Insomnia, Psychosocial Well-Being, and Weight Control Behaviors Among Healthy-Weight Adolescent Females: Brief Report.

BACKGROUND: Weight control behaviors (WCBs) typically involve appearance- or health-driven behaviors that may be influenced by physiological, psychological, or social factors. Sleep disturbances like insomnia are an important area of research for adolescent populations, as early intervention may result in improvements in other physical and mental health domains. The purpose of this study was to investigate the relationship of insomnia, psychosocial well-being, and current WCBs in healthy-weight female adolescents. METHOD: Female adolescents (N = 323; Mage = 12.33 ± .04) who had healthy body mass index (BMI) levels completed self-report items on insomnia, depression, self-esteem, and physical self-concept. Multivariate analysis of covariance (MANCOVA), controlling for age, was conducted to further examine differences in insomnia and psychosocial variables among the WCB groups. RESULTS: Compared to those who were trying to stay the same weight or not trying to do anything about their weight, the girls who were trying to lose weight had significantly greater insomnia and depression symptoms, and lower self-esteem, with small to medium effect sizes. CONCLUSIONS: Clinicians working with adolescent girls should include assessments of WCBs in addition to measures of insomnia symptoms, even for adolescent girls within a normal BMI range, as these are common and frequently co-occurring phenomena. Additional research is needed to further disentangle these complicated relationships.

Meeting USDHHS Physical Activity Guidelines and Health Outcomes.

Current public health physical activity (PA) guidelines suggest ≥500 METmin/week of PA, with additional benefits beyond 1000 METmin/week (i.e., a dose response). Revised U.S. PA guidelines are scheduled for 2018. The purpose was to relate health markers (blood pressure, percent fat, BMI, blood glucose, cholesterol, and cardiorespiratory fitness) to verify the dose response for PA guidelines revision. 505 non-smoking participants self-reported PA behaviors and completed medical screening. MANCOVA controlling for age and gender determined the relation between health markers and PA. MANCOVA indicated significantly (P<.001) different health markers of percent fat, BMI, glucose, and treadmill time as a function of PA. Post-hoc Helmert contrasts (1] <500 METmin/week vs. ≥500 METmin/week and 2] 500 to <1000 METmin/week vs. ≥1000 METmin/week) indicated that meeting the PA guidelines was associated with better health markers and higher cardiorespiratory fitness. Effect sizes were greater for contrast 1 than for contrast 2, suggesting a plateauing effect. Revised public health guidelines should consider achievement of ≥500 METmin/week to be most important, with additional modest gain thereafter. Revised PA guidelines should stress the importance of achieving 500-1000 METmin/week.

Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab.

Autoimmune hemolysis (AH) and immune thrombocytopenic purpura (ITP) are recognized complications after cord blood transplantation (CBT). We evaluated the incidence and characteristics of AH/ITP after double-unit CBT in a day 100 landmark analysis of 152 patients (median age 36 years, range 0.9-70 years) transplanted for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor (CNI)/mycophenolate mofetil. With a median 5.2-year (range 1.6-9.7 years) survivor follow-up, 10 patients developed autoimmune cytopenias (8 AH, 1 ITP, 1 both) at a median of 10.4 months (range 5.8-24.5) post CBT for a 7% cumulative incidence 3 years after the day 100 landmark. Six patients presented with severe disease (hemoglobin ⩽6 g/dL and/or platelets <20 × 109/L). All AH patients were direct antiglobulin test positive. All 10 cases developed during immunosuppression taper with 8 having prior acute GVHD. All 10 patients received rituximab 2-18 days after diagnosis, and corticosteroids combined with rituximab within <7 days was the most effective. No patient died of AH/ITP. AH/ITP occurs infrequently after CBT but may be life-threatening requiring emergency therapy. Rituximab combined with corticosteroids at diagnosis is warranted in patients with severe disease.

The "re-entry group"--a transitional therapeutic framework for mentally ill patients discharged from the hospital to community clinics.

An effective transition of the psychiatric patient from the hospital to the community clinic is vital to the continuity of care. This study shows a short-term group, the "re-entry group," to be more effective in this transition than are patients discharged from a psychiatric hospital by the traditional process. We used a psychoeducational approach to facilitate active participation and compliance with outpatient therapy. Outcome variables included absorption of patients into the clinic, continued therapy, compliance with treatment, rehospitalization, level of knowledge regarding illness and medication, quality of rehabilitation, and attitude towards treatment.

A survey of the San Diego-Tijuana cross-border binging. Methods and analysis.

On a typical weekend night between 12:00 a.m. and 4:00 a.m., about 4 thousand Americans 25 or younger cross back into the United States from a night in Tijuana, Mexico, clubs. More than 40% of the drinkers return the next morning with an illegal blood-alcohol concentration (.08 or higher). To study this phenomenon and to provide data with which to evaluate the community effort in San Diego County, a border research effort involving two separate surveys of individuals entering and leaving Mexico was established in June 1997. This article briefly reviews past roadside survey studies and reports on the survey methods developed to conduct these surveys and the procedure required to analyze the data collected.

