Prevention and control of iodine deficiency : studies on the efficacy of oral iodized oil

Iodized oil, either injected or given orally, is the major alternative to iodized salt for controlling iodine deficiency. Oral administration has considerable advantages despite its shorter duration of effect. Little information is available on factors which influence the effect of orally administered iodized oil. In this dissertation the efficacy of oral iodized oil is studied with regard to the type of oil used, the dosage technique, intestinal parasites, nutritional status, sex and the consumption of raw cassava. The studies were carried out among Malawian school children. All results are based on iodine concentrations in casual urine samples collected at regular intervals after oral dosing with iodized oil. A model has been developed to describe the urinary iodine excretion pattern over time based on the retention and rate of elimination of iodine for subjects with different characteristics. The estimated durations of effectiveness were 13.7, 9.9 and 55.2 weeks for a single dose of iodized oil A (ethyl esters of iodized fatty acids; 490 mg iodine in 1 mL), a split-dose of oil A (2 x 245 mg iodine in 0.5 mL), and a single dose of iodized oil B (triacylglycerols; 675 mg iodine in 1.25 mL), respectively. In general, the duration of effectiveness of iodized oil A was significantly increased in subjects treated for parasitic infestations. For Entamoeba histolytica it appears that the absorption of oral iodized oil A is greatly disturbed as the assessed duration of effectiveness was found to be only 2 weeks for the untreated subjects. Children with a relatively large subcutaneous fat mass retained more iodine than subjects with little subcutaneous fat. For goitrous subjects both the retention and elimination of iodine were increased. A reduction in midupper-arm. circumference during the study increased the duration of effect. Based on the cumulative frequency distributions, of individually assessed durations of effectiveness, oral dosing with iodized oil was less effective in girls than in boys, and in those who consumed raw cassava than those who did not

Health and income:a meta-analysis to explore cross-country, gender and age differences

Background: Evidence of an effect of income on self-reported poor health (SRPH) is widely available in the literature. We compare this effect across age, different countries and between men and women using meta-analysis. Studies that report on an effect of income lack a homogenous effect size. To overcome this problem we propose a method to derive a homogenous effect size to enable us to compare the effect of income across groups. Methods: We take a meta-analytical approach to examine the effect of income on SRPH. The data consists of reported and calculated odds ratios as a measure of effect for SRPH outcomes across different income categories. Self-reported health outcomes are dichotomised into 'good' and 'poor'. With least-squares techniques, we estimate the functional parameters that describe the log-linear association between income and SRPH. Subsequently, F-tests are performed to show variations between the groups. Results: The relationship between income and SRPH is log-linear for most countries but not significantly for Sweden and the Netherlands. Our results show significant differences in the effect of income between countries. We find that men require a higher income than women to achieve comparable SRPH outcomes, and that the effect of income depends on age. Conclusions: There is significant income related variation in SRPH between different countries even if the levels of income or the standards of living are comparable. For women income affects SRPH differently than for men. The effect of income on SRPH depends on the age of the individual respondent

The health effects of education: a meta-analysis

Background: There is an abundance of empirical evidence, mainly from the epidemiological and social science literature, on the relation between education and health. Until now a meta-analysis of the relation between education and health was not available. This article presents a meta-analysis of studies that use self- reported health as an outcome variable to quantify the effect of education on health. Methods: Meta-analysis using a random and a fixed-effects model to quantify the marginal effect of education on self-reported health. Results: The results of the meta-analysis show that the quality adjusted life years weight (QALYweight) of a year of education is 0.036. Some tentative calculations suggest that the cost-benefit ratio of investments in education on health is highly positive. Conclusion: For public policy this implies that a more integrated approach to education and health policies should be taken

Efficacy of oral iodised oil is associated with anthropometric status in severely iodine-deficient schoolchildren in rural Malawi

