/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya. DESIGN A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions. DISCUSSION Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa. TRIAL REGISTRATION National Institutes of Health NCT00878007.
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Affiliation(s)
- Simon Brooker
- Malaria Public Health & Epidemiology Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
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Tageja N. Relationship between anemia and cognitive functions in the geriatric population. Eur J Intern Med 2010; 21:e26. [PMID: 20603029 DOI: 10.1016/j.ejim.2010.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/11/2010] [Indexed: 11/17/2022]
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Tajima R, Kondo M, Kai H, Saito C, Okada M, Takahashi H, Doi M, Tsuruoka S, Yamagata K. Measurement of health-related quality of life in patients with chronic kidney disease in Japan with EuroQol (EQ-5D). Clin Exp Nephrol 2010; 14:340-8. [PMID: 20567874 DOI: 10.1007/s10157-010-0304-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/25/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a health-related quality-of-life (HRQOL) deteriorating disease which is not only a public health but also a socioeconomic problem. Interest in developing cost-effective interventions to control CKD has increased. The aim of this study was to measure HRQOL in terms of quality-adjustment weights for cost-effectiveness analysis using EQ-5D in patients with CKD. The relationships between the measured HRQOL and clinical indices/complications were also analyzed. METHODS EQ-5D, a generic preference-based instrument, was administered to 569 CKD outpatients at Tsukuba University Hospital between November and December 2008. The response rate was 94.4% (537/569). Data on sex, age, creatinine, hemoglobin, serum albumin and eGFR were obtained from the patients' records. Data on the presence of complications such as hypertension, diabetes, and history of cardiovascular disease (CVD) were also retrieved. RESULTS Measured quality-adjustment weights by the CKD stage were 0.940 (95% CI 0.915-0.965), 0.918 (0.896-0.940), 0.883 (0.857-0.909), 0.839 (0.794-0.884), and 0.798 (0.757-0.839) for stages 1-5, respectively. The decrease in weight was significant by ANOVA (P < 0.0001), and the weight for all stages was 0.885 (0.871-0.898). There was a positive relationship between hemoglobin/serum albumin and the weight. The presence of hypertension lowered the weight from 0.910 (0.885-0.936) to 0.874 (0.858-0.891), diabetes from 0.901 (0.886-0.917) to 0.840 (0.811-0.869), and CVD from 0.892 (0.878-0.906) to 0.783 (0.718-0.848). CONCLUSIONS HRQOL decreases with progression of CKD stage and/or presence of anemia, undernutrition, hypertension, diabetes, or history of CVD.
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Affiliation(s)
- Reiko Tajima
- Department of Nephrology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
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Doni L, Perin A, Manzione L, Gebbia V, Mattioli R, Speranza GB, Latini L, Iop A, Bertetto O, Ferraù F, Pugliese P, Tralongo P, Zaniboni A, Di Costanzo F. The impact of anemia on quality of life and hospitalisation in elderly cancer patients undergoing chemotherapy. Crit Rev Oncol Hematol 2010; 77:70-7. [PMID: 20483635 DOI: 10.1016/j.critrevonc.2010.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 03/19/2010] [Accepted: 04/08/2010] [Indexed: 11/19/2022] Open
Abstract
AIM OF THE STUDY at present, there is very little data available about the impact of anemia on elderly cancer patient's quality of life (QoL). Most of the acquired knowledge has been derived from small studies selected for primary site cancer. This observational study investigates the association between hemoglobin (Hb) level and comprehensive geriatric assessment variables: Cancer Linear Analog Scale (CLAS), Activities of Daily Living (ADL), Mini-Mental State Examination (MMSE) in elderly cancer patients undergoing chemotherapy (CT). METHODS we enrolled 586 elderly cancer patients undergoing CT who were evaluated at baseline and every 3-4 weeks for at least 12 weeks. The correlation between Hb level changes and the examined index changes were performed using Pearson correlation analysis and a multivariate analysis was performed using a logistic regression model. RESULTS both univariate and multivariate analyses at baseline showed that Hb values are related to ECOG performance status (PS), stage of disease and self-reported QoL. Hb level variation significantly correlated with CLAS and ADL changes measured at baseline and after 12 weeks. This correlation is highly significant in patients with Hb< 11g/dl. Multivariate analysis showed that Hb change of at least 1g/dl was the only independent predictor of a better quality of life, when assessed by using the CLAS and ADL questionnaire (p<0.05). Moreover the median time of hospitalisation was found to be significantly lower in patients showing higher Hb level (Hb ≥ 11g/dl) (p=0.037). CONCLUSIONS the findings of this study seem to provide adequate support for the correlation between anemia and elderly cancer patient's QoL. Interestingly, we reported an association between anemia and the length of hospitalisation in this setting of patients. However, the above results do need to be confirmed by further prospective trials.
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Affiliation(s)
- Laura Doni
- Medical Oncology Unit, AOU Careggi Hospital, Viale Pieraccini n. 17, 50139 Firenze, FI, Italy.