Stressful nurses: the effect on patient outcomes.

The article describes a study that measured, over a 3-month period, staffing problems, including turnover rates; nurse incidents, including absenteeism, back injuries, and needle sticks; and patient incidents, including falls and medication errors. The self-reported stress of the nurses caring for these patients was recorded over the same 3-month period. Data showed that a relatively strong relationship exists between a hospital unit's Stress Continuum Scale (SCS) and the occurrence of patient incidents. The relationship between the SCS and personal incidents and nurse injuries appears weak, as does the relationship between staff turnover and stress. Lagging staff turnover by 1 month resulted in a moderate association with the SCS, however.

Reclassification of Lactobacillus casei subsp. casei ATCC 393 and Lactobacillus rhamnosus ATCC 15820 as Lactobacillus zeae nom. rev., designation of ATCC 334 as the neotype of L. casei subsp. casei, and rejection of the name Lactobacillus paracasei.

The type strain of Lactobacillus casei subsp. casei (ATCC 393) exhibits low levels of DNA homology with other strains of L. casei subsp. casei (8 to 46%) and strains of Lactobacillus paracasei (30 to 50%), but exhibits a level of DNA similarity of 80% with Lactobacillus rhamnosus ATCC 15820, the original type strain of "Lactobacterium zeae" Kuznetsov 1959. Strains ATCC 393T (T = type strain) and ATCC 15820T are members of one protein profile cluster that is separate from the other Lactobacillus spp. The randomly amplified polymorphic DNA PCR profile of strain ATCC 393T is also different from the profiles obtained for the other species. L. casei ATCC 334T is genetically closely related to L. casei subsp. casei strains (71 to 97%) and L. paracasei strains (71 to 91%), is a member of the same protein profile cluster as these organisms, and shares several DNA amplicons with L. paracasei strains. On the basis of these results, we propose that L. casei subsp. casei ATCC 393T and L. rhamnosus ATCC 15820 should be reclassified as members of Lactobacillus zeae nom. rev. (type strain, ATCC 15820), that strain ATCC 334 should be designated the neotype strain of L. casei subsp. casei, and that the name L. paracasei should be rejected.

Active autoimmune gastritis without total atrophy of the glands.

To date, autoimmune gastritis has been diagnosed for the most part only when total atrophy of the oxyntic glands is detected. On the basis of 40 patients without total atrophy of the glands, and with parietal cell antibodies in the serum, we show that the diagnosis of type A gastritis is also possible in the pre-atrophic stage. The histological criteria for the diagnosis of active autoimmune gastritis without total atrophy of the glands are 1. usually dense, diffuse locally emphasized lymphocytic infiltration of the lamina propria between the glands in the oxyntic mucosa, 2. focal destruction of individual glands in the corpus of the stomach by lymphocytes, and 3. reactive pseudohypertrophy of the parietal cells. A comparison with a group of patients with autoimmune gastritis and total atrophy of the glands shows that in active autoimmune gastritis, too, women are more frequently affected than men (in both groups, the sex ratio is approximately 3:1). Patients without atrophy of the glands are, on average, about 12 years younger than those with "burnt out" type A gastritis (average age 69.98:57.80 years). While in the case of burnt out type A gastritis, no colonisation with Helicobacter pylori was to be found, such colonisation was demonstrated for the corpus mucosa in 22.5%, and for the antral mucosa in 15.0%. In 27.5% a minimal or low-grade inactive superficial gastritis, as may be seen after eradication of Helicobacter pylori, was additionally diagnosed in the antrum. A knowledge of the histological appearance of the pre-atrophic stage of type A gastritis might be of importance for the possible prevention of pernicious anaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

[General practice of colorectal cancer surgery: often still inadequate resection]. / Praxis der kolorektalen Karzinomchirurgie: vielfach immer noch inadäquate Resektionen.

With the aim of investigated the question as to whether surgery for colorectal carcinoma is being carried out in a standardised tumor-oriented manner, 777 surgical specimens containing colorectal carcinomas obtained from 33 hospitals were analysed. Only 4.76% of these carcinomas were pT 1 early carcinomas, the largest portion of the tumors (63.96%) was classified as pT 3. The pN stages were distributed as follows: pN 0 53.4%, pN 1 22.0%, pN 2 13.77%, pN 3 9.39%, and pN X 1.41%. The surgeons indicated an R-classification in only 24% of the specimens. Measurements of the length of the resected material, the width of the mesocoli or perirectal tissue, the distal margin of clearance, the number of lymph nodes on the vessel trunk, and the number of pericolic or perirectal lymph nodes revealed a considerable degree of fluctuation in the measurements, and thus in the operative methodology applied to colorectal carcinoma surgery. Analysis of the four hospitals with the highest operating rates taking sigmoidorectal specimens as an example, showed that some abdominal surgeons are still not performing this operation in accordance with the oncological rules for tumor-oriented surgery.

