Search

Line Tang Møllehave,1 Allan Linneberg,1–3 Tea Skaaby,1 Nils Knudsen,4 Torben Jørgensen,1,5,6 Betina Heinsbæk Thuesen1 1Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark; 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark; 4Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark; 5Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 6Faculty of Medicine, Aalborg University, Aalborg, Denmark Background: Long-term iodine exposure may influence the frequency of thyroid disease treatments through fluctuations in thyroid diseases. Yet, the long-term fluctuations in thyroid disease treatments upon iodine fortification (IF) are not fully known. We aimed to examine the development in thyroid disease treatments in Denmark before and following the implementation of IF in 2000. Methods: Nationwide data on antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment were obtained from Danish registries. Negative binominal regression was applied to analyze annual changes in treatment rates adjusted for region of residence, sex, and age. Results: Incidence of antithyroid medication transiently increased but fell and reached steady state from 2010 at an incidence rate ratio (RR) of 0.72 (95% confidence interval [CI] 0.67–0.77) compared to year 2000. Thyroid hormone therapy increased and reached steady state in 2010 at an incidence RR of 1.75 (95% CI 1.62–1.89) compared to year 2000. Thyroid surgery was constant except for higher rates in 2014–2015, and radioiodine treatment fluctuated with no apparent pattern. Conclusion: Ten years after IF, a steady state was observed for incident antithyroid medication below the level at IF, and thyroid hormone therapy above the level at IF. Only small changes were observed in thyroid surgery and radioiodine treatment. In the same period, changes in diagnostic and treatment practices and lifestyle factors are likely to have occurred and should be considered when evaluating the effects of IF on treatment of thyroid diseases. Keywords: iodine, pharmacoepidemiology, thyroid diseases

RationaleFollowing acute respiratory distress syndrome (ARDS), joblessness is common but poorly understood.ObjectivesTo evaluate the timing of return to work after ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up, ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.Measurements and main resultsOf 922 consenting survivors, 386 (42%) were employed before ARDS (56% male; mean ± SD age, 45 ± 13 yr), with seven dying by 12-month follow-up. Of 379 previously employed 12-month survivors, 166 (44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among nonwhite survivors. Over 12-month follow-up, 274 (71%) survivors accrued lost earnings, averaging $26,949 ± $22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95% confidence interval, 5-22%; P = 0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95% confidence interval, 7-24%; P

Objective: The most accurate way to measure urinary iodine excretion in epidemiological surveys is still debated. We propose a new principle of estimating iodine excretion based on casual urine samples. Material and methods: A total of 123 24 h urine samples and corresponding casual urine samples were collected from 31 subjects. Iodine excretion was expressed as 24h iodine excretion and three different estimates: iodine concentration in the casual sample, iodine/gram creatinine in the casual sample, and the new principle--iodine/ creatinine ratio in the casual sample, adjusted for expected creatinine excretion of the individual. Results: All three estimates based on casual urine samples correlated significantly to 24h values with a r (Pearson) of 0.37 for iodine concentration, 0.61 for iodine/creatinine ratio and 0.62 for the age- and sex-adjusted iodine/creatinine ratio. The median iodine excretion in the entire group was 143 [micro]g/day in 24 h samples, 87 [micro]g/l as iodine concentration, 77[micro]g/g creatinine as iodine/creatinine ratio and 126 [micro]g/day as age- and sex-adjusted iodine/creatinine ratio. Conclusion: Age- and sex-adjusted iodine/creatinine ratio is a more accurate and unbiased estimate of iodine excretion in epidemiological surveys of adults than the two most frequently used estimated: iodine concentration and iodine/gram creatinine, as these two estimates may introduce a bias depending on the composition of the investigated group. The adjusted iodine/creatinine ratio is superior to the other estimates, especially when individual estimates of 24h iodine excretion is required or cohorts of selected groups are investigated. Sponsorship: This work was supported by grants from the Medical Research Foundation Region Greater Copenhagen, Faroe Islands and Greenland; the Wedell-Wedellsborg Foundation; Musikforlaeggerne Agnes and Knut Morks Foundation. Descriptors: iodine; urine; methods; epidemiology; evaluation studies, Introduction How iodine excretion is best evaluated in epidemiological investigations is still a matter of continual discussion. Preferably 24h urine collections should be obtained, but as compliance may be low [...]