Effects of oral iron(III) hydroxide polymaltose complex supplementation on hemoglobin increase, cognitive function, affective behavior and scholastic performance of adolescents with varying iron status: a single centre prospective placebo controlled study.

OBJECTIVE: To assess the effects of iron supplementation on iron status, cognitive function, affective behavior and scholastic performance in adolescents with varying iron status. METHODS: Adolescents of both sexes with varying iron status were allocated to four treatment groups by using inclusion criteria. Three of the four groups (iron deficient anemic, iron deficient and control supplement) received iron(III) hydroxide polymaltose complex (IPC, Maltofer) containing 100 mg of elemental iron 6 days a week for 8 months, while the fourth group (control placebo) was given a placebo. Hematological parameters, cognitive function, affective behavior and scholastic performance were assessed at baseline, 4 months and 8 months of supplementation. RESULTS: Cognitive and scholastic performance test scores for the three supplemented groups increased from baseline to 4 months and from 4 months to 8 months (with concomitant increases in hematological parameters), whereas no increase was observed in the placebo group. No increase was seen in affective behavior scores for any of the groups during or after supplementation. CONCLUSIONS: IPC supplementation for eight months yielded significant improvements in cognitive function and scholastic performance in Indian adolescents with and without iron deficiency and anemia.

Pubertal process and green-sickness in Renaissance drama: a form fruste of anorexia nervosa?

OBJECTIVE: The aim of this paper is to investigate the relationship between puberty and the onset of green-sickness in early modern popular culture with findings on puberty and the onset of anorexia nervosa. METHOD: Four plays from the late 16th and early 17th centuries dealing with 14-15-year-old girls were analysed for information on puberty and for precipitating factors for the onset of green-sickness. These were then contrasted with the literature on anorexia nervosa where puberty has been proposed as a potential risk factor for the development of the disorder. RESULTS: These four plays endorse a common understanding in early modern popular culture that puberty presents a major developmental challenge for young women. Four common precipitating factors for the development of green-sickness were identified: socio-economic status; age at onset; nutrition and sexual development. These have a striking resemblance to our current understanding of the development of anorexia nervosa in adolescence. CONCLUSION: Green-sickness shares certain similarities with anorexia nervosa. It is a post menarcheal condition arising out of the body's ripeness for reproduction at around the age of 14. Affluence and improved nutrition were recognized as contributory factors. The development of both green-sickness and anorexia nervosa appear to share a common theme in the context of puberty.

Quantitative EEG and cognitive evoked potentials in anemia.

OBJECTIVE: The anemic status may alter brain functions and electrogenesis, as reflected by EEG and cognitive EPs (CEPs). This study aims to evaluate CEPs and EEG power spectra in adult patients with iron-deficiency anemia and to determine the effects of appropriate iron therapy on electrodiagnostic findings. METHODS: Fifty-one patients with iron-deficiency anemia underwent CEP and EEG recording. All patients were re-assessed after three months of oral-iron therapy. RESULTS: All patients had recovered from their anemia through the three-month iron therapy. Central N1 amplitude and parietal P2 amplitude was increased. N2 latencies were shortened in frontal and central regions. P3 latencies were shortened in frontal, central and parietal areas and P3 amplitude was increased in the parietal region. Except in the gamma-band, all pretreatment and post-treatment mean-power values were significantly lower at the temporal, parietal and occipital regions. CONCLUSIONS: This study indicates that in iron-deficiency anemia, appropriate iron therapy can improve brain electrogenesis, as reflected by P300 and EEG power spectra.

[Diagnostic categories and gender: two examples in contemporary Spanish medicine, chlorosis and neurasthenia (1877-1936)]. / Categorías diagnósticas y género: los ejemplos de la clorosis y la neurastenia en la medicina española contemporánea (1877-1936).

Chlorosis and Neurasthenia are two classical examples of pathological dissociations and the difficulties involved in approaching their diagnosis using scientific-naturalistic criteria. In the realm of those difficulties, the study examines the androcentric viewpoint and the ideological perspective of Contemporary Spanish Medicine when addressing the feminine nature and women's pathologies. Moreover, based on the similarities with present-day pain and fatigue syndromes, the study underlines the need to review the clinical approach to these illnesses by attempting to overcome the existing biomedical limitations.

[Anemia by self-injury: the Lasthenie de Ferjol syndrome]. / L'anémie par spoliation sanguine volontaire: le syndrome de Lasthénie de Ferjol.

Patients with factitious disorders need to be ill and to defy physicians. These syndromes are difficult to diagnose because of the permanent disorder appearing inside the therapeutic relation. The case of a young woman who presents with a factitious anemia, also called Lasthenie de Ferjol syndrome, shows the complexity of such psychosomatic symptoms.

Determinants of compliance with iron supplementation: supplies, side effects, or psychology?

Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation. The review showed that compliance with iron therapy is a specific case of medical compliance. Reasons for non-compliance with iron deficiency treatment include: inadequate program support (lack of political commitment and financial support); insufficient service delivery (poor provider-user dynamics; lack of supplies, access, training, and motivation of health care professionals); and patient factors (misunderstanding instructions, side effects, frustration about the frequency and number of pills taken, migration, fear of having big babies, personal problems, nausea that accompanies pregnancy, and the subtlety of anemia which makes demand for treatment low). Much has been made about the side effects (nausea, constipation, etc.) that women might experience during iron therapy as the cause of poor compliance with iron supplementation without justification according to this review. Instead, unavailability of iron supplements was the most common reason why women did not take iron supplements. Women bear a disproportionate burden from iron deficiency anemia even though the technology exists to address the problem at low cost. Governments and health care professionals must renew their commitment to iron therapy by monitoring and improving compliance. We can significantly improve compliance by: making sure that iron supplements are available at all times; providing advanced warning about the possibility of side effects; involving the patient in the therapeutic strategy; and providing reminders, such as posters and calendars, about taking supplements.

[Iron deficiency anemia and psychomotor development in infants]. / Jernmangelanemi og spedbarns psykomotoriske utvikling.

During the last few years, several studies have indicated a strong correlation between iron-deficiency anaemia and a delay in the psychomotor development of infants. It is suggested that controlled studies should be carried out in order to reveal the prevalence of iron-deficiency anaemia among Norwegian infants, and that screening of the haemoglobin of the infants should be seriously considered as part of the routine health control of mother and child.

Poverty and child development: relevance of research in developing countries to the United States.

Data from low-income countries are helpful in understanding the effects of poverty on child development in the U.S. Illustrative are 3 public health issues: (1) In the U.S., among poor African-American and Hispanic babies anemia is as high as 20%-24%, while in low-income countries, iron deficiency anemia (IDA) causes poor performance on mental and motor tests among babies and children. These data suggest that IDA is a major public health problem among poor minority children that requires prompt attention. (2) In 1993 the U.S. government appropriated $2.86 billion for the Special Supplemental Food Program for Women, Infants, and Children (WIC). Evaluations of WIC, however, have failed to yield conclusive information on the benefits of the program. In low-income countries, nutritional supplements targeted to at-risk groups have resulted in developmental benefits. Thus, WIC is likely to buffer intellectual development against the adverse effects of malnutrition observed among poor children. (3) Evidence from developing countries suggests that concurrent illnesses and poor nutrition interfere with schooling. However, in the U.S., attention to such issues has declined, while common illnesses have increased among the poor. A reappraisal of this issue is warranted to meet the education and health goals proposed for the year 2000 in the U.S.

Improvements in cognitive performance for schoolchildren in Zaire, Africa, following an iron supplement and treatment for intestinal parasites.

Tested 47 first-year primary school children at a mission school in rural Zaire for cognitive ability with the Kaufman Assessment Battery for Children (K-ABC) adopted to the language of Kituba. Within a day of this test, each child was evaluated for blood hemoglobin (Hgb) level and the presence of intestinal parasites. Half of the children received an iron supplement (20 mg Fe) for 30 days and those children positive for the intestinal parasites of ankylostome or ascaris were randomly selected to receive either a vermifuge treatment or placebo. All of the children were again evaluated medically and cognitively 4 weeks after the initiation of treatment. Using discriminant analysis, performance on the Mental Processing Composite of the K-ABC 1 month after treatment in combination with increases in blood Hgb resulted in the successful classification of 74% in terms whether a child had received both iron supplement and vermifuge treatment (p = .007). With respect to our home evaluation for each child, factors related to the nutritional and economic well-being of the home environment proved a reliable marker for Simultaneous Processing ability. However, the present findings also suggest that over the short-term, changes in blood Hgb that accompany both vermifuge and iron supplement treatment together can improve certain aspects of cognitive ability, perhaps by means of heightened attentional capacity.

Infection, nutrition and cognitive performance in children.

The paper considers briefly the nature of cognition and its relationship to intelligence. The information processing model of human cognition is outlined and IQ and DQ are explained. The literature dealing with the effects of malnutrition and parasitic infection on cognitive performance and development in children is selectively reviewed. A speculative hypothesis concerning the psychological effects of parasitic infection is sketched and brief consideration is given to models and measures in research on development.

A patient with severe iron-deficiency anemia and memory disturbance.

A 56-year-old woman presented with severe iron-deficiency anemia and memory disturbance. She had been in a state of severe iron deficiency for many years due to an unbalanced diet. Aerobic exercise test revealed an abnormal elevation of lactate and pyruvate reflecting mitochondrial dysfunction. After iron replacement therapy, WAIS verbal IQ score improved from 63 to 83, and levels of lactate and pyruvate on aerobic exercise test were normalized. We raise the possibility that severe and long-term iron deficiency anemia may cause memory disturbance due to mitochondrial dysfunction.