Cryptosporidiosis of the appendix vermiformis: a case report.

The present case report describes a 30-year-old man with AIDS who developed cryptosporidiosis of the appendix vermiformis. The patient had been admitted to hospital with all the symptoms of appendicitis, and an appendectomy was performed. The histological work-up of the surgical specimen revealed an acute phlegmonous appendicitis, and also a welldeveloped cryptosporidiosis, which was confirmed by electron-microscopic examination. Two years later, the patient died of pneumonia contracted during a generalised CMV infection. The postmortem examination revealed cryptosporidial organisms in the biliary tract. As far as we know, this is the first ever report of cryptosporidiosis of the appendix vermiformis.

[Malignant somatostatinoma--diagnosis after 6 years]. / Malignes Somatostatinom--Diagnosestellung nach 6 Jahren.

UNLABELLED: Early symptoms of malignant somatostatinoma with dyspeptic complaints, moderate diabetes mellitus and cholecystolithiasis are the reason of primary treatment of these patients by surgeons. CASE REPORT: In a 34-year old patient with typical anamnesis of cholecystitis and moderate diabetes mellitus liver metastases were seen during laparotomy. In the beginning the metastases were mistaken for hepatocellular carcinoma histologically. There was no deterioration until June 1988 when a high-grade stenosis of the duodenum has developed. Now a malignant somatostatinoma was diagnosed histologically and confirmed by immunohistology. Somatostatinomas are generally diagnosed by repeated measures of increased plasma SLI associated with decreased insulin, glucagon, pancreatic-polypeptide (PP) and vasoactive-intestinal-peptide (VIP). In normally or moderately increased plasma SLI concentrations provocation with tolbutamid may be helpful. Treatment should remove most of the tumor by surgical intervention, while chemotherapy must be less pronounced.

Bifidobacterium gallicum sp. nov. isolated from human feces.

A bifidobacterial isolate from human feces was found to have very low genetic relatedness to any previously described species of the genus. This strain, which also contained a unique type of peptidoglycan, L-lysine-L-alanine-L-serine (A3 alpha), is considered to represent a new species, which is designated Bifidobacterium gallicum. Its description is presented. The type strain is strain DSM 20093. gallicum. Its description is presented. The type strain is strain DSM 20093.

["Brown bowel" syndrome--lipofuscinosis of the intestine as a cause of atonia]. / "Brown-bowel"-Syndrom-Lipofuszinose des Darmes als Ursache von Atonien.

We report on a 42 year old male patient having been ill with pseudo-pobstruction and gastroinstestinal atonid for 24 years. He was thought to suffer from Crohn's disease and was treated conservatively. Since the therapy proved to be insufficient, explorative laparatomie was performed and parts of the small and large intestine which were thought to be inflamed, were removed. The histologic examination revealed the deposition of a significant amount of lipofuscin in the muscularis propria. This so-called brown bowel syndrome is known to be responsible for the development of gastrointestinal atonia. It is generally believed that this syndrome is caused by a vitamin E deficiency which may occur due to malabsorption. The brown bowel syndrome is treated sympomatically, and until now only one case achieving a remission of the disease has been reported.

[Campylobacter pylori in heterotopic gastric mucosa in Meckel's diverticulum]. / Campylobacter pylori in heterotoper Magenschleimhaut im Meckelschen Divertikel.

We report a case of Meckel's diverticulum with heterotopic gastric body mucosa, active gastritis in the heterotopic mucosa and dense colonisation by Campylobacter pylori. This case, together with four identical cases recently reported, and a further case with C. pylori colonisation of heterotopic gastric mucosa in the rectum, shows that C. pylori obviously traverses the length of the Gl tract--a fact that makes the faecal-oral route of infection probable.

Ultrastructure of the islets of Langerhans after long-term occlusion of the pancreatic duct system.

The long-term effect of surgically induced atrophy and fribrosis of the exocrine parenchyma of the pancreas on the islets of Langerhans was examined electron-microscopically in animal experiments in mini-pigs. Ligature of the pancreatic duct, occlusion of the pancreatic duct system with an alcoholic solution of amino acids and the combination of this occlusion with ligature of the pancreatic duct were compared. A largely similar result was found in all three experimental groups 9 months post-operatively: The islets of Langerhans are mostly subdivided into predominantly small and apparently intact islet cell complexes by peri- and intra-insular fibrosis, and, where larger islet cell complexes are found, these are, in places, also destroyed in the peripheral region. The diffusion distance between the capillaries and the endocrine cells is, in part, considerably dilated by the interposition of collagen fibres. In the capillaries, