scholarly journals Comparative study of lipid profile between clinical and subclinical hypothyroidism

2018 ◽  
Vol 5 (4) ◽  
pp. 978
Author(s):  
Tumbanatham A. ◽  
Jayasingh K. ◽  
Varun Vijayan Vijayan
Keyword(s):  
Lipid Profile ◽  
Total Cholesterol ◽  
Subclinical Hypothyroidism ◽  
Tertiary Care ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Care Hospital ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean

Background: Subclinical hypothyroidism (SH) is characterized by elevated levels of serum thyroid stimulating hormone in the presence of normal thyroxin levels. Subclinical hypothyroidism is often associated with elevated total cholesterol and other lipid profile parameters. This study was done to evaluate the lipid metabolism in subclinical hypothyroidism.Methods: This case control study was done to compare the lipid profile parameters between subclinical and overt hypothyroidism cases attending the outpatient facility of our tertiary care hospital of our medical college in Puducherry. Newly diagnosed cases of hypothyroidism were selected by convenient sampling. A total of 37 SH cases and 31 overt hypothyroidism cases were included. Blood samples were drawn to measure lipid profile. A 2D echocardiogram was done to evaluate cardiac function. Ultrasonogram was done to evaluate fatty liver.Results: The mean age of the participants in the subclinical hypothyroidism group was 34.2±12.2 years while in the clinical hypothyroidism group was 35.7±9.8 years. About 13.5% of the participants in subclinical hypothyroidism group and 12.9% of the participants in clinical hypothyroidism had fatty liver in ultrasound. A significant difference was observed in the mean values of total cholesterol, triglycerides and LDL levels between clinical and subclinical hypothyroidism.Conclusions: This study highlights the need for screening of subclinical hypothyroidism in order to prevent the incidences of cardiovascular complications and other diseases like metabolic syndrome.

scholarly journals Study of Fasting Lipid Profile in Patients with Subclinical Hypothyroidism in a Tertiary Care Hospital in Bangladesh

2021 ◽  
Vol 16 (1) ◽  
pp. 17-20
Author(s):  
Mohammad Afjal Hossain ◽  
- Atiquzzaman ◽  
Mirza Sharifuzzaman ◽  
Farzana Amin ◽  
Lutful Kabir ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Subclinical Hypothyroidism ◽  
Tertiary Care ◽  
Thyroid Function Test ◽  
Significant Negative Correlation ◽  
Thyroid Stimulating Hormone ◽  
Care Hospital ◽  
Cross Sectional ◽  
Metabolic Complications ◽  
Normal Thyroid Function

Subclinical hypothyroidism (SCH) is a metabolic disorder with prevalence about 4-10% in general population. This study was conducted to observe the pattern of fasting lipid profile in SCH and to correlate the components of it with thyroid stimulating hormone and free thyroxin level. This cross sectional observational study included 31 newly diagnosed cases of SCH and 17 age and BMI matched healthy control subjects with normal thyroid function test. Fasting lipid profile was recorded and compared. TSH was significantly higher in SCH compared to controls (9.09±2.79 vs 2.31±0.92 μIU/ml; p=0.001). FT4 was comparable between the groups (1.17±0.18 vs 1.28±0.20 ng/dl; p=0.938). Significantly higher level of Total cholesterol and LDL-C were observed in SCH compared to controls (TC 194.77±29.70 vs 156.59±20.45 mg/dl; p=0.042 and LDL-C 124.81±27.85 mg/dl vs 88.59±18.41mg/dl; p=0.045 respectively). Triglycerides and HDL-C were comparable between the groups (TG 134.90±80.97 vs 118.12±49.14 mg/dl; p=0.171 and HDL-C 42.87±4.83 vs 44.47±5.66; p=0.633 respectively). TSH showed significant positive correlation with TC and LDL-C (r=0.591, p<0.001 and r=0.644, p<0.001 respectively), but not with TG or HDL-C (r=0.011, p=0.943 and r=0.115, p=0.435 respectively). FT4 only showed significant negative correlation with LDL-C (r=0.302; P=0.037) but not with TC, TG or HDL-C (TC: r=0.245, P=0.093; TG: r=0.121, p=0.411 and HDL-C: r=0.108, p=0.466 respectively). SCH is associated with raised TC and LDL-C. So patients with SCH are more vulnerable to develop future adverse cardio-metabolic complications. Faridpur Med. Coll. J. 2021;16(1):17-20

scholarly journals A Prospective Comparative Study of Efficacy and Pleiotropic Effect of Telmisartan versus Enalapril in Hypertensive Patients with Dyslipidaemia in a Tertiary Care Hospital in Visakhapatnam