The effect of anthropometric status on the efficacy of an oral supplement of iodised oil (1 ml Lipiodol Ultrafluide, 490 mg I; Laboratoire Guerbet, Aulnay-sous-Bois, France) was examined in 8–10-year-old schoolchildren (n 197) of Ntcheu, a severely I-deficient district of Malawi. The study was a controlled trial using the I concentration of casual urine samples to monitor the I status. The median urinary I concentration increased from 0?15 mol/l at baseline (51?3 % of children < 0?16 mol/l, 89?7 % < 0?40 mol/l, 95?7 % 0?79 mol/l) to 0?32 mol/l at 40 weeks (29?1 % of the children < 0?16 mol/l, 71?0 % < 0?40 mol/l, 96?1 % < 0?79 mol/l) while the total goitre prevalence fell from 63 % to 21 %. Variables of efficacy were estimated from a hyperbolic function describing the longitudinal pattern of urinary I excretion after the dose. The I retention and I elimination rate, and the periods of protection from mild (< 0?79 mol/l) or moderate (< 0?40 mol/l) I deficiency were obtained for groups of children with differing anthropometric status at baseline. Initial height-for-age and mid upper-arm circumference were not significantly related to efficacy. However, both the I retention and I elimination rate were reduced in children with lower initial weight-for-height. Children with lower skinfold thickness at baseline also had reduced I retention, which resulted in shorter protection periods from recurrent moderate and mild I deficiency. The efficacy of the oral iodised-oil supplement was not related to changes in anthropometric status during follow-up, nor was it related to the consumption of a food supplement of 1610 kJ immediately before the iodised-oil dose. Very low (< 0?16 mol/l) urinary I concentration, and the presence of goitre at baseline were both associated with higher I retention and elimination rate. Children with goitre at baseline were found to have a prolonged duration of protection against recurrent moderate I deficiency. We conclude that in apparently healthy schoolchildren in I-deficient areas, general anthropometric status has a little influence on the efficacy of oral iodised oil for correcting I deficiency

Efficacy of oral iodised oil is associated with anthropometric status in severely iodine-deficient schoolchildren in rural Malawi

The effect of anthropometric status on the efficacy of an oral supplement of iodised oil (1 ml Lipiodol Ultrafluide, 490 mg I; Laboratoire Guerbet, Aulnay-sous-Bois, France) was examined in 8–10-year-old schoolchildren (n 197) of Ntcheu, a severely I-deficient district of Malawi. The study was a controlled trial using the I concentration of casual urine samples to monitor the I status. The median urinary I concentration increased from 0?15 mol/l at baseline (51?3 % of children < 0?16 mol/l, 89?7 % < 0?40 mol/l, 95?7 % 0?79 mol/l) to 0?32 mol/l at 40 weeks (29?1 % of the children < 0?16 mol/l, 71?0 % < 0?40 mol/l, 96?1 % < 0?79 mol/l) while the total goitre prevalence fell from 63 % to 21 %. Variables of efficacy were estimated from a hyperbolic function describing the longitudinal pattern of urinary I excretion after the dose. The I retention and I elimination rate, and the periods of protection from mild (< 0?79 mol/l) or moderate (< 0?40 mol/l) I deficiency were obtained for groups of children with differing anthropometric status at baseline. Initial height-for-age and mid upper-arm circumference were not significantly related to efficacy. However, both the I retention and I elimination rate were reduced in children with lower initial weight-for-height. Children with lower skinfold thickness at baseline also had reduced I retention, which resulted in shorter protection periods from recurrent moderate and mild I deficiency. The efficacy of the oral iodised-oil supplement was not related to changes in anthropometric status during follow-up, nor was it related to the consumption of a food supplement of 1610 kJ immediately before the iodised-oil dose. Very low (< 0?16 mol/l) urinary I concentration, and the presence of goitre at baseline were both associated with higher I retention and elimination rate. Children with goitre at baseline were found to have a prolonged duration of protection against recurrent moderate I deficiency. We conclude that in apparently healthy schoolchildren in I-deficient areas, general anthropometric status has a little influence on the efficacy of oral iodised oil for correcting I deficiency

Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit

Background: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p 65 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery