Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Office of Charles C. Chapman, Los Angeles, California

Office of Charles C. Chapman, Los Angeles, California.

At a special session of the General Assembly of the State of Connecticut, held at Hartford, on the twenty third day of February, A.D. 1809 ... An address of the General Assembly, to the people of Connecticut. --

Caption title.

The claim of Amasa Stetson, of Massachusetts, on the United States, for money advanced, in fulfilling the orders of the Government while discharging the duties of Commissary General of Purchases, in time of the late war with Great Britain ; and for services rendered. --

Claim relating to the War of 1812.

Report of the Committee on Military Affairs, on the differences that exist, between the United States and some of the individual States, respecting the relative powers of the general and state governments over the militia.--

February 28, 1815. Printed by order of the Senate of the United States.

Short summary of the life of Major-General Sir Isaac Brock, K.B. /

On leaf preceding t. p.: Who was Isaac Brock?

Convocation Records, Office of the Registrar, 1967-2008, n.d.

University Archives

The effects of a general excercise program on task self-efficacy and social physique anxiety in older adults

Older adults represent the most sedentary segment of the adult population, and thus it is critical to investigate factors that influence exercise behaviour for this age group. The purpose of this study was to examine the influence of a general exercise program, incorporating cardiovascular, strength, flexibility, and balance components, on task selfefficacy and SPA in older adult men and women. Participants (n=114, Mage = 67 years) were recruited from the Niagara region and randomly assigned to a 12-week supervised exercise program or a wait-list control. Task self-efficacy and SPA measures were taken at baseline and program end. The present study found that task self-efficacy was a significant predictor of leisure time physical activity for older adults. In addition, change in task self-efficacy was a significant predictor of change in SPA. The findings of this study suggest that sources of task self-efficacy should be considered for exercise interventions targeting older adults.

Profile Portrait of Major General Sir Isaac Brock 1769-1812

This work is a copy of a pastel oval portrait of General Brock that is supposedly the only known portrait of Brock to be done in his lifetime. The original was by William Berczy, circa 1808, and is in the possession of Captain M.H.T Mellish, a descendant of one of Brock's sisters. This portrait was completed on canvas.

Report of the Committee of the General Assembly, at their special session, August 25, 1812, on that part of His Excellency the Governor's speech which relates to his correspondence with the Secretary of War, andc

Printed by Walter and Steele

Report of the Committee on Military Affairs, on the differences that exist, between the United States and some of the individual States, respecting the relative powers of the general and state governments over the militia

February 28, 1815. Printed by order of the Senate of the United States. Printed be Roger C. Weightman

Short summary of the life of Major-General Sir Isaac Brock, K.B.

On leaf preceding t. p.: Who was Isaac Brock? Printed by Clarke

Letters to Secretary General Drummond from Thomas Scott, July 1814

Thomas Scott (1746-1824) was a politician and judge originally from Scotland. He came to Canada in 1800 after accepting the appointment of Attorney General of Upper Canada, and in 1806 was promoted to Chief Justice of Upper Canada. The declaration of war in 1812 brought into question the loyalty of the colony’s population, who were largely born in America. As concerns over allegiance intensified, the government sought out traitors in an attempt to make an example of them and deter others. The subsequent trials of citizens accused of treason resulted in 15 convictions, including Jacob Overholser. These trials were intended to assert the authority of the state, but also to demonstrate clemency. Only 8 of the convicts were executed, with the rest being banished from the colony. Scott supported these measures, although they were largely initiated by Attorney General John Beverly Robinson. Thomas Scott retired in 1816 and died in 1824.