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Terekeci HM, Kucukardali Y, Onem Y, Erikci AA, Kucukardali B, Sahan B, Sayan O, Celik S, Gulec M, Sanisoglu YS, Nalbant S, Top C, Oktenli C. Relationship between anaemia and cognitive functions in elderly people. Eur J Intern Med 2010; 21:87-90. [PMID: 20206877 DOI: 10.1016/j.ejim.2009.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 11/29/2009] [Accepted: 12/04/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people. METHODS This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folstein's Mini-Mental State Examination (MMSE). RESULTS The mean age of the anaemic group and the nonanaemic group were 76.0+/-11.7 and 72.5+/-15.2 years, respectively. The average haemoglobin level among the anaemic population was 10.4 g/dL compared with 13.6 g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8+/-4.3 vs 9.3+/-3.7) and cognition (MMSE) (17.9+/-6.4 vs 21.7+/-6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring. CONCLUSION In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.
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Affiliation(s)
- Hakan M Terekeci
- Division of Internal Medicine, GATA Haydarpasa Training Hospital, Tibbiye Caddesi TR-34668 Kadikoy-Istanbul, Turkey.
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Affiliation(s)
- Shanique R. Palmer
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | | | - Alexandra P. Wolanskyj
- Adviser to fellow and Consultant in Hematology, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Alexandra P. Wolanskyj, MD, Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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van Nooten FE, Green J, Brown R, Finkelstein FO, Wish J. Burden of illness for patients with non-dialysis chronic kidney disease and anemia in the United States: review of the literature. J Med Econ 2010; 13:241-56. [PMID: 20438399 DOI: 10.3111/13696998.2010.484307] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the health-related quality of life (HRQL) and economic burden of chronic kidney disease (CKD) related anemia in non-dialysis patients in the United States (US) via literature review. METHODS MEDLINE, EMBASE, PROQOLID, and Cochrane Library/Renal Group Resources were searched. Studies were appraised for patient populations, disease-specific versus generic HRQL assessments, and type and magnitude of health-related costs. RESULTS The treatment costs for CKD patients with anemia compared to those without anemia were significantly higher and were blunted but persistent after controlling for comorbidities and confounders. Intervention with erythropoiesis stimulating agents (ESA) decreased anemia and avoided hospital admissions. Costs were higher when anemia was poorly controlled or untreated. HRQL burden was mainly due to physical limitations and difficulty in ability to perform activities of daily living. Significant positive correlations between increases in hemoglobin levels and HRQL measures were reported. CONCLUSIONS Although evidence is limited, the economic and HRQL burden of non-dialysis CKD-related anemia is substantial. Under-treatment of anemia may contribute to higher resource consumption and higher costs; however, patient co-morbidities, use of erythropoietin-stimulating agents, and overall management introduce potential confounds. The contribution of anemia to humanistic disease burden is due to a constellation of factors, including physical activity and functional status.
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Affiliation(s)
- Floortje E van Nooten
- Centre for Health Economics & Science Policy, United BioSource Corporation, 20 Bloomsbury Square, London, UK.
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Thein M, Ershler WB, Artz AS, Tecson J, Robinson BE, Rothstein G, Liede A, Gylys-Colwell I, Lu ZJ, Robbins S. Diminished quality of life and physical function in community-dwelling elderly with anemia. Medicine (Baltimore) 2009; 88:107-114. [PMID: 19282701 PMCID: PMC2893336 DOI: 10.1097/md.0b013e31819d89d5] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The occurrence of anemia in older adults has been associated with adverse outcomes including functional decline, disability, morbidity, and mortality. It is not clear to what extent these outcomes are the result of the anemia or concurrent illness. We performed a cross-sectional, observational study to determine whether lower hemoglobin concentrations in older adults are associated with reduced health-related quality of life, functional status, depression, disability, and physical strength, independent of chronic disease. Three sites participated in this research: an academic geriatric practice, a hospital-based geriatric outpatient unit, and a community-based multispecialty internal medicine group. Health-related quality of life and functional status were measured using the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Chronic Illness Therapy-Anemia (FACIT-An). Disability and depression were assessed using the Instrumental Activities of Daily Living (IADL) and the Geriatric Depression Scale (GDS) questionnaires, respectively. Handgrip strength was used as a physical performance measure. Anemia was defined as hemoglobin <13 g/dL for men or <12 g/dL for women. The mean SF-36 physical health component summary scores were 38.9 (with anemia) and 44.1 (without anemia) (p<0.001). Anemia was associated with greater fatigue (p < 0.001), lower handgrip strength (p = 0.014), increased number of disabilities (p=0.005), and more depressive symptoms (p = 0.002). Multivariate regression analysis, adjusted for demographic and clinical characteristics, demonstrated strong associations for reduced hemoglobin, even within the "normal" range, and poorer health-related quality of life across multiple domains. Thus, anemia was independently associated with clinically significant impairments in multiple domains of health-related quality of life, especially in measures of functional limitation. Mildly low hemoglobin levels, even when above the World Health Organization (WHO) anemia threshold, were associated with significant declines in quality of life among the elderly.
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Affiliation(s)
- Mya Thein
- Institute for Advanced Studies in Aging & Geriatric Medicine, Washington, DC
| | - William B Ershler
- Institute for Advanced Studies in Aging & Geriatric Medicine, Washington, DC
- Clinical Research Branch, National Institute on Aging, Baltimore, MD
| | - Andrew S. Artz
- Institute for Advanced Studies in Aging & Geriatric Medicine, Washington, DC
- University of Chicago Hospitals, Chicago, IL
| | - Josephine Tecson
- Institute for Advanced Studies in Aging & Geriatric Medicine, Washington, DC
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Abstract
The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor-patient relationship within which consent is given.
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Affiliation(s)
- E Winburn
- Otago District Health Board, Dunedin, New Zealand.
