[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.

A prospective study of iron status in white and black pregnant women in an urban hospital.

Evaluation of the iron status (haemoglobin and ferritin concentrations, and percentage transferrin saturation) in a prospective study of 65 pregnant women (55 white and 10 black) revealed that adequate maternal iron stores during pregnancy cannot be maintained with prevailing dietary patterns. Although 80.6% of the patients had normal indices in the first trimester, only 12.3% were normal in the third. Significant depletion of iron stores occurred in the second trimester, but significant iron-deficient erythropoiesis only occurred in the third trimester. Despite the decline in iron status, iron deficiency anaemia was only seen in 7-8% of the patients. Even after correction for the haemodilution and increased transferrin concentrations in pregnancy, over 70% of women had depleted iron stores in the third trimester. No beneficial effect on fetal birth weights was found on withholding of maternal iron supplementation. This study clearly demonstrated that white and urban black pregnant women require iron prophylaxis to maintain iron stores.

Iron deficiency. Current trends and fads.

Anaemia due to iron deficiency remains the commonest form of anaemia world-wide, predominantly due to blood loss, either associated with infestations such as hook worm or menstrual blood loss, or malnutrition. In Australia, iron deficiency anaemia is the commonest form of anaemia and is seen in pregnant and breastfeeding females where the iron balance is often in a negative state. Fads and fallacies abound, particularly in this group. Despite extensive knowledge of iron metabolism, diagnosis of iron deficiency often remains a difficult problem. The use of diagnostic tests available is discussed in this article.

Hemoglobin difference between black and white women with comparable iron status: justification for race-specific anemia criteria.

To determine the appropriateness of race-specific criteria for anemia, we used the sample of women of child-bearing age from the Second National Health and Examination Survey to examine the relationship between hemoglobin and iron status for blacks and whites. After adjustment for major factors known to cause hemoglobin variation, including iron nutrition status, black women overall had a significantly lower mean hemoglobin value (126 +/- 12 g/L) than white women (134 +/- 11 g/L). Comparison of the probability plots of black and white hemoglobin distributions found the difference across the distributions to not be uniform, likely because a subset of black women had lower hemoglobin values rather than because of a generalized lowering. This finding suggests that it may not be appropriate to have a separate criteria for all blacks to accommodate the subset with lower hemoglobin. However, evaluation of the screening performance of hemoglobin found that race-specific anemia criteria (10 g/L difference) yielded a comparable sensitivity and specificity in detecting iron deficiency for both races. In contrast, a fixed anemia criterion did not yield comparable screening performances for the two races. This functional evaluation supports considering race-specific anemia criteria for screening iron deficiency.

Iron deficiency anaemia in infants.

AIM: To determine the prevalence of iron deficiency anaemia in infants presenting to their general practitioner in a socially deprived, ethnically mixed suburb. METHODS: A total of 43 infants between 6 and 36 months of age were tested for iron deficiency anaemia. The blood tests were collected opportunistically over a 10 month period. Infants with other than trivial illness were excluded. Parents of infants with evidence of iron deficiency were offered dietary counselling, and infants with iron deficiency anaemia were treated with oral iron therapy. Follow up blood tests for iron deficient infants were performed after approximately three months of treatment with oral iron therapy. RESULTS: 42% (18) of infants tested were Pacific Island, 35% (15) were Maori, 16% (7) were European and 7% (3) belonged to other ethnic groups. 23.2% (10) of those tested had iron deficiency anaemia (haemoglobin less than 110 g/L and mean cell volume less than 70 fL). Six of the 10 were followed up and all six found to have improved haematological indices following oral iron therapy. CONCLUSION: Given the known adverse effects of iron deficiency anaemia in infancy primary health care providers in socially disadvantaged areas should consider screening all infants for iron deficiency anaemia.

[The composition of the red blood and iron metabolism in the native population of the Republic of Sakha]. / K voprosu o sostave krasnoi krovi i obmene zheleza u korennogo naseleniia Respubliki Sakha.

