Relevance and importance of universal salt iodization in India

It is well known that iodine and thyroid hormone are essential for normal development of the human brain and body. Lack of iodine in the diet leads to 'visible' and 'invisible' spectrum of iodine deficiency disorders. The prevalence of iodine deficiency can be assessed by estimating the total goitre rate in the population. A large section of the Indian population suffers from iodine deficiency disorders. These are easily preventable as was shown more than 40 years ago in the study conducted in Kangra Valley. Salt is the best medium of iodine supplementation in India. The potential risks of iodine supplementation, including the risk of iodine-induced thyrotoxicosis, are discussed. Finally, we attempt to formulate policy guidelines on iodine supplementation on the basis of presumed risk:benefit ratio for carrying out an iodine supplementation programme. Taking into consideration medical, social, economic and political aspects of universal salt iodization, the benefits far outweigh the potential low risk due to iodine excess in a small segment of the population.     

Representativeness of clinical samples of youths with mental disorders: A preliminary population-based study.

In a household community sample of 1,285, 9–17 year-olds with mental disorders who had received outpatient specialty mental health services in the past year were compared with youths with mental disorders who had not received those services to determine if samples drawn from clinical settings are representative of youths with mental disorders in the general population. Those who had used services were more impaired, less competent, more likely to have comorbid disorders, more likely to belong to non-Hispanic White relative to other ethnic groups, and less likely to be prepubertal girls. Their parents were more educated, but less satisfied with family life, engaged in less monitoring of their children, and more likely to have used mental health services themselves. These findings suggest the hypothesis that samples of youths with mental disorders drawn from outpatient clinical settings are not representative of all youths with mental disorders. If confirmed, this would indicate the importance of population-based samples for the study of psychopathology in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiology in epilepsy. Epilepsy primarily affects small children and the elderly

Epilepsy is one of the commonest neurological/disorders, with peak incidences among the elderly and among children in the first year of life. Approximately 60,000 (0.7 per cent) of the Swedish population, 50,000 adults and 10,000 children, have active epilepsy. Stroke is the aetiology most commonly identified. The majority of those with a first-ever unproven seizure suffer no further seizures. Of those who do have further seizures (i.e., who develop epilepsy), 65-85 per cent eventually become free from seizures, and many of them are able to cease antiepileptic medication. Epilepsy is a heterogeneous disorder. The larger proportion of patients who are otherwise healthy, and who respond readily to antiepileptic treatment and manifest no side effects or only mild ones, are characterised by the best prognosis and are able to terminate treatment within 2-5 years without recurrence. At the other extreme is the smaller group of patients with onset of epilepsy very early in life, and characterised by multiple severe neurological defects, severe daily seizures, resistance (more or less) to all available treatment, and high mortality. In many cases of epilepsy, however, severity and prognosis lie somewhere between these two extremes.     

Current views on the importance of iodine for animals

The study summarizes current experience on the cause and impacts of iodine deficiency, compares the measures to ensure iodine needs and shows the consequences in human population and farm animal. The hazard of iodine deficiency is increasing at present due to underevaluation of mineral nutrition importance, restrictive measures in feeding techniques, further due to stronger effect of natural and anthropogenic goitrogens from feedstuffs and drinking water, higher iodine consumption due to higher performance and load caused by large-scale technologies. These facts have impact on health state of cattle which is confirmed by increased occurrence of functional disorders of the thyroid gland in young farm animals, and consequently affect iodine deficiency in human population as the major source of iodine in child s food is milk and milk products.     

Effect of postoperative 131I treatment on thyroglobulin measurements in the follow-up of patients with thyroid cancer

Correlation of serum thyroglobulin (Tg) levels with recurrent cancer was performed in 200 patients who had undergone a subtotal thyroidectomy for well-differentiated thyroid carcinoma. Patients were divided into three groups: (1) those not treated postoperatively with radioactive iodine, (2) those treated with low dose (30 mCi) radioactive iodine, and (3) those treated with high dose (50-250 mCi) radioactive iodine. Tg levels proved to be reliable in detecting recurrent thyroid cancer regardless of the dose of radioactive iodine given postoperatively. These results reinforce the recommendation of using the Tg assay as the primary method of following these patients postoperatively, even when there was less than a total thyroidectomy and ablation with radioactive iodine.     