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Abstract
Erythopoietin (EPO) treatment of anemia during cancer has dramatically improved the tolerance of chemotherapy and quality of life of patients at all stages of the disease. Several surveys have demonstrated a high prevalence and a high incidence of anemia in lung cancer patients. The guidelines updates concerning EPO treatment for these patients are described. They take into account the debate concerning the potential harm of these molecules on the neoplastic disease and the possible role of EPO receptors expressed by several tumors, including non small cell lung cancer.
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Affiliation(s)
- J-M Bréchot
- Service d'Oncologie Médicale, Hôpital Avicenne, Université Paris-XIII, AP-HP, 125 Route de Stalingrad, 93009 Bobigny Cedex, France.
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Petranović D, Taksić V, Dobrila-Dintinjana R, Roncević-Grzeta I, Ruzić K, Janović S, Crnarić I, Duletić-Nacinović A, Sincić-Mijandrusić B. Correlation of anaemia and cognitive functions measured by the complex reactiometer Drenovac. Coll Antropol 2008; 32:47-51. [PMID: 18494187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cognitive impairment impinges significantly on the quality of life. Previous research revealed that anaemia can have a major influence on cognitive functioningt. The article is a correlational study examining the relationship between anaemia levels and cognitive functioning in adult patients. Sixty-one patients (both inpatients and outpatients), among them 30 anemic and 31 non-anaemic, 33 female and 28 male, aged 32-60 (median 43) treated at the Dept. of Hematology, Clinical Hospital Center Rijeka, Croatia were analysed according to hemoglobin (Hb) level and cognitive ability. Assessment of cognition (convergent inductive thinking) was performed by the Complex reactiometer Drenovac (CRD). The results showed that anaemia significantly undermines cognitive functions in adult patients (p < 0.01). Even in non-anaemic patients (Hb higher than 120 g/L), Hb level is related to better cognitive ability.
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Affiliation(s)
- Duska Petranović
- Department of Hematology, School of Medicine, University of Rijeka, University Hospital Center, Internal Clinic, Rijeka, Croatia.
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30
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Hasegawa T, Suzukamo Y, Akizawa T, Fukuhara S. [Validation of the Japanese SF-36 v2 acute form in patients with chronic kidney disease]. Nihon Jinzo Gakkai Shi 2008; 50:42-50. [PMID: 18318243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The SF-36v2 (version 2 of the SF-36 health survey) is an instrument used worldwide to measure the generic health-related quality of life (HQOL). The SF-36v2 has "standard" and "acute" forms, in which respondents are asked about the previous month and the previous week, respectively. The standard form of the Japanese-language version of the SF-36v2 has already been validated, but the acute form has not. We evaluated the validity and reliability of the Japanese SF-36v2 acute form in patients with chronic kidney disease (CKD). METHODS Cross-sectional data from 210 CKD patients who enrolled a clinical trial of a long-acting erythropoiesis stimulating agent (darbepoetin alfa) were analyzed. The feasibility of question items and distributions of the response choices were examined. Cronbach's alpha was computed to assess internal-consistency reliability. Construct validity was evaluated with tests of convergent and discriminant validity, and with factor analysis. Validity with regard to reference groups for the severity of anemia and for performance states was also assessed. RESULTS There were few missing data and the distribution of response choices did not differ between the acute form and the standard form. Values of Cronbach's alpha for the acute form sub-scales were sufficient. The percentages of items that passed the tests of convergent validity and discriminant validity were 100% and 98.7%, respectively. Factor analysis identified the same components in the acute form as in the standard form. "Dose-response" relationships were found between the sub-scale scores on the acute form and the severity of anemia, and also between those scores and performance states. CONCLUSIONS The Japanese SF-36v2 acute form can be expected to provide valid and reliable HQOL data in CKD patients.
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Affiliation(s)
- Takeshi Hasegawa
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
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31
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Wish J. Taking a subq approach to EPO: experience in the clinic. Nephrol News Issues 2007; 21:68. [PMID: 17970511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Jay Wish
- University Hospitals Case Medical Center, Cleveland, Ohio, USA
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32
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Holloway M. Route of administration for erythropoiesis-stimulating agents: patient and nursing considerations. Nephrol Nurs J 2007; 34:527-531. [PMID: 18041455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Several clinical studies have indicated that compared with intravenous (IV) administration, subcutaneous (SC) administration of Epoetin alfa may result in a dose-sparing effect in patients on hemodialysis. However, data also indicate wide inter-patient variability in response, with many patients requiring the same or a higher dose following conversion to SC administration. Convenience favors IV administration of Epoetin alfa in patients on hemodialysis, and patient preferences and comfort should also be primary considerations. For patients who prefer SC injections, the nurse's coordination of the required dosing, administration, and operational factors is key to maintaining and improving anemia-related outcomes.
