The cost of mental disorders: a systematic review.

AIMS: To identify and synthesise the literature on the cost of mental disorders. METHODS: Systematic literature searches were conducted in the databases PubMed, EMBASE, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to January 1980-May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder; (3) study population based on the general population; (4) outcome in monetary units. The systematic review was preregistered on PROSPERO (ID: CRD42019127783). RESULTS: In total, 13 579 potential titles and abstracts were screened and 439 full-text articles were evaluated by two independent reviewers. Of these, 112 articles were included from the systematic searches and 31 additional articles from snowball searching, resulting in 143 included articles. Data were available from 48 countries and categorised according to nine mental disorder groups. The quality of the studies varied widely and there was a lack of studies from low- and middle-income countries and for certain types of mental disorders (e.g. intellectual disabilities and eating disorders). Our study showed that certain groups of mental disorders are more costly than others and that these rankings are relatively stable between countries. An interactive data visualisation site can be found here: https://nbepi.com/econ. CONCLUSIONS: This is the first study to provide a comprehensive overview of the cost of mental disorders worldwide.

Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India.

INTRODUCTION: Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women's self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar. METHODS: Cost analysis was conducted from a provider's perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India's life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs. RESULTS: The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved. CONCLUSION: SHGs can be an effective platform to increase uptake of women's health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

Effect of dietary utilisation of sugarcane press mud on production performance of Muzaffarnagari lambs.

Sugarcane press mud (SPM) is one of the potential agro-industrial by-products available in India and research exploring its utilisation in small ruminant nutrition is scanty. In this direction, the present study evaluated the feasibility of dietary incorporation of SPM at different levels in a feeding trial lasting 180 days. A total of 21 Muzaffarnagari ram lambs were randomly distributed into three groups of seven each based on comparable body weight (11.70 ± 0.29 kg) and age (3-5 months) following a completely randomised design. The three dietary treatments were (1) SP0 (control), concentrate mixture without SPM; (2) SP10, concentrate mixture comprising 10% SPM and (3) SP20, concentrate mixture comprising 20% SPM on air-dry basis. The experimental lambs were offered weighed quantity of designated isonitrogenous (crude protein = 20.6%) and isoenergetic (metabolisable energy = 12.1 MJ/kg) concentrate mixture (coarse mash) and along with ad libitum wheat straw (threshed to 1-2-cm length) and a 9-day metabolism trial was conducted. Results revealed no significant (P > 0.05) differences in intake and digestibility of nutrients, nitrogen balance, nutritive value of diets, average daily gain, as well as feed conversion ratio among three groups. The serum concentration of triiodothyronine and tetraiodothyronine did not differ due to treatments. Likewise, wool yield and its quality, measured in terms of fibre diameter, medullation percentage and staple length were also comparable irrespective of dietary variation. Furthermore, the cost of concentrate mixture (Rs/day) was lower (P ≤ 0.05) in SP20 followed by SP10 as compared to group SP0. These findings suggested that SPM could be safely fed up to 20% level in the concentrate mixture for lambs substituting expensive traditional feed ingredients without negatively inflicting the performance of growing lambs.

Assessment of systemic inflammatory response after total extraperitoneal repair and Lichtenstein repair for inguinal hernia.

PURPOSE: The aim of the study was assessment of the systemic inflammatory response (SIR) intensity by measuring the blood serum levels of high sensitivity C-reactive protein (hsCRP), Interleukin-6 (IL-6) and Total Leukocyte Counts of patients. The estimations were done before and after the patient underwent either open Lichtenstein or endoscopic TEP inguinal hernia repair. This is a prospective observational type of study. METHODS: Sixty patients with a diagnosis of unilateral uncomplicated inguinal hernia were included in the study. Patients were divided into two groups. In the first group, endoscopic total extraperitoneal repair (TEP) was done, while the other group underwent Lichtenstein repair. The patient selection was random. Serum markers for SIR were measured prior to and 24 h post-surgery. RESULTS: Total extraperitoneal repair (TEP) and open Lichtenstein inguinal hernia repair both cause a significant Systemic Inflammatory Response in the body. The rise in serum markers for SIR post-surgery was statistically significant in both the groups. The rise in serum hsCRP and IL-6 concentrations was observed to be equivocal among the two groups. Statistically significant difference was observed in serum TLC rise: Lichtenstein repair group having a higher value. CONCLUSION: Both, open and endoscopic surgical techniques incite a systemic inflammatory response in the body. However, it cannot be conclusively stated that TEP is associated with lesser SIR compared to the Lichtenstein repair on the basis of this study.

