Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis

BACKGROUND: Anaemia is highly prevalent in children of developing countries. It is associated with impaired physical growth and mental development. Palmar pallor is recommended at primary level for diagnosing it, on the basis of few studies. The objective of the study was to systematically assess the accuracy of clinical signs in the diagnosis of anaemia in children. METHODS: A systematic review on the accuracy of clinical signs of anaemia in children. We performed an Internet search in various databases and an additional reference tracking. Studies had to be on performance of clinical signs in the diagnosis of anaemia, using haemoglobin as the gold standard. We calculated pooled diagnostic likelihood ratios (LR's) and odds ratios (DOR's) for each clinical sign at different haemoglobin thresholds. RESULTS: Eleven articles met the inclusion criteria. Most studies were performed in Africa, in children underfive. Chi-square test for proportions and Cochran Q for DOR's and for LR's showed heterogeneity. Type of observer and haemoglobin technique influenced the results. Pooling was done using the random effects model. Pooled DOR at haemoglobin <11 g/dL was 4.3 (95% CI 2.6–7.2) for palmar pallor, 3.7 (2.3–5.9) for conjunctival pallor, and 3.4 (1.8–6.3) for nailbed pallor. DOR's and LR's were slightly better for nailbed pallor at all other haemoglobin thresholds. The accuracy did not vary substantially after excluding outliers. CONCLUSION: This meta-analysis did not document a highly accurate clinical sign of anaemia. In view of poor performance of clinical signs, universal iron supplementation may be an adequate control strategy in high prevalence areas. Further well-designed studies are needed in settings other than Africa. They should assess inter-observer variation, performance of combined clinical signs, phenotypic differences, and different degrees of anaemia

Vigilância para acidentes e violência: instrumento para estratégias de prevenção e controle Injury surveillance: a tool for prevention and control strategies

A rápida e expressiva elevação da morbi-mortalidade por acidentes e violência constituiu um dos pontos mais relevantes da transição epidemiológica no Brasil, a partir dos anos 80. A complexidade do problema implica a aplicação de medidas no âmbito de políticas sociais, elaboração de legislação específica e desenvolvimento de instrumentos de intervenção voltados à prevenção, ao tratamento e à reabilitação dos atingidos, o que pressupõe a identificação de grupos e fatores de risco. O objetivo deste texto é discutir aspectos conceituais e operacionais da utilização da vigilância em eventos adversos à saúde relacionados a acidentes e à violência. Apresentados os conceitos, características comuns e aspectos relativos à operacionalização dos sistemas de vigilância, independente do evento adverso à saúde a que se destinam, foram discutidas algumas questões específicas relativas à elaboração de definições de caso, à identificação de fontes de informação e à coleta dos dados de interesse, buscando identificar diferenças da utilização da vigilância para acidentes e violência se comparadas com a aplicação deste instrumento para doenças infecciosas, salientando entre elas que, para a identificação de fatores de risco, geralmente, se faz necessário complementar os resultados obtidos pela vigilância com pesquisas epidemiológicas.<br>The fast and important increase in morbidity and mortality due to accidents and violence has been one of the most relevant aspects of the epidemiological transition in Brazil since the 80s. This intricate problem calls for social and political measures, and the development of specific legislation and tools for intervening in terms of prevention, treatment, and rehabilitation of those affected, so that risk groups and factors can be identified. The aim of the present paper is to discuss conceptual and operational aspects of using surveillance in adverse health events related to accidents and violence/trauma. Some specific issues related to case definition, identification of sources of information and collecting relevant data are discussed after presenting the concepts, common features and operational aspects related to surveillance systems, regardless of the adverse health events they are aimed at. These issues are discussed in order to try to identify the differences of applying surveillance to accidents and violence in comparison to applying it to infectious diseases. Among the differences one must point out that it is generally necessary to supplement results obtained through surveillance with epidemiological studies in order to identify risk factors

Prevalência de sobrepeso e obesidade em crianças e adolescentes de diferentes condições socioeconômicas Prevalence of overweight and obesity in children and adolescents of different socioeconomic conditions

