ABSTRACT
Objective: To evaluate the success rate of the Nationalnewborn screening program in maintenance of intelligent quotient(IQ) of children with congenital hypothyroidism in Iran.Design: Retrospective cohort study.Methods: The IQ scores, in three subsets of verbal, non verbal(Performance) and full scale IQ, of 240 children diagnosed withTransient congenital hypothyroidism (TCH) and Permanentcongenital hypothyroidism (PCH), from 5 provinces in 5 differentgeographical areas of Iran, were measured at the age of 6 yearsusing revised Wechsler pre school and primary scale ofintelligence and compared with 240 healthy children. We usedindependent sample t test and two-way ANOVA for data analysis. Results: Mean of verbal, performance, and full scale IQ scoreswere lower in the CH cases (permanent and transient) than thecontrol group. Most of the IQ differences in two studied groupsrelated to the PCH cases (P=0.005). Mean difference of IQsbetween children in the two groups in Yazd province (center ofIran) was higher than other provinces, and they also hadsignificantly lower IQ than their control (healthy) children(P=0.001). No treated child had IQ<70.Conclusion: Although mean IQs of CH children was lower thantheir controls, IQ of all treated CH cases were close to the healthychildren
ABSTRACT
This study was conducted to examine the relationship between urbanization and risk factors of noncommunicable diseases [NCDs] according to the World Health Organization stepwise approach to surveillance of NCDs. This study is part of a NCD risk factor surveillance of 10 069 individuals in all provinces of the Islamic Republic of Iran, aged over 20 years, during 2011. By utilizing 2011 census data, urbanization levels were determined in all provinces and logistics regression was used to examine the relationship between urbanization and risk factors. Among males, urbanization had a positive correlation with low physical activity [OR=1.7; 95% CI: 1.42-2.09], low fruit and vegetable consumption [OR=1.8; 95% CI: 1.09-2.96], and high BMI [OR=1.4; 95% CI: 1.20-1.70]. Among females there was a positive and significant correlation with low physical activity [OR=1.2; 95% CI: 1.08-1.49], low fruit and vegetable consumption [OR=1.22; 95% CI: 0.78-1.91] and high BMI [OR=1.3; 95% CI: 1.14-1.53]. Thus, urbanization has a significant correlation with increases in NCD factors in the Islamic Republic of Iran
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Urbanization , Risk Factors , World Health OrganizationABSTRACT
The threshold of thyroid-stimulating hormone [TSH] in current screening for congenital hypothyroidism [CH] from the heel prick test is 5 mU/l. This study uses cost-effective analysis to evaluate increasing the threshold to minimize false-positive results and recall rates. Cost of screening, diagnosis and treatment, education, and care of mentally retarded patients were gathered from the Ministry of Health State Welfare Organization and Department of Education in Tehran. Screening data were obtained from 34,007 neonates in the Central Health Laboratory of Tehran University of Medical Sciences in 2009. Sensitivity analysis and calculation of confidence interval for incremental costs and effects [gained disability adjusted life years - DALYs] and incremental cost-effectiveness ratios [ICER] were performed by Monte Carlo simulation with Ersatz software. ICER for screening programs with different TSH cut-off points versus no screening was similar, and approximately -4.5 +/- 0.2 thousand US dollars per gained DALY. In the proposed cohort [10,000 neonates], gained DALYs were 316 +/- 50 for a cut off point of 5 mU/l, 251 +/- 40 for 10 mU/l, 146 _ 23 for 15 mU/l, and 113 +/- 18 for a cut-off point of 20 mU/l. Sensitivity analysis showed that the model remained the same when the input parameters were changed. This study demonstrates that the current threshold of TSH in the national CH screening program in terms of cost-effectiveness is the most appropriate threshold. However, more studies are needed to examine new strategies and methods to reduce recall rates and related consequences such as repeated thyroid testing in neonates