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PubMed2001

[Eliminating iodine deficiency disorders in Nepal through precede-proceed].

OBJECTIVES: Assess the PRECEDE-PROCEED model's suitability for developing countries. Analyze the Iodine Deficiency Disorders (IDD) control program in Nepal according to PRECEDE-PROCEED. METHODS: Primary and secondary data analysis within the framework of PRECEDE-PROCEED's first five steps. Key informant interviews. Qualitative data from Nepal's IDD control program participants were assessed according to PRECEDE-PROCEED's third through fifth steps. RESULTS: According to the first and second steps of PRECEDE-PROCEED for social and epidemiological assessment, Nepal's IDD control program needs improvement. Limited data were available for the assessment, making it difficult to execute the first two steps with certainty. Social and epidemiological assessments can be problematic in any developing country since the necessary data are typically not available. Behavioral and environmental assessments (step three) showed that: Most people are unaware of IDD and manage iodized salt poorly. The environment within which iodized salt is managed is insufficient for maintaining proper salt iodination at the consumer level. Educational and ecological assessments (step four) pointed out several problems, including: Inadequate understanding of IDD Incorrect beliefs about refined salt Poor supply of refined salt in markets Weak regulation of non-iodized salt importation and sales Finally, administrative and policy assessments (step five) emphasized the need for an active role of the Salt Trading Corporation in Nepal, with a significant manpower and budget, in improving the IDD program. Data for completing PRECEDE-PROCEED steps three through five were readily available. In addition to providing a framework within which to assess Nepal's IDD control program, the model helped highlight specific action goals for behavioral and environmental objectives (consume more iodized salt, improve quality of salt warehouses and increase iodized salt's market availability). DISCUSSION: Though it was difficult to obtain data for social and epidemiological assessments, the PRECEDE-PROCEED model proved useful in analyzing IDD control in Nepal. The model can comprehensively analyze ongoing interventions and assess the status of various nation-wide health programs, highlighting areas of modification needed to help programs achieve their goals.

Developing Countries↗
PubMed1986

Beta-adrenoceptor blocking drugs and cytochrome P-450: the influence of propranolol treatment on caffeine, antipyrine, D-glucaric acid and indocyanine green elimination in patients with hepatic disorders.

The effect of the beta-adrenoceptor blocking drug propranolol was investigated in patients with alcoholic liver disease and in those without liver disease before and after ten days treatment with 80 mg daily. Caffeine as a marker drug for the 3-methylcholanthrene-inducible subtype had a significantly enhanced clearance after propranolol in liver-diseased patients, while the clearance of antipyrine which represents the phenobarbital-inducible subtype was unchanged. D-glucaric acid excretion as an endogenous compound which serves as an indicator of induced state of drug-metabolizing capacity of the liver was slightly enhanced in liver patients, but significantly decreased in patients without liver disorders. Indocyanine green elimination as a test material for substances limiting liver blood flow was not significantly reduced by this propranolol dosage.

Adult↗
PubMedDate not supplied

[The potentials of local and intravascular laser irradiation for eliminating the immunological disorders in patients with chronic pyelonephritis].

61 patients suffering from chronic pyelonephritis in the stage of active inflammation associated with either urolithiasis (67.4%) or prostatic adenoma (32.6%) were divided into three groups. Group 1 received conventional antibacterial treatment, group 2 conventional treatment + local laser radiation (LLR), group 3 received combined therapy including intravascular laser irradiation of blood (IVLIB). The treatments efficacy was controlled by urine seeding for microflora and its sensitivity to antibiotics, by immunological supervision. The patients were found to have immunological abnormalities in the form of cellular and humoral immunity suppression, neutrophil phagocytic hypoactivity, elevated levels of medium-molecular peptides nonresponsive to standard antibacterial therapy. Adjuvant use of LLR improved humoral immunity and reduced total urine bacterial count. LLR replacement for IVLIB resulted in a complete regression of immunological shifts and more pronounced reduction of urinary bacterial contamination.

Antibody Formation↗
PubMed1977

[Idiopathic cyclic edema: disorders in water elimination accentuated by orthostasis].

