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Hunziker S, Morosoli F, Zuercher K, Tscherter A, Grunt S. Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide-A Survey of the Swiss Cerebral Palsy Registry. Children (Basel) 2023; 10:1838. [PMID: 38136040 PMCID: PMC10742030 DOI: 10.3390/children10121838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Cannabinoids are prescribed to children with cerebral palsy despite limited evidence. We aimed to assess cannabinoid prescribing practices in children with cerebral palsy, focusing on indications, types of preparations used, and tolerability. Furthermore, we investigated how physicians acquire knowledge about cannabinoid medication. We asked physicians with expertise in the care of children with cerebral palsy about their prescribing practices for cannabinoids. Data were collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, experiences regarding efficacy, and observed side effects of the therapy. Seventy physicians from Europe, North America, and Australia completed the survey. Forty-seven participants were experienced in treating of children with cerebral palsy with cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The preparations and doses prescribed varied considerably. Half of the participants evaluated the effect of the cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently, drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhea (13%). Despite the lack of evidence to date, cannabinoids are used to treat children with cerebral palsy in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.
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Affiliation(s)
- Sandra Hunziker
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Federico Morosoli
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Freiburgstr. 15, CH-3010 Bern, Switzerland
| | - Kathrin Zuercher
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Freiburgstr. 15, CH-3010 Bern, Switzerland
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Hunziker S, Örgel A, Tatagiba M, Adib SD. Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature. Front Surg 2023; 10:1238448. [PMID: 37614664 PMCID: PMC10442939 DOI: 10.3389/fsurg.2023.1238448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Objective The pathophysiology of idiopathic spinal cord herniation remains unknown. However, several different factors have been postulated, such as congenital causes (ventral dura mater duplication, preexisting pseudomeningocele, or other congenital dural defects), inflammation, remote spinal trauma, or thoracic disc herniation. Herein, the diagnosis and surgical treatment of a patient with spinal cord herniation caused by an intraspinal bone spur is presented along with a relevant literature review. Case presentation A 56-year-old male patient presented with a non-traumatic Brown-Sequard syndrome persisting for over 1 year. A magnetic resonance imaging of the spinal axis revealed a ventral spinal cord displacement in the level of T 6/7. A supplementary thin-sliced computed tomography of the spine revealed a bone spur at the same level. For neurosurgical intervention, T 6 and T 7 laminectomy was performed. The cranial and caudal end of the right paramedian ventral dural defect was visualized and enlarged. Following extradural spinal cord mobilization by denticulate ligament transection, the spinal cord was finally released. The spinal cord was rotated and the ventral closure of the dural defect was performed by continuous suture. The patient recovered from surgery without additional deficits. The patient's postoperative gait, sensory, and motor function deficits improved, and further neurological deterioration was prevented. Conclusion Since the first description of spinal cord herniation by Wortzman et al. in 1974, approximately 260 cases have been reported in the literature. In addition to other causes, intraspinal bone spur is a possible cause of spinal cord herniation.
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Affiliation(s)
- S. Hunziker
- Department of Neurosurgery, University of Tuebingen, Tübingen, Germany
| | - A. Örgel
- Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tübingen, Germany
| | - M. Tatagiba
- Department of Neurosurgery, University of Tuebingen, Tübingen, Germany
| | - S. D. Adib
- Department of Neurosurgery, University of Tuebingen, Tübingen, Germany
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Dineva M, Rayman MP, Levie D, Hunziker S, Guxens M, Peeters RP, Murcia M, Rebagliato M, Irizar A, Jimeno-Romero A, Sunyer J, Korevaar TIM, Bath SC. Exploration of thyroglobulin as a biomarker of iodine status in iodine-sufficient and mildly iodine-deficient pregnant women. Eur J Nutr 2023:10.1007/s00394-023-03131-x. [PMID: 36973522 DOI: 10.1007/s00394-023-03131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Urinary iodine-to-creatinine ratio (UI/Creat) reflects recent iodine intake but has limitations for assessing habitual intake. Thyroglobulin (Tg) concentration, which increases with thyroid size, appears to be an indicator of longer-term iodine status in children and adults, however, less is known in pregnancy. This study investigated the determinants of serum-Tg in pregnancy and its use as an iodine-status biomarker in settings of iodine-sufficiency and mild-to-moderate deficiency. METHODS Stored blood samples and existing data from pregnant women from the Netherlands-based Generation R (iodine-sufficient) and the Spain-based INMA (mildly-to-moderately iodine-deficient) cohorts were used. Serum-Tg and iodine status (as spot-urine UI/Creat) were measured at median 13 gestational weeks. Using regression models, maternal socio-demographics, diet and iodine-supplement use were investigated as determinants of serum-Tg, as well as the association between UI/Creat and serum-Tg. RESULTS Median serum-Tg was 11.1 ng/ml in Generation R (n = 3548) and 11.5 ng/ml in INMA (n = 1168). When using 150 µg/g threshold for iodine deficiency, serum-Tg was higher in women with UI/Creat < 150 vs ≥ 150 µg/g (Generation R, 12.0 vs 10.4 ng/ml, P = 0.010; INMA, 12.8 vs 10.4 ng/ml, P < 0.001); after confounder adjustment, serum-Tg was still higher when UI/Creat < 150 µg/g (regression coefficients: Generation R, B = 0.111, P = 0.050; INMA, B = 0.157, P = 0.010). Iodine-supplement use and milk intake were negatively associated with serum-Tg, whereas smoking was positively associated. CONCLUSION The association between iodine status and serum-Tg was stronger in the iodine-deficient cohort, than in the iodine-sufficient cohort. Serum-Tg might be a complementary (to UI/Creat) biomarker of iodine status in pregnancy but further evidence is needed.