The social consequences of psychiatric disorders, III: probability of marital stability

OBJECTIVE: The associations of prior DSM-III-R disorders with probability and timing of subsequent divorce were examined. METHOD: The data came from the part II subsample (N=5,877) of the National Comorbidity Survey. The respondents completed a structured diagnostic interview that retrospectively dated age at onset of each of 14 lifetime DSM-III-R disorders and recorded ages at first marriage and divorce. These data were used to estimate survival models describing the relationships between prior disorders and subsequent divorce. In addition, simulations were used to estimate the number of years spent out of marriage because of these causal relationships in the total U.S. population. RESULTS: Prior psychiatric disorders were associated with a substantially higher risk of divorce. The simulations suggested that the effects of these associations in the U.S. population in the survey's age range are approximately 23 million lost years of marriage among men and 48 million lost years of marriage among women. CONCLUSIONS: Psychiatric disorders have a number of adverse consequences for those who suffer from them and for their families and communities. The results reported here suggest that an increase in the number of people who divorce and a decrease in the number of years of marriage in the population may be among them. The debate over whether society can afford to provide universal treatment for psychiatric disorders needs to take these costs into consideration.     

The disorders induced by iodine deficiency

This paper reviews present knowledge on the etiology, pathophysiology, complications, prevention, and therapy of the disorders induced by iodine deficiency. The recommended dietary allowances of iodine are 100 micrograms/day for adults and adolescents, 60-100 micrograms/day for children aged 1 to 10 years, and 35-40 micrograms/day in infants aged less than 1 year. When the physiological requirements of iodine are not met in a given population, a series of functional and developmental abnormalities occur including thyroid function abnormalities and, when iodine deficiency is severe, endemic goiter and cretinism, endemic mental retardation, decreased fertility rate, increased perinatal death, and infant mortality. These complications, which constitute a hindrance to the development of the affected populations, are grouped under the general heading of iodine deficiency disorders (IDD). At least one billion people are at risk of IDD. Iodine deficiency, therefore, constitutes one of the most common preventable causes of mental deficiency in the world today. Most of the affected populations live in mountainous areas in preindustrialized countries, but 50 to 100 million people are still at risk in Europe. The most important target groups to the effects of iodine deficiency from a public health point of view are pregnant mothers, fetuses, neonates, and young infants because the main complication of IDD, i.e., brain damage resulting in irreversible mental retardation, is the consequence of thyroid failure occurring during pregnancy, fetal, and early postnatal life. The main cause of endemic goiter and cretinism is an insufficient dietary supply of iodine. The additional role of naturally occurring goitrogens has been documented in the case of certain foods (milk, cassava, millet, nuts) and bacterial and chemical water pollutants. The mechanism by which the thyroid gland adapts to an insufficient iodine supply is to increase the trapping of iodide as well as the subsequent steps of the intrathyroidal metabolism of iodine leading to preferential synthesis and secretion of triiodotyronine (T3). They are triggered and maintained by increased secretion of TSH, which is ultimately responsible for the development of goiter. The acceleration of the main steps of iodine kinetics and the degree of hyperstimulation by TSH are much more marked in the pediatric age groups, including neonates, than in adults, and the development of goiter appears as an unfavorable side effect in the process of adaptation to iodine deficiency during growth. The most serious complication of iodine deficiency is endemic cretinism, a syndrome characterized by irreversible mental retardation together with either a predominant neurological syndrome or predominant hypothyroidism, or a combination of both syndromes.(ABSTRACT TRUNCATED AT 400 WORDS)     