Effect of combining a health program with a microfinance-based self-help group on health behaviors and outcomes.

OBJECTIVES: Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program. DESIGN: A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka. METHODS: A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions. RESULTS: Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% CI 1.21-21.35), feeding colostrum to their newborn (OR: 2.83, 95% CI 1.02-5.57), and having a toilet at home (OR: 1.53, 95% CI 0.76-3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86, 95% CI 0.42-1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported. CONCLUSION: Our study found evidence that health programs implemented with microfinance-based SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women.

In vitro assessment of antibacterial effect of garlic (allium sativum) extracts on pseudomonas aeruginosa.

The study was aimed to determine the antibacterial effect of crude and aqueous extract of garlic (Allium stivum) against standard strain of Pseudomonas aeruginosa ATCC 27853. An interventional study was conducted in Department of Pharmacology and Therapeutics in collaboration with Department of Microbiology, Mymensingh Medical College, Mymensingh. The minimum inhibitory concentration (MIC) of aqueous garlic extract (AGE) and antibiotic Imipenem were also determined with the help of broth dilution method. Inhibitory effect of crude garlic extract (CGE) was determined by inoculation of bacteria in CGE incorporated nutrient agar (NA) media and for AGE antibacterial effect was determined by disc diffusion method. All experiments except disc diffusion procedure were reconfirmed by subculture in pure NA media. In case of CGE the growth inhibition of test organism was observed in 30% CGE incorporated NA media. On the other hand sensitivity of AGE also determined in disc diffusion and the zone of inhibition (ZOI) was 7 mm, 12 mm and 20 mm at 25 µg/10 µl, 50 µg/10 µl and 100 µg/10 µl concentrations respectively. The MICs of AGE and Imipenem were 600 µg/ml and 1µg/ml. The MIC of imipenen was far less in comparison with the MIC of AGE. From the findings it is clearly determined that both the extracts have definite antibacterial effect upon Pseudomonas aeruginosa. Further studies are required to detect and isolate the active ingredients present in the Garlic extract responsible for antibacterial effect. Then their effects against the studied organism should be studied in vivo separately and its toxicity profile should also be taken into account. Only then the Garlic extracts fulfilled the criteria for its therapeutic use. Still then external application advised for burn and superficial skin infections and may be used in food poisoning, and respiratory tract infection along with conventional antibiotics which are used in those conditions.

Assessment of small C-fiber status for screening of oxidative stress in patients at risk of diabetes.

Oxidized LDL (oxLDL), anti-oxLDL antibody (anti-oxLDL) and paraoxonase (PON1) are increasingly being reported to be associated with diabetic atherosclerosis. Oxidative stress could affect also small C-fibers innervating the sweat glands even in prediabetes. Hence it could be hypothesized that sweat dysfunction may be a predictor of oxidative stress status for early detection of diabetes. Ezscan, a new device, has recently been developed to measure the sweat function. Therefore, this study was aimed to determine the relevance of this Ezscan method to identify impairment in oxidative stress parameters. Plasma levels of oxLDL and anti-oxLDL were measured by enzyme immunoassay and ELISA respectively. Small C-fiber status was assessed by measurement of hand and foot sweat function with the help of Ezscan device and subsequent calculation of a risk score. Out of 82 subjects recruited in this study, 38 had impaired glucose tolerance and 6 had newly diagnosed diabetes mellitus. Ezscan risk score was significantly (p=0.004) correlated with oxLDL/anti-oxLDL ratio (0.32). Area under the curve (AUC) of receiver operating characteristics (ROC) analysis for detection of oxLDL/anti-oxLDL ratio (>0.12) was 0.76. For an Ezscan risk score of 50%, the sensitivity and specificity were 68% and 71% respectively. After adjustment for age and BMI, PON1 activity showed significant difference among the 3 risk groups defined by Ezscan risk score. Based on these results it may be concluded that Ezscan could be a useful screening tool in daily practice to assess alterations in oxidative stress parameters in individuals at risk of developing diabetes.

