Cancer-Related Anemia and Frailty in Older Persons.

Anemia, defined by the World Health Organization as a hemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women, is particularly prevalent at advanced age. Nevertheless, it is not a condition simply explained by the normal aging process. Anemia represents a potentially reversible condition associated with numerous adverse health-related events, including hospitalization, disability, and mortality in older persons. Low haemoglobin concentrations are particularly common among patients with cancer due to direct (e.g., micro- and macroscopic blood losses) and indirect causes (e.g., increased production of pro-inflammatory cytokines with consequent reduction of erythropoietin release and erythropoiesis). The impaired oxygen-carrying capacity caused by the presence of anemia may play a major role in multiple clinical manifestations of cancer, such as dyspnea, fatigue, exhaustion, dizziness and/or headache. In the present review, we discuss the importance of low hemoglobin concentrations and anemia as important determinants of the frailty syndrome, a condition commonly present among cancer patients. Treatment of cancer-related anemia may improve quality of life and health-related outcomes (including disability and mortality) in older patients with oncological conditions.

Validity of a screening test for school learning problems in a pediatric clinical setting.

Children brought to pediatric outpatient clinics with the primary complaint of developmental difficulty often arrive with little or no information as to the nature of their problem. This study sought to determine if a brief screening test could facilitate the referral process by predicting the primary diagnosis subsequently given to the child based on a comprehensive interdisciplinary evaluation. Subjects for the study were 176 English-speaking children between the ages of 5 and 11 who had been evaluated at the child development center of a large urban medical school. Of the children later diagnosed as learning handicapped, 89% failed the routing test, while 78% with other primary diagnoses passed it. The results of this preliminary study suggest that a brief screening test can be used effectively to form initial hypotheses about the problems (learning vs. nonlearning) experienced by students referred to pediatric clinics for developmental difficulties. Suggestions for further research are offered.

The development and preliminary evaluation of a screening test to detect school learning problems.

The Einstein Assessment of School-Related Skills was developed to aid pediatricians and other professionals in the identification of children who are at risk for, or are exhibiting, school learning difficulties. This brief (7-10 minutes) screening instrument measures reading, arithmetic, auditory memory, language cognition, and visual-motor abilities of children in grades K-5. The Einstein Assessment was standardized on 1665 nonhandicapped and 116 learning-disabled children in grades K-5. The median percent of nonhandicapped children in grades 2-5 passing was 78% in the fall and 74% in the spring, compared with 18% and 14% of the learning-disabled children (numbers of diagnosed learning-disabled children in grades K-1 were too small for analysis). The median test-retest reliability coefficient was 0.94. These data provide preliminary support for the Einstein as a screening test for school learning difficulty.