Forty patients suffering from idiopathic oedema were studied. The disturbance in water excretion is characterised by a delay in excretion of a water load (20 ml/kg body weight), an inability to decrease urinary osmolarity below 137 mOsm/1 standing (normal: 60 mOsm +/- 25) and an inability to increase free water clearance: 2.36 +/- 2 ml/mn/1. 73 m2 (normal value: 6.8 ml/mn/1.73 m2) in the upright position. This problem of water excretion related to orthostasis defines and characterises the syndrome, the clinical picture of which is well known. The disturbance suggest a fault in the regulation of anti-diuretic hormone whilst the aldosteronism often described would seem to be inconstant and secondary to diuretic therapy too often prescribed without supervision.

Adult↗
PubMed1997

The challenge of the global elimination of iodine deficiency disorders.

Most nations of the world are well positioned for success in their pursuit of the virtual elimination of iodine deficiency disorders (IDD) by the year 2000. In 1990 at the World Summit for Children, Heads of State and Government had agreed on this global goal and in 1992 at the International Conference on Nutrition, multi-sector country delegations from all over the world developed the prototype framework for national action. Following a special recommendation of the United Nations Joint Committee on Health Policy, universal salt iodization (USI) is now being applied in almost all countries with an IDD problem recognized as being of public health significance. The core components of national IDD programmes based on USI are presented in this paper, and examples are given of effective actions ongoing in a number of countries. While in principle all components such as communications, information management and laboratory support should integrate and complement with ongoing efforts for general nutritional improvement, national IDD programmes also have specific needs which require separate arrangements. Sources of support and information, available from the international public nutrition community are indicated. The global conquest of IDD provides an example for other effective public nutrition practices from the important lessons that are being learned. Particularly, the role of the private food sector as full partner in national programmes is relevant to ongoing and future attempts to reduce and eliminate other major global malnutrition problems.

Humans↗
PubMed2000

Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure.

BACKGROUND: Patients with heart failure and systolic dysfunction may develop disordered breathing during sleep. Repeated episodes of apnea and hypopnea may result in desaturation and arousals, which could adversely affect left ventricular function. The purpose of this study was to determine the short-term effects of continuous positive airway pressure (CPAP) on sleep-disordered breathing and its consequences in heart failure patients. METHODS AND RESULTS: The author prospectively studied 29 male patients whose initial polysomnograms showed 15 or more episodes of apnea and hypopnea per hour (apnea-hypopnea index, AHI). Twenty-one patients had predominately central and 8 patients obstructive sleep apnea. All were treated with CPAP during the subsequent night. In 16 patients, CPAP resulted in virtual elimination of disordered breathing. In these patients, the mean AHI (36+/-12 [SD] versus 4+/-3 per hour, P=0.0001), arousal index due to disordered breathing (16+/-9 versus 2+/-2 per hour, P=0.0001), and percent of total sleep time below saturation of 90% (20+/-23% to 0.3+/-0.7%, P=0.0001) decreased, and lowest saturation (76+/-8% versus 90+/-3%, P=0.0001) increased with CPAP. In 13 patients who did not respond to CPAP, these values did not change significantly. In patients whose sleep apnea responded to CPAP, the number of hourly episodes of nocturnal premature ventricular contractions (66+/-117 versus 18+/-20, P=0.055) and couplets (3.2+/-6 versus 0.2+/-0.21, P=0.031) decreased. In contrast, in patients whose sleep apnea did not respond to CPAP, ventricular arrhythmias did not change significantly. CONCLUSIONS: In 55% of patients with heart failure and sleep apnea, first-night nasal CPAP eliminates disordered breathing and reduces ventricular irritability.

Aged↗
PubMedDate not supplied

[Changes in corneal topography after photorefractive keratectomy in myopia and their elimination].

