Maintenance treatment of ulcerative proctitis with mesalazine suppositories: a double-blind placebo-controlled trial. The Italian IBD Study Group

OBJECTIVE: To examine the outcome of trial second labor after a first cesarean performed because of cephalopelvic disproportion, defined according to strict diagnostic criteria. METHODS: Obstetric details of nulliparous women delivering at 37 or more weeks' gestation by cesarean for cephalopelvic disproportion, between 1975 and 1990, were recorded prospectively. The diagnostic criteria for cephalopelvic disproportion were cervical dilation arrested after 5 cm, unresponsive to oxytocin augmentation, after active dilatation of 2 cm or more in 2 hours. Fetal malpresentations and malpositions were excluded. The outcome of next delivery in our hospital by each woman enrolled was then examined. RESULTS: Eighty-four of 42,793 women met the criteria for disproportion, and 40 with cephalic presentations delivered their next baby in our hospital. All 40 underwent a trial of labor and 27 (68%) delivered vaginally, comprising seven (47%) women with larger second and 20 (80%) with smaller second babies. Of 15 women previously delivered by cesarean at full dilatation, 11 (73%) delivered vaginally with no serious maternal or neonatal morbidity. CONCLUSION: The strictly defined diagnosis of nulliparous cephalopelvic disproportion should not constitute an automatic "recurrent" indication for elective cesarean delivery, because 68% of patients in our series had successful vaginal deliveries in their next pregnancies. This rate is similar to those reported after all nulliparous cesareans for dystocia.     

Positive aspects of caregiving as a moderator of treatment outcome over 12 months.

The authors examined the influence of positive aspects of caregiving (PAC) as a moderator of treatment outcome across 12 months in 1 of the original sites of the Resources for Enhancing Alzheimer's Caregiver Health I project. They used multilevel random coefficients regression analysis to predict time-varying PAC, depression, behavioral bother, and daily care burden in Alzheimer's caregivers (N = 243; mean age = 60.89, SD = 14.19). They found that time-varying PAC was predicted by time-varying daily care burden. They also found significant effects of time-varying PAC for depression, behavioral bother, and daily care burden. Notably, a PAC × Phase × Treatment effect was found for daily care burden, such that individuals who endorsed less PAC benefited most from the intervention across 12 months. The tendency to positively appraise the caregiving experience (i.e., PAC) in response to chronic stressors such as Alzheimer's caregiving may affect individuals' responsiveness to, and benefit from, interventions, whereas only daily care burden affected the tendency to find enjoyment in caregiving across 12 months. Future intervention research should assess individual PAC in order to better tailor interventions to caregiving needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined therapy with 5-aminosalicylic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study

OBJECTIVES: To assess the efficacy of a combination of oral and topical 5-aminosalicylic acid (5-ASA) for the maintenance treatment of ulcerative colitis, we undertook a double-blind randomized clinical trial. METHODS: Patients aged 18 to 65 yr (with disease extent greater than proctitis only) were eligible for inclusion in the study if they met the following criteria: (a) history of two or more relapses in the last year; (b) achievement of remission in the last 3 months (with maintenance of remission for at least 1 month). Patients enrolled in the study were randomly assigned to one of the two following 1-yr treatments: (1) combined therapy with 5-ASA tablets 1.6 g/day and 5-ASA enemas 4 g/100 ml twice weekly; (2) oral therapy with 5-ASA tablets 1.6 g/day and placebo enemas/twice weekly. The main end point of the study was the maintenance of remission at 12 months. RESULTS: Upon completion of the study, relapse occurred in 13 of 33 patients in the combined treatment group versus 23 of 36 patients in the oral treatment group (39 vs 69%; p = 0.036). No significant side effects related to treatment were observed in either group. A simplified pharmacoeconomic analysis shows that this form of combined treatment can have a favorable cost-effectiveness ratio. CONCLUSIONS: Our results indicate that 5-ASA given daily by oral route and intermittently by topical route can be more effective than oral therapy alone. This form of combination treatment can be appropriate for patients at high risk of relapse.     