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Affiliation(s)
- Maggie Holloway
- Department of Pediatrics, Division of Pediatric Nephrology, University of California, Los Angeles, USA
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Thomas CM, Coleman HR, Morritt Taub LF. A case study of an older adult with severe anemia refusing blood transfusion. ACTA ACUST UNITED AC 2007; 19:43-8. [PMID: 17214867 DOI: 10.1111/j.1745-7599.2006.00188.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs. DATA SOURCES Extensive review of the scientific literature on anemia and the situation in which a patient refuses blood transfusion presented in a case study format. CONCLUSIONS A thorough physical assessment, complete health history, and appropriate diagnostic workup should be used to distinguish the normal effects of senescence from the signs and symptoms of anemia. Common conditions that cause anemia in the elderly include chronic disease, iron deficiency, and gastrointestinal bleeding. These conditions may result in profound anemia. The challenge can be compounded when, because of religious tenets, a patient does not accept a blood transfusion. This case study challenges nurse practitioners to apply knowledge, seek guidance, and make appropriate referrals to care for a patient in order to render care within the parameters of the patient's belief system. IMPLICATIONS FOR PRACTICE The astute primary care provider recognizes that anemia is not an expected physiological change associated with aging but a manifestation of an underlying disease process. Fatigue, weakness, and dyspnea are all symptoms of anemia that may be overlooked and attributed to the aging process. Further, in keeping with the principles of autonomy and self-determination, it is the clinician's duty to work with all patients to restore them to a state of optimal health while respecting deeply held spiritual beliefs.
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Affiliation(s)
- C Michelle Thomas
- The University Center for Bloodless Surgery and Medicine at University Hospital, The University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
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35
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Plantinga LC, Fink NE, Jaar BG, Huang IC, Wu AW, Meyer KB, Powe NR. Relation between level or change of hemoglobin and generic and disease-specific quality of life measures in hemodialysis. Qual Life Res 2007; 16:755-65. [PMID: 17286191 DOI: 10.1007/s11136-007-9176-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 01/09/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to examine the relation between meeting or exceeding the current minimum guideline for hemoglobin (11 g/dl) in dialysis patients and generic and disease-specific QOL scores at 1 year. METHODS In 438 incident hemodialysis patients from a national prospective cohort study, we used regression models to predict QOL score (all scaled 0-100) at 1 year using 6-month values of hemoglobin, adjusting for potential confounders. RESULTS Compared to values < 11 g/dl, hemoglobin > or = 11 g/dl at 6 months was associated with higher scores for the general domains of physical functioning, role physical, mental health, social functioning, and bodily pain at 1 year; cognitive function, diet restriction, and dialysis access dialysis-specific domain scores were also higher for these patients. Each 1 g/dl greater hemoglobin was also statistically significantly associated with higher QOL scores for most domains. In longitudinal analyses, most of the domains showed that, with each 1 g/dl increase in hemoglobin concentration from baseline to 6 months, QOL score increased significantly over the first year. CONCLUSIONS Hemodialysis patients who attain higher hemoglobin concentration at 6 months, especially > or = 11 g/dl, have better QOL at 1 year, with regard to important physical, mental, social, and cognitive domains.
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Affiliation(s)
- Laura C Plantinga
- Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
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36
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de Gaona ER, Rifón J, Pérez-Calvo J, Bendandi M, Iglesias R, Panizo C. [Anemia in chronic lymphatic leukemia: is erythropoietin the solution?]. Rev Med Univ Navarra 2007; 51:3-10. [PMID: 17555114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Anemia is a common complication in the clinical course of chronic lymphocytic leukemia. Low hemoglobin levels both correlate with an adverse prognosis and adversely affect the quality of life of chronic lymphocytic leukemia patients. Different physiopathological phenomena may lead to anemia: marrow infiltration, hypersplenism, immune hemolysis or toxicity of chemotherapy. Treatment with human recombinant erythropoietic agents has been shown to be effective for anemia associated with different lymphoproliferative syndromes. This paper analyses the available evidence on erythropoietic agent treatment for chronic lymphocytic leukemia associated anemia. The comparative effect of different dosage schemes, the role of possible response-prediction factors such as the endogenous erythropoietin level and the results achieved using darbopoietin alpha are reviewed.
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Affiliation(s)
- E Ruiz de Gaona
- Servicio de Hematología y Hemoterapia, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra, España
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Wedding U, Röhrig B, Pientka L, Höffken K. Anaemia-related impairment in quality of life in elderly cancer patients prior to chemotherapy. J Cancer Res Clin Oncol 2006; 133:279-86. [PMID: 17139442 DOI: 10.1007/s00432-006-0167-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 10/13/2006] [Accepted: 10/23/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE Quality of life (QoL) of patients with cancer is a major area of concern for both patients and their physicians. PATIENTS AND METHODS We investigated QoL with the EORTC-QLQ-C30 questionnaire with reference to anaemia and Karnofsky Performance Status (KPS) prior to the start of chemotherapy in 477 patients: 195 elderly cancer patients (Group A), 152 younger cancer patients (Group B), and 130 patients aged 60 years or older admitted for non-cancer related disorders (Group C). RESULTS In univariate analysis QoL was significantly worse in 8 out of 15 scales in anaemic compared to non anaemic patients in Group A, in 2 in Group B, and in 7 in Group C. In ANOVA analysis including KPS and haemoglobin status, the influence of anaemia and KPS independently persists in most scales in Group A, in some in Group C, but not in Group B. CONCLUSIONS Anaemia and functional impairment are independently related to QoL in elderly cancer and elderly medical patients, but not in younger cancer patients.
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Affiliation(s)
- Ulrich Wedding
- Internal Medicine, Department of Haematology and Medical Oncology, Friedrich Schiller University, Erlanger Allee 101, Jena 07747, Germany.