Length of time from extubation to cardiorespiratory death in neonatal intensive care patients and assessment of suitability for organ donation.

OBJECTIVE: A common concern for parents when end of life decisions are made is the length of time their baby may take to die. Postcardiac death organ donation is now becoming more common, along with neonatal organ donation. The aim was to determine the length of time from extubation until cardiorespiratory death (CRD) in neonatal intensive care patients and consideration of potential organ donation. DESIGN: Retrospective review of medical records of neonates who died in a neonatal intensive care unit between 2000 and 2009. PATIENTS: Data collected included gestation at birth, age at death, birth weight, reason for cessation of intensive care, inotrope and ventilation requirements, sedation and muscle relaxation prior to death, time from extubation to documented CRD. An assessment was made for potential suitability for consideration of organ donation with a gestation at birth ≥ 34 weeks and birth weight >2.0 kg. RESULTS: 117 neonates were included, median gestation 29 weeks and median birth weight 1220 grams. The median age at death was 4 days of age. The median time from discussing prognosis to death was 137 min. The median time from extubation to CRD was 30 min. Seven (6%) neonates were considered suitable for organ donation, and for these infants the median time from extubation to CRD was 120 min. Two neonates donated heart valves. CONCLUSIONS: This provides a guide for grieving parents on time frames for the interval between extubation and CRD. More accurate postextubation CRD times are required to determine likely potential for postcardiac death organ donation.

Socio-economic disadvantage and delusional-like experiences: a nationwide population-based study.

PURPOSE: Delusional-like experiences (DLE) have been associated with low income, suggesting that more broadly defined socio-economic disadvantage may be associated with these experiences. We had the opportunity to explore the association between DLE and both individual- and area-level measures of socio-economic disadvantage. METHOD: Subjects were drawn from the Australian National Survey of Mental Health and Wellbeing 2007. The Composite International Diagnostic Interview was used to identify DLE, common psychiatric disorders, and physical disorders. Individual-level and area-level socio-economic disadvantage measures were available based on variables including income, educational attainment, employment status, and housing. We examined the relationship between the variables of interest using logistic regression, adjusting for potential confounding factors. RESULTS: Of the 8773 subjects, 8.4% (n=776) positively endorsed one or more DLE. DLE screen items were more likely to be endorsed by those who were (a) younger, (b) never married, or widowed, separated or divorced status, (c) migrants, or (d) living in rented houses. There were significant associations between socio-economic disadvantage and increased DLE endorsement, and this was found for both individual-level and area-level measures of socio-economic disadvantage. In general, the associations remained significant after adjusting for a range of potential confounding factors and in planned sensitivity analyses. CONCLUSIONS: DLE are associated with socio-economic disadvantage in the general population. We speculate that the link between socio-economic disadvantage and DLE may be mediated by psychosocial stress and general psychological distress.

From home to hospital, a continuum of care: making progress towards Millennium Development Goals 4 and 5 in rural Bangladesh.