Psychosomatics and psychoanalytic theory: The psychology of ulcerative colitis and Crohn's disease.

Psychoanalytic psychosomatic theory is reviewed here with particular reference to inflammatory bowel disease, that is, ulcerative colitis and Crohn's disease. The importance of recognizing empirical research findings in conjunction with clinical inference is stressed, as well as the usefulness of exploring the full relationship context of illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients

The records of a series of 700 patients with inflammatory bowel disease, 498 with Crohn's disease and 202 with ulcerative colitis, have been analyzed to determine the relative incidence and characteristic features of their extra-intestinal manifestations. The group with Crohn's disease included 62 with colitis, 223 with ileocolitis, and 213 with regional enteritis. A consideration of the clinical patterns and an understanding of their pathophysiology suggested a subdivision into two main groups: one "colitis related" and one related to the pathophysiology of the small nonspecific third group. Group A, colitis related, comprises joint, skin, mouth, and eye disease. The complications might be immunologically determined, were closely associated with active inflammation, and often responded to medical or surgical treatment of the underlying bowel disease. They occurred in 36% of the entire series of patients: joints were involved in 23%, skin in 15%, and mouth and eye each in 4%. Pyoderma gangrenosum was observed most often in ulcerative colitis and erythema nodosum most often in granulomatous colitis. The incidence of Group A complications was higher in disease involving the colon (42%) than in disease restricted exclusively to the small bowel (23%). There were interrelationships among the various members of Group A, with multiple manifestations occurring in a third of affected patients. Group B, related to small bowel pathophysiology, includes malabsorption, gallstones, kidney stones, and non-calculous hydronephrosis and hydroureter. Disorders in this group were generally related to the severity of the disease in the small bowel and tended to persist even in the absence of active inflammation. In contrast to Group A, this group occurred most frequently in small bowel disease, and least in colonic disease. Malabsorption was virtually confined to the patients with small bowel disease (10% incidence), while gallstones and renal stones were also both more frequent in Crohn's disease (11% and 9% respectively), the latter usually in association with small bowel resection or ileostomy. Group C, found in a small percentage of patients, consists of nonspecific complications, including osteoporosis (3%), liver disease (5%), peptic ulcer (10%), and amyloidosis (1%).     

Child weighing by the unschooled: a report of a controlled study of growth monitoring over 12 months of Maasai children using direct recording scales

Growth monitoring was developed as a clinic-based programme in the early 1960s, and has spread widely in many countries. The results of weighing children are usually presented in a graphic form, unintelligible to most mothers and difficult for many health workers to interpret. This study suggests that the TALC Direct Recording Scale will allow growth monitoring to be undertaken even by illiterate mothers in the community and reports the results of a trial with a group of illiterate mothers amongst the Maasai of Kenya.     

A comparison of perceived- and computed-change measures over a three-year period.

Used longitudinal data, collected for 3 yrs from a large community general hospital, to assess the validity of retrospective reports of changes in job satisfaction, communication, and coordination. 90 registered nurses answered 2 questionnaires 3 yrs apart. Responses were assessed using correlational and contingency analyses. Although retrospective reports of change did to some extent measure before-after change, it is noted that retrospective measures are not accurate enough to be considered as substitutes for computed-change measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceiving group members: A comparison of derived and imposed dimensions.

Three studies with 54 18–55 yr olds compared 2 methods for spatially representing the perceived internal structure of small groups. R. F. Bales's (1980) Systematic Multiple Level Observation of Groups (SYMLOG) imposes 3 a-priori dimensions of interpersonal behavior—dominant vs submissive, friendly vs unfriendly, and instrumentally controlled vs emotionally expressive. Multidimensional scaling (MDS) derives dimensions on the basis of perceived similarity of group members. Each of the 3 studies demonstrated substantial and statistically significant overlap between the SYMLOG and MDS dimensions. In particular, the 1st MDS dimension was highly correlated with the axis of greatest differentiation in the SYMLOG space. Findings are discussed in terms of psychological salience and the behavioral attributes underlying the 3 SYMLOG dimensions. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring group processes: A comparison of the GCQ and CCI.

