Thyroxine treatment in patients with symptoms of hypothyroidism but thyroid function tests within the reference range: randomised double blind placebo controlled crossover trial

OBJECTIVES: To determine whether thyroxine treatment is effective in patients with symptoms of hypothyroidism but with thyroid function tests within the reference range, and to investigate the effect of thyroxine treatment on psychological and physical wellbeing in healthy participants. DESIGN: Randomised double blind placebo controlled crossover trial. SETTING: Outpatient clinic in a general hospital. Participants: 25 patients with symptoms of hypothyroidism who had thyroid function tests within the reference range, and 19 controls. Methods: Participants were given thyroxine 100 microgram or placebo to take once a day for 12 weeks. Washout period was six weeks. They were then given the other to take once a day for 12 weeks. All participants were assessed physiologically and psychologically at baseline and on completion of each phase. MAIN OUTCOME MEASURES: Thyroid function tests, measures of cognitive function and of psychological and physical wellbeing. RESULTS: 22 patients and 19 healthy controls completed the study. At baseline, patients' scores on 9 out of 15 psychological measures were impaired when compared with controls. Patients showed a significantly greater response to placebo than controls in 3 out of 15 psychological measures. Healthy participants had significantly lower scores for vitality when taking thyroxine compared to placebo (mean (SD) 60 (17) v 73 (16), P<0.01). However, patients' scores from psychological tests when taking thyroxine were no different from those when taking placebo except for a poorer performance on one visual reproduction test when taking thyroxine. Serum concentrations of free thyroxine increased and those of thyroid stimulating hormone decreased in patients and controls while they were taking thyroxine, confirming compliance with treatment. Although serum concentrations of free triiodothyronine increased in patients and controls taking thyroxine, the difference between the response to placebo and to thyroxine was significant only in the controls. CONCLUSIONS: Thyroxine was no more effective than placebo in improving cognitive function and psychological wellbeing in patients with symptoms of hypothyroidism but thyroid function tests within the reference range. Thyroxine did not improve cognitive function and psychological wellbeing in healthy participants

The 4^4He(e,e′p)(e,e'p) Cross Section at Large Missing Energy

The $(e,e'p)$ reaction on $^{4}{He}$ nuclei was studied in kinematics designed to emphasize effects of nuclear short-range correlations. The measured cross sections display a peak in the kinematical regions where two-nucleon processes are expected to dominate. Theoretical models incorporating short-range correlation effects agree reasonably with the data.Comment: 4 pages LaTeX, using espcrc1.sty and wrapfig.sty (included), two figures. Talk presented by J. Templon at the 15th Int. Conf. on Few-Body Problems in Physics, Groningen, The Netherlands, 22-26 July, 199

Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up

The objective of this study was to determine the impact of a pharmaceutical care (PC) program in a sample of public outpatients with metabolic syndrome (MS) who were being treated in Brazil's health system; the patients were randomized into PC or standard care. The pharmacotherapy follow-up (PF) was performed in a total of 120 patients with type 2 diabetes for 6 months. Adherence to treatment (measured with the Morisky test), negative outcomes associated with medication (NOM) and anthropometric and biochemical parameters were measured before and after PF. The Framingham scoring method was used to estimate changes in 10-year coronary heart disease risk scores in all patients. Ninety-six of 120 patients had characteristics of MS and were randomized into two groups (G): the control group (CG: 36) and the intervention group (IG: 38). Among the MS patients, 100% were taking a glucose-lowering drug; many were also taking anti-hypertensive drugs (CG: 72%; IG: 73%), and some patients were also taking hypolipemic drugs (CG: 12.0%; IG: 14.7%). Only 20.7% of the IG patients were considered adherent to their prescribed drugs. In the CG, an increase of coronary heart disease (CHD) risk (22±2 to 26±3; pO objetivo deste estudo foi o de determinar o impacto de um Programa de atenção Farmacêutica (AF) em uma amostra de pacientes ambulatoriais de Sistema Público de Saúde do Brasil portadores de Síndrome Metabólica, randomizados em AF ou atenção à saúde usual. Realizou-se o seguimento farmacoterapêutico com 120 pacientes com diabetes tipo 2 durante seis meses. Avaliou-se o nível de aderência ao tratamento (teste Morisky), resultados clínicos negativos associados a medicamentos (RNM), parâmetros bioquímicos e antropométricos, antes e após o seguimento. O método de Framingham foi usado para calcular as variações no risco de doenças coronarianas em 10 anos em todos os pacientes. Dos 120 pacientes, 96 tiveram características de SM e foram então randomizados em dois grupos (G): Controle (GC: 36) e Intervenção (GI: 38). Entre os pacientes com SM, 100% faziam uso de medicamentos para diminuir a glicose, anti-hipertensivos (GC: 72%; GI: 73%) e hipoglicemiantes (GC: 12.0%; GI: 14.7%). Apenas 20,7% do GI foram considerados aderentes aos fármacos prescritos. No GC foi observado aumento do risco de Doença Arterial Coronariana (DAC) (22±2 para 26±3; p<0,05), enquanto no GI foi observado redução (22±2 para 14±2%; p<0,01). O Programa de AF para pacientes com SM monitorados na atenção primária do Sistema de Saúde Pública brasileiro melhora o funcionamento do serviço resultando na melhoria clínica dos pacientes com redução do risco de doença cardiovascular em um período de dez anos

