Perspectives from micronutrient malnutrition elimination/eradication programmes.
Micronutrient malnutrition cannot be eradicated, but the elimination and control of iron, vitamin A and iodine deficiencies and their health-related consequences as public health problems are currently the targets of global programmes. Remarkable progress is occurring in the control of goitre and xerophthalmia, but iron-deficiency anaemia (IDA) has been less responsive to prevention and control efforts. Subclinical consequences of micronutrient deficiencies, i.e. "hidden hunger", include compromised immune functions that increase the risk of morbidity and mortality, impaired cognitive development and growth, and reduced reproductive and work capacity and performance. The implications are obvious for human health and national and global economic and social development. Mixes of affordable interventions are available which, when appropriately adapted to resource availability and context, are proven to be effective. These include both food-based interventions, particularly fortification programmes, such as salt iodization, and use of concentrated micronutrient supplements. A mix of accompanying programmes for infection control, community participation, including education, communication and information exchange, and private sector involvement are lessons learned for overcoming deterrents and sustaining progress towards elimination. (+info)
Important micronutrient deficiencies in at-risk populations can be addressed simultaneously with programmatically cost-effective results. Because of the interaction between many micronutrients, this would also be biologically effective. With adequate investment and political support, the chances of eliminating iodine deficiency as a problem in women of reproductive age and young children and of eliminating vitamin A deficiency as a problem in young children in the future are high. To eliminate iron deficiency and folic-acid-dependent neural tube defects (FADNTDs) in low-income populations, a new set of approaches will have to be developed. These same approaches, if successful, could be used to tackle other important micronutrient deficiencies. (+info)
Idiopathic pulmonary haemosiderosis. Epidemiology, pathogenic aspects and diagnosis.
Idiopathic pulmonary haemosiderosis (IPH) is a rare clinical entity characterized by recurrent episodes of diffuse alveolar haemorrhage, often presenting with haemoptysis. Many patients have iron deficiency anaemia due to deposition of haemosiderin iron in the alveoli, and eventually develop moderate pulmonary fibrosis. Typically, intensive search for an aetiology ends up negative. There is no evidence of pulmonary vasculitis or capillaritis. The aetiology is obscure, but may be an immunological or toxic mechanism causing a defect in the basement membrane of the pulmonary capillary. IPH affects both children and adults. During an acute episode, a chest X-ray demonstrates bilateral, alveolar infiltrates. Sputum examination discloses haemosiderin-laden alveolar macrophages. Diagnosis is established by lung biopsy (fiber-optic or thoracoscopic), showing large numbers of haemosiderin-laden macrophages in the alveoli and without evidence of capillaritis or deposition of immunoglobulins. Corticosteroids and/or immunosuppressive drugs may be effective during an acute bleeding episode, and may in some patients improve symptoms and prognosis on the long-term, but the response to treatment displays great interindividual variation. (+info)
Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study.
OBJECTIVE: To compare the effect of unmodified cows' milk and iron supplemented formula milk on psychomotor development in infants from inner city areas when used as the main milk source. DESIGN: Double blind, randomised intervention trial. SETTING: Birmingham health centre. SUBJECTS: 100 infants, mean age 7.8 months (range 5.7 to 8.6 months), whose mothers had already elected to use unmodified cows' milk as their infant's milk source. INTERVENTION: Changing to an iron supplemented formula milk from enrolment to 18 months of age, or continuing with unmodified cows' milk. MAIN OUTCOME MEASURES: Developmental assessments using Griffiths scales at enrolment and at 18 and 24 months. RESULTS: 85 participants completed the trial. There were no significant differences in haemoglobin concentration between the two groups at enrolment, but by 18 months of age 33% of the unmodified cows' milk group, but only 2% of the iron supplemented group, were anaemic (P<0.001). The experimental groups had Griffiths general quotient scores that were not significantly different at enrolment, but the scores in both groups declined during the study. By 24 months the decrease in the mean scores in the unmodified cows' milk group was 14.7 whereas the decrease in the mean scores in the iron supplemented group was 9.3 (P<0.02, 95% confidence interval 0.4 to 10.4). Mean subquotient scores were considerably lower in the unmodified cows' milk group at 24 months; significantly so for personal and social scores (P<0.02, 1.2 to 16.8 [corrected]). CONCLUSION: Replacing unmodified cows' milk with an iron supplemented formula milk up to 18 months of age in infants from inner city areas prevents iron deficiency anaemia and reduces the decline in psychomotor development seen in such infants from the second half of the first year. (+info)
Two way push videoenteroscopy in investigation of small bowel disease.