The Lutheran Aid to Medicine in Bangladesh (LAMB) health and development project in rural Bangladesh has developed an integrated maternal and child healthcare system providing appropriate, accessible and affordable health services for the poor, through a home-to-hospital, continuum-of-care approach. LAMB is thus an example of how high-quality maternity health services accessible to women of all socio-economic classes in a rural context can be provided, making progress towards Millennium Development Goals 4 and 5.

Assessment of nutritional status of rural tribal children in Tripura.

This cross-sectional study evaluated the nutritional status of 608 rural tribal children (age 6 to 15 years) from Jampuijala block of West Tripura district, India. Prevalence of stunting, thinness and overweight were 23.7%, 33.4% and 0.8%, respectively. The prevalence of stunting and thinness was found to be higher in boys than in girls.

A comparative study among laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy and abdominal hysterectomy: experience in a tertiary care hospital in Bangladesh.

The study was undertaken to compare the efficiency and outcome of laparoscopically assisted vaginal hysterectomy (LAVH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complications rate and patients recovery. A total of 750 patients were prospectively collected in the study period from January 2005 through January 2009 in a tertiary care hospital. The mean estimated blood loss in LAVH and VH group were significantly lower compared with the TAH group. As to postoperative pain, significantly less diclofenac was required in the LAVH and VH group vs the TAH group. LAVH, VH is clinically and economically comparable with TAH, with patients' benefits of less estimated blood loss; less analgesia use; less intra- and postoperative complication rates; less postoperative pain; rapid patient recovery and shorter hospital stay. The study concludes that thus, LAVH, VH is clinically and economically comparable with TAH.

Demography and findings of reported rape cases.

Six hundred and ninety nine cases of alleged rape were studied by the authors during the period from 2007-2008 at the Mymensingh Medical College, Mymensingh. Of these cases, 122 had positive findings of recent sexual intercourse; 250 cases had the positive findings of habituated sexual intercourse, and 327 cases had no findings of sexual intercourse but they complained of forcible sexual intercourse and found no sign of sexual intercourse. Most of the alleged victims of rape were nulliparous 87.12% and parous was only 12.87%. 430 (61.51%) cases of reported victims who were students of schools and colleges were not considered as rape cases considering their victim's history of love affairs, leaving home secretly with their lovers, living with them for many days. Gang rape was not so common (4.29% of raped cases) in our study. Age groups, their occupations, living areas, time of arrival for medico-legal examination have been studied. Most of the cases were students (61.51%). A few numbers of victims were subjected to gang rape. Examination and reporting the cases have been discussed.

Cervical cancer in Bangladesh: community perceptions of cervical cancer and cervical cancer screening.

We investigated the awareness of, and the attitude towards screening for, cervical cancer in Bangladesh. We performed a qualitative study using focus group discussions (FGD). The framework approach to qualitative analysis was used. The study was performed in the catchment areas of Addin Hospital, Jessore, Southern Bangladesh (peri-urban) and LAMB hospital, Parbatipur, North West Bangladesh (rural). A total of 220 men, women and adolescents participated in 28 FGDs. Awareness of cervical cancer was widespread. Knowledge about causes was often inadequate. The perceived consequences of cervical cancer were numerous and awareness of the need for cervical cancer treatment was present. Barriers to accessing care include: low priority for seeking help for symptoms, limited availability of health services and cost. Most women were unaware of the possibility of screening via speculum examination, which was considered acceptable to women (and men), as long as the examination was done by a female healthcare provider in an environment with sufficient privacy. In conclusion, adequate gynaecological services are not available or accessible for most women in rural and peri-urban Bangladesh. However, awareness of cervical cancer is widespread. Screening for cervical cancer in these communities is acceptable if done by a female healthcare provider under conditions with sufficient privacy.

Biophysical and socioeconomic characterization of a water-stressed area and simulating agri-production estimates and land use planning under normal and extreme climatic events: a case study.