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Falk K, Swedberg K, Gaston-Johansson F, Ekman I. Fatigue and anaemia in patients with chronic heart failure. Eur J Heart Fail 2006; 8:744-9. [PMID: 16690352 DOI: 10.1016/j.ejheart.2006.01.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 11/08/2005] [Accepted: 01/26/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Fatigue is common in patients with chronic heart failure (CHF) and has great impact on functional ability and daily activity. Although anaemia is associated with fatigue, the relationship between fatigue and anaemia is unclear in CHF. The aim of this study was to describe the fatigue experience and its relationship to haemoglobin (Hb) concentration and to evaluate its effect on health-related quality of life in an unselected hospitalised CHF population. METHODS Ninety three consecutive patients hospitalised with a diagnosis of CHF, enrolled in the EuroHeart Failure Survey, completed the Multidimensional Fatigue Inventory Scale (MFI-20). New York Heart Association (NYHA) functional class, quality of life and haemoglobin were also assessed. RESULTS Anaemia (Hb < or = 125 g/L) was found in 31 (33%) patients. The perception of fatigue differed significantly between patients with CHF and healthy individuals. Anaemic patients reported significantly more fatigue compared to non-anaemic patients. Decreased haemoglobin and higher NYHA class explained 30% of the variance in General Fatigue. Perceived fatigue was also inversely related to global health and quality of life. CONCLUSION Our findings suggest that the subjective experience of fatigue in patients with CHF is associated with low haemoglobin concentration and reduced functional status after controlling for age and sex.
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Affiliation(s)
- Kristin Falk
- Institute of Nursing, Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, S-405 30 Göteborg, Sweden.
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Chaves PHM, Carlson MC, Ferrucci L, Guralnik JM, Semba R, Fried LP. Association between mild anemia and executive function impairment in community-dwelling older women: The Women's Health and Aging Study II. J Am Geriatr Soc 2006; 54:1429-35. [PMID: 16970654 PMCID: PMC2668150 DOI: 10.1111/j.1532-5415.2006.00863.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the relationship between mild anemia and executive function in community-dwelling older women. DESIGN Cross-sectional. SETTING Community-based. PARTICIPANTS High-functioning subjects participating in the baseline assessment of the Women's Health and Aging Study (WHAS) II, Baltimore, Maryland, 1994 to 1996. WHAS II eligibility criteria included aged 70 to 80, a Mini-Mental State Examination score of 24 or greater, and absence of advanced disability (difficulty in no more than 1 domain of physical function). Included in this study were 364 subjects with a hemoglobin concentration 10 g/dL or greater and known executive function status. MEASUREMENTS Trail Making Test (TMT) Parts B and A. Tertiles of time to complete each test were used to define best (bottom), intermediate, and worst (top) performance. Tertiles of the difference TMT-B minus TMT-A were calculated. Anemia defined as hemoglobin concentration less than 12 g/dL. RESULTS The percentage of subjects in the worst TMT-B, TMT-A, and TMT-B minus TMT-A performance tertile was highest for those with anemia. Prevalent anemia substantially increased the likelihood of performing worst (as opposed to best) on the TMT-B (odds ratio (OR) = 5.2, 95% confidence interval (CI) = 1.3-20.5), TMT-A (OR = 4.8, 95% CI = 1.5-15.6), and TMT-B minus TMT-A (OR = 4.2, 95% CI = 1.0-17.2), even after controlling for age, education, race, prevalent diseases, and relevant physiological and functional parameters. CONCLUSION This study provides preliminary evidence in support of the hypothesis that mild anemia might be an independent risk factor for executive function impairment in community-dwelling older adults. Whether such an association is causal or noncausal remains to be determined.
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Affiliation(s)
- Paulo H M Chaves
- Center on Aging and Health and Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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Kurita M, Shimozuma K, Morita S, Fujiki Y, Ishizawa K, Eguchi H, Saito Y, Ushirozawa N, Wasada I, Ohashi Y, Eguchi K. Clinical validity of the Japanese version of the Functional Assessment of Cancer Therapy-Anemia Scale. Support Care Cancer 2006; 15:1-6. [PMID: 17028890 DOI: 10.1007/s00520-006-0138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 07/19/2006] [Indexed: 11/30/2022]
Abstract
GOALS OF WORK The purpose of this study was to reveal the clinical validity of the Japanese version of the Functional Assessment of Cancer Therapy-Anemia scale (FACT-An) in relation to hemoglobin level. We also analyzed patients' scores for the related FACT-General scale (FACT-G), the FACT Anemia subscale, and the FACT Trial Outcome Index-Anemia scale (FACT TOI-An) to determine which was the most sensitive to anemia measurements. MATERIALS AND METHODS Throughout Japan, we recruited 227 patients (mean+/-SD, 59+/-12.1 years old) diagnosed with a variety of cancers. We correlated the severity of anemia, as measured by hemoglobin levels, to scores on the FACT-An and on the other scales at baseline and at 3 months. MAIN RESULTS The questionnaire completion rate was more than 98% at both time points. The FACT-An had high internal consistency (Cronbach's alpha coefficient >0.8). FACT-An scores were significantly and positively correlated with hemoglobin levels both at baseline (r=0.24; 95% CI=0.12 to 0.36; n=225) and at 3 months (r=0.24; 95% CI=0.10 to 0.36; n=204). FACT-G, FACT Anemia subscale, and FACT TOI-An scores also successfully discriminated between patients with lower (Hb <11.0 g/dl) and higher (Hb > or =11.0 g/dl) hemoglobin levels. Moreover, the changes of these FACT scores over 3-months could discriminate changes in hemoglobin level. CONCLUSION The Japanese version of the FACT-An has higher clinical validity and can be used to appropriately assess health-related quality of life among Japanese cancer patients with anemia.
