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Differences in the type of psychometric test employed, the local severity of iodine deficiency, the study design, the inclusion of a control group, as well as difficulty in excluding other nutritional or educational factors related to iodine deficiency disorders could explain the discordant results of these studies 8 — Most interventional studies have focused on evaluating the effect of iodine administration on intellectual capacity in socially depressed areas with low levels of iodine intake 6.
Few studies, however, have been undertaken in European schoolchildren. Studies in the Hurdes region of eastern Spain, well known for its iodine deficiency 8 , 10 , 11 , showed that school-age children from this area had a mean score on psychometric tests approximately 1 sd lower than children from areas with no iodine deficiency. In a systematic review in the Cochrane database of the role of iodized salt intake in the prevention of iodine deficiency disorders, Wu et al. The main conclusion was that methodological differences between the studies were so great that a meta-analysis was not feasible.
Other conclusions were 1 iodized salt is an effective and harmless procedure for increasing iodine intake increase in urinary iodine ; 2 the prevalence of goiter tended to decrease although not always significantly ; 3 no clear conclusions can be derived about the long-term effect on intellectual or physical development of children or on mortality; and 4 further studies are needed of the relation between iodine intake and psychomotor activity.
International Journal of Nephrology
The study was carried out in state schools. Education in Spain is universal, compulsory, and free for the age group studied, thereby ensuring that selection of a school unit was fully representative of the entire population. The following data were obtained from all children: All psychometric evaluations were made by the same person. The former is for children 4—8 yr old and was used in the first grade. The latter is for children 9—14 yr old and was used in the fifth and eighth grades. The instructions, the administration, and the correction of both forms were undertaken by the same person, although with the help of another psychologist for their administration to check that the children performed the tests correctly.
These scales enable evaluation of intellectual function free of cultural influence and minimize the influence of accumulated knowledge and experience. All elements are composed of drawings; thus, children readily accept the task, and it is not difficult for them to maintain their attention. Scale 1 comprises the following subtests: The tests were all administered collectively because of the large number of children involved. This necessitated elimination of the subtests concerning classification, orders, mistakes, and riddles, which are given individually.
The subtests given, therefore, were substitution, maze, identification, and similarities. The tests given compose the abbreviated form Scale 2 is composed of four subtests, all perceptive: In all cases the elements are presented graphically, with no cultural content. The scores obtained in the different subtests of both scales are combined to give a single score, which is then transformed into a score out of or in deviation IQ normal distribution of the IQ, with an arithmetic mean of and an sd of These tests have already been validated for schoolchildren in Spain 22 — A blood sample obtained by venipuncture was taken from all children.
Measurements were made of TSH reference value, 0. Data are represented as percentages, percentiles, means, and sd s. Hypothesis contrast of continuous variables was made by t test for two comparisons or by one- or two-way ANOVA for multiple comparisons. The study was authorized by the relevant health and education authorities, and the parents of all the children attending the school at the time gave written informed consent to the participation of their children in the study.
The study was also approved by the ethics and investigation committee of one of the participating centers. The mean age of the children was The prevalence of goiter was The mean urinary iodine level was There was no significant correlation between urinary iodine levels and FT 3 or FT 4. The mean IQ was The distribution of the IQ of the schoolchildren according to percentile was: There were no significant differences in IQ when the sex, level of education, and presence of goiter were considered Table 2.
The correlations in the boys were not statistically significant. These OR rose to 2.
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Introduction in the model of other variables, such as education level, presence of goiter, or sex, did not change the strength of the association between IQ and urinary iodine or thyroglobulin levels data not shown. Table 4 shows the risk gradient of having an IQ below the 25th percentile according to urinary iodine level.
Prevalence percentage and risk OR of an IQ below the 25th percentile according to decreasing urinary iodine levels micrograms per liter. Risk OR of an IQ below the 25th percentile according to urinary iodine level exposure variable , calculated from a logistic regression model that included age and sex as confounding variables.
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As expected, urinary iodine levels were significantly higher in the IQ was significantly higher in children who consumed iodized salt None of the other food groups was related to urinary iodine level or IQ data not shown. There was no interaction among intake of dairy products, iodized salt, and sex data not shown. The risk of an IQ below the 25th percentile was significantly related to the intake of common vs. Inclusion in the model of sex and age did not change this association Table 6. We found data not shown that 7. Intake of iodized salt or a greater amount of milk reduced the probability of being below this threshold.
The strength and significance of this association were unchanged alter adjusting for age and sex.