This study verified and compared the factor structures of two frequently used measures of small group climate, the Group Climate Questionnaire (GCQ-S; MacKenzie, 1983) and the Curative Climate Instrument (CCI; Fuhriman, Drescher, Hanson, Henrie, & Rybicki, 1986) at both group and individual levels. Data included third session assessments of 124 group members in 20 university counseling center groups. Confirmatory factor analyses partially supported the GCQ factor structure, but indicated that the Catharsis subscale of the CCI was not independent of the other two CCI subscales. Factor analysis of the six subscales from both measures yielded two higher order factors, representing positive (Engagement, Cohesion, Insight, and Catharsis) and negative (Conflict and Avoidance) group processes. Findings provide guidance for interpreting and comparing group processes using these measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sialyl-Tn antigen as a marker of colon cancer risk in ulcerative colitis: relation to dysplasia and DNA aneuploidy

Radiopharmaceuticals are essential to the performance of nuclear medicine procedures. These radioactive drugs consist of two components: a drug component for localization in a specific tissue or organ and a radioactive component for diagnostic or therapeutic purposes. The majority of radiopharmaceuticals are used for diagnostic imaging procedures. The radioisotopes used for radiopharmaceuticals are produced in a number of ways: as by-products of fission, by means of neutron activation, by cyclotrons, and by generators. These methods produce isotopes with both desirable and undesirable properties. Approximately 80% of all nuclear medicine procedures performed in the United States use radiopharmaceuticals labeled with technetium-99m. The chemical properties of technetium allow relatively simple preparation of Tc-99m compounds by using reagent kits. Quality control testing of radiopharmaceuticals is routinely performed to ensure compliance with various purity standards such as assay for radioactivity, radionuclidic purity, chemical purity, radiochemical purity, pharmaceutical purity, and biologic purity.     

Management of poor performance: A comparison of manager, group member, and group disciplinary decisions.

Managers and 231 members of 41 work groups representing 4 diverse organizations participated in an experiment involving disciplinary decisions. Managers and group members responded individually to scenarios describing a group member's poor performance, followed by group members meeting to reach consensus on the disciplinary decisions. As hypothesized, manager disciplinary decisions were more severe than decisions made by individual group members. Contrary to predictions, the severity of manager and group disciplinary decisions did not differ. A test of choice shifts revealed that when the prevailing view among individual group members was for a relatively lenient disciplinary action, the group consensus decision was more severe than the average of the individual decisions. Attributions and outcome seriousness were found to influence the severity of manager, group member, and group decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer influence on smoking initiation during early adolescence: A comparison of group members and group outsiders.

Compared group members' and group outsiders' susceptibility to the influence of their friends' smoking. Ss were nonsmokers in Grade 7 who were observed for 1 yr. As hypothesized, group outsiders (Ss who did not have reciprocal friends) were affected more by the smoking of their best friend and by the overall level of smoking among their friends than group members were. Furthermore, this peer influence was strongest for teens who were very concerned about their friends' reactions to their substance use. In addition, consistency in smoking status was related to the formation, but not the breakdown, of reciprocal friendships. Results indicate that teenagers may view smoking as a vehicle for entering a desired friendship group. The authors suggest ways that prevention programs might address this mechanism for adolescent smoking initiation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Systematic desensitization of test anxiety: A comparison of group and individual treatment.

Assigned 30 college students with high test anxiety (as measured by the Suinn Test Anxiety Behavior Scale) to group or individual desensitization therapy or to a no-treatment control group. Results clearly demonstrate the efficacy of both individual and group desensitization in treating high test anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months

AIM: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. METHODS: After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV1 percent predicted, 42.8 [8.4]). RESULTS: After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups. CONCLUSION: Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.     

