The effects of alpha-MSH and testosterone propionate on sebum secretion, sebaceous gland volume, dermal lipogenesis, and preputial gland weight and lipogenesis were examined in hypophysectomized rats. Hypophysectomy reduced sebum secretion, sebaceous and preputial gland size, and dermal and preputial gland lipogenesis. The greatest effects were seen on the biosynthesis of wax esters and squalene. Testosterone propionate (TP) increased sebum secretion, sebaceous gland volume and preputial gland weight and lipogenic activity, but had no significant effect on the pattern of lipid labelling. alpha-MSH had no effect on sebaceous or preputial gland size, but increased sebum secretion and dermal lipogenesis, especially wax ester biosynthesis. When given together TP and alpha-MSH had a synergistic effect on sebum secretion and on dermal and preputial gland lipogenesis, and the pattern of lipid labelling was shifted towards normal. TP and alpha-MSH also showed synergism in increasing preputial gland weight, but together they had no greater effect on sebaceous gland volume than that achieved with TP alone. These results suggest that TP and alpha-MSH have different actions on the sebaceous glands with alpha-MSH acting predominantly on lipogenesis and TP on cellualr proliferation and turnover leading to an increase in gland size. Preputial glands differ from cutaneous sebaceous glands in their response to alpha-MSH and androgen which could be a reflection of their more specilized function.

Given its lower mean costs and higher mean effectiveness, a stratified care strategy, which included zolmitriptan, was the dominant strategy and was unequivocally more cost effective from a societal perspective than either stepped care strategy. When the uncertainty around these means was considered, stratified care had the highest probability of being cost effective.

The FHNSI is a reliable and valid symptom index, which can be administered alone or scored using items embedded within the FACT-H&N.

No abstract

The Onset-of-Effect Questionnaire (OEQ) is a self-administered instrument used to assess patient perception of how quickly asthma maintenance medications begin to work. This study was designed to quantify the relative importance that patients using combination inhaled corticosteroid and long-acting beta(2)-agonist (ICS/LABA) maintenance medication place on the onset-of-effect outcomes. Patients aged >or=18 years with a self-reported diagnosis of asthma, currently using combination ICS/LABA maintenance medication, completed an Internet-based SC conjoint survey instrument that included 10 choice trade-off tasks. In four choice tasks, patients were asked to choose between two hypothetical medications. In six choice tasks, patients were asked to choose among two hypothetical medications and their current medication. Each choice alternative was defined by response levels of the five OEQ statements and out-of-pocket cost. We used random-parameters logit methods to estimate the relative importance of outcomes assessed by the OEQ. Five hundred nine patients completed the study. Satisfied was the most important OEQ outcome and physical sensations were the least important. When offered a choice, 80% (95% CI, 75-85%) of patients preferred a maintenance medication for which they are satisfied with how quickly they feel it begins to work and 62% (95% CI: 57-67%) of patients preferred a maintenance medication that they feel begins to work right away. Combination maintenance medications with rapid onset of effect, especially those that impact a patients' ability to feel the medication work right away and patient satisfaction with how quickly the medication works, may increase the use of and adherence to maintenance medications.