The thyroid eye disease (TED) treatment landscape is rapidly evolving. How new treatment options have impacted practice is unknown.
We conducted a cross-sectional electronic survey of American and ...European Thyroid Association members between June 2 and June 30, 2021. The survey included TED questions about resources for its management, index cases for different severities and presentations of TED, barriers for the management of TED, and participants' concerns about TED. We classified respondents into three geographic categories: North America, Europe, or other regions.
Two hundred fifty-two eligible participants started the survey (15% response rate), and 227 completed it. Participants were mostly men (50.2%, 114/227), white (79.7%, 181/227), endocrinologists with a thyroid focus (66.1%, 150/227), practicing in a tertiary academic center (46.7%, 106/227), caring for 10 or more TED patients over the last 12 months (40.5%, 92/227), and reported not having a multidisciplinary TED clinic in their institution (52.8%, 120/227). The majority reported that new TED cases per annum have not changed in the past 10 years (47.5%, 108/227), and that TED patients are found in practice during the management of hyperthyroidism (41.8%, 95/227). For mild active TED, participants from Europe reported a higher use of selenium (73%96/132 vs. 32%20/62 of respondents from North America and 24%8/33 of respondents from other regions). For moderate-to-severe active TED, there was a modest preference for teprotumumab as first-line therapy (37%, 23/62) among North American participants and intravenous (IV) steroids (73%96/132, and 42%14/33) for participants from Europe and other regions, respectively. These treatment preferences did not change in patients with moderate-to-severe active TED with poorly controlled diabetes. In contrast, participants from the three geographic categories preferred IV steroids for optic neuropathy and women planning pregnancy. The three top "very important" concerns about TED management according to participants were: the cost of TED treatment (31.3%, 71/227), lack of effective TED treatments (19.8%, 45/227), and difficulty in predicting whether TED will develop (18.9%, 43/227).
There is a marked geographic practice variation in the management of TED. Clinicians' concerns about TED management demand ongoing research on more effective treatment, TED predictive tools, and policy changes to improve the affordability of new TED therapies.
Graves' disease is a most common cause of hyperthyroidism. It is an autoimmune disease, and autoimmune process induces an inflammatory reaction, and reactive oxygen species (ROSs) are among its ...products. When balance between oxidants and antioxidants is disturbed, in favour of the oxidants it is termed “oxidative stress” (OS). Increased OS characterizes Graves' disease. It seems that the level of OS is increased in subjects with Graves' ophthalmopathy compared to the other subjects with Graves' disease. Among the other factors, OS is involved in proliferation of orbital fibroblasts. Polymorphism of the 8-oxoG DNA N-glycosylase 1 (hOGG1) involved in repair of the oxidative damaged DNA increases in the risk for developing Grave's disease. Treatment with glucocorticoids reduces levels of OS markers. A recent large clinical trial evaluated effect of selenium on mild Graves' ophthalmopathy. Selenium treatment was associated with an improved quality of life and less eye involvement and slowed the progression of Graves' orbitopathy, compared to placebo.
The prevalence of subclinical hypothyroidism (SH) is 3-10%. The prevalence of subclinical hyperthyroidism (SHr) is 0.7-9.7%. Thyroid hormones affect cardiac electrophysiology, contractility, and ...vasculature. SH is associated with an increased risk of coronary heart disease (CHD), especially in subjects under 65. SHr seems to be associated with a slightly increased risk of CHD and an increase in CHD-related mortality. Both SH and SHr carry an increased risk of developing heart failure (HF), especially in those under 65. Both SH and SHr are associated with worse prognoses in patients with existing HF. SH is probably not associated with atrial fibrillation (AF). SHr, low normal thyroid-stimulating hormone (TSH) and high normal free thyroxine (FT4) are all associated with the increased risk of AF. An association between endothelial dysfunction and SH seems to exist. Data regarding the influence of SHr on the peripheral vascular system are conflicting. SH is a risk factor for stroke in subjects under 65. SHr does not increase the risk of stroke. Both SH and SHr have an unfavourable effect on cardiovascular disease (CVD) and all-cause mortality. There is a U-shaped curve of mortality in relation to TSH concentrations. A major factor that modifies the relation between subclinical thyroid disease (SCTD) and mortality is age. SH increases blood pressure (BP). SHr has no significant effect on BP. Lipids are increased in patients with SH. In SHr, high-density lipoprotein cholesterol and lipoprotein( a) are increased. SCTD should be treated when TSH is over 10 mU/l or under 0.1 mU/l. Treatment indications are less clear when TSH is between normal limits and 0.1 or 10 mU/L. The current state of knowledge supports the understanding of SCTD's role as a risk factor for CVD development. Age is a significant confounding factor, probably due to age-associated changes in the TSH reference levels.
Objective
Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this.
Design and patients
We conducted ...an online survey of individuals with self‐reported hypothyroidism.
Results
Nine hundred sixty‐nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L‐T4) and liothyronine (L‐T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L‐T4 or L‐T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L‐T4 + L‐T3 or L‐T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L‐T4 (P < .001) and expectations for more support from the GP (P < .001), for L‐T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L‐T3 independently (P = .014), negative experiences with L‐T4 (P = .013), having expectations for L‐T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006).