2021 ◽  
Vol 8 (23) ◽  
pp. 1915-1921
Author(s):  
Supriya Sanke ◽  
Chitra Karuppiah ◽  
Hema Sundar Rao Dumpala ◽  
Sai Vishnu Vardhan Allu ◽  
Syamala Shanthi Kumari Bonela
Keyword(s):  
Blood Pressure ◽  
Lipid Profile ◽  
Total Cholesterol ◽  
Tertiary Care ◽  
Density Lipoprotein ◽  
Blood Levels ◽  
Care Hospital ◽  
Significant Difference ◽  
Enalapril Group

BACKGROUND Hypertension is a silent killer, an asymptomatic chronic disorder if left untreated which results in major health problems. Goal of treatment is to decrease the morbidity and mortality associated with cardiovascular and cerebrovascular complications of hypertension when it is associated with dyslipidaemia. The renin angiotensin system plays an important role in the regulation of blood pressure and in the pathogenesis of hypertension. Telmisartan is an ARB (angiotensin receptor blocker) and Enalapril is an ACE inhibitor. The purpose of this study is to compare the efficacy of Telmisartan with Enalapril in patients of essential hypertension with dyslipidaemia, and to observe the effects of Telmisartan and Enalapril on blood lipid levels of these patients. METHODS This is a prospective, randomized, comparative and open label study conducted among 70 patients who were included in the study and were divided in to two groups. Group A - consisting of 35 patients receiving Telmisartan 40 mg, and Group B receiving Enalapril 5 mg orally once a day. Informed consent was obtained from all the patients. Follow up was done after 4, 8 and 12 weeks. Blood pressure was recorded at every visit and lipid profile was done at the time of enrolment and after 12 weeks of study period. RESULTS Baseline demographic attributes were comparable between both the groups including total cholesterol and low-density lipoprotein (LDL). The mean reduction in systolic and diastolic blood pressure (BP) after 12 weeks was highly significant (P value < 0.001) in both the groups but when mean reduction in SBP & DBP was compared, there was no significant difference (P > 0.05) between the drugs. Blood levels of total cholesterol, LDL, triglyceride had significantly reduced (P < 0.05) in Telmisartan group compared to Enalapril group after 12 weeks of follow up and mean high density lipoprotein (HDL) level significantly increased in Telmisartan group (P < 0.05) but no increment was seen in Enalapril group. CONCLUSIONS Telmisartan and Enalapril had comparable antihypertensive effect and significant reduction in blood pressure was seen after 12 weeks of therapy in both the groups. In addition, Telmisartan showed more beneficial effects on lipid profile when compared to Enalapril. KEYWORDS Hypertension, Dyslipidemia, Lipid Profile, Telmisartan, Enalapril

scholarly journals A study of levothyroxine substitution therapy on subclinical hypothyroid patients and its effects on lipid profile in the department of medicine at tertiary care hospital

2020 ◽  
Vol 4 (2) ◽  
pp. 4-11
Author(s):  
Binod Raut ◽  
N Paudel ◽  
N Bhosekar
Keyword(s):  
Lipid Profile ◽  
Subclinical Hypothyroidism ◽  
Tertiary Care ◽  
Serum Triglyceride ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Slight Reduction ◽  
Care Hospital ◽  
Free T4