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Affiliation(s)
- Maya Kurita
- Division of Clinical Research, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
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Geiser F, Hahn C, Conrad R, Liedtke R, Sauerbruch T, Schmidt-Wolf I, Glasmacher A. Interaction of psychological factors and the effect of epoetin alfa treatment in cancer patients on hemoglobin and fatigue. Support Care Cancer 2006; 15:273-8. [PMID: 16932973 DOI: 10.1007/s00520-006-0132-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 07/12/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND BACKGROUND Epoetin alpha is known to produce a hematological response in anemic cancer patients. A concomitant reduction in fatigue as well as an improvement of depression and anxiety and of quality of life has been reported. However, these effects are discussed controversially. Psychological variables may have a moderating effect on fatigue reduction. MATERIALS AND METHODS Fifty-four anemic cancer outpatients were treated with epoetin alpha over 26 weeks with an initial dose of 3 x 10,000 IU/week and further individually adapted dosage. Hemoglobin level, fatigue, depression, anxiety, and health-related quality of life were measured every 4 weeks. RESULTS The hematological response rate was 50%, with 1/3 occurring after more than 8 weeks of treatment. Fatigue, depression, and quality of life improved significantly. Reduction in fatigue was associated with response, but the correlations between fatigue and hemoglobin were weak. Less depression and higher quality of life before treatment correlated with a better fatigue reduction when controlling for hemoglobin increase and initial fatigue level. CONCLUSION Psychological variables influence the reduction of fatigue during therapy with epoetin alpha in anemic cancer patients and should therefore be assessed at the beginning of treatment.
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Affiliation(s)
- Franziska Geiser
- Clinic for Psychosomatics, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
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de Castro J, Ordóñez A, Isla D, Sánchez A, Arrivi A, Manzano JL, Barón MG. Early intervention with epoetin beta prevents severe anaemia in patients with solid tumours receiving platinum-based chemotherapy: results of the NeoPrevent study. Cancer Chemother Pharmacol 2006; 59:35-42. [PMID: 16874498 DOI: 10.1007/s00280-006-0251-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 04/11/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anaemia is common during platinum-based chemotherapy. This study aimed to evaluate the efficacy and safety of epoetin beta in the prevention of severe anaemia in patients with solid tumours receiving concomitant platinum therapy. PATIENTS AND METHODS In this open-label, single-arm study, patients (n = 255) with solid tumours and haemoglobin (Hb) levels </= 13 g/dl (men) or </= 12 g/dl (women) received epoetin beta 450 IU/kg ( approximately 30,000 IU) weekly until 4 weeks after their last platinum-based chemotherapy cycle. RESULTS An anaemia prevention response [defined as patients with a Hb response (increase in Hb level > 1 g/dl from baseline) plus patients whose Hb levels remained +/- 1 g/dl of baseline throughout the study] was observed in 234 patients (92%). Response to epoetin beta was rapid. Of the 159 patients achieving a Hb response, 139 (87%) had Hb levels > 1 g/dl of baseline within 4 weeks of treatment initiation. Mean Hb levels had improved from 10.8 +/- 1.0 g/dl at baseline to 12.2 +/- 1.8 g/dl by the final visit. Quality of life measured by linear analogue scale assessment significantly (P < 0.01) improved in patients achieving a Hb response (n = 159). CONCLUSIONS Epoetin beta effectively prevents anaemia in most patients with solid tumours receiving concurrent platinum-based chemotherapy.
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Affiliation(s)
- Javier de Castro
- Servicio de Oncología Médica, Hospital Universitario La Paz (Madrid), Paseo de la Castellana, 261, 28046, Madrid, Spain
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Aapro MS, Dale DC, Blasi M, Sarokhan B, Ahmed F, Woodman RC. Epoetin alfa increases hemoglobin levels and improves quality of life in anemic geriatric cancer patients receiving chemotherapy. Support Care Cancer 2006; 14:1184-94. [PMID: 16758175 DOI: 10.1007/s00520-006-0076-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 03/30/2006] [Indexed: 11/25/2022]
Abstract
GOAL To evaluate epoetin alfa (EPO) treatment of anemia in geriatric cancer patients receiving chemotherapy, a retrospective subgroup analysis was conducted of anemic cancer patients > or =65 years of age from three 16-week community-based studies of thrice-weekly (TIW) or once-weekly (QW) EPO for chemotherapy-related anemia (CRA). PATIENTS AND METHODS Analyses were conducted on the overall geriatric population (> or =65 years) and by age subgroup (65-74, 75-84, and > or =85 years), and compared with younger patients (<65 years) for each individual study and for pooled data. MAIN RESULTS Some 3,634 geriatric patients were compared with 3,467 younger patients. From baseline to final measurement, EPO therapy significantly increased Hb by 2.0 g/dl in patients > or =65 years and 1.9 g/dl in patients <65 years (P<0.0001) and reduced transfusion utilization in both groups (P<0.006). Both age groups also had significant improvements in quality of life (QOL), measured by the 100-mm Linear Analog Assessment Scale (LASA). In younger patients, mean LASA changes were significantly greater than those in geriatric patients (P<0.05); however, QOL improvements in both age groups were clinically meaningful. There were no significant differences across geriatric age subgroups or between TIW and QW regimens for Hb change or QOL improvement. Overall hematopoietic response rate to EPO was 65.4% for patients > or =65 years and 64.7% for patients <65 years. Predictors of greater hematopoietic response (based on a pooled analysis) included lower body weight, baseline Hb, and baseline serum erythropoietin levels; better tumor response; and history of EPO dose reduction and longer time on study. CONCLUSIONS Anemic geriatric patients receiving EPO for CRA responded comparably to younger patients <65 years and should be treated similarly.