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Affiliation(s)
- Mariana Dineva
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mario Murcia
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Marisa Rebagliato
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, University Jaume I, Castelló, Spain
| | - Amaia Irizar
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- BIODONOSTIA Health Research Institute, Donostia‑San Sebastián, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Alba Jimeno-Romero
- BIODONOSTIA Health Research Institute, Donostia‑San Sebastián, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Parc Salut Mar-IMIM, Barcelona, Spain
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
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Brandt PC, Provornikova E, Bale SD, Cocoros A, DeMajistre R, Dialynas K, Elliott HA, Eriksson S, Fields B, Galli A, Hill ME, Horanyi M, Horbury T, Hunziker S, Kollmann P, Kinnison J, Fountain G, Krimigis SM, Kurth WS, Linsky J, Lisse CM, Mandt KE, Magnes W, McNutt RL, Miller J, Moebius E, Mostafavi P, Opher M, Paxton L, Plaschke F, Poppe AR, Roelof EC, Runyon K, Redfield S, Schwadron N, Sterken V, Swaczyna P, Szalay J, Turner D, Vannier H, Wimmer-Schweingruber R, Wurz P, Zirnstein EJ. Future Exploration of the Outer Heliosphere and Very Local Interstellar Medium by Interstellar Probe. Space Sci Rev 2023; 219:18. [PMID: 36874191 PMCID: PMC9974711 DOI: 10.1007/s11214-022-00943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/07/2022] [Indexed: 06/18/2023]
Abstract
A detailed overview of the knowledge gaps in our understanding of the heliospheric interaction with the largely unexplored Very Local Interstellar Medium (VLISM) are provided along with predictions of with the scientific discoveries that await. The new measurements required to make progress in this expanding frontier of space physics are discussed and include in-situ plasma and pick-up ion measurements throughout the heliosheath, direct sampling of the VLISM properties such as elemental and isotopic composition, densities, flows, and temperatures of neutral gas, dust and plasma, and remote energetic neutral atom (ENA) and Lyman-alpha (LYA) imaging from vantage points that can uniquely discern the heliospheric shape and bring new information on the interaction with interstellar hydrogen. The implementation of a pragmatic Interstellar Probe mission with a nominal design life to reach 375 Astronomical Units (au) with likely operation out to 550 au are reported as a result of a 4-year NASA funded mission study.
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Affiliation(s)
- P. C. Brandt
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - E. Provornikova
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - S. D. Bale
- University of California Berkeley, Berkeley, CA USA
| | - A. Cocoros
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - R. DeMajistre
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - K. Dialynas
- Office of Space Research and Technology, Academy of Athens, Athens, 10679 Greece
| | | | - S. Eriksson
- Laboratory for Atmospheric and Space Physics, University of Colorado at Boulder, Boulder, CO USA
| | - B. Fields
- University of Illinois Urbana-Champaign, Urbana, IL USA
| | - A. Galli
- University of Bern, Bern, Switzerland
| | - M. E. Hill
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - M. Horanyi
- Laboratory for Atmospheric and Space Physics, University of Colorado at Boulder, Boulder, CO USA
| | | | | | - P. Kollmann
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - J. Kinnison
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - G. Fountain
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - S. M. Krimigis
- Office of Space Research and Technology, Academy of Athens, Athens, 10679 Greece
| | | | - J. Linsky
- University of Colorado Boulder, Boulder, CO USA
| | - C. M. Lisse
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - K. E. Mandt
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - W. Magnes
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - R. L. McNutt
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | | | - E. Moebius
- University of New Hampshire, Durham, NH USA
| | - P. Mostafavi
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - M. Opher
- Boston University, Boston, MA USA
| | - L. Paxton
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - F. Plaschke
- Technical University Braunschweig, Braunschweig, Germany
| | - A. R. Poppe
- University of California Berkeley, Berkeley, CA USA
| | - E. C. Roelof
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | - K. Runyon
- Planetary Science Institute, Tucson, AZ USA
| | | | | | | | | | - J. Szalay
- Princeton University, Princeton, NJ USA
| | - D. Turner
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD USA
| | | | | | - P. Wurz
- University of Bern, Bern, Switzerland
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Hunziker S, Valko P, Graf K, Werth E, Baumann C. Sleep-wake misperception. A comprehensive analysis of a large sleep lab cohort. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hunziker S, Nasi-Kordishti I, Tatagiba M. P02.06.B Calvarial metastases: overview of the different entities and the pre-, intra- and postoperative course. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Calvarial metastases are most often in cancer with systematic bony metastatic disease. Calvarial metastases occur via hematogenous spread, retrograde seeding through Batson’s venous plexus, or direct extension. A variety of different primary tumours can cause calvarial metastases. The lesions can be palpable on the skin, cause local swelling and, depending on the location, neurological deficits can also occur. The aim of this research is to present an overview of the different entities and the neurosurgical management.
Material and Methods
Retrospectively, all patients who underwent surgery on a calvarial metastasis in our department between 2004 and 2021 (n=22) were identified. Data on the morphological and histological findings as well as the pre-, intra- and postoperative course were gathered and analysed.
Results
Swelling (n=14), cosmetically disturbing (n=9), pain (n=6), neurological deficits (n=4), epilepsy (n=3) and B-symptoms (n=1) were the main complaints. 7 had no symptoms at the time of diagnosis. There was a side preference with most of the lesions occurring on the right (n=13), less on the left (n=5) or bilateral (n=4). Calvarial metastases are divided in primary lesions, originating in the bone and secondary lesions infiltrating the bone. The majority of lesions originated from the bone except two, which wer secondary infiltrating the bone. 20 were not limited to the bone, infiltrating adjacent tissue (skin 70%, dura 85%, brain 35%). 18 lesions were osteolytic except four, where no further description was provided. Intraoperatively, craniectomy or in case of biopsy a craniotomy was performed. 70% of cases required Dural plastic. Depending on history and location the operative approach was biopsy (n=1), extended (n=6), subtotal (n=1) or complete (n=14) resection. Intraoperative major bleeding occurred in 15 % of cases, all with macroscopic high vascularization; hemodynamically relevant (n=1), requiring LAE (n=1). Histologically most common were adenocarcinoma of the lung (n=5), mamma (n=3), prostate (n=2), sigma (n=1), rectum (n=1) and gastric (n=1). Melanoma (n=3), neuroblastoma (n=1) and clear cell renal carcinoma (n=2) were less common. Other rare primaries were carcinoma of the parotid (n=1), SCLC (n=1) and follicular thyroidal cancer (n=1). Postoperatively, further treatment was initiated depending on the primary tumour.