Background: Subclinical hypothyroidism is represented by high serum thyroid stimulating hormone (TSH) and normal serum free T4 and T3, Recent studies on subclinical hypothyroidism and lipid profile indicates that the serum total cholesterol, LDL-C, and total triglycerides were significantly increased. Clinical evidence suggests that thyroid replacement therapy with levothyroxine has beneficial effect. Methods: It is a hospital based prospective observational study involving 122 patients based on non probability sampling conducted in the Department of Internal Medicine. The study involved patients who have been diagnosed with subclinical hypothyroidism with normal level of free T4, T3 and elevated levels of TSH with positive Thyroperoxidase (TPO) antibodies. Patients were advised to investigate lipid profile before and after prescribing levothyroxine. Follow up was done after 6-9 wks. Results: In this study 122 patients diagnosed with Subclinical hypothyroidism were prescribed with levothyroxine in which 112 came for follow up. The mean age of the patient was 46.81. There was significant reduction in mean TSH from 12.09 (±1.89)mIU/L to 7.97(±1.59)mIU/L,TC from 217.12( ±20.87)mg/dl to 198.47( ±17.34)mg/dl and LDL from 137.16(±14.57)mg/dl to 124.62( ±12.89)mg/dl was found along with significant reduction in VLDL was found after levothyroxine therapy, There was slight reduction in serum triglyceride was found with no significant alteration in HDL and BMI levels. Conclusion: The study showed significant reduction in the lipid profile including TC, LDL and VLDL after levothyroxine therapy. There was significant reduction in the level of TSH was also found whereas the level of free T4 and T3 were not much altered. There was no significant change found in the level of HDL and BMI.  

scholarly journals Lipid Profile and Prevalence of Dyslipidemia in Pre- and Postmenopausal Women in Yaounde, Cameroon

2019 ◽  
pp. 1-11
Author(s):  
Nkeunen Gerard ◽  
Tsafack Takadong Julie Judith ◽  
Simo Gustave ◽  
Betrand Ayuk Tambe ◽  
Ayangma Celestin Roger ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Total Cholesterol ◽  
Postmenopausal Women ◽  
Energy Homeostasis ◽  
Plasma Lipid ◽  
Military Hospital ◽  
Cross Sectional ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean

Aims: Lipids serve several important physiologic functions like energy homeostasis or biosynthesis of hormone within the human body. The deterioration of lipid metabolism which is favoured by menopause is the source of cardiovascular diseases. This study aimed to determine the plasma lipid profile and dyslipidemia prevalence of some Cameroonian women. Study Design: This was a cross-sectional study. Place and Duration of Study: The enrollment took place at the Yaounde Military Hospital from November 2016 to July 2017. Methodology: To achieve this goal, two sets of 105 postmenopausal and 127 premenopausal participants were enrolled in this study. 5ml of blood were collected on EDTA coated tubes from each participant. Enzymatic methods were used to evaluate total cholesterol, HDL cholesterol and triglyceride, while LDL cholesterol was determined using the Friedewald equation. These biological parameters were used to determine dyslipidemia. Thereafter, they were compared within age and year since menopause subgroups. Results: There was no significant difference in the mean values of total cholesterol, HDL-C, LDL-C as well as triglyceride between premenopausal and postmenopausal women. The mean HDL-C concentration was stable in the age subgroups while the mean total cholesterol and LDL-C were slightly increasing as postmenopausal participants got older. LDL-C level was significantly higher in women who had been in menopause for more than 15 years. The overall dyslipidemia prevalence was 53%. Dyslipidemia was significantly higher in the subgroup of women who had freshly entered menopause. Conclusion: Even though there was no change in the mean concentration of the plasma lipid parameters, of pre- and postmenopausal participants there was a general need to improve their lifestyle in order to reduce dyslipidemia prevalence.

scholarly journals Association of Hypothyroidism with Infrequent Tension-Type Headache

2021 ◽  
Vol 7 (1) ◽  
pp. 60-64
Author(s):  
Rafiqul Islam ◽  
Monsur Habib ◽  
Farida Khatun ◽  
Uzzwal Kumar Mallick ◽  
Md Mamnur Rashid ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Tertiary Care ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Overt Hypothyroidism ◽  
Care Hospital ◽  
Primary Headache Disorders ◽  
Co Morbidity ◽  
Significant Difference ◽  
Type Headache