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Zamboni V, Cesari M, Zuccalà G, Onder G, Woodman RC, Maraldi C, Ranzini M, Volpato S, Pahor M, Bernabei R. Anemia and cognitive performance in hospitalized older patients: results from the GIFA study. Int J Geriatr Psychiatry 2006; 21:529-34. [PMID: 16783797 DOI: 10.1002/gps.1520] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anemia represents a major risk factor for adverse health-related events in older persons. The aim of this study was to evaluate the association between hemoglobin levels/anemia and cognitive function in hospitalized older persons. METHOD Data are from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study. Hemoglobin levels (in g/dL) were measured upon admission to hospital; anemia was defined according to the WHO criteria. Cognitive performance was assessed by the Abbreviated Mental Test (AMT) on admission; an AMT score <7 defined cognitive impairment. Logistic regressions and analyses of covariance were performed to evaluate the relationship between cognitive status and hemoglobin levels/anemia. RESULTS Mean age of the sample (n = 13,301) was 72.0 years. Participants with cognitive impairment presented a higher prevalence of anemia (47%) compared to those without cognitive impairment (35%, p < 0.001). Adjusted logistic regressions showed that hemoglobin levels/anemia were significantly associated with cognitive impairment (OR = 0.96, 95%CI = 0.94-0.99, p = 0.004, and OR = 1.32, 95%CI = 1.18-1.48, p < 0.001, respectively). Patients with anemia and cognitive impairment at the hospital admission presented a higher number of impaired Activities of Daily Living compared to those with only one or none of the studied conditions (p for trend < 0.001). CONCLUSION Low hemoglobin levels and anemia are independently associated with cognitive performance in older persons admitted to acute care units.
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Affiliation(s)
- Valentina Zamboni
- Department of Gerontology, Geriatrics and Physiatry, Catholic University of Sacred Heart, Rome, Italy.
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Weiskopf RB, Feiner J, Hopf H, Lieberman J, Finlay HE, Quah C, Kramer JH, Bostrom A, Toy P. Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology 2006; 104:911-20. [PMID: 16645441 DOI: 10.1097/00000542-200605000-00005] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Erythrocytes are transfused to treat or prevent imminent inadequate tissue oxygenation. 2,3-diphosphoglycerate concentration decreases and oxygen affinity of hemoglobin increases (P50 decreases) with blood storage, leading some to propose that erythrocytes stored for 14 or more days do not release sufficient oxygen to make their transfusion efficacious. The authors tested the hypothesis that erythrocytes stored for 3 weeks are as effective in supplying oxygen to human tissues as are erythrocytes stored for less than 5 h. METHODS Nine healthy volunteers donated 2 units of blood more than 3 weeks before they were tested with a standard, computerized neuropsychological test (digit-symbol substitution test [DSST]) on 2 days, 1 week apart, before and after acute isovolemic reduction of their hemoglobin concentration to 7.4 and 5.5 g/dl. Volunteers randomly received autologous erythrocytes stored for either less than 5 h ("fresh") or 3 weeks ("stored") to return their hemoglobin concentration to 7.5 g/dl (double blinded). Erythrocytes of the alternate storage duration were transfused on the second experimental day. The DSST was repeated after transfusion. RESULTS Acute anemia slowed DSST performance equivalently in both groups. Transfusion of stored erythrocytes with decreased P50 reversed the altered DSST (P < 0.001) to a time that did not differ from that at 7.4 g/dl hemoglobin during production of acute anemia (P = 0.88). The erythrocyte transfusion-induced DSST improvement did not differ between groups (P = 0.96). CONCLUSION Erythrocytes stored for 3 weeks are as efficacious as are erythrocytes stored for 3.5 h in reversing the neurocognitive deficit of acute anemia. Requiring fresh rather than stored erythrocytes for augmentation of oxygen delivery does not seem warranted.
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Affiliation(s)
- Richard B Weiskopf
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, USA.
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Abstract
Objective:In this pilot project we examined the quality of life of spouses of cancer patients who had significant fatigue.Methods:We assessed both the spouses of cancer patients and the patients who presented with chemotherapy-induced fatigue and anemia. Study endpoints included the impact that cancer patients' fatigue had on their spouses' quality of life, including their own levels of fatigue, depressive symptoms, activity levels, work absenteeism, and marital adjustment. We examined the extent to which changes in patients' fatigue from baseline to one month follow-up were associated with changes in spouses' quality of life indices.Results:25 couples completed the study. Seven (28%) spousal caregivers reported handling fewer responsibilities at work, 8 (32%) had reduced their work hours, and 8 (32%) felt that they were less effective overall at work. Spousal caregivers also missed a significant amount of time at work during the month long study, missing an average of 2.7 (SD= 2.95) days, with an additional 1.29 (SD= 2.97) sick days and 1.76 (SD= 2.63) vacation days during that time. Spouses reporting greater levels of caregiver strain were more likely to have increased fatigue at baseline (F1,23= 8.11,p< .01), and worse dyadic adjustment at both time points (baseline:F1,23= 7.80,p< .01; follow-up:F1,21= 9.24,p< .01). Also, those with more caregiver strain were less likely to engage in social activity at baseline (F1,23= 6.11,p< .05) and more likely to engage in less work by the one month follow-up (F1,20= 8.36,p< .01).Significance of results:Spouses who were identified as having elevated burden experienced more personal fatigue, had worse dyadic adjustment, reported poor energy levels, and tended to engage in fewer work and social activities; the impact of patient's fatigue level on these parameters was highly variable in this small pilot study.