Conclusion:
Above mentioned clinical symptoms or the staging of a cancer leads to the diagnosis of calvarial metastasis. Preoperative imaging shows localisation and the degree of infiltration into adjacent tissues. Imaging results and the clinical symptoms determine the surgical strategy. But definitive diagnosis can only be made by histological analysis. After surgery, the histology, the extension of the primary tumour and the clinical condition of the person influence the kind of further treatment initiated.
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Affiliation(s)
- S Hunziker
- University Hospital of Tübingen , Tübingen , Germany
| | | | - M Tatagiba
- University Hospital of Tübingen , Tübingen , Germany
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Belle FN, Hunziker S, Fluss J, Grunt S, Juenemann S, Kuenzle C, Meyer-Heim A, Newman CJ, Ramelli GP, Weber P, Claudia E K, Tscherter A. Cohort profile: the Swiss Cerebral Palsy Registry (Swiss-CP-Reg) cohort study. Swiss Med Wkly 2022; 152:w30139. [PMID: 35230014 DOI: 10.4414/smw.2022.w30139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is a group of permanent disorders of movement and posture that follow injuries to the developing brain. It results in motor dysfunction and a wide variety of comorbidities like epilepsy; pain; speech, hearing and vision disorders; cognitive dysfunction; and eating and digestive difficulties. Central data collection is essential to the study of the epidemiology, clinical presentations, care, and quality of life of patients affected by CP. CP specialists founded the Swiss Cerebral Palsy Registry (Swiss-CP-Reg) in 2017. This paper describes the design, structure, aims and achievements of Swiss-CP-Reg and presents its first results. METHODS Swiss-CP-Reg records patients of any age diagnosed with CP who are born, are treated, or live in Switzerland. It collects data from medical records and reports, from questionnaires answered by patients and their families, and from data linkage with routine statistics and other registries. The registry contains information on diagnosis, clinical presentation, comorbidities, therapies, personal information, family history, and quality of life. RESULTS From August 2017 to August 2021, 546 participants (55% male, mean age at registration 8 years [interquartile range IQR: 5-12]), were enrolled in Swiss-CP-Reg. Most had been born at term (56%), were less than two years old at diagnosis (73%, median 18 months, IQR: 9-25), and were diagnosed with spastic CP (76%). Most (59%) live with a mild motor impairment (Gross Motor Function Classification System [GMFCS] level I or II), 12% with a moderate motor impairment (GMFCS level III), and 29% with a severe motor impairment (GMFCS level IV or V). In a subset of 170 participants, we measured intelligence quotient (IQ) and saw lower IQs with increasing GMFCS level. Swiss-CP-Reg has a strong interest in research, with four nested projects running currently, and many more planned. CONCLUSIONS Swiss-CP-Reg collects and exchanges national data on people living with CP to answer clinically relevant questions. Its structure enables retrospective and prospective data collection and knowledge exchange between experts to optimise and standardise treatment and to improve the health and quality of life of those diagnosed with CP in Switzerland.
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Affiliation(s)
- Fabiën N Belle
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sandra Hunziker
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Joël Fluss
- Paediatric Neurology Unit, University Children's Hospital Geneva, Geneva, Switzerland
| | - Sebastian Grunt
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital Bern, University Hospital, University of Bern, Switzerland
| | - Stephanie Juenemann
- Division of Neuropaediatric and Developmental Medicine, University Children's Hospital of Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Andreas Meyer-Heim
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland
| | - Christopher J Newman
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
| | - Gian Paolo Ramelli
- Neuropaediatric Unit, Paediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Peter Weber
- Division of Neuropaediatric and Developmental Medicine, University Children's Hospital of Basel (UKBB), University of Basel, Basel, Switzerland
| | - Kuehni Claudia E
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Children's University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Avramovska M, Kostova NM, Karanfilski B, Hunziker S, Vaskova O, Dimitrov G, Dzikova E, Markova AD, Lega MH, Tofoski G, Sikole A. Thyroid Function of Pregnant Women and Perinatal Outcomes in North Macedonia. Rev Bras Ginecol Obstet 2021; 43:736-742. [PMID: 34784629 PMCID: PMC10183913 DOI: 10.1055/s-0041-1736172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Thyroid diseases are the second most common endocrine disorders in the reproductive period of women. They can be associated with intrauterine growth restriction (IUGR), preterm delivery, low Apgar score, low birthweight (LBW) or fetal death. The aim of the present study is to explore thyroid dysfunction and its relationship with some poor perinatal outcomes (Apgar Score, low birthweight, and preterm delivery). METHODS Dried blood spot samples from 358 healthy pregnant women were analyzed for thyroid stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg). Neonatal data were collected upon delivery. Four groups were formed based on thyroid function tests (TFTs). RESULTS Of the 358 tested women, 218 (60.72%) were euthyroid. Isolated hypothyroxinemia was present in 132 women (36.76%), subclinical hyperthyroidism in 7 women (1.94%), and overt hypothyroidism in 1 (0.28%). The perinatal outcomes IUGR (p = 0.028) and Apgar score 1 minute (p = 0.015) were significantly different between thyroid function test [TFT]-distinct groups. In the multiple regression analysis, TT4 showed a statistically significant inverse predictive impact on LBW (p < 0.0001), but a positive impact of Tg on LBW (p = 0.0351). CONCLUSION Thyroid hormones alone do not have a direct impact on neonatal outcomes, but the percentage of their participation in the total process cannot be neglected. Based on the regression analysis, we can conclude that TT4 and Tg can be used as predictors of neonatal outcome, expressed through birthweight and Apgar score. The present study aims to contribute to determine whether a test for thyroid status should become routine screening during pregnancy.
