Summary
objective We evaluated menopausal symptoms, menstrual cycle bleeding characteristics and reproductive hormones for their associations with thyroid stimulating hormone (TSH) concentrations in ...women at the mid‐life from five ethnic groups.
methods This report is from the baseline evaluation of the Study of Women's Health Across the Nation (SWAN), a community‐based multiethnic study of the natural history of the menopausal transition. Enrollees were 42–52 years old (pre‐ and early perimenopausal) African American, Caucasian, Chinese, Hispanic and Japanese women (n = 3242). Enrollees were interviewed about self‐reported diagnosed hypo‐ and hyperthyroidism or thyroid treatment, menopausal symptoms and menstrual cycle bleeding characteristics. Serum was assayed for TSH, oestradiol, testosterone, FSH and SHBG.
results There were 6·2% of women with TSH > 5·0 mIU/ml and 3·2% with TSH < 0·5 IU/ml, cutpoints that have been used to encompass clinical and subclinical hypo‐ and hyperthyroidism, respectively. African American women had significantly lower mean TSH concentrations than Caucasian, Hispanic and Chinese women. Of the more than 15 menopause symptoms evaluated, only fearfulness was associated with having a TSH value > 5·0 mIU/ml (P < 0·008) or < 0·5 mIU/ml (P < 0·02). Women with TSH values outside the range of 0·5–5·0 mIU/ml were more likely to report shorter or longer menstrual periods (P = 0·004 for both) than women within that range. FSH, SHBG, dehydroepiandrosterone sulphate (DHEA‐S), testosterone, and oestradiol concentrations were not associated with TSH concentrations.
conclusion In mid‐aged women, there was a 9·6% prevalence of TSH values outside the euthyroid range of 0·5–5·0 mIU/ml. Although TSH was associated with bleeding length and self‐reported fearfulness, it was not associated with indicators of the menopausal transition, including menopausal stage defined by bleeding regularity, menopausal symptoms or reproductive hormone concentrations.
Background Major depression and depressive symptoms are associated with cardiovascular disease (CVD), but the impact of depression on early atherogenesis is less well known, particularly in women and ...minorities. This study examined whether depressive symptoms are associated with progression of coronary artery calcification (CAC) among women at midlife. Methods The SWAN is a longitudinal, multisite study assessing health and psychologic factors in midlife women. An ancillary study (SWAN Heart) evaluated subclinical atherosclerosis in women who reported no history of CVD or diabetes. In 346 women, CAC was measured twice by electron beam computed tomography, an average of 2.3 years apart. Progression, defined as an increase by ≥10 Agatston units, was analyzed using relative risk (RR) regression. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression (CES-D) Scale. Results Progression of CAC was observed in 67 women (19.1%). Each 1-SD-higher CES-D score at baseline related to a 25% increased risk of CAC progression (RR 1.25, 95% CI 1.06-1.47, P = .007), adjusting for age, time between scans, ethnicity, education, menopausal status, and known CVD risk factors. This risk was similar to the risk induced by body mass index (RR 1.31, 95% CI 1.11-1.54, P = .001) and systolic blood pressure (RR 1.28, 95% CI 1.06-1.55, P = .01). Conclusions Depressive symptoms were independently associated with progression of CAC in this cohort of midlife women. Depressive symptoms may represent a risk factor that is potentially modifiable for early prevention of CVD in women.
...Bond et al did not confirm the diagnosis of intracranial hypertension as the cerebrospinal fluid pressure, which should be markedly raised, was not measured on any occasion. 2 Their conclusions ...can thus at best be based only on papilloedema, headache, and backache.
Background. Atazanavir is a once-daily protease inhibitor (PI) for the treatment of human immunodeficiency virus (HIV) infection that has previously been studied in cohorts of treatment-naive and ...treatment-experienced patients. Limited data are available on the usefulness of switching from a PI-based regimen to a regimen based on a different PI, such as atazanavir, in HIV-infected patients experiencing virologic suppression but seeking regimen simplification. Methods. The Switch to Another Protease Inhibitor (SWAN) study was a 48-week, open-label trial involving HIV-positive patients with virologic suppression who were receiving stable PI-based regimens (with or without ritonavir). Patients were randomized 2 : 1 to switch to atazanavir (400 mg per day)—or, if they were receiving tenofovir, to atazanavir-ritonavir (300/100 mg per day)—or to continue to receive their existing PI. The proportion of patients who experienced virologic rebound (defined as an HIV RNA load ≥50 copies/mL) was compared through study week 48. Results. Patients either received an atazanavir-containing regimen (278 patients) or continued to receive a comparator PI-containing regimen (141 patients). The proportion of patients who experienced virologic rebound was significantly lower among those who switched to an atazanavir-containing regimen (19 7% of 278) than it was among those who continued to receive a comparator PI regimen (22 16% of 141; P = .004). Patients who switched to atazanavir therapy experienced significantly fewer total cholesterol, fasting triglyceride, and non—high density lipoprotein cholesterol elevations than did patients in the comparator PI group (P < .001); patients receiving atazanavir had comparable rates of adverse event—related discontinuation and serious adverse events. Conclusions. In patients with virologic suppression who were receiving other PIs, switching to a once-per-day regimen containing atazanavir provided better maintenance of virologic suppression (as demonstrated by significantly lower rates of virologic rebound and treatment failure than those observed with continued unmodified therapy), a comparable safety profile, and improved lipid parameters, compared with those for patients who continued their prior PI-based regimen through 48 weeks.
Small-scale flat plates representing flat bridge decks were subjected to forced and free vibration to ascertain their fundamental frequencies, mode shapes and frequency response functions (FRF). Edge ...conditions were varied by altering the support stiffness and the effects of these alterations
upon the vibrations analysed. Plots of accelerance against frequency showed that support stiffness affected the resonances developed: an increase consistent from least stiff spring support to stiffest spring support. As the support stiffness increased, some mode-shapes no longer appeared in
the FRF. Forced vibration testing showed an increase in support stiffness to effect the dissipation of vibrations as they traversed the plate.
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