AIMS: To evaluate the diagnostic yield and safety of a new push type videoenteroscope (PVE) for diagnosis of small bowel disease. METHODS: Three hundred and thirteen patients were referred for one or two way PVE from December 1993 to June 1996. Indications for PVE were: an unexplained iron deficiency anaemia with or without clinically evident gastrointestinal bleeding; or a complementary investigation for suspected small bowel disease, after a small bowel barium follow through (SBBFT) considered as normal or abnormal, but without a definite diagnosis. RESULTS: A jejunoscopy and a retrograde ileoscopy were carried out in 306 and 234 patients, respectively. In patients with isolated anaemia (n = 131) and those with clinically evident gastrointestinal bleeding associated anaemia (n = 72), PVE provided a diagnosis in 26 (19.8%) and 22 (30.5%) cases, respectively. Lesions found were located in the jejunoileum in 30 (14.7%) patients and in the gastroduodenum or the colon in 18 (8.8%) patients--that is, within the reach of the conventional gastroscope/colonoscope. In patients with normal (n = 54) or abnormal (n = 56) SBBFT, PVE provided a diagnosis in 17 (31%) and 27 (48%) cases, respectively. In 25% of cases, the abnormal appearance of SBBFT was not confirmed. The site of the radiological abnormality was not reached in 27% of cases. Lesions were located at the jejunum and the ileum in 59 (64%) and 33 (36%) cases, respectively. CONCLUSIONS: PVE is useful in around 30% of cases of unexplained anaemia or after an SBBFT which failed to provide an accurate aetiological diagnosis. Use of retrograde videoenteroscopy increases diagnostic yield by one third. (+info)
Ambulatory management of common forms of anemia.
Anemia is a prevalent condition with a variety of underlying causes. Once the etiology has been established, many forms of anemia can be easily managed by the family physician. Iron deficiency, the most common form of anemia, may be treated orally or, rarely, parenterally. Vitamin B12 deficiency has traditionally been treated with intramuscular injections, although oral and intranasal preparations are also available. The treatment of folate deficiency is straightforward, relying on oral supplements. Folic acid supplementation is also recommended for women of child-bearing age to reduce their risk of neural tube defects. Current research focuses on folate's role in reducing the risk of premature cardiovascular disease. (+info)
The comparison of mixed distribution analysis with a three-criteria model as a method for estimating the prevalence of iron deficiency anaemia in Costa Rican children aged 12-23 months.
BACKGROUND: A maximum likelihood method of mixed distribution analysis (MDA) is presented as a method to estimate the prevalence of iron deficiency anaemia (IDA) in Costa Rican infants 12-23 months old. MDA characterizes the parameters of the admixed distributions of iron deficient anaemics and non-iron-deficient-anaemics (NA) from the frequency distribution of haemoglobin concentration of the total sample population. METHODS: Data collected by Lozoff et al. (1986) from 345 Costa Rican infants 12-23 months old were used to estimate the parameters of the IDA and NA haemoglobin distributions determined by MDA and the widely used three-criteria model of iron deficiency. The estimates of the prevalence of IDA by each of the methods were compared. The sensitivity and specificity of MDA compared to diagnosis by the three-criteria method were assessed. Simulations were carried out to assess the comparability of MDA and the three-criteria method in low and high prevalence scenarios. RESULTS: The mean and standard deviation (SD) of the NA haemoglobin distribution determined by both methods was 12.1 +/- 1.0 g/dL. The IDA haemoglobin distribution determined by MDA had a mean and SD of 10.2 +/- 1.3 g/dL while the IDA distribution by the three-criteria method had a mean and SD of 10.4 +/- 1.3 g/dL. The prevalences of IDA as estimated by MDA and the three-criteria method were 24% and 29%, respectively. The sensitivity and specificity of MDA were 95% and 97%, respectively. The performance of MDA was similar to the three-criteria method at a simulated high prevalence of IDA and less similar at a low prevalence of IDA. CONCLUSIONS: Compared to the reference three-criteria method MDA provides a more accurate estimate of the true prevalence of IDA than the haemoglobin cutoff method in a population of children aged 12-23 months with a moderate to high prevalence of IDA. MDA is a less costly method for estimating the severity of IDA in populations with moderate to high prevalences of IDA, and for assisting in the design, monitoring and evaluation of iron intervention programmes. (+info)
Does illness experience influence the recall of medical information?
Recall of a storyboard description of an unfamiliar illness was assessed in 66 healthy children and 40 children with chronic illness (cystic fibrosis or asthma). A significant interaction between verbal intelligence quotient and illness experience (p < 0.001) suggested that more able sick children may be resistant to learning new medical information. (+info)