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Affiliation(s)
- Maja Avramovska
- Department of Obstetrics and Gynecology, Clinical Hospital "Dr. Trifun Panovski" - Bitola, Partizanska nn, North Macedonia
| | - Neda Milevska Kostova
- Departement Gesundheitswissenschaften und Technologie, Institute for Social Innovation, Skopje, Skopje, North Macedonia
| | - Borislav Karanfilski
- National Committee for Iodine Deficiency, Ministry of Health, Skopje, North Macedonia
| | - Sandra Hunziker
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Olivija Vaskova
- Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
| | - Goran Dimitrov
- University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
| | - Elena Dzikova
- University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
| | - Ana Daneva Markova
- University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
| | - Marija Hadzi Lega
- Department for Fetal Screening and Perinatal Medicine, Danat al Emarat Hospital for Women and Children, Abu Dhabi, Emirate of Abu Dhabi
| | - Gligor Tofoski
- University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
| | - Aleksandar Sikole
- Department of Nephrology, University Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University Skopje, Skopje, North Macedonia
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Prpić M, Franceschi M, Vidranski V, Andersson M, Zimmermann MB, Hunziker S, Milošević M, Kusić Z, Jukić T. IODINE STATUS AND THYROID FUNCTION IN LACTATING WOMEN AND INFANTS - A SURVEY IN THE ZAGREB AREA, CROATIA. Acta Clin Croat 2021; 60:259-267. [PMID: 34744276 PMCID: PMC8564841 DOI: 10.20471/acc.2021.60.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
Lactating women (LW) and infants have high dietary iodine requirements and are at risk of iodine deficiency. The aim of the study was to assess iodine status and thyroid function in LW and their breastfed infants in Zagreb, Croatia. The study included 133 LW and breastfed infant pairs. Urinary iodine concentration (UIC) and thyroid function parameters were measured in all subjects. In LW, breast milk iodine concentration (BMIC) was measured and iodine and salt rich food frequency questionnaire data were collected. Results of analysis indicated that 99.2% of the LW used iodized salt in household and 20.4% used iodine-containing vitamin and mineral supplements. Median (IQR) UIC was 75 µg/L (19.0-180.5 µg/L) in LW and 234 µg/L (151.0-367.5 µg/L) in infants, whereas BMIC was 121 µg/kg (87.8-170.8 µg/kg). Multivariate regression analysis revealed BMIC to be a significant predictor of infant UIC (p<0.001). Positive correlation was recorded between LW and infant thyroid function. This was the first study in Croatia demonstrating BMIC to be a reliable biomarker of iodine status during lactation and predicting iodine intake in breastfed infants. The study confirmed that mandatory salt iodization in Croatia ensured sufficient dietary iodine for LW and optimal iodine intake for breastfed infants via breast milk.
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Affiliation(s)
| | - Maja Franceschi
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Valentina Vidranski
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Maria Andersson
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Michael B Zimmermann
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Sandra Hunziker
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Milan Milošević
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Zvonko Kusić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Division of Gastroenterology and Nutrition, Zurich University Children's Hospital, Zurich, Switzerland; 5Iodine Global Network, Ottawa, Ontario, Canada; 6Human Nutrition Laboratory, Institute of Food, Nutrition and Health, Zurich ETH, Zurich, Switzerland; 7University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, WHO Collaborative Centre for Occupational Health, Zagreb, Croatia; 8Croatian Academy of Sciences and Arts, Zagreb, Croatia
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Eriksen KG, Andersson M, Hunziker S, Zimmermann MB, Moore SE. Effects of an Iodine-Containing Prenatal Multiple Micronutrient on Maternal and Infant Iodine Status and Thyroid Function: A Randomized Trial in The Gambia. Thyroid 2020; 30:1355-1365. [PMID: 32183608 PMCID: PMC7482118 DOI: 10.1089/thy.2019.0789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Iodine supplementation is recommended to pregnant women in iodine-deficient populations, but the impact in moderate iodine deficiency is uncertain. We assessed the effect of an iodine-containing prenatal multiple micronutrient (MMN) supplement in a rural Gambian population at risk of moderate iodine deficiency. Materials and Methods: This study uses data and samples collected as a part of the randomized controlled trial Early Nutrition and Immune Development (ENID; ISRCTN49285450) conducted in Keneba, The Gambia. Pregnant women (<20 weeks gestation) were randomized to either a daily supplement of MMNs containing 300 μg of iodine or an iron and folic acid (FeFol) supplement. Randomization was double blinded (participants and investigators). The coprimary outcomes were maternal urinary iodine concentration (UIC) and serum thyroglobulin (Tg), assessed at baseline and at 30 weeks' gestation. Secondary outcomes were maternal serum thyrotropin (TSH), total triiodothyronine (TT3), total thyroxine (TT4) (assessed at baseline and at 30 weeks' gestation), breast milk iodine concentration (BMIC) (assessed at 8, 12, and 24 weeks postpartum), infant serum Tg (assessed at birth [cord], 12, and 24 weeks postpartum), and serum TSH (assessed at birth [cord]). The effect of supplementation was evaluated using mixed effects models. Results: A total of 875 pregnant women were enrolled between April 2010 and February 2015. In this secondary analysis, we included women from the MMN (n = 219) and FeFol (n = 219) arm of the ENID trial. At baseline, median (interquartile range or IQR) maternal UIC and Tg was 51 μg/L (33-82) and 22 μg/L (12-39), respectively, indicating moderate iodine deficiency. Maternal MMN supplement increased maternal UIC (p < 0.001), decreased maternal Tg (p < 0.001), and cord blood Tg (p < 0.001) compared with FeFol. Maternal thyroid function tests (TSH, TT3, TT4, and TT3/TT4 ratio) and BMIC did not differ according to maternal supplement group over the course of the study. Median (IQR) BMIC, maternal UIC, and infant Tg in the MMN group were 51 μg/L (35-72), 39 μg/L (25-64), and 87 μg/L (59-127), respectively, at 12 weeks postpartum, and did not differ between supplement groups. Conclusions: Supplementing moderately iodine-deficient women during pregnancy improved maternal iodine status and reduced Tg concentration. However, the effects were not attained postpartum and maternal and infant iodine nutrition remained inadequate during the first six months after birth. Consideration should be given to ensuring adequate maternal status through pregnancy and lactation in populations with moderate deficiency.
