{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:47:35Z","timestamp":1786978055091,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001700","name":"Ministry of Education, Culture, Sports, Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001700","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gen and Family Med"],"published-print":{"date-parts":[[2025,5]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Clinical pallor has traditionally served as a screening tool for anemia; however, its assessment lacks objectivity. Therefore, this study aimed to investigate the correlation between skin and mucosal color, as measured by a spectrophotometer, and venous hemoglobin (Hb) values, to identify the optimal anatomical assessment site for detecting anemia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A cross\u2010sectional design. Ninety\u2010two adult Japanese outpatients participated in the study. Using a spectrophotometer, the color of the lip and conjunctiva was measured indirectly, while the color of the nail, palm, and inside of the upper arm was measured directly. Colors were quantified using the\n L<\/jats:italic>\n *\n a<\/jats:italic>\n *\n b<\/jats:italic>\n * color scale. This is an international color scale, where the\n L<\/jats:italic>\n * value is an index of brightness,\n a<\/jats:italic>\n * value is red\/green, and\n b<\/jats:italic>\n * value is yellow\/blue. The color difference (\n \u0394<\/jats:italic>\n E<\/jats:italic>\n *) was employed to evaluate the discriminability of anemia identification across different assessment sites. Additionally, Hb values were recorded, with anemia defined as Hb <12.0\u2009g\/dL.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The\n a<\/jats:italic>\n * values of the lip, conjunctiva, palm, and arm exhibited a positive correlation with Hb values and were significantly lower in the anemic group. While the\n \u0394<\/jats:italic>\n E<\/jats:italic>\n * levels for the conjunctiva and lip were readily discernible by the human eye when comparing the normal and anemic groups, recognition at this level proved challenging for other sites.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The conjunctiva and lip demonstrate potential suitability for visual diagnosis of anemia. In the nail, palm, and arm, anemia detection may require highly trained observation. Consequently, reliance on these sites for anemia diagnosis may lead to potential oversight.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jgf2.776","type":"journal-article","created":{"date-parts":[[2025,2,15]],"date-time":"2025-02-15T00:38:37Z","timestamp":1739579917000},"page":"246-254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["An observational study to determine the optimal physical evaluation site for detecting anemia"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5844-5940","authenticated-orcid":false,"given":"Ken","family":"Horibata","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Kameyama Municipal Medical Center Kameyama Mie Japan"},{"name":"Department of Community Medicine Kameyama Mie University School of Medicine Tsu Mie Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seigo","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Nabari Municipal Hospital Nabari Mie Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Hashimoto General Clinic Nabari Mie Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuke","family":"Takemura","sequence":"additional","affiliation":[{"name":"Department of General Medicine Tokyo Women's Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-06-508325"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu9030192"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/131.2.636S"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyi195"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1539\/sangyoeisei.E9007"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyv088"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/aimcc.2023.0381"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2000.tb00518.x"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0008545"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-3124-2"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1990.00390130165027"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380040071013"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288-022-01543-z"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-5-46"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.53.12.933"},{"key":"e_1_2_13_17_1","first-page":"103","article-title":"Evaluation of clinical signs to diagnose anaemia in Uganda and Bangladesh, in areas with and without malaria","volume":"75","author":"Kalter HD","year":"1997","journal-title":"Bull World Health Organ"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.51.1.21"},{"key":"e_1_2_13_19_1","first-page":"477","article-title":"Using clinical signs to diagnose anaemia in African children","volume":"73","author":"Luby SP","year":"1995","journal-title":"Bull World Health Organ"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)00005-X"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2005.12.011"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2005.12.010"},{"key":"e_1_2_13_23_1","first-page":"15","article-title":"Diagnosing anaemia in pregnancy in rural clinics: assessing the potential of the Haemoglobin colour scale","volume":"77","author":"Van den Broek NR","year":"1999","journal-title":"Bull World Health Organ"},{"key":"e_1_2_13_24_1","first-page":"113","article-title":"Pallor as a clinical sign of severe anaemia in children: an investigation in The Gambia","volume":"75","author":"Weber MW","year":"1997","journal-title":"Bull World Health Organ"},{"key":"e_1_2_13_25_1","first-page":"97","article-title":"Clinical signs for the recognition of children with moderate or severe anaemia in Western Kenya","volume":"75","author":"Zucker JR","year":"1997","journal-title":"Bull World Health Organ"},{"key":"e_1_2_13_26_1","first-page":"762","article-title":"Diagnostic accuracy of \"pallor\" for detecting mild and severe anaemia in hospitalized patients","volume":"60","author":"Butt Z","year":"2010","journal-title":"J Pak Med Assoc"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1997.00014.x"},{"key":"e_1_2_13_28_1","unstructured":"Illumination ICo.About the CIE.2024. 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