Conclusions
Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.
Objective
Information on the impact of SARS‐COV‐2 on the daily life of thyroid patients during lockdown is sparse. The main objective was explorative, focusing on how SARS‐COV‐2 affected thyroid ...patients.
Design
Cross‐sectional, questionnaire‐based, using an online platform.
Patients
Patients >18 years with a history of thyroid disease.
Measurements
Demographic data, psychological impact of SARS‐COV‐2, medical care during the pandemic.
Results
Valid responses were received from 609 responders. The median age was 50 years, 94% were female and 98.5% were UK residents. The commonest diagnosis was primary hypothyroidism (52.2%). Negative psychological effects following the lockdown were reported by 45.6%–58.7%. Cancellations of appointments with thyroid specialists were reported by 43.8%, although cancellations of thyroid investigations and treatments were relatively infrequent (12.9%–14.1%). Overall satisfaction rates for thyroid services were low (satisfaction score 40.1–42.8 out of 100), but nearly 80% were satisfied with remote consultations. Responder ratings of online information sources about SARS‐COV‐2 and thyroid diseases were lowest for government sites. Unmet needs during lockdown were: more remote access to thyroid specialists, more online information in ‘plain English’, and psychological support. In multivariate analyses, younger age, female gender, history of depression, hyperthyroidism, not having contracted SARS‐COV‐2 and multiple comorbidities were risk factors for a negative psychological impact of lockdown.
Conclusions
This survey identified a significant negative impact of SARS‐COV‐2 and lockdown on psychological wellbeing, particularly in some groups of patients defined by demographic factors, history of hyperthyroidism and comorbidities. Low satisfaction with healthcare services among thyroid patients was noted, but remote consultations were rated favourably.
Use of ANN model in economies Ćetković, Jasmina; Knežević, Miloš; Žarković, Miloš
E3S Web of Conferences,
01/2022, Letnik:
363
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
In this paper, the authors made their contribution by constructing a model for the forecast of average annual net earnings in the EU countries. The model is based on the artificial neural network ...(ANN) use and for the needs of its creation the authors have presented their proposal for a model entry – economic variables that determine earnings. Generally, implementing an economic policy aimed at preventing stagnation of earnings levels can be achieved by running a sustainable earnings policy and our model can be used as an acceptable tool in the function of keeping that policy.
Economic growth is a key point of macroeconomic policy and is the subject of constant attention and debate by professional public and policy makers. Theoretical and empirical research indicates ...differences in the level and direction of determinants’ influence on the growth rate. The main goal of our article is to construct a model of economic growth determinants in South-East European countries. We used an unbalanced panel of 12 selected SEE countries over the period 2006–2019. Our empirical findings have shown that the most robust results can be obtained using a two-step generalized method of moments (GMM) model with dummy variable. In our dynamic model, we found that trade openness and gross fixed capital formation have a positive impact on economic growth, while government expenditures negatively determine economic growth. Gross fixed capital formation has the greatest positive impact on economic growth, while government expenditure has the greatest negative impact.
Classical, neoclassical, institutional and other schools have debated what is crucial for economic growth. Literature review related to economic growth models is extensive. The objective of our paper ...is to construct a model of economic growth determinants in EU countries, with focus on construction. Our model includes determinants that reflect the impact of construction on economic growth, which is the contribution to existing literature. It has been created for three groups of countries: EU28, old EU and new EU countries. We believe that this has improved the quality of the results and enabled a comparative analysis of the old and new EU countries. In order to create a model, we used a strongly balanced panel of 28 EU countries in the period 1995–2019 and employed the difference-in-differences approach. Our results for EU28 confirm positive effect of industry, gross fixed capital formation, production in construction and cost construction index on GDP, while gross wages are statistically insignificant. FDIs have low negative impact on economic growth in EU28 and old EU, but statistically insignificant in new EU countries. CO2 is significant and positively correlated with economic growth in all countries. Based on empirical results, we propose policy relevance in concluding remarks.
Improved Cost-Benefit Analysis (CBA) analysis requires a broader analytical framework, in order to perceive each project individually from the perspective of potentially measurable and significant ...effects on the environment and society as a whole. The main goal of our paper is to assess the financial and economic justification for variant V3 (as the most technically optimal) of the wastewater treatment plant (WWTP) construction project in Nov Dojran, North Macedonia, with the purpose of advancing municipal infrastructure and environmental benefits from improved water treatment. Based on the economic analysis conducted, we conclude that the investment in the WWTP project is justified, because the economic internal rate of return is higher than the opportunity cost of capital (EIRR = 16.38%), the economic net present value is higher than 0, and EBCR (benefit-cost ratio) is greater than 1 (EBCR = 2.11). The highest environmental benefit of 49.2% in total environmental benefits is associated with nitrogen, while phosphorus is the next pollutant in the structure of environmental benefits at 46.1%. The environmental benefits of removing biological oxygen demand (BOD) and chemical oxygen demand (COD) are significantly less important, despite the removal of significant amounts of these pollutants during treatment. The situation is similar with suspended particles.
PDF