Background: Tension-type headache is a common neurological problem among general population of Bangladesh. Objective: This study was undertaken to ascertain the frequency of subclinical and over hypothyroidism in patients with infrequent TTH. Methodology: This study was conducted in a tertiary care hospital Dhaka medical college in Bangladesh. The study subjects consisted of 200 patients primary headache disorders. Thyroid function test were performed. All four sub-types of tension type headache were considered to include in the study, namely: Infrequent episodic (or infrequent), frequent episodic (or frequent), chronic sub-type and probable sub-type. Result: Forty percent (40%) patients in this study had infrequent TTH, 30% had frequent episodic TTH, 21% had chronic sub-type of TTH and 9% patients had probable sub-type of TTH. overt hypothyroidism. Among 46 patients with frequent episodic TTH 10 patients had subclinical hypothyroidism and 4 patients had overt hypothyroidism. Out of 18 patients with probable TTH 3 patients had subclinical hypothyroidism but no patient was overt hypothyroid. Out of 42 chronic TTH patients 12 had subclinical and another 12 had overt hypothyroidism. Statistically significant difference was seen among different sub-types of headache in relation to thyroid status. Conclusion: Hypothyroidism is found to be a co morbidity or precipitating factors to be development of infrequent type of tension-type headache. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 60-64

scholarly journals Gender-wise Comparative Assessment of Lifestyle Patterns and Well-being Status among Healthcare Employees at a Tertiary Care Hospital

2021 ◽  
Author(s):  
Vanajakshamma Velam ◽  
Vyshnavi Kancherla ◽  
Latheef Kasala ◽  
Anusha Kancherla ◽  
Mounica Reddy Pillaram
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Well Being ◽  
Care Hospital ◽  
Cross Sectional ◽  
Significant Difference ◽  
Female Employees ◽  
The Mean ◽  
Lifestyle Patterns ◽  
Comprehensive Study

Abstract Background This study was an attempt to assess and compare the gender-wise lifestyle patterns and well-being status among the employees of a tertiary care teaching hospital. Material and Methods This is a cross-sectional, questionnaire-based study conducted at a tertiary care hospital between May and August 2019. A total of 777 employees belonging to both genders (male and female) and working at different professional levels were assessed. All the enrolled employees were subjected to a comprehensive study tool consisting of various dimensions of their health, which included physical, mental, social, spiritual and intellectual health dimensions. Results Among the participants, 327 (42.1%) were male and 450 (57.9%) were female. There was no significant difference in the mean age of male (37.91 ± 7.52) and female (36.85 ± 8.16) employees (p = 0.07). A significantly higher proportion of diabetes and hypertension were seen in male employees (9.8% and 14.4%, respectively) than in female (5.6% and 6.2% respectively). The overall well-being was better in male employees than in females and was statistically significant (p < 0.0001). We found that male employees had statistically significant better well-being in terms of physical, mental and social health whereas female employees had intellectual health. Conclusion The overall well-being in healthcare staff was good at our tertiary care hospital, and the outstanding/good well-being rate was higher in male employees than in female employees. Female employees experienced risks with regard to their physical health.

scholarly journals The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

2021 ◽  
Vol 8 ◽  
pp. 204993612110365
Author(s):  
Kundan Mishra ◽  
Suman Kumar ◽  
Sandeep Ninawe ◽  
Rajat Bahl ◽  
Ashok Meshram ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Febrile Neutropenia ◽  
Burkholderia Cepacia ◽  
Myeloid Leukemia ◽  
Tertiary Care ◽  
Care Hospital ◽  
Significant Difference ◽  
The Mean ◽  
Acute Myeloid

Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days ( p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 ( p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.

A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

2021 ◽  
Vol 8 (41) ◽  
pp. 3559-3566
Author(s):  
Abdul Salam R. T. ◽  
Shahul Hameed A. ◽  
Meera Rajan
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Tertiary Care ◽  
Operation Time ◽  
Care Hospital ◽  
Adenoid Tissue ◽  
Significant Difference ◽  
Tube Function ◽  
Prospective Comparative Study ◽  
The Mean

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

scholarly journals The Effect of Smoking on the Lipid Profile of Inhabitant Smokers of Hasilpur, District Bahawalpur, Pakistan

2020 ◽  
Vol 10 (2) ◽  
pp. 82-86
Author(s):  
Mushtaq Hussain Lashari ◽  
Sumbel Sumera ◽  
Umer Farooq ◽  
Zia Ur Rehman ◽  
Nuzhat Sial ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Serum Triglyceride ◽  
Mean Value ◽  
Heavy Smoker ◽  
Control Group ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean ◽  
Control Light ◽  
Heavy Smokers