This study aims in linking the biophysical and socioeconomic data base layers with the technical coefficients or simulation models for agri-production estimates and land use planning under normal and extreme climatic events, and exploring the resource and inputs management options in village Shikohpur, Gurgaon district located in the northwest part of India. The socioeconomic profile of Shikohpur is highly skewed with mostly small and marginal farmers. Though the areas under wheat in Shikohpur are increasing, the productivity is declining or remaining stagnant over the years. Most of the area during kharif season (June-September) remains fallow. Pearl millet based cropping systems (pearl millet-mustard and pearl millet-wheat) are predominant. Soils are mostly loamy sand to sandy loam with average of 70-80% sand content. Organic C content in soil is less than 0.3%, due to high prevailing temperature with little rainfall and also intensive agriculture followed in this region. Though the annual average seasonal rainfall in Gurgaon did not have much variation over the years, occurrence of extreme climate events has increased in the last two decades. The crop intensity is low and the water table is declining. Water and nitrogen production functions were developed for the important crops of the region, for their subsequent use in scheduling of the inputs. InfoCrop, WTGROWS and technical coefficients were used for crop planning and resource management under climate change and its variability, extreme events, limited resource availability and crop intensification. These will help in disseminating necessary agro-advisories to the farmers so that they will be able to manipulate the inputs and agronomic management practices for sustained agricultural production under normal as well as extreme climatic conditions.

Development of a food frequency questionnaire for the assessment of quercetin and naringenin intake.

OBJECTIVES: To measure the relationship between quercetin and naringenin intakes as estimated by food frequency questionnaire (FFQ), and the urinary excretion of quercetin and naringenin aglycones after their enzymatic hydrolysis in human volunteers. SUBJECTS AND METHODS: Volunteers were recruited via the Human Nutrition Unit volunteer databank at the Institute of Food Research, Norwich. Sixty-three volunteers were recruited into the study, of which 14 were excluded and 49 completed the study. A modified FFQ was developed and used to estimate daily intake of quercetin and naringenin in 49 healthy volunteers who also provided five 24-h urine samples over a 2-week period. Urinary excretion of quercetin and naringenin metabolites was determined by solid-phase extraction and high-pressure liquid chromatography. RESULTS: The estimated mean intakes of quercetin and naringenin were 29.4 mg (s.d. 15.0) and 58.1 mg (s.d. 62.7) per day, respectively. Mean urinary excretion of quercetin was 60.1 microg (s.d. 33.1) and that of naringenin was 0.56 mg (s.d. 0.4). The correlation between FFQ estimated intake of quercetin and naringenin and levels excreted in the urine were r=0.82 (P<0.0001) and r=0.25 (P=0.05), respectively. CONCLUSIONS: We observed a statistically significant correlation between the urinary excretion of quercetin and naringenin metabolites and their dietary intake as estimated by FFQ. Use of FFQs in epidemiological studies requiring an estimate of flavonoid intake seems justified.

Role of GFR estimation in assessment of the status of nephropathy in type 2 diabetes mellitus.

OBJECTIVES: Study the status of glomerular filtration rate (GFR) estimation vis-a-vis other noninvasive modes of assessment of renal involvement in Type2 Diabetes Mellitus (T2DM) and assess the temporal profile of the prevalence of nephropathy with a cross sectional cohort. METHODS: A total of 100 patients of T2DM were selected after screening and segregated into 3 groups according to duration of T2DM. Duration of < 5 years constituted group A and had 31 patients, group B duration was between 5-15 years and had 40 patients, rest belonged to group C with duration > 15 years. The parameters studied and compared were (1) various grades of albuminuria--normal, micro and macro by 24 hrs. urinary albumin excretion rates (UAER- gm/24 hr), (2) sonologically detected renal size(normal, small, large) and morphology (loss or presence of corticomedullary differentiation, (3) serum creatinine level ( 1.4 mg/dl) and (4) different levels (high, normal, low, very low) of GFR (ml/min) by DTPA renal scan. RESULT ANALYSIS: There was high prevalence of nephropathy in all durations. Microalbuminuria had a high prevalence in patients of shorter duration (group A-74.2%). Albuminuria increased with duration but plateued off with longer duration (> 15 yrs) (UAER - 0.0842 +/- 0.083 vs. 0.906 +/- 0.84 vs. 1.346 +/- 1.28). Sonographic loss of corticomedullary differentiation and azotemia were late feature only and none had a contracted kidney. Only the parameter of GFR showed a graded and rather linear decrement with duration (132.57 +/- 19.3 vs. 76.33 +/- 20.8 vs. 40.08 +/- 17.1). Hyperfiltration had a high prevalence in patients of early detection (61.3%) and was the earliest change noted before change in any other parameter. GFR shows wide variation in various grades of albuminuria, especially microalbuminuria, and azotemia. A value in the normal range was uncommon (8%). CONCLUSION: GFR estimation is probably the most rational noninvasive mode of assessing the renal status in patients of T2DM, irrespective of the status of the other noninvasive methods as they express significant variation in inception and progression.

Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh.

STUDY OBJECTIVE: To examine socioeconomic gradients in mortality in adult women and their husbands in Bangladesh, paying particular attention to the independent effects of the educational status of each spouse. DESIGN: Historical cohort study. SETTING: Matlab, a rural area 60 km south east of Dhaka, the capital of Bangladesh. PARTICIPANTS: 14803 married women aged 45 or over and their husbands who were resident in the Matlab Demographic Surveillance area between 30 June 1982 and 31 December 1998. MAIN RESULTS: Mortality was lower in women with formal or Koranic education compared with those with none (adjusted rate ratio for formal education = 0.68, 95% CI 0.53 to 0.86; adjusted rate ratio for Koranic schooling = 0.82, 95% CI 0.66 to 1.00). After adjusting for her own education, the husband's level of education or occupation did not have an independent effect on a woman's survival. Men who had attended formal education had lower mortality than those without any education (adjusted rate ratio = 0.84, 95% CI 0.75 to 0.93), but men whose wives had been educated had an additional survival advantage independent of their own education and occupation (adjusted rate ratio = 0.76, 95% CI 0.67 to 0.87). Mortality in both sexes was also significantly associated with marital status and the percentage of surviving children, and in men was associated with the man's occupation, religion, area of residence. CONCLUSIONS: The data suggest that socioeconomic status has a strong influence on mortality in adults in Bangladesh. They also illustrate how important the continued promotion of education, particularly for women, may be for the survival of both women and men in rural Bangladesh.

Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries.

UNLABELLED: Topical therapy to enhance skin barrier function may be a simple, low-cost, effective strategy to improve outcome of preterm infants with a developmentally compromised epidermal barrier, as lipid constituents of topical products may act as a mechanical barrier and augment synthesis of barrier lipids. Natural oils are applied topically as part of a traditional oil massage to neonates in many developing countries. We sought to identify inexpensive, safe, vegetable oils available in developing countries that improved epidermal barrier function. The impact of oils on mouse epidermal barrier function (rate of transepidermal water loss over time following acute barrier disruption by tape-stripping) and ultrastructure was determined. A single application of sunflower seed oil significantly accelerated skin barrier recovery within 1 h; the effect was sustained 5 h after application. In contrast, the other vegetable oils tested (mustard, olive and soybean oils) all significantly delayed recovery of barrier function compared with control- or Aquaphor-treated skin. Twice-daily applications of mustard oil for 7 d resulted in sustained delay of barrier recovery. Moreover, adverse ultrastructural changes were seen under transmission electron microscopy in keratin intermediate filament, mitochondrial, nuclear, and nuclear envelope structure following a single application of mustard oil. CONCLUSION: Our data suggest that topical application of linoleate-enriched oil such as sunflower seed oil might enhance skin barrier function and improve outcome in neonates with compromised barrier function. Mustard oil, used routinely in newborn care throughout South Asia, has toxic effects on the epidermal barrier that warrant further investigation.