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Affiliation(s)
- Kamilla G. Eriksen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Address correspondence to: Kamilla G. Eriksen, PhD, Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Copenhagen, Denmark
| | - Maria Andersson
- Division of Gastroenterology and Nutrition, Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Michael B. Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
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11
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Ittermann T, Albrecht D, Arohonka P, Bilek R, de Castro JJ, Dahl L, Filipsson Nystrom H, Gaberscek S, Garcia-Fuentes E, Gheorghiu ML, Hubalewska-Dydejczyk A, Hunziker S, Jukic T, Karanfilski B, Koskinen S, Kusic Z, Majstorov V, Makris KC, Markou KB, Meisinger C, Milevska Kostova N, Mullen KR, Nagy EV, Pirags V, Rojo-Martinez G, Samardzic M, Saranac L, Strele I, Thamm M, Top I, Trofimiuk-Müldner M, Ünal B, Koskinen S, Vila L, Vitti P, Winter B, Woodside JV, Zaletel K, Zamrazil V, Zimmermann M, Erlund I, Völzke H. Standardized Map of Iodine Status in Europe. Thyroid 2020; 30:1346-1354. [PMID: 32460688 DOI: 10.1089/thy.2019.0353] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized urinary iodine concentration (UIC) data. Materials and Methods: We established a gold-standard laboratory in Helsinki measuring UIC by inductively coupled plasma mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to postharmonize the studies by standardizing the UIC data of the individual studies. Results: In comparison with the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from -36.6% to 49.5%. Of the 40 postharmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults, and 11 in pregnant women. Median standardized UIC was <100 μg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC <100 μg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC <150 μg/L. Conclusions: We demonstrate that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that noniodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine-related studies and iodine measurements to improve the validity and comparability of results.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Diana Albrecht
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- Leibniz Institute for Plasma Science and Technology (INP), Greifswald, Germany
| | - Petra Arohonka
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Joao J de Castro
- Department of Endocrinology, Hospital das Forças Armadas, Lisbon, Portugal
| | - Lisbeth Dahl
- Food Security and Nutrition, Institute of Marine Research (IMR), Bergen, Norway
| | - Helena Filipsson Nystrom
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Simona Gaberscek
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - Eduardo Garcia-Fuentes
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Monica L Gheorghiu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | | | - Sandra Hunziker
- Department of Health Sciences and Technology, ETH, Zürich, Switzerland
| | - Tomislav Jukic
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Borislav Karanfilski
- Centre for Regional Policy Research and Cooperation "Studiorum", Skopje, North Macedonia
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Zvonko Kusic
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Venjamin Majstorov
- Institute of Pathophysiology and Nuclear Medicine, Ss. Cyril and Methodius University, Skopje, Former Yougoslavian Rebublic of Macedonia
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Kostas B Markou
- Department of Endocrinology, Institute University of Patras Medical School, Patras, Greece
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians Universität Munich, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Neda Milevska Kostova
- Centre for Regional Policy Research and Cooperation "Studiorum", Skopje, North Macedonia
| | - Karen R Mullen
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Endre V Nagy
- Division of Endocrinology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Valdis Pirags
- Department of Internal Medicine, University of Latvia, Riga, Latvia
| | - Gemma Rojo-Martinez
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Mira Samardzic
- Department of Endocrinology and Diabetes, Institute for Sick Children, Podgorica, Montenegro
| | - Ljiljana Saranac
- Department of Pediatrics, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Ieva Strele
- Department of Internal Medicine, University of Latvia, Riga, Latvia
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Işık Top
- Department of Public Health, Dokuz Eylul University Medical Faculty, İzmir, Turkey
| | | | - Belgin Ünal
- Department of Public Health, Dokuz Eylul University Medical Faculty, İzmir, Turkey
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lluis Vila
- Department of Endocrinology and Nutrition, Hospital de Sant Joan Despi Moisès Broggi, Barcelona, Spain
| | - Paolo Vitti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Benjamin Winter
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Katja Zaletel
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | | | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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12
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Manousou S, Andersson M, Eggertsen R, Hunziker S, Hulthén L, Nyström HF. Iodine deficiency in pregnant women in Sweden: a national cross-sectional study. Eur J Nutr 2019; 59:2535-2545. [PMID: 31616973 PMCID: PMC7413865 DOI: 10.1007/s00394-019-02102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023]
Abstract
Purpose Voluntary salt iodization at 50 mg/kg salt ensures adequate iodine nutrition in Swedish school-aged children, but iodine status in pregnant women is uncertain. Methods We conducted a cross-sectional national study of 743 pregnant women, at median gestational age of 23 weeks (IQR 9, 38), recruited from maternal health care centers. We measured: urinary iodine concentration (UIC) and urinary creatinine concentration in spot urine samples; thyroglobulin (Tg), thyroid-stimulating hormone (TSH), and total thyroxine (tT4) on dried blood spots (DBS); and thyreoperoxidase antibodies in serum samples. Data on dietary supplement use were obtained, and women were classified as supplement users (consuming multivitamins containing ≥ 150 µg iodine/day) and non-supplement users (no supplements or < 150 µg iodine/day from supplements). Results Overall median UIC [bootstrapped 95% confidence interval (CI)] was 101 µg/L (95, 108; n = 737): 149 µg/L (132, 164) in supplement users (n = 253) and 85 µg/L (79, 92) in non-supplement users (n = 440) (p < 0.001). Overall geometric mean DBS-Tg (95% CI) was 22.1 μg/L (20.8, 23.5; n = 675) and the prevalence of elevated DBS-Tg was 19%. DBS-Tg was lower in supplement users (n = 229) than in non-supplement users (n = 405) (19.1 vs 24.4 μg/L, p < 0.001). DBS-TSH, DBS-tT4, and S-TPOab positivity did not differ between the two groups. Conclusions Pregnant women in Sweden have inadequate iodine nutrition. Women not taking iodine supplements containing ≥ 150 µg iodine/day are affected by mild iodine deficiency and are at higher risk for increased thyroid activity, while maintaining euthyroidism. Iodine intake should be improved in women both before and after conception by promotion of iodized salt instead of non-iodized salt. We urge regular monitoring of iodine status in the general Swedish population, as well as in risk groups.