Individual and group psychotherapy of childhood aggression: A comparison of outcomes and processes.

The purpose of this study was to compare outcomes and processes of a therapeutic intervention to reduce children's aggressive behavior, delivered in individual and group formats. Children in 15 small groups (n?=?71) and 15 individual treatment children were compared in a pre–post experimental and control design. The Achenbach self-report behavior checklist and teachers' evaluations were used to measure outcomes. To assess outcome results further, the process of change was qualitatively analyzed. In addition, the therapeutic processes were compared using Hill's counselor and client verbal response modes system. Results concerning outcomes indicated reduced aggression of treated children compared with wait-list children, with no differential impact of the format of treatment. The analyses of stages of change supported the similarity in outcomes. Results concerning process variables indicated differences in both therapist and client verbal responses. In therapists' responses, directives were used more in groups and self-disclosure was used more in individual therapy. In clients' responses, most variables were more frequently used in individual therapy. Experiencing was more frequent in group therapy, and there was no difference in insight and simple responses… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of cancer on daily living: A comparison with cardiac patients and healthy controls.

Examined the psychosocial and physical problems of 32 Ss with cancer by comparing them to Ss with cardiac disease with a similar functional performance status and to Ss without any illnesses. All Ss completed a cancer inventory of problem situations. Ss with cancer were found to have a larger number of problems and more severe problems than Ss with cardiac disease. Some of the problem subscales that were particularly notable for cancer patients were Functional Health Status, Body Image, Weight Maintenance, Worry, Sexual Dysfunction, Problems Associated with Treatment, and Job-Related. Ss with cancer and cardiac disease did not differ greatly from one another or from the healthy controls in subscales associated with the medical setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appendectomy and the risk of developing ulcerative colitis or Crohn''s disease: results of a large case-control study. South Limburg Inflammatory Bowel Disease Study Group

Copper amine oxidase from lentil seedlings was shown to be able to catalyze the oxidative deamination of the indoleamines tryptamine, 5-hydroxytryptamine, and 5-methoxytryptamine. These compounds showed saturation kinetics with Km values as normal substrates, but their oxidation led to irreversible loss of enzyme activity suggesting a covalent interaction with the enzyme, most probably through its cofactor 6-hydroxydopa (2,4,5-trihydroxyphenylalanine). These indoleamines acted as irreversible inhibitors of the enzyme only in the absence of oxygen but they brought about changes in the electronic spectra of the enzyme both in aerobiosis and in anaerobiosis. This study reports on the mechanism by which these compounds inhibit lentil amine oxidase which involves first the oxidation of indoleamines bound to 6-hydroxydopa followed by the formation of an irreversible covalent derivative. The same inhibitory mechanism could possibly lead to inactivation of mammalian amine oxidases involved in serotonin neurotransmitter metabolism in conditions of ischemia or hypoxia.     

Omeprazole and ranitidine in long-term treatment of duodenal ulcer: a double-blind comparison of length of time in remission

In most patients duodenal ulcer is a chronic relapsing disease. If no active maintenance treatment or eradication therapy is given after healing, around 70-100% of patients have a relapse during the first year. We conducted a double-blind multicenter study in 472 patients with duodenal ulcer. They were treated with omeprazole 20 mg every morning for four or eight weeks and when healed were randomly allocated to maintenance treatment with either omeprazole 20 mg every morning or ranitidine 150 mg at bedtime for up to six months. The patients were assessed by endoscopy at monthly intervals until healing occurred. Thereafter scheduled endoscopy was carried out after 1, 3, and 6 months of maintenance treatment or immediately in the event of a suspected relapse. Healing status (intention to treat approach) was 87% at four weeks and 93% at eight weeks. At six months the estimated remission rate was 90% for omeprazole and 82% for ranitidine (P = 0.03, 95% CI 1-15%). The incidence of adverse events was similar during the two maintenance treatments. Treatment with omeprazole 20 mg every morning maintained significantly more patients in remission than treatment with ranitidine 150 mg at bedtime.