BackgroundThyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States.MethodsStudy sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Serum thyroxine (T4) and thyroid stimulating hormone (TSH) were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R) and the Wechsler Intelligence Scale for Children-Revised (WISC-R). The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments.ResultsSubclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level.ConclusionSubclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor.

East Tennessee State University's Department of Family Medicine (DFM) implements a student-run outreach clinic series that addresses health care needs of communities in the southern Appalachians. Offered during the third-year family medicine clerkship, the clinics link academic family physicians and students with community health care providers. Services vary with each community's needs, but include history taking, physical examinations, patient education, and testing. The planning and implementation that begin with an annual meeting of faculty and community representatives include visits by DFM personnel to the rural communities and orientations of medical students conducted by faculty and community representatives. Students rate this experience highly because it provides them with useful hands-on experience, reasonable autonomy, collaboration with community providers, and understanding the needs of the underserved. Community hosts rate students highly in their respect for patients, sensitivity to confidentiality, and professionalism. Identified weaknesses are attributed to the fact that the outreach clinics were established in response to community needs and did not follow a careful curricular development. There was little attempt to standardize the procedures performed by each student or the amount of direct observation and feedback they received from their preceptors. Changes are underway that will strengthen the educational value of the outreach clinics. Participating students are provided a daylong orientation during which they practice full and focused physical examinations and review common medical problems such as diabetes, hypertension, and depression. Students also now document the patients encountered, their medical problems, and the clinical skills practiced.

Child overweight has reached an epidemic level throughout the United States. A total of 65 primary care providers in southern Appalachia were surveyed to understand current issues in addressing child overweight in rural primary care practice. The study shows that while providers realized the importance of child overweight intervention, many were not ready and did little to address child overweight in their practices. The providers' skill levels in addressing child overweight were generally less than sufficient. Common barriers to child overweight treatment included lack of parental motivation and involvement, lack of supportive services, and lack of clinician time. In conclusion, rural primary care is facing many challenges in addressing child overweight. However, with more training in behavioral intervention skills and through establishing a family-based intervention and a group visit approach, primary care providers could play a more active role in the fight against the epidemic of child overweight.

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