Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.)--University of Missouri-Columbia, 2004. / Typescript. Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references. Also available on the Internet.

Thesis (M.Sc.(Clinical Epidemiology))--University of Pretoria, 2003. / Includes abstract in English and Afrikaans. Includes bibliographical references. Also available online.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2009. / Directed by Keith Erikson; submitted to the Dept. of Nutrition. Title from PDF t.p. (viewed Apr. 29, 2010). Includes bibliographical references (p. 154-191).

Thesis (M.S.)--University of Missouri-Columbia, 2004. / Typescript. Includes bibliographical references. Also available on the Internet.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2003. / Bibliography: leaves 101-110. Also available online.

BACKGROUND: Anemia is a common extra-intestinal manifestation of disease in patients with inflammatory bowel disease (IBD), and iron deficiency anemia (IDA) represents the most prevalent form of anemia in this population ((Gasche, Dejaco et al. 1997) (Plantz, Maxwell et al. 2016)). IDA can result from a combination of decreased dietary iron intake, impaired intestinal absorption, and excessive gastrointestinal (GI) bleeding, all of which can lead to decreased iron stores and poor iron utilization. Furthermore, chronic IDA in children with IBD can adversely influence development and cognition, as well as contribute to the increased fatigue and decreased stamina observed in these patients (Laass, Straub et al. 2014). Treatment of IDA in pediatric patients with IBD can be with either oral iron supplementation or parenteral iron infusions, and both can result in an improvement in iron parameters and subsequent improvement in patient overall quality of life. However, there is wide variability in physician practice with respect to the identification and treatment of IDA in pediatric patients with IBD. OBJECTIVE: To assess physician practice at Boston Children’s Hospital with respect to the identification and treatment of IBD-related IDA in a population of patients admitted for management of a flare in their underlying ulcerative colitis. This information will be useful to develop initiatives directed at improving recognition and management of IDA in this population. METHODS: The Institutional Review Board (IRB) at Boston Children's Hospital (BCH) approved the study protocol. Patient electronic medical records were reviewed and abstracted from subjects with ulcerative colitis (UC) that were treated at BCH between January 2005 and January 2013. Each patient was assigned a study identification number to protect private health information, and this data was stored in a computer file behind the hospital’s internet firewall. Inpatient and outpatient office notes, as well as clinical data, were reviewed to track the identification of patients with anemia as well as physician management practices. All of the information collected was stored in the Research Electronic Database Capture (REDCap) and used for analysis. RESULTS: A total of 243 patients met initial inclusion criteria. Subsequent review of the electronic medical records revealed that only 178 patients had complete data available for use in our analysis. 55.5% of the 178 study subjects were anemic at admission, with a mean hemoglobin value of 9.32 g/dL (SD 1.89) and a mean MCV value of 77.49 fl (SD 10.24). None of the patients in this cohort had iron studies (plasma iron, ferritin, total iron binding capacity) included in their admissions laboratory testing. Only 24 patients received oral iron supplementation during their hospital stay while none received IV iron infusions. Over half of the total patient cohort (78.7 %,) were not prescribed oral iron supplementation at the time of discharge. 84% of patients that were discharged anemic remained anemic at the time of their first post-discharge ambulatory visit. Less than half of the total patient cohort (30.34%) had iron studies included in their follow-up ambulatory laboratory testing. Patients that were given iron supplementation at the time of discharge showed increased gains in their hemoglobin levels at follow-up compared to patients with no iron supplementation at the time of discharge (p <0.0001). CONCLUSION: These data suggest that there is a low prevalence with respect to the identification and treatment of IDA and anemia in pediatric patients with ulcerative colitis (UC) at admission, discharge, and follow-up clinic visits. A secondary finding was a statistically significant increase in hemoglobin levels in anemic patients treated with some form of iron supplementation. As a result, our data support both the need to improve recognition of IDA in pediatric patients admitted for a UC flare as well as document the clinical value to this effort. Additional studies are necessary to determine if improved iron surveillance and therapy will improve patient quality of life, linear growth, and cognition in patients with IBD.

o presente trabalho teve por objetivo verificar a possível associação entre alimentação no primeiro ano de vida e anemia ferropriva. Estudou-se uma amostra de 317 crianças com até 12 meses de idade, matriculadas e freqüentando quatro Centros de Saúde Escola do município de São Paulo. As informações sobre a alimentação foram obtidas pelo método de inquérito recordatório, em entrevista com as mães das crianças, na ocasião da consulta ou da vacinação. A presença de anemia foi verificada pela concentração de hemoglobina, determinada pelo método da cianometahemoglobina. Utilizou-se o critério recomendado pela Organização Mundial de Saúde (OMS) para diagnóstico da anemia, verificando-se a prevalência de 14,5 por cento entre toda a população e 22,4 por cento entre as crianças maiores de 180 dias. As associações entre anemia e duração do aleitamento materno exclusivo, idade de introdução de alimentos não lácteos e freqüência de consumo de alimentos fontes de ferro e/ou potenciadores da sua absorção não foram significantes. A ausência do aleitamento materno, até pelo menos 4 meses, associou-se à anemia. Nessa faixa etária encontraram-se 26,9 por cento de anêmicas entre as crianças que tomavam outros leites e 8,6 por cento entre as que só recebiam leite materno. A anemia não se associou às variáveis sócioeconômicas estudadas: escolaridade do pai, da mãe e renda familiar. / This study was made to find out the possible association between the diet in the first year of life and iron deficiency anemia. A sample of 317 infants aged 0-12 months was studied in four school health centers in the city of São Paulo. The informations about diet were obtained by the recordatory survey method, in interviews with the infant\'s mothers. The presence of anemia was verified by hemoglobin concentration, using the cianometahemoglobin method. The criteria recommended by the World Health Organization (WHO) was utilized for the diagnostic of anemia. The prevalence of 14,5 per cent was found in all the population and 22,4 per cent in infants aged more than 180 days. The associations between anemia and time of exclusively breast-feeding, and age of introduction of other foods and/or eating foods which enhance iron absorption were not significants. The absence of breast-feeding, until at least 4 months, were associated with anemia. In this age were found 26,9 per cent of anemics among infants receiving others milks and 8,6 per cent among those receiving only breast milk. Anemia was not associated with socioeconomic variables: parents education levels and familiar income.