Nutritional anaemias.

Nutritional anaemia is recognized as a major public health problem throughout the world, especially in developing countries. Infants, young children, menstruating women and, in particular, pregnant women are most frequently affected. Sufficient evidence suggests that iron deficiency is the most common cause of nutritional anaemia in the world. Folate deficiency is considered as the second most common cause. In this chapter we discuss the factors determining nutritional inadequacy in iron and folate requirements versus iron and folate intake, particularly in different age/sex categories; the amounts of iron and folate involved in daily exchange and the role of the diet and physiological and pathological variations in losses and requirements are reviewed. The consequences in terms of health of iron and folate deficiencies and methods for assessing iron and folate status of populations are also presented.

[The intelligence quotient and malnutrition. Iron deficiency and the lead concentration as confusing variables]. / Cociente intelectual y desnutrición. La deficiencia de hierro y la concentración de plomo como variables confusoras.

This study gave us the opportunity to know the roles iron deficiency and the presence of lead in blood play, as confounding variables, in relation to the state of malnutrition and the intellect of those children. A sample of 169 school children were classified according to their state of nutrition, their condition in reference to serum iron and lead concentrations. In addition, their intelligence was evaluated. The results confirmed that those children with lower weights and heights registered lesser points of intelligence; in fact, iron deficiency cancels out the difference in favor of those taller and weighing more. Lead did not contribute as a confounding variable, but more than half of the children showed possible toxic levels of this metal.

[Lasthénie de Ferjol syndrome. Apropos of a case]. / Le syndrome de Lasthénie de Ferjol. A propos d'une observation.

After a brief review of literature, the authors report a case of the "Lasthénie de Ferjol" syndrome. From clinical observations, they establish theoretical landmarks and underline the necessity for searching the meaning.

Long-term developmental outcome of infants with iron deficiency.

BACKGROUND: Iron-deficiency anemia has been associated with lowered scores on tests of mental and motor development in infancy. However, the long-term developmental outcome of infants with iron deficiency is unknown, because developmental tests in infancy do not predict later intellectual functioning. METHODS: This study is a follow-up evaluation of a group of Costa Rican children whose iron status and treatment were documented in infancy. Eighty-five percent (163) of the 191 children in the original group underwent comprehensive clinical, nutritional, and psychoeducational assessments at five years of age. The developmental test battery consisted of the Wechsler Preschool and Primary Scale of Intelligence, the Spanish version of the Woodcock-Johnson Psycho-Educational Battery, the Beery Developmental Test of Visual-Motor Integration, the Goodenough-Harris Draw-a-Man Test, and the Bruininks-Oseretsky Test of Motor Proficiency. RESULTS: All the children had excellent hematologic status and growth at five years of age. However, children who had moderately severe iron-deficiency anemia as infants, with hemoglobin levels less than or equal to 100 g per liter, had lower scores on tests of mental and motor functioning at school entry than the rest of the children. Although these children also came from less socioeconomically advantaged homes, their test scores remained significantly lower than those of the other children after we controlled for a comprehensive set of background factors. For example, the mean (+/- SD) adjusted Woodcock-Johnson preschool cluster score for the children who had moderate anemia in infancy (n = 30) was 448.6 +/- 9.7, as compared with 452.9 +/- 9.2 for the rest of the children (n = 133) (P less than 0.01); the adjusted visual-motor integration score was 5.9 +/- 2.1, as compared with 6.7 +/- 2.3 (P less than 0.05). CONCLUSIONS: Children who have iron-deficiency anemia in infancy are at risk for long-lasting developmental disadvantage as compared with their peers with better iron status.

Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. A prospective study.

The purpose of this study was to investigate the prevalence and type of lesions in the upper gastrointestinal tract and to identify characteristics associated with ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Two thousand five hundred and four patients aged 60-98 (mean, 82) years admitted to a geriatric clinic for rehabilitation were screened by faecal occult blood test, for B-haemoglobin, and, in a case of anaemia, analyses of serum levels of mean corpuscular volume, mean corpuscular haemoglobin concentration, iron, and total iron-binding capacity. One hundred and seventy patients were included in the study. A high prevalence of ulcer disease (22%) was found. Significantly higher proportions of non-steroidal anti-inflammatory drugs and steroid users and of patients with rheumatoid arthritis and osteoarthrosis were found among ulcer patients than among patients without ulcerative upper gastrointestinal lesions. The clinical picture of ulcer disease differed from the classic presentation: abdominal pain occurred in only 7 of 38 patients (18%), whereas appetite and weight loss and nausea/vomiting were common. It is important to be aware of the high prevalence and the clinical picture of ulcer disease among geriatric inpatients with iron deficiency anaemia and/or occult gastrointestinal bleeding.