Endocrinología y Obesidad | Endocrinología y Enfermedades del Metabolismo, Huesos y Riñones | IGTP
Numerous studies in populations with iodine deficiency have shown a reduction in the psychomotor ability of children 3 , 8 , Our study confirms this association in a representative sample of schoolchildren from a developed country in southern Europe who were all similar from an ethnic and social viewpoint and who had no associated nutritional problems. Although the results suggest that the degree of iodine deficiency can be classified as mild, this does not mean that the consequences are mild, as indicated by decreases in IQ and hearing acuity These disorders should not be considered merely mild handicaps in the current competitive environment found in developed nations.
This is an observation appearing more and more frequently from studies in other European countries, where surveys in schoolchildren suggested that iodine deficiency was mild, but the children were affected by iodine deficiency disorders that are not really mild 6 , Previous studies in the same area have shown the main nutritional determinants of urinary iodine in schoolchildren to be intake of iodized salt and amount of dairy products consumed In the present study the highest urinary iodine levels were found in children who consumed iodized salt and those who consumed dairy products at least three times a day.
The association between IQ and urinary iodine levels, on one hand, and between IQ and intake of iodized salt and dairy products, on the other, confirms the nutritional nature of this relation as well as the probable persistence over time of a deficient iodine intake. The possibility that other components of milk, such as amino acids or fatty acids, whose beneficial effect on brain development is known 31 , may influence these results cannot be ruled out, but they are outside the scope of this study.
Most children were clinically and analytically euthyroid, according to the reference values and usual clinical criteria. In fact, no marked changes in TSH, FT 3 , or FT 4 levels are usually found with moderate iodine deficiency, although thyroglobulin levels are increased Just as we found an association between thyroglobulin and IQ in this study, we had previously found a relation between thyroglobulin and auditory threshold in schoolchildren who were socially and geographically very similar to those in the present study This association suggests that the effect of iodine deficiency on IQ is produced by the persistence of thyroid dysfunction, presently subclinical, but which at some point during development fetal or postnatal must have caused damage to brain maturation 2 , 29 , 33 — Numerous clinical and experimental studies have shown the importance of an adequate iodine supply for maturation of the fetal and newborn brain 2 , This study demonstrates yet again the need to guarantee sufficient iodine intake even in developed areas with western lifestyles.
The presence and grade of goiter were related to urinary iodine levels. The increased standard of living and nutritional improvements as well as chance contact with iodine-rich chemicals or nutrients favor silent iodine prophylaxis Defects related to neuronal maturation may be the consequence of exposure to low iodine levels during the first half of pregnancy or the early period of life, which leave sequelae that are not wholly reversible 37 — However, the literature is discordant regarding the influence of postnatal iodine administration on defects of cerebral maturation and function caused by exposure to iodine deficiency after birth 6 — 8 , 12 , 40 , Increased intake of iodized salt has been shown to reduce the prevalence of goiter Iodine deficiency in the region studied Andalusia has been known since at least the second half of the 20th century Despite this, no iodine prophylaxis campaigns have been undertaken because other health markers in both adults and children were officially acceptable, even very satisfactory 42 , and the health authorities did not consider these campaigns necessary.
Manual de Endocrinologia y Metabolismo (Spanish Edition) by Norman Lavin
Although most of the palpated goiters in our study were grade IA, the prevalence of goiter was still high. This suggests that many of these children are growing up in an environment of mild iodine deficiency, including during fetal development. We also found a biological slope between IQ and urinary iodine levels. The ultimate goal is to translate these findings to clinical practice by including them in the therapeutic algorithms.
In the REMAH initiative, more than pituitary tumours have been obtained and included in a specific database, in which in more than of the cases have clinical and molecular data associated with the sample. The group has also been working for many years on the evaluation of thyroid function in relation to iodine nutrition and its consequences during pregnancy. Several population studies have been performed over the last decade, either in children or in pregnant women.
Position statements have been published in relation to this question and a specific project is currently ongoing, studying a cohort of pregnant women to define a TSH dependent risk score that could be predictive of obstetricl complications and foetal outcomes. The group is participating in a European project, the EUthyroid project, as the Spanish partner. In the EUtyroid project, Dr Lluis Vila, who has participated in the last decade in different joint projects, and is currently the President of the Catalan Society of Endocrinology, is also co- local IP.
Additionally, the group also carries out thyroid cancer research, as part and founder of a Catalan consortium for the study of thyroid cancer, in which 20 different hospitals have incorporated their clinical expertise. Currently, a database has been generated, including more than patients and a biobank tissue collection has been generated to study different issues. In particular our group is interested in defining biomarkers that could identify biological and clinical behaviour of poorly differentiated thyroid cancer, by applying genetic and epigenetic profiling.
Since , different research activities have been initiated to study the complications of Obesity and its potential reversal after therapeutic bariatric surgery. We have explored the implications of bariatric surgery weight loss in different hormonal systems such as the gonadotropic axis and the somatotropic axis, as well as the participation of the ghrelin system in surgical weight loss outcomes, with Dr Silvia Pellitero carrying out these studies as PI.