OBJETIVOS: comparar as prevalências de sobrepeso e obesidade em um grupo de pré-escolares, escolares e adolescentes de diferentes condições socioeconômicas na cidade do Recife. MÉTODOS: estudo do tipo transversal envolvendo uma amostra de 1616 crianças e adolescentes, escolhida por conveniência. Os indicadores nutricionais foram definidos conforme as recomendações do National Center of Health Statistics 2000, sendo considerado sobrepeso o índice de massa corporal igual ou superior ao percentil 85 e inferior ao percentil 95 e obesidade, o índice de massa corporal igual ou superior ao percentil 95. RESULTADOS: foi identificado sobrepeso em 234 (14,5%) indivíduos e obesidade, em 134 (8,3%). A prevalência de sobrepeso foi maior nos pré-escolares (22,2%), observando-se redução progressiva da freqüência nas faixas etárias de escolar (12,9%) e adolescente (10,8%). Constatou-se fato idêntico quanto à obesidade, detectada em 13,8% dos pré-escolares, 8,2% dos escolares e 4,9% dos adolescentes. O sobrepeso e a obesidade foram mais observados entre crianças e adolescentes de melhor condição socioeconômica. CONCLUSÕES: as prevalências de sobrepeso e obesidade diminuíram à medida que ocorreu aumento da faixa etária. Entre os pré-escolares observou-se prevalência de sobrepeso semelhante, independente das condições socioeconômicas. A prevalência da obesidade foi maior entre escolares de boas condições socioeconômicas e adolescentes de baixa condição socioeconômica.<br>OBJECTIVES: to compare overweight and obesity in preschool children, school children and adolescents belonging to different socioeconomic conditions. METHODS: cross-sectional and based on a 1616 children and adolescents sample. Nutritional indicators were defined according to the National Center of Health Statistics 2000 recommendations, overweight being BMI equal to or above 85 percentile and below percentile 95; obesity indicator being defined with BMI equal to or above the 95 percentile. RESULTS: overweight was detected in 234 (14.5%) individuals and obesity in 134 (8.3%). Overweight prevalence was higher among preschool children (22.2%), though prevalence reduction was noted in younger school children (12.9%) and adolescents (10.8%). A similar pattern was found for obesity in 13.8% of preschool children, 8.2% of school children, and 4.9% of adolescents. Overweight and obesity were mostly observed among children and adolescents of high income families. CONCLUSIONS: as age increases overweight and obesity diminish. Similar overweight prevalence was detected among preschool children irrespective of socioeconomic conditions. Overweight prevalence was highest among school children with high socioeconomic conditions and adolescents with low socioeconomic conditions

Relation of the disaccharidases in the small intestine of the rat to the degree of experimentally induced iron-deficiency anemia

Hypolactasia associated with severe iron-deficiency anemia has been reported in several studies. The objective of the present study was to determine whether hypolactasia is associated with the degree and duration of iron-deficiency anemia. Newly weaned male Wistar rats were divided into a control group receiving a diet supplemented with iron (C) and an experimental group (E) receiving a diet not supplemented with iron (iron-deficiency diet). The animals were studied on the 3rd, 5th, 7th, 14th, 21st, 28th and 35th days of the experiment, when overall and iron nutritional status and disaccharidase activity in the small intestine were determined by the Dahlqvist method. A reduction in weight occurred in the anemic animals starting on the 5th day of the study. Anemia was present in the experimental animals, with a progressive worsening up to the 14th day (hemoglobin: C = 13.27 and E = 5.37) and stabilizing thereafter. Saccharase and maltase activities did not differ significantly between groups, whereas lactase showed a significant reduction in total (TA) and specific activity (SA) in the anemic animals starting on the 21st day of the study. Median lactase TA for the C and E groups was 2.27 and 1.25 U on the 21st day, 2.87 and 1.88 U on the 28th day, and 4.20 and 1.59 U on the 35th day, respectively. Median lactase SA was 0.31 and 0.20 U/g wet weight on the 21st day, 0.39 and 0.24 U/g wet weight on the 28th day, and 0.42 and 0.23 U/g wet weight on the 35th day, respectively. These findings suggest a relationship between the enzymatic alterations observed and both the degree and duration of the anemic process. Analysis of other studies on intestinal disaccharidases in anemia suggests that the mechanism of these changes may be functional, i.e., that the enterocytes may suffer a reduction in their ability to synthesize these enzymes