Background: Health problem are culturally associated with smoking in developing countries. Many hazardous chemicals are taken up by direct or passive smoking causing lipid peroxidation resulting in oxidative stress. Objectives: To estimate the occurrence of smoking and its effects on the lipid profile in populations of Hasilpur, Pakistan. Methodology: The current study was conducted from April - August 2014. Out of 247 apparently healthy subjects of both genders (male=220; female=27), 134 were smokers and 113 were non-smokers. In order to analyze lipid profile, blood samples were collected in early morning hours from the selected members who were asked to fast all night. By using Chem-100 chemistry analyzer, cholesterol, triglyceride, HDL, LDL and VLDL were analyzed. Results: The overall prevalence of smokers was 54.25%. The results showed 60.9% prevalence in males and 0% in females. The mean value of serum triglyceride in control, light smokers and heavy smokers was 147.4±11.7mg/dl, 190.8±41.4 and 205.3±29.7mg/dl, respectively. The results of cholesterol in control, light smokers and heavy smokers were 147.38±7.99mg/dl, 136.8 ±12. 8mg/dl and 173.44±8.63mg/dl, respectively. There was a considerable distinction in the mean level of serum triglyceride and cholesterol between the control group, light smokers and heavy smoker groups (P<00.5). The mean value of HDL of control, light smokers and heavy smokers was 30.93±1.30mg/dl, 31.10±2.45 and 34.58±1.55mg/dl, respectively. The mean values of LDL and VLDL of control, light smokers and heavy smokers were 110.46±3.63mg/dl, 106.00±4.52mg/dl, 117.19±3.48mg/dl and 33.54±3.11mg/dl, 49±9.02mg/dl, 41.06±5.34mg/dl, respectively. There was significant difference in the mean level of HDL, LDL and VLDL between the control group, light smokers and heavy smoker groups (P<0.05). Conclusion: This study concluded that smoking is the reasons of variation in the lipid profile. Elevated period of smoking and the number of smoked cigarettes/day reason the alteration in serum lipid levels and is probably related with increased danger for coronary artery disease.

scholarly journals A Lifestyle (Dietary) Intervention Reduces Tiredness in Children with Subclinical Hypothyroidism, a Randomized Controlled Trial

2020 ◽  
Vol 17 (10) ◽  
pp. 3689
Author(s):  
Ellen van der Gaag ◽  
Job van der Palen ◽  
Pim Schaap ◽  
Mirthe van Voorthuizen ◽  
Thalia Hummel
Keyword(s):  
Lipid Profile ◽  
Subclinical Hypothyroidism ◽  
Dietary Intervention ◽  
Controlled Trial ◽  
Intervention Group ◽  
Well Being ◽  
Thyroid Stimulating Hormone ◽  
Control Group ◽  
Significant Difference ◽  
Scale Scores

Purpose: Subclinical hypothyroidism (SH) in children and adults is a subject for discussion in terms of whether to treat it or not with respect to the short-term clinical implications and consequences of SH and in the long term. If treatment with thyroxine supplementation is not indicated, no other treatment is available. We investigated whether a lifestyle (dietary) intervention improves or normalizes SH or decreases the presence of Thyroid Stimulating Hormone (TSH) and/or tiredness. Methods: We randomized children aged 1–12 years with SH to the control group (standard care = no treatment) or intervention group (dietary intervention). The dietary intervention consisted of green vegetables, beef, whole milk and butter for 6 months. The rest of the diet remained unchanged. We measured TSH, FreeT4, Lipid profile, Body Mass Index (BMI) and Pediatric Quality of Life (PedQL) multidimensional fatigue scale scores. Results: In total, 62 children were included. After 6 months, TSH decreased in both groups without a significant difference between the groups (p = 0.98). PedQL fatigue scores for sleep (p = 0.032) and total fatigue scores (p = 0.039) improved significantly in the intervention group, compared to the control group. No unfavorable effects occurred in the lipid profile or BMI. Conclusion: The lifestyle (dietary) intervention did not normalize SH and TSH levels, but it significantly reduced tiredness. These results suggest that children’s well-being can be improved without medication.

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