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Affiliation(s)
- Sofia Manousou
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. .,Frölunda Specialist Hospital, Marconigatan 31, 42144, Västra Frölunda, Sweden.
| | - Maria Andersson
- Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Iodine Global Network, Ottawa, ON, Canada
| | - Robert Eggertsen
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Mölnlycke Health Care Centre, Ekdalavägen 2, 43530, Mölnlycke, Sweden
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Lena Hulthén
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 13, 40530, Gothenburg, Sweden
| | - Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, 41345, Gothenburg, Sweden
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13
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Meier C, Camargo SM, Hunziker S, Moehrlen U, Gros SJ, Bode P, Leu S, Meuli M, Holland-Cunz S, Verrey F, Vuille-Dit-Bille RN. Intestinal IMINO transporter SIT1 is not expressed in human newborns. Am J Physiol Gastrointest Liver Physiol 2018; 315:G887-G895. [PMID: 30160974 DOI: 10.1152/ajpgi.00318.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The expression of amino acid transporters in small intestine epithelia of human newborns has not been studied yet. It is further not known whether the maturation of imino acid (proline) transport is delayed as in the kidney proximal tubule. The possibility to obtain small intestinal tissue from patients undergoing surgery for jejunal or ileal atresia during their first days after birth was used to address these questions. As control, adult terminal ileum tissue was sampled during routine endoscopies. Gene expression of luminal imino and amino acid transporter SIT1 (SLC6A20) was approximately threefold lower in newborns versus adults. mRNA levels of all other luminal and basolateral amino acid transporters and accessory proteins tested were similar in newborn mucosa compared with adults. At the protein level, the major luminal neutral amino acid transporter B0AT1 (SLC6A19) and its accessory protein angiotensin-converting enzyme 2 were shown by immunofluorescence to be expressed similarly in newborns and in adults. SIT1 protein was not detectable in the small intestine of human newborns, in contrast to adults. The morphology of newborn intestinal mucosa proximal and distal to the obstruction was generally normal, but a decreased proliferation rate was visualized distally of the atresia by lower levels of the mitosis marker Ki-67. The mRNA level of the 13 tested amino acid transporters and accessory proteins was nonetheless similar, suggesting that the intestinal obstruction and interruption of amniotic fluid passage through the small intestinal lumen did not affect amino acid transporter expression. NEW & NOTEWORTHY System IMINO transporter SIT1 is not expressed in the small intestine of human newborns. This new finding resembles the situation in the proximal kidney tubule leading to iminoglycinuria. Lack of amniotic fluid passage in small intestinal atresia does not affect amino acid transporter expression distal to intestinal occlusion.
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Affiliation(s)
- C Meier
- Institute of Physiology and Zurich Center for Integrative Human Physiology , Zürich , Switzerland
| | - S M Camargo
- Institute of Physiology and Zurich Center for Integrative Human Physiology , Zürich , Switzerland
| | - S Hunziker
- Institute of Physiology and Zurich Center for Integrative Human Physiology , Zürich , Switzerland
| | - U Moehrlen
- Department of Pediatric Surgery, Children's Hospital of Zürich , Zürich , Switzerland
| | - S J Gros
- Department of Pediatric Surgery, Children's Hospital of Basel , Basel , Switzerland
| | - P Bode
- Department of Pathology, University Hospital of Zürich , Zürich , Switzerland
| | - S Leu
- Institute of Physiology and Zurich Center for Integrative Human Physiology , Zürich , Switzerland
| | - M Meuli
- Department of Pediatric Surgery, Children's Hospital of Zürich , Zürich , Switzerland
| | - S Holland-Cunz
- Department of Pediatric Surgery, Children's Hospital of Basel , Basel , Switzerland
| | - F Verrey
- Institute of Physiology and Zurich Center for Integrative Human Physiology , Zürich , Switzerland.,Swiss National Centre of Competence in Research Kidney Control of Homeostasis, University of Zürich , Zürich , Switzerland
| | - R N Vuille-Dit-Bille
- Institute of Physiology and Zurich Center for Integrative Human Physiology , Zürich , Switzerland
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14
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Tondorf T, Grossert A, Rothschild S, Koller M, Rochlitz C, Kiss A, Schaefert R, Meinlschmidt G, Hunziker S, Zwahlen D. Focusing on cancer patients' intentions to use psychooncological support: A longitudinal, mixed-methods study. Psychooncology 2018; 27:1656-1663. [PMID: 29656415 PMCID: PMC6001470 DOI: 10.1002/pon.4735] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Distress screening programs aim to ensure appropriate psychooncological support for cancer patients, but many eligible patients do not use these services. To improve distress management, we need to better understand patients' supportive care needs. In this paper, we report the first key finding from a longitudinal study that focused on patients' intentions to use psychooncological support and its association with distress and uptake of the psychooncology service. METHODS We conducted a prospective, observational study in an Oncology Outpatient Clinic and assessed distress, intention to use psychooncological support, and uptake of the psychooncology service by using the Distress Thermometer, a semistructured interview, and hospital records. We analyzed data with a mixed-methods approach. RESULTS Of 333 patients (mean age 61 years; 55% male; 54% Distress Thermometer ≥ 5), 25% intended to use the psychooncology service (yes), 33% were ambivalent (maybe), and 42% reported no intention (no). Overall, 23% had attended the psychooncology service 4 months later. Ambivalent patients reported higher distress than patients with no intention (odds ratio = 1.18, 95% confidence interval [1.06-1.32]) but showed significantly lower uptake behavior than patients with an intention (odds ratio = 14.04, 95% confidence interval [6.74-29.24]). Qualitative analyses revealed that ambivalent patients (maybe) emphasized fears and uncertainties, while patients with clear intentions (yes/no) emphasized knowledge, attitudes, and coping concepts. CONCLUSIONS We identified a vulnerable group of ambivalent patients with high distress levels and low uptake behavior. To optimize distress screening programs, we suggest addressing and discussing patients' supportive care needs in routine clinical practice.