A specific elevation in tissue plasminogen activator antigen in women with polycystic ovarian syndrome

There is increasing evidence that elevated plasma levels of hemostatic factors [fibrinogen, factor VII, von Willebrand factor, fibrin D-dimer, and tissue plasminogen activator (t-PA) antigen] are independently linked to risk for coronary heart disease (CHD). Women with polycystic ovary syndrome (PCOS) are insulin-resistant and have increased risk for CHD and type 2 diabetes, but there are few data on hemostatic markers in women with PCOS. Seventeen women with PCOS (defined on the basis of elevated testosterone and oligomenorrhea) and 15 healthy women matched as a group for body mass index (BMI) were recruited. Insulin sensitivity was assessed using the hyperinsulinemic euglycemic clamp technique. Factor VIIc was determined by a clotting assay; fibrinogen was determined by nephelometry; and t-PA, D-dimer, and von Willebrand factor antigens were measured by ELISA techniques. Of these hemostatic markers, only t-PA concentration was significantly (P = 0.013) elevated in women with PCOS relative to controls. t-PA correlated with BMI in both PCOS and controls (r = 0.428, P lt 0.1; and r = 0.686, P lt 0.01) and inversely with the insulin sensitivity index (r = - 0.590, P lt 0.05; and r = -0.620, P lt 0.05, respectively). After further adjustment for BMI and insulin sensitivity, there remained a significant difference in t-PA between cases and controls (P = 0.017). Together, age and insulin sensitivity explained 39% of the variance in t-PA in women with PCOS (P lt 0.05). Total testosterone did not correlate significantly with t-PA in either group. We conclude that women with PCOS have significantly increased t-PA concentrations relative to women with normal menstrual rhythm and normal androgens. We suggest that elevated t-PA and dysfibrinolysis may be a factor in the increased cardiovascular morbidity seen in PCOS

After the reforms: how have public science research organizations changed?

Throughout the Western world, the provision of public good science research has undergone dramatic reforms over the past two decades. In the aftermath of these reforms, this paper asks whether the organisations engaged in science research and knowledge production have actually changed, and if so, how? Archetype analysis is used to explore the deep structures of four comparable case study organisations drawn from the New Zealand science sector. The study concludes that no new, stable organisational archetype has emerged following the reforms, but that in fact, a dynamic style of organisation that is in a state of endless transition is the most appropriate response to contemporary demands for knowledge production. The role of organisational leaders in this context is not only to make sense of the organisation's ever-changing situation, but also to translate this sense into the actions of organisational members and other stakeholders

Teachers becoming lay practitioners of school community psychology

This article reports on a study that explored how a community-based intervention with ten teachers could enhance their knowledge and skills related to supporting community members coping with HIV/ AIDS. We conducted a case study using participatory action research methods. Individual interviews, observation, field notes, visual data and reflective journals were utilised as data sources. We found that the participating teachers displayed a willingness to support their community in coping with HIV/AIDS, yet did not perceive themselves as being adequately equipped to do so, and therefore refrained from acting intuitively. The intervention did, however, show signs of an emergent sense of ‘becoming’ lay practitioners in the face of the social upheaval brought on by the pandemic

Cardiovascular disease and inflammation

Polycystic ovary syndrome (PCOS) is not only a reproductive disorder, but also a complex, multifaceted, endocrine disease with several associated health complications. In fact, multiple lines suggest an increased cardiovascular risk and cardiovascular disease characterized by an impairment of cardiac structure and function, endothelial dysfunction, lipid abnormalities, and low-grade chronic inflammation. The increased prevalence of low-grade chronic inflammation in women with PCOS represents an emerging novel mechanism for cardiovascular disease in these women. All these features are likely linked to the insulin-resistance often present in women with PCOS. Cardiovascular disease and inflammation represent important long-term sequelae of PCOS that warrant further in-depth investigation