Mild hearing loss in children with communication disorders

The prevalence of MHL in 202, 1 to 6 year-old children with communication disorders who visited our clinic in 1991 was investigated. 1) 31% of the subjects had MHL bilaterally. The prevalence of MHL was 44% at age 1 year, 20% at age 2 years, 36% at age 3 years, 24% at age 4 years, 39% at age 5 years, 33% at age 6 years. 2) 88% of children with MHL had OME, 10% had mild sensorineural hearing loss, and 2% had cerminous plug. 3) The prevalence of MHL in children with mental retardation and autistic disorders was 9%, that with stuttering was 9%, that of OME accompanied by moderate and severe hearing disorders was 6%. 4) The primary causes in 191, except for those with stuttering, were as follows; the prevalence of MHL was 30%, that of mental retardation and autistic disorders was 24%, and that of articulation disorders was 28%. 5) On the other hand, the prevalence of MHL in children with retarded language development and articulation disorders was 30%, which was significantly higher than that of the other communication disorders. Accordingly, the results of this study suggest that MHL in early childhood greatly influences communication disorders.     

Endemic iodine deficiency in Hungary and possibilities of iodine substitution

Following a short historical review the authors summarize the latest results regarding domestic iodine supply. Iodine content in drinking waters, samples of mother's milk, urine and goiter screening data from all regions of Hungary unanimously verify that significant part of the population is deficient in iodine, yet supplementation of iodine is still even today an unsolved problem in our country. In the search for the reasons the authors review the theoretical possibilities of iodine supplementation by discussing advantages and disadvantages of the individual models. They establish that alimentary iodine supplementation in itself is not suitable due to both theoretical and practical reasons for the complete elimination of iodine deficiency, therefore they make recommendations to supplement iodine in other ways. They also discuss the effect of selenium deficiency on the metabolism of thyroid hormones. They call attention that domestic, endemic selenium deficiency may be related to the frequency of Hungarian occurrences of iodine deficiency disorders. The authors review the iodine deficiency disorders and their effects on the health of present and future generations. They compare the practical benefit and costs of iodine supplementation, and furthermore discuss in detail the possible side effects of iodine supplementation.     

Assessment of iodine deficiency disorders using the 30 cluster approach in the National Capital Territory of Delhi

OBJECTIVE: Iodine Deficiency Disorders (IDD) are a major public health problem in India. The National Capital Territory (NCT) of Delhi is a known iodine deficiency endemic area. The Delhi Government banned the sale of non-iodised salt since 1989. The present study was conducted to assess the status of IDD after 7 years of salt iodisation programme in the state. DESIGN: Cross sectional. METHODOLOGY: The recent indicators recommended by the World Health Organization-United Nations Childrens Fund-International Council for the Control of Iodine Deficiency Disorders (WHO-UNICEF-ICCIDD) were utilized for the assessment of IDD. A total of 30 clusters were selected using population proportionate to size cluster sampling procedure. In each identified cluster, one primary school was selected using random sampling. A total of 6911 school children in the age group of 8-10 years were included for the study. RESULTS: The total goiter prevalence rate was 8.6% while 2.1, 8.4, 17.6 and 71.9% of the children had urinary iodine excretion levels of < 2, 2-4.9, 5-9.9 and 10 and above mcg/dl, respectively. The median urinary iodine excretion was 17 mcg/dl. Of the 1854 salt samples analyzed, salt with a nil iodine content was consumed only by 1.4% of the beneficiaries. Forty one per cent of families consumed salt with an iodine content of less than 15 ppm. CONCLUSION: IDD continues to be a public-health problem in the NCT of Delhi. There is a need of strengthening the existing monitoring system for the quality of iodised salt.     