Topographic disorders in the cornea, regression of the refraction effect, and subepithelial corneal opacities are characteristic complications of photorefraction keratectomy. Disorders in corneal topography are early haze, asymmetrical haze, and optic zone decentration. Disorders in topography lead to decrease in visual acuity, numerous optic effects (monocular doubling, aureola, blurred image, etc.). Methods for these complications control by means of transepithelial ablation, which is carried out with due consideration for the data of topographic examinations under pseudofluorescence control, normalizes corneal topography in the majority of cases, notably increases visual acuity, decreases doubling, etc. No side effects were observed after transepithelial phototherapeutic keratectomy for a period of up to 12 months.

Adolescent↗
PubMed2006

Tracking progress towards sustainable elimination of iodine deficiency disorders in Bihar.

OBJECTIVES: To assess the status of the iodine deficiency in the population of Bihar and track progress of the elimination efforts. METHODS: A community based field survey was conducted. Using quantitative and qualitative research methods, data was collected by following internationally recommended protocol and methodology. Thirty clusters were selected using population proportionate to size technique. School age children (6 to 12 years) were the target group studied. Urinary iodine in target children and iodine content of salt at households were the indicators used. RESULTS: Total of 1169 children were studied. The median urinary iodine concentration was found to be 85.6 microg/L. Urinary iodine concentration was less than 50 microg/L in 31.5% of the subjects. Only 40.1% of the household salt samples were found to be adequately iodised as determined by titration method (> or =15 ppm iodine). CONCLUSIONS: Study results show existence of iodine deficiency in the state. There is need to accelerate our efforts to achieve iodine sufficiency and this should be done on a war-footing.

Child↗
PubMed2004

Experiences in the prevention, control and elimination of iodine deficiency disorders: a regional perspective.

Before 1987, iodine deficiency was not considered an issue of major importance in the countries of the Eastern Mediterranean Region (EMR). Progress began with a systematic national study of goitre and other iodine deficiency disorders (IDD) in the Islamic Republic of Iran in 1983. Following a major review of the prevalence of IDD in member states, Guidelines for national programmes for the control of iodine deficiency disorders in the EMR were published by the World Health Organization (WHO) in 1988. This paper discusses progress towards elimination of iodine deficiency by reviewing the status of IDD in the countries of EMR and programmes for prevention and control of IDD with particular reference to the Islamic Republic of Iran, the first country to be declared IDD-free by WHO.

Feeding Behavior↗
PubMed2003

Mild disorders should not be eliminated from the DSM-V.

BACKGROUND: High prevalence estimates in epidemiological surveys have led to concerns that the DSM system is overly inclusive and that mild cases should be excluded from future DSM editions. OBJECTIVE: To demonstrate that the DSM-III-R disorders in the baseline National Comorbidity Survey (NCS) can be placed on a severity gradient that has a dose-response relationship with outcomes assessed a decade later in the NCS follow-up survey (NCS-2) and that no inflection point exists at the mild severity level. METHODS: The NCS was a nationally representative household survey of DSM-III-R disorders in the 3-year time span 1990-1992. The NCS-2 is a follow-up survey of 4375 NCS respondents (76.6% conditional response rate) reinterviewed in 2000 through 2002. The NCS-2 outcomes include hospitalization for mental health or substance disorders, work disability due to these disorders, suicide attempts, and serious mental illness. RESULTS: Twelve-month NCS/DSM-III-R disorders were disaggregated into 3.2% severe, 3.2% serious, 8.7% moderate, and 16.0% mild case categories. All 4 case categories were associated with statistically significantly (P<.05, 2-sided tests) elevated risk of the NCS-2 outcomes compared with baseline noncases, with odds ratios of any outcome ranging monotonically from 2.4 (95% confidence interval, 1.6-3.4) to 15.1 (95% confidence interval, 10.0-22.9) for mild to severe cases. Odds ratios comparing mild to moderate cases were generally nonsignificant. CONCLUSIONS: There is a graded relationship between mental illness severity and later clinical outcomes. Retention of mild cases in the DSM is important to represent the fact that mental disorders (like physical disorders) vary in severity. Decisions about treating mild cases should be based on cost-effectiveness not current severity. Cost-effectiveness analysis should include recognition that treatment of mild cases might prevent a substantial proportion of future serious cases.

Adolescent↗