Excessive weight in childhood is a serious public health concern because of its costly health consequences and its increasing prevalence. Our objective was to compare the efficacy of a family-based approach for the treatment of childhood obesity, in which the parents served as the exclusive agents of change, with that of the conventional approach, in which the children served as the agents of change. This study had a randomized, longitudinal prospective design and lasted 1 y. Sixty obese children aged 6-11 y were randomly allocated to the experimental (parents as agents of change) or control (children as agents of change) group. Anthropometric and biochemical measurements were determined at the start and end of the study. A sociodemographic questionnaire and a family eating and activity habits questionnaire were completed by both parents. Hour-long support and educational sessions were conducted by a clinical dietitian: 14 sessions for the parents in the experimental group and 30 sessions for the children in the control group. The dropout rate was nine times greater in the control group (n = 9) than in the experimental group (n = 1). Mean percentile weight reduction was significantly (P < 0.03) higher in children in the experimental group (14.6%) than in the control group (8.1%). Treatment of childhood obesity with parents as the exclusive agents of change was superior to the conventional approach, as indicated by the dropout rate and the percentage weight loss of the children during the 1-y intervention.

Cognitive decline in schizophrenia is a fundamental component of the illness.¹ Importantly, this decline is evident years prior to the emergence of psychotic symptoms,^2-11 indicating that the onset of the disease process precedes the emergence of overt symptoms.¹² In clinical practice, psychosis is a necessary diagnostic criterion prompting initiation of treatment. The time lag between onset of the disease process and diagnosis of schizophrenia is a major challenge for research into early phases of the disorder. Given the prevalence of schizophrenia (approximately 1%), large samples are required to establish the association of early phenotypic changes with subsequent development of psychosis.

Context: In some patients symptoms of hypothyroidism persist despite therapy with T₄. Objective: The objective of the study was to compare the effectiveness of T₄-T₃ combination vs. T₄ monotherapy for the treatment of clinical hypothyroidism in adults. Data Sources: PubMed, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in September 2005. References of all included trials were scanned for additional studies. We put no restrictions on language, year of publication, or publication status. Study Selection: All randomized trials that compared the effectiveness of T₄-T₃ combination vs. T₄ monotherapy for the treatment of clinical hypothyroidism in adults were included. Data Extraction: The data were extracted by two independent reviewers. Data Synthesis: We included 11 studies, in which 1216 patients were randomized. No difference was found in the effectiveness of combination vs. monotherapy in any of the following symptoms: bodily pain [standardized mean difference (SMD) 0.00, 95% confidence interval (CI) −0.34, 0.35], depression (SMD 0.07, 95% CI −0.20, 0.34), anxiety (SMD 0.00, 95% CI −0.12, 0.11), fatigue (SMD −0.12, 95% CI −0.33, 0.09), quality of life (SMD 0.03, 95% CI −0.09, 0.15), body weight, total serum cholesterol, triglyceride levels, low-density lipoprotein, and high-density lipoprotein. Adverse events did not differ between regimens. Conclusions: T₄ monotherapy should remain the treatment of choice for clinical hypothyroidism.