Suicide mortality in patients on lithium maintenance therapy

Mood disorders are frequently recurrent and it has been shown that maintenance treatment can reduce long-term morbidity in this condition. It has also been shown that mood disorders carry an increased risk of suicide and that a significant proportion of individuals who commit suicide suffer from a mood disorder. This paper reports the results of a long term follow-up of a cohort of patients attending a specialist mood disorder clinic over a period of 18 years. Sixty-seven suffered from unipolar depression and 36 had bipolar or schizo-affective disorders In order to qualify for entry to the cohort the unipolar patients had to have had at least three episodes of depression and those with bipolar disorders had to have had at least three episodes - with at least one manic episode and one depressive episode. All patients were treated with lithium. The initial treatment refusal rate and drop our rates were low. The mortality from suicide in this group was compared with that reported in five recent studies - all of which involved patients who had not been given maintenance therapy. The standardised mortality ratio (SMR) for all causes for the whole group was 0.93. There were two suicides. In one case the patient had continued treatment with lithium until death and in the other the patient had discontinued treatment 12 months before death. The overall suicide rate was 1.3 per 1000 patient years. Amongst similar groups of patients who had not been given maintenance therapy suicide rates of about 5.5 per 1000 patient years have been reported. It is concluded that maintenance treatment of mood disorders reduces the suicide rate in this vulnerable group of patients.     

Psychiatric disorders and their predictors in young adulthood in Finland

Mental disorders are one main focus of research interest in the 31 year study of the Northern Finland 1966 Birth Cohort Study. Mental disorders are quite common in young adulthood and they have a great impact on quality of life and working ability. Good national registers in Finland ensure the possibility to follow up treated incidence of severe mental disorders. On the other hand, a notable part of those who suffer from non-psychotic mental disorders do not receive any psychiatric treatment. That is why it is not possible to follow up psychiatric morbidity of the non-psychotic disorders from register data. In this review, principles of psychiatric diagnostics, known prevalences of psychiatric disorders in population and factors connected with mental disorder are briefly presented. Especially childhood predictors of mental disorders are reviewed.     

Thyroid gland function in neonates with transient hyperthyrotrophinemia from a region of slight iodine deficiency

The aim of this study was to evaluate thyroid gland function in neonates and babies with transient hyperthyrotrophinemia during the first twelve months of life in an attempt to establish the causes of this condition in neonates born in a region of slight iodine deficiency. Thirty-eight newborns were screened. Clinical observations and measurements of serum T3, T4, TSH levels as well as urinary iodine were conducted for one year (at the age of 2 weeks, 3-4 months, and after one year of life). The screened children showed significantly higher values of T4 (p < 0.001) in comparison with the reference value in successive follow-up examinations. High T4 values may result from an increased TBG concentration in serum, and its level should be determined in the analysed material. Other hormonal values normalized after the second weak of life. Iodine deficiency was found in 80% of the children. Our assessments concerning the causes of transient hyperthyrotrophinemia conform with previous findings. It was established that the most common causes are iodine deficiency and maternal thyroid disease. None of the screened children had goitre somatic anomalies or delayed psychomotoric development did not appear more frequently than in the general pediatric population.     

Cell biological analysis with respect to cause of fibrous opacification of the anterior capsule after cataract extraction

To assess whether juvenile-onset epilepsy or motor disability is complicated by an increased number of mental health disorders or experience of psychosomatic symptoms in young adulthood, we studied 81 subjects with epilepsy and 52 with motor disabilities at the age of 19 to 25 years and compared them with 211 controls. The main diagnostic tool, the Present State Examination, was administered to those attending the interviews in person who were of normal intelligence; there were 62, 38, and 123 subjects in the three categories, respectively. Compared with the controls, the subjects with epilepsy showed an equal prevalence of psychiatric disorders whereas those with motor disabilities had a significantly higher prevalence, particularly of depressive disorders. The reported prevalence of psychosomatic symptoms confirmed this main result. Psychological illness affected everyday life of two out of five subjects with motor disabilities, but only half of those in the other two groups. It is concluded that motor disability since childhood, but not epilepsy, could be a factor that increases susceptibility to psychiatric morbidity, especially depression, and causes a large number of psychosomatic symptoms. The results challenge staff of clinics working with such adolescents to find individual approaches in preventing the negative influence of psychological disorders on social life.     

Folic acid deficiency in chronically hospitalized mental patients

Studies over the past 30 years have shown a relationship between folic acid deficiency and psychopathology. FA deficiency was observed more often in depressed and in psychotic patients, in alcoholics, in those suffering from organic mental disorders and in the psycho-geriatric population. In a chronic inpatient population of 120 patients, of the 106 in whom FA serum levels were examined, only 1 had a definitely subnormal level. An additional 16 had close to the lower limit of normal (2 ng/ml) and were considered borderline cases. FA-deficient and borderline patients were then compared to matched patients with normal FA levels on the MMSE and PANSS scales by blinded raters. Small differences were found between the 2 groups. The FA-deficient and borderline patients had more organic and psychotic symptoms, but the differences were not statistically significant.     

Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California

BACKGROUND: The Mexican American Prevalence and Services Survey presents lifetime prevalence rates for 12 DSM-III-R psychiatric disorders in a sample of 3012 adults of Mexican origin by place of residence and nativity, and compares these results with those of population surveys conducted in the United States and Mexico. METHODS: The stratified random sample included non-institutionalized persons aged 18 to 59 years of Mexican origin, who were residents of Fresno County, California. Psychiatric disorders were assessed using a modified version of the World Health Organization Composite International Diagnostic Interview in face-to-face interviews. RESULTS: Mexican immigrants had lifetime rates similar to those of Mexican citizens, while rates for Mexican Americans were similar to those of the national population of the United States. This difference is attributable to a prevalence rate for any disorder among immigrants of 24.9%, compared with 48.1% among US-born respondents. A higher prevalence for any disorder was reported in urban (35.7%) compared with town (32.1%) or rural (29.8%) areas. Multivariate analyses showed an adjusted effect of country of birth, but not of urban residence. CONCLUSIONS: Despite very low education and income levels, Mexican Americans had lower rates of lifetime psychiatric disorders compared with rates reported for the US population by the National Comorbidity Survey. Psychiatric morbidity among Mexican Americans is primarily influenced by cultural variance rather than socioeconomic status or urban vs rural residence.     

Complications of pediatric thoracolumbar and lumbar pedicle screws

STUDY DESIGN: This was a retrospective review of 223 consecutive cases (1986-1996) from one institution where 759 thoracolumbar and lumbar pedicle screws were used in the treatment of various pediatric spinal disorders in patients less than 18 years of age. OBJECTIVES: To determine the incidence of short- and long-term (> 2 years follow-up) complications in this group of patients-specifically, complications related to instrumentation and those directly attributable to pedicle screws in these pediatric patients. SUMMARY OF BACKGROUND DATA: Although much has been written regarding the use of pedicle screws in the adult population, no published study has examined complication rates with regard to thoracolumbar and lumbar pedicle screws placed for pediatric spinal disorders. METHODS: A retrospective review of 223 consecutive cases involving 759 pedicle screws placed for a variety of pediatric spinal disorders was performed. Complications were divided into short term and long term (> 2 years follow-up) and into those relating to instrumentation and those relating to pedicle screws specifically. RESULTS: Short-term complication occurred in 5 patients (2.2%) for a total of 17 screws ultimately removed. Only two of these patients had screws removed for lumbar radicular complaints. No residual sequellae resulted. No long-term (> 2 years postoperative) complications were noted. CONCLUSION: Low short- and long-term complication rates specific for pediatric pedicle screws suggests that for properly trained spinal surgeons, pedicle screws fixation in the pediatric population can be performed safely to treat a variety of spinal disorders.     