A field study in the Sakha Republic has been performed to characterize iron deficiency conditions in native population. Yakuts and Evens were examined for clinical, physiological, biochemical picture of the red blood cells and iron metabolism. European standards by total and fetal hemoglobin, reticulocytes, plasma iron metabolism in the native population were surpassed. The prevalence of iron deficiency and anemia proved higher than in Russia and other northern regions. Reindeer breeders got iron deficient less frequently than population of local settlements. A peculiar ecological situation, life style, traditions, nutrition habits are essential factors in hemopoietic system of the Sakha Yakuts and Evens.

Prevalence and risk factors of iron-deficiency in women of Chukotka.

A study of iron deficiency states (IDS) in Chukotkan native women aged 20-59 years revealed a relatively high prevalence of 36.4%. The prevalence of anemia was 5.6%. Some risk factors of IDS have been defined including frequent deliveries, prolonged lactation and also some peculiarities in the nutrition of these women.

Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study.

Using criteria from the Centers for Disease Control, anemia and iron-deficiency anemia (anemia with serum ferritin concentrations less than 12 micrograms/L) were assessed in greater than 800 inner-city gravidas at entry to prenatal care. Iron-deficiency anemia was associated with significantly lower energy and iron intakes early in pregnancy and a lower mean corpuscular volume. The odds of low birth weight were tripled and of preterm delivery more than doubled with iron deficiency, but were not increased with anemia from other causes. When vaginal bleeding at or before entry to care accompanied anemia, the odds of a preterm delivery were increased fivefold for iron-deficiency anemia and doubled for other anemias. Inadequate pregnancy weight gain was more prevalent among those with iron-deficiency anemia and in those with anemias of other etiologies. The prevalence of iron-deficiency anemia (3.5%), however, was lower than anticipated for an inner-city, minority population in whom most anemias had been attributed clinically to iron deficiency.

Iron deficiency in infants of Cambodian refugees.

A community study was designed to establish the prevalence of iron deficiency and iron deficiency anaemia in the infants of Cambodian refugees in Dunedin. Nineteen infants between the ages of three and 19 months were identified belonging to this population and 18 had a full blood count and/or serum ferritin estimation performed. Iron deficiency (serum ferritin less than 10 micrograms/L) was found in 65% (11/17) of those tested, and anaemia (haemoglobin less than 110 g/L) with iron deficiency in 37% (6/16). While primary prevention of this problem should continue by promoting a weaning diet with adequate available iron, and perhaps by ensuring adequate maternal iron stores, screening all Cambodian infants for iron deficiency and anaemia is presently indicated.

[Iron deficiency in infants and children]. / Carence martiale chez le nourrisson et l'enfant.

A study of the incidence of iron deficiency and its risk factors was carried out in 90 hospitalized or outpatient children and infants, 4 to 48 months old. Iron deficiency (serum iron concentration less than 10 mumol/l) was found in 70% of them and microcytosis (mean corpuscular volume less than 70 fl) in 10%. A good correlation was observed between hemoglobin concentration or mean corpuscular volume, and serum iron or ferritin concentrations. When risk factors were studied, 20% of the children were found to have insufficient meat or vegetable intakes. Only 45% of 6 month-old and 20% of 1 year-old infants received iron fortified milk formulas. However no significant correlation was found between the nutritional factors and the hematological data. Anemia and microcytosis were significantly more frequent in children born from immigrant parents as compared with native children, but there was no difference between these two groups for isolated iron deficiency. These results indicate that there is a need for a better prevention of iron deficiency in French infants and young children; a larger use of iron fortified milk formula until the age of 12 months is to be recommended.

[Iron status in presumably healthy children 10 months, 2 years and 4 years of age]. / Le statut en fer chez l'enfant de 10 mois, 2 ans et 4 ans présumé bien-portant.