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Affiliation(s)
- T. Tondorf
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
- Clinical Psychology and Psychotherapy, Department of PsychologyUniversity of BaselBaselSwitzerland
| | - A. Grossert
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
- Clinical Psychology and Psychotherapy, Department of PsychologyUniversity of BaselBaselSwitzerland
| | - S.I. Rothschild
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
| | - M.T. Koller
- Swiss Transplant Cohort Study (STCS)University Hospital BaselBaselSwitzerland
| | - C. Rochlitz
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
| | - A. Kiss
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - R. Schaefert
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Faculty of MedicineUniversity of BaselBaselSwitzerland
| | - G. Meinlschmidt
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Faculty of MedicineUniversity of BaselBaselSwitzerland
- Division of Clinical Psychology and Epidemiology, Department of PsychologyUniversity of BaselBaselSwitzerland
- Division of Clinical Psychology and Cognitive Behavioral TherapyInternational Psychoanalytic UniversityBerlinGermany
| | - S. Hunziker
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Faculty of MedicineUniversity of BaselBaselSwitzerland
| | - D. Zwahlen
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
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15
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Ovadia YS, Arbelle JE, Gefel D, Brik H, Wolf T, Nadler V, Hunziker S, Zimmermann MB, Troen AM. First Israeli National Iodine Survey Demonstrates Iodine Deficiency Among School-Aged Children and Pregnant Women. Thyroid 2017; 27:1083-1091. [PMID: 28657479 DOI: 10.1089/thy.2017.0251] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND National data on iodine status in Israel are lacking. Reliance on iodine-depleted desalinated water, the absence of a salt iodization program, and reports of increased use of thyroid medication in Israel suggest that the population's iodine intake is likely inadequate. The aims of this study were therefore to determine the iodine status of Israeli school-age children (SAC) and pregnant women (PW) in a nationally representative sample obtained by a novel approach of using pre-discard urinalysis samples collected from a centralized national laboratory. METHODS Spot urine samples from 1023 SAC and 1074 PW, representing all regions and major sectors in Israel, were collected during 2016 at the Maccabi Healthcare Services central laboratory. Urinary iodine concentration (UIC) was measured, and the results were analyzed by trimester, sex, region, and sector. RESULTS SAC were iodine deficient, with a median (interquartile range [IQR]) UIC of 83 μg/L (52-127 μg/L); 62% of SAC UICs were below the World Health Organization adequacy range for SAC (100-199 μg/L). PW were also iodine deficient, with a median (IQR) UIC of 61 μg/L (36-97 μg/L); 85% of PW UICs were below the adequacy range for PW (150-249 μg/L). For both SAC and PW, the median UIC was below the World Health Organization's adequacy range across all sectors, sexes, and districts. Among SAC, the median (IQR) UIC was lower among females (75 μg/L; 48-119 μg/L) than males (92 μg/L; 59-133 μg/L; p < 0.05). Median UIC values of PW correlated significantly with the median UIC for SAC by sub-district (R2 = 0.3, p < 0.05). CONCLUSIONS Urine sampling via a centralized national laboratory was efficient and cost-saving. Iodine deficiency in Israeli SAC and PW is a serious public-health concern. A national program of salt iodization and iodine supplementation of PW should be urgently considered.
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Affiliation(s)
- Yaniv S Ovadia
- 1 Nutrition and Brain Health Laboratory, School of Nutritional Sciences and Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University of Jerusalem , Rehovot, Israel
- 2 Department of Internal Medicine "C," Barzilai University Medical Center Ashkelon , Ashkelon, Israel
| | - Jonathan E Arbelle
- 3 Southern Region, Maccabi Healthcare Services , Omer, Israel
- 4 The Joyce and Irving Goldman Medical School, Ben Gurion University of the Negev , Beersheba, Israel
| | - Dov Gefel
- 2 Department of Internal Medicine "C," Barzilai University Medical Center Ashkelon , Ashkelon, Israel
| | - Hadassah Brik
- 5 Central Laboratory, Maccabi Healthcare Services , Omer, Israel
| | - Tamar Wolf
- 5 Central Laboratory, Maccabi Healthcare Services , Omer, Israel
| | - Varda Nadler
- 5 Central Laboratory, Maccabi Healthcare Services , Omer, Israel
| | - Sandra Hunziker
- 6 Human Nutrition Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Michael B Zimmermann
- 6 Human Nutrition Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Aron M Troen
- 1 Nutrition and Brain Health Laboratory, School of Nutritional Sciences and Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University of Jerusalem , Rehovot, Israel
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16
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Cocchi MN, Miller J, Hunziker S, Carney E, Salciccioli J, Farris S, Joyce N, Zimetbaum P, Howell MD, Donnino MW. The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest. Minerva Anestesiol 2011; 77:1063-1071. [PMID: 21597442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Currently there are few tools available for clinicians to predict outcomes in cardiac arrest survivors. Our objective was to determine if the combination of simple clinical parameters (initial blood lactate and vasopressor use) can predict outcome in post-cardiac arrest patients. METHODS The design was a retrospective medical record review. The study was carried on in two urban, tertiary-care, university teaching hospitals. As for patients, inclusion criteria were: 1) age ≥18 years; 2) non-traumatic out-of-hospital cardiac arrest with return of spontaneous circulation; 3) lactic acid measured within one hour of return of circulation. No interventions was performed. RESULTS Patients were divided into groups based on two variables: 1) vasopressor status (receipt of vasopressors vs. no vasopressors); and 2) initial blood lactate (categories defined as lactate <5 mmol/L, lactate 5 to 10 mmol/L, lactate ≥10 mmol/L); 128 out-of-hospital cardiac arrest patients met study inclusion criteria. Overall mortality was 71% (95%CI 63-79%). Patients who received vasopressors had significantly higher mortality rates compared to patients who did not receive vasopressors (80% vs. 52%; P=0.002). A stepwise increase in mortality is associated with increasing lactate levels (39% lactate <5 mmol/L, 67% lactate 5 mmol/L to10 mmol/L, and 92% lactate ≥10 mmol/L; P<0.001). The AUC for our model was 0.82. CONCLUSION The combination of two clinical parameters, vasopressor need and lactic acid levels, is an accurate severity of illness classification system and can predict mortality in patients following out-of-hospital cardiac arrest. Prospective validation of these variables in post-cardiac arrest is needed.
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Affiliation(s)
- M N Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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17
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Hunziker S, Tschan F, Semmer NK, Howell MD, Marsch S. Human factors in resuscitation: Lessons learned from simulator studies. J Emerg Trauma Shock 2010; 3:389-94. [PMID: 21063563 PMCID: PMC2966573 DOI: 10.4103/0974-2700.70764] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 07/19/2010] [Indexed: 11/10/2022] Open
Abstract
Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR). Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.