The efficiency of goiter prevention due to iodine deficiency in pregnant women

The iodine is indispensable element for life that is also fundamental substract for thyroid hormone synthesis which make very important influence on protein's lipid's, carbohydrate's and highly caloric substances metabolism and are a requisite of proper man development. The pregnant women are one of population group which is the most sensitive on iodine's deficiency. The results of researches indicate on insufficient iodine intake in pregnant women diet, whose take food even according to diet's recommendation given by physician. The wide iodine's prophylaxis which was provided as yet is insufficient in case of pregnant and nursing women. It is confirmed the necessity of additional iodine supplementation. A set of control tests should be done in requires cases that inform physician about changes in function and size of thyroid gland and make possible the individualization of treatment. The supplementation doses of iodine about 150 micrograms are safe and there was not observed any side effects during their taking.     

First-contact rate for schizophrenia in community psychiatric care. Consideration of the oestrogen hypothesis

The study deals with the incidence of schizophrenia in Finland. All patients aged 15 years and over who during 1 year for the first time in their life contacted any psychiatric treatment unit in six health care districts (catchment areas), with a total population of 1.1 million people, and suffered from schizophrenia as defined by the DSM-III (schizophrenic and schizophreniform disorders) or ICD-8 classifications were studied and followed for 5 years. A total of 186 DSM-III and 158 ICD-8 schizophrenia patients were registered. The incidence rate of DSM-III schizophrenia was 17 per 100,000 total population and that for ICD-8 schizophrenia 14 per 100,000. The incidence rates for individuals aged 22-34 years, singles and those with low education were higher than average, but there were no gender differences. The comprehensiveness of the psychiatric services may explain why the age distributions were similar for both genders and why the mean age of patients at their first psychiatric contact was lower than in many other studies dealing with hospitalized patients. The patients' age at first psychiatric contact did not support the view that oestrogens specifically delay the onset of schizophrenia in women. There is some evidence, however, that oestrogens as antidopaminergic agents may protect women from psychotic disorders in general and that the reduction in oestrogen production may explain why at menopause and afterwards admissions for psychotic disorders for women increase more than for men.     

1997 IPA/Bayer Research Awards in Psychogeriatrics. The wish to die in very old persons near the end of life: a psychiatric problem? Results from the Berlin Aging Study

The wish to die in elderly persons is currently under debate. Experts are questioning whether it is natural for these individuals to show a wish to die, whether the right to eventually kill oneself should be respected, or whether suicidal intentions in old age are expressions of mental disorders that need intensive, professional care. A representative community sample of 516 persons aged 70 to 105 was extensively investigated by psychiatrists using the structured interview Geriatric Mental State Examination-Version A (GMS-A) and several self-rating and observer-rating scales. Diagnoses were made according to DSM-III-R criteria and by clinical judgment. The goal of the study was to find examples of "pathology-free wishes to kill oneself." A total of 115 out of 516 very old (70 to 105 years) persons, which represents 21.1% of the community population, said at the time of investigation that they wanted to die or felt life was not worth living (Hamilton Depression Rating Scale [HAMD] score 1, 2, or 3). Forty-three very old persons (6% of the community population) had the wish to be dead according to the HAMD or the GMS-A, and 11 persons (2% of the community population) had suicidal intentions. Depending on the intensity of suicidality, 80% to 100% were clinically diagnosed as having psychiatric disorders and half to three quarters showed symptoms fulfilling the criteria of at least one specified psychiatric diagnosis. Acute suicidal intentions were in all cases associated with at least one specified diagnosis according to DSM-III-R. Thirteen persons out of 54 who actually wanted to die (GMS-A category 4, 5, 6 or HAMD category 2, 3) did not fulfill criteria for specified diagnoses. Seven individuals showed scores in self-rating and observer-rating scales that speak for mental disorders apart from pure suicidality. Six remaining persons are described in greater detail in short case vignettes. They showed either mild but chronic psychiatric disorders, fluctuating courses, or an atypical phenomenology of psychiatric disorders. The results of this study strongly suggest that the wish to be dead in the very old is most probable, and suicidal intentions are definitely associated with psychiatric disorders.