Iron status was assessed using a combination of several biochemical indicators (serum ferritin, erythrocyte protoporphyrin, serum iron, MCV, hemoglobin) in 3,676 apparently healthy children. Children who were 10 months, 2 years and 4 years of age were selected from the population undergoing a free medical check up in a Paris Child Health Center. The prevalence of iron deficiency in children of parents from continental France was 29% in the 10 month olds, 13% in the 2 year olds and 7% in those who were 4 years of age. Corresponding figures in children born of immigrant parents were 50%, 44% and 15% respectively. Iron deficiency anemia was found in 8% of 10 month olds from continental France versus 23% in the other group. Children born of parents from the South Sahara were found to be at high risk for iron deficiency.

Iron status: prevalence of impairment in three Hispanic groups in the United States.

Little is known about the iron status of Hispanic groups in the United States. Data from the Hispanic Health and Nutrition Examination Survey were used to estimate the prevalence of impaired Fe status for persons aged 5-74 y from three Hispanic groups: Mexican Americans (MAs), Cubans, and Puerto Ricans; prevalences were also calculated for non-Hispanic whites (NHWs) and non-Hispanic blacks (NHBs) using data from the second National Health and Nutrition Examination survey. A three-variable model called the MCV model was used to assess impaired Fe status. Prevalences based on the MCV model did not differ between Hispanic groups. Differences between Hispanics and non-Hispanics occurred only among 20-44-y-old females, where MAs had a higher prevalence than NHWs or NHBs. With this exception, these Hispanic groups do not appear to be at greater risk of impaired Fe status than non-Hispanics.

Prevalencia de anemia por déficit de hierro en lactantes mapuches alimentados con leche materna / Prevalejnce of anemia caused by iron deficiency in mapuchean infants fed breast milk

Con el propósito de conocer la nutrición del Fe en lactantes mapuches alimentados con pecho, se estudió un grupo de 110 niños de 8 a 14 meses provenientes de áreas rurales de la provincia de Cautín, empleando concentración sanguínea de hemoglobina (Hb), hematocrito (Hto), saturación de transferrina (S.T.) y ferritina sérica (F.S.). La alimentación de los sujetos era básicamente láctea, 78,4% recibían lactancia materna exclusiva y 21,6% lactancia mixta. Ningún lactante había sido destetado precozmente. El consumo de alimentos sólidos era escaso hasta los 6 meses y sólo 50% de los lactantes había consumido carne, ocasionalmente, hasta el momento del estudio. En 4,5% de los niños se encontró evidencia de anemia (Hb < 11 g/dl), en 4,5% eritropoyesis deficiente de hierro (S.T. < 9) y en 76,4% depósitos escasos de hierro (F.S. < 10 ng/dl). No se encontraron diferencias en la nutrición del hierro entre pacientes con lactancia exclusiva materna y mixta, como tampoco según el peso de nacimiento de los lactantes. Es posible que la leche materna cumpla un rol biológico importante en este grupo étnico, lo que podría explicar la baja prevalencia de anemia

Iron status of predominantly lacto-ovo vegetarian East Indian immigrants to Canada: a model approach.

Iron status of East Indian predominantly lacto-ovo vegetarian immigrants (59 males, mean age 37.7 +/- 10.5 yr; 55 females, mean age 33.3 +/- 7.4 yr) was assessed using dietary and biochemical-iron indices, including a Tri-index (TI) model. Iron deficiency was higher among females than males: 33% vs 5%, respectively, via the TI model (serum ferritin, serum-transferrin saturation, and mean corpuscular-hemoglobin concentration) and 18-42% vs 2-22%, respectively, via individual biochemical-iron indices. Rates of anemia calculated via the TI model in combination with low hemoglobin and mixed-distribution analysis (MDA) were similar and higher for the females (TI + Hb = 16%; MDA = 12%) than for the males (TI + Hb = 5%; MDA = 3%). High prevalence among females was attributed to low available iron intakes, concomitant with high intakes of dietary fiber, phytate, and tannins. We recommend the TI-model approach to estimate relative prevalence of iron deficiency in small surveys.