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Affiliation(s)
- S Hunziker
- Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland
- Silverman Institute for Health Care Quality and Safety and the Department of Medicine, Beth Israel Deaconess Medical Center, Boston
- Harvard Medical School, Boston, MA, USA
| | - F Tschan
- Department of Psychology, University of Neuchâtel, Switzerland
| | - N K Semmer
- Department of Psychology, University of Bern, Bern, Switzerland
| | - M D Howell
- Silverman Institute for Health Care Quality and Safety and the Department of Medicine, Beth Israel Deaconess Medical Center, Boston
- Harvard Medical School, Boston, MA, USA
- Department of Psychology, University of Neuchâtel, Switzerland
| | - S Marsch
- Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland
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18
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19
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Bareiss D, Semela D, Heim M, Terracciano L, Hunziker S. [44 year old gardener with lower back pain, myalgia and fever]. Praxis (Bern 1994) 2010; 99:127-132. [PMID: 20087833 DOI: 10.1024/1661-8157/a000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the case of a 44 year old female gardener who presented to our emergency ward with lumbago, myalgia and fever of 39 degrees Celsius. She also reported acholic stools, darker looking urine and ikteric skin complexion. The patient was suffering from acute hepatitis A virus induced liver failure and was rapidly announced to a liver transplant centre. In the course of the illness the condition of the patient improved spontaneously and the serious hepatitis resolved and was self limiting. As a source of infection to possibilities were identified. Eating shellfish at the East Sea 4 weeks prior to admission or handling natural animal dung during her work as a gardener. One year after the event the patient once again is healthy and well.
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Affiliation(s)
- D Bareiss
- Abteilung für Innere Medizin, Universitätsspital Basel, Basel.
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20
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Hunziker S, Baumgart A, Denz C, Schüpfer G. [Economic benefits of overlapping induction: investigation using a computer simulation model]. Anaesthesist 2009; 58:623-32. [PMID: 19562399 DOI: 10.1007/s00101-009-1551-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate the potential economic benefit of overlapping anaesthesia induction given that all patient diagnosis-related groups (AP DRG) are used as the model for hospital reimbursement. A computer simulation model was used for this purpose. Due to the resource-intensive production process, the operating room (OR) environment is the most expensive part of the supply chain for surgical disciplines. The economical benefit of a parallel production process (additional personnel, adaptation of the process) as compared to a conventional serial layout was assessed. A computer-based simulation method was used with commercially available simulation software. Assumptions for revenues were made by reimbursement based on AP DRG. Based on a system analysis a model for the computer simulation was designed on a step-by-step abstraction process. In the model two operating rooms were used for parallel processing and two operating rooms for a serial production process. Six different types of surgical procedures based on historical case durations were investigated. The contribution margin was calculated based on the increased revenues minus the cost for the additional anaesthesia personnel. Over a period of 5 weeks 41 additional surgical cases were operated under the assumption of duration of surgery of 89+/-4 min (mean+/-SD). The additional contribution margin was CHF 104,588. In the case of longer surgical procedures with 103+/-25 min duration (mean+/-SD), an increase of 36 cases was possible in the same time period and the contribution margin was increased by CHF 384,836. When surgical cases with a mean procedural time of 243+/-55 min were simulated, 15 additional cases were possible. Therefore, the additional contribution margin was CHF 321,278. Although costs increased in this simulation when a serial production process was changed to a parallel system layout due to more personnel, an increase of the contribution margin was possible, especially with procedures of shorter duration (<120 min). For longer surgical times, the additional costs for the workforce result in a reduced contribution margin depending on the models chosen to handle overtime of the technical OR personnel. Important advantages of this approach for simulation are the use of the historical production data and the reflection of the specificities of the local situation. Computer simulation is an ideal tool to support operation room management, particularly regarding the planning of resource allocation and the coordination of workflow.
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Affiliation(s)
- S Hunziker
- Medizinischer Stab, Luzerner Kantonsspital, 6000, Luzern, Schweiz.
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21
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Abstract
A growing body of evidence supports or rejects preventive interventions in asymptomatic adults. Thus, counseling for smoking cessation and some immunizations have been shown to be cost-effective. Evidence supports screening for body weight (obesity), hypertension, hyperlipidemia, cervical cancer, colorectal cancer and breast cancer. Screening for lung, pancreatic and ovarian cancer has no effect on outcome and should not be performed. Controversial preventive interventions include general screening for diabetes mellitus in the young adult, thyroid disorders and prostate cancer. Physicians should be aware of a possible hidden agenda in patients presenting for a check-up.
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Affiliation(s)
- S Hunziker
- Medizinische Poliklinik, Universitätsspital Basel, Petersgraben 4, 4031 Basel, Switzerland
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22
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Hunziker S, Jundt G, Bongartz G. [Chronic thoracic vertebral syndrome by roundabout diagnosis]. Praxis (Bern 1994) 2005; 94:479-482. [PMID: 15846954 DOI: 10.1024/0369-8394.94.12.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Back pain, especially in the lumbar region is a frequent symptom in ambulatory medicine. The differential diagnosis is wide and ranges from rather harmless muscular distortions to systematic disease, such as chronic infections or cancer. Our case shows, that sometimes the diagnosis is not quite simple to determine. A atypically picture may lead to unnecessary further evaluations and in some case even invasive diagnostic tests. However, the benefit should overweight the harm and costs. Not every back pain needs to be examined in every case and with every diagnostic possibility. Recent guidelines recommend a conservative approach to patients with back pain if they are younger than 50 years of age and if cancer or chronic infection is not suspected from their clinical evaluation and past medical history. For patients older than 50 years of age and suspicion for systematic disease, a radiograph of the spine and a routine laboratory measurement, including markers of inflammation (e.g. C-reactive protein), alkaline phosphatase, PSA (prostate-specific antigen) and immune-electrophoresis is mandatory. More detailed diagnostic steps, e.g. CT or MRT, should be performed if symptoms persist for longer than 6 weeks. In addition, if symptoms do not resolve with analgesia and physiotherapy more invasive therapeutically options may be considered.
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Affiliation(s)
- S Hunziker
- Medizinische Poliklinik, Universitätsspital Basel
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23
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Hofer S, Hunziker S, Tornillo L, Ludwig CU. Fatal herpes simplex virus hepatitis complicating chemotherapy with weekly docetaxel. Ann Oncol 2003; 14:340. [PMID: 12562665 DOI: 10.1093/annonc/mdg052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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