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CONTEXT: Current clinical practice relies on hemoglobin to detect iron deficiency, which misses infants not yet anemic and places them at higher risk for neurocognitive impairment. Reticulocyte hemoglobin content (CHr) has never been compared with hemoglobin for screening healthy infants. OBJECTIVES: To evaluate CHr for detecting iron deficiency without anemia in healthy 9- to 12-month-old infants and to compare CHr with hemoglobin in screening for iron deficiency in this population. A secondary objective was to explore the association between CHr and subsequent development of anemia. DESIGN, SETTING, AND PATIENTS: A prospective observational cohort study of 202 healthy 9- to 12-month-old infants from an urban, hospital-based, primary care clinic in Boston, Mass, who were screened for iron deficiency between June 2000 and April 2003, and followed up for a median of 5.6 months. MAIN OUTCOME MEASURES: Iron deficiency (transferrin saturation <10%) and anemia (hemoglobin <11 g/dL). RESULTS: Of 202 infants enrolled, 23 (11.4%) had iron deficiency and 6 (3%) had iron deficiency and anemia. Iron-deficient and non-iron-deficient infants had significantly different values for all measured hematological and biochemical markers for iron deficiency. Optimal CHr cutoff for detecting iron deficiency was 27.5 pg (sensitivity, 83% and specificity, 72%); a hemoglobin level of less than 11 g/dL resulted in a sensitivity of 26% and a specificity of 95%. Reticulocyte hemoglobin content was more accurate overall than hemoglobin was for detecting iron deficiency (area under the receiver operating characteristic curve, 0.85 vs 0.73; P = .007). A CHr of less than 27.5 pg without anemia at initial screening was associated with subsequent anemia when screened again in the second year of life (risk ratio, 9.1; 95% confidence interval, 1.04-78.9; P = .01). CONCLUSIONS: A CHr of less than 27.5 pg is a more accurate hematological indicator of iron deficiency compared with hemoglobin of less than 11 g/dL in these healthy 9- to 12-month-old infants. Further studies are warranted to determine whether CHr should be the preferred screening tool in the early detection of iron deficiency in infants.

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OBJECTIVE: To assess skills and preferred learning formats in teaching health promotion (HP). METHODS: A self-administered needs assessment of Maternal and Child Health (MCH) educators from multiple disciplines was conducted on a convenience sample taken nationally via e-mail using Dillman's method. Respondents rated ability to use, and desire to improve skills in, different teaching strategies (brainstorming, case method, collaborative learning, mini-presentation, reflective exercise, role play) and health concepts (partnership, communication, HP/illness prevention, time management, education, advocacy). Preferred learning formats were assessed with 5-point Likert scale and were analyzed using ANOVA. RESULTS: Fifty-seven percent of respondents (n = 180) taught in an urban setting, 26% suburban, and 17% rural. Most taught at academic health centers (35%), public health clinics (25%), or hospitals (17%). Seventy-five percent were female; average age was 42 years (SD--9.1 years). Specific disciplines showed no major difference in mean responses compared with others. The greatest barriers to integrating HP into teaching were time (82%) and budget (58%). Although a majority of all respondents felt comfortable in their abilities to use the teaching strategies and concepts, an equal percentage still wanted to improve these skills. One-third of respondents had experience using web-based study: 64% of them indicated web-based study as their preferred method of continuing education. CONCLUSIONS: While a majority of MCH educators felt confident using various teaching strategies to teach the integration of HP into practice, most still wished to improve their personal skills. Use of an inexpensive, time-efficient modality to access and learn to teach HP was appealing to respondents across disciplines.

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To examine the association between exposure to Reach Out and Read and vocabulary outcomes in children, a consecutive sample of 200 parent/child pairs was studied at two inner-city health centers. Children at clinic A were exposed to Reach Out and Read, a clinic-based literacy intervention, for 3 years at the time of the study; children at clinic B were unexposed. Main outcome measures were the "Expressive and Receptive One Word Picture Vocabulary Tests" to measure vocabulary in the children and the "Home Literacy Orientation" scale and "READ" subscale of the STIMQ, to measure book-sharing activities. A total of 200 subjects participated, and the mean age of children was 3.8 years. Demographic characteristics were comparable for both clinics at baseline. Exposed children scored higher on receptive vocabulary (81.5 vs. 74.3; p = 0.005). They also scored higher on both the Home Literacy Orientation scale (4.3 vs. 3.3; p = 0.002) and the STIMQ-READ (12.6 vs. 11.0; p = 0.056). There were no differences in expressive vocabulary scores between the two sites (79.5 vs. 77.5; p = 0.26). In conclusion, we found a positive association between exposure to Reach Out and Read and better receptive vocabulary scores. We also found higher scores for Reach Out and Read-exposed children on measures of home reading activities.

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