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Affiliation(s)
- Steven D Passik
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 641 Lexington Avenue, New York, NY 10022, USA.
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Kallich J, McDermott A, Xu X, Fayers P, Cella D. The relationship between patient knowledge of hemoglobin levels and health-related quality of life. Qual Life Res 2006; 15:57-68. [PMID: 16411031 DOI: 10.1007/s11136-005-8324-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND An anti-anemia drug may improve self-reported quality of life (QOL) partly because patients know their hemoglobin level is rising. In the absence of any published studies on this topic, the authors investigated the association between knowledge of hemoglobin levels and self-reported QOL. METHODS The study analyzed health-related QOL (HRQOL) data from five randomized clinical trials of erythropoietic therapy in patients with cancer-related anemia. Patients were asked whether they knew their hemoglobin level and, if so, to report its value. Patients (n=1007) were grouped into three categories depending on the extent and accuracy of hemoglobin level knowledge. HRQOL scale scores were compared between categories. RESULTS Only 23.2% of patients reported knowing their hemoglobin level at the end of the study; however, the value was accurate (within 1 g/dl) in 88.0% of these patients. On five of the 11 HRQOL scales studied, there was a significant association between knowledge of hemoglobin level and HRQOL score. However, the magnitude of the mean difference between those who knew vs. those who did not know their hemoglobin was generally below scale thresholds for minimally important differences. CONCLUSIONS Patient knowledge of hemoglobin level has a modest association with some aspects of self-reported HRQOL. The magnitude of this association, where it exists, would be unlikely to explain large group differences in HRQOL reports over time, even for patients who know their hemoglobin level.
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Affiliation(s)
- J Kallich
- Amgen Inc., Thousand Oaks, CA 91320-1799, USA.
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Mackey HT. Improving patient outcomes: managing anemia through maintaining treatment goals and maximizing quality of life. ONS News 2006; 21:41-2. [PMID: 16925146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Heather T Mackey
- Palliative Care Program, Wake Forest University Baptist Medical Center, Winston Salem, NC, USA
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Abstract
BACKGROUND To our knowledge, the relationship between changes in hemoglobin level and energy and physical functioning in the anemic and "normal" ranges of hemoglobin among individuals with AIDS has not been well characterized. METHODS In a multicenter, prospective, cohort study involving 19 clinics in the United States, 1406 individuals, 13 years and older, with AIDS were administered the Medical Outcomes Study HIV [human immunodeficiency virus] Health Survey (MOS-HIV) at baseline and at 3- to 6-month follow-up visits. Energy and physical functioning scores were the main outcomes. RESULTS At baseline, a higher hemoglobin level was associated with a higher energy score and a higher physical functioning score (P < .001 for both), after adjusting for CD4 lymphocyte count, sex, age, education, and HIV risk factor. In longitudinal analyses, increases in hemoglobin were associated with increases in energy and physical functioning scores (P < .001 for both), after adjusting for CD4 lymphocyte count, sex, age, education, and HIV risk factor. Changes in the energy scales were, on average, 1.5 and 2.3 scale points per 1-g/dL change in hemoglobin level in the normal and anemic ranges, respectively. For the physical functioning scale, average changes were 2.7 and 2.6 scale points per 1-g/dL change in hemoglobin level in the normal and anemic ranges, respectively. CONCLUSIONS Higher levels of hemoglobin are associated with better quality of life among individuals with AIDS. Changes in hemoglobin level within the conventional normal range of hemoglobin are also significantly associated with changes in quality of life.
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Affiliation(s)
- Richard D Semba
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Field AJ, Cottrell DJ. Postural hallucinations? An unusual presentation of anaemia. Arch Dis Child 2005; 90:1192-3. [PMID: 16243877 PMCID: PMC1720147 DOI: 10.1136/adc.2005.075994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The case of a 14 year old girl is reported, referred to Child Psychiatry with tearfulness and possible auditory hallucinations. Closer questioning revealed a history of low energy, sleeping excessively without refreshment, exertional dyspnoea, and poor growth. Psychologically, there was no evidence of low mood or negative cognitions despite the inexplicable tearfulness. Detailed enquiry revealed the "hallucinations" to be "whooshing" noises in her ears precipitated by standing. She was found to have a haemoglobin level of 55 g/l, attributed to a combination of poor diet and menorrhagia.Periodic, anaemic, cerebral hypoxia could be proposed to be the root of most, if not all, of the symptoms, illustrating the importance of marrying physical and psychological history taking with suitable investigations for an eminently treatable condition.
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Affiliation(s)
- A J Field
- Academic Unit of Child and Adolescent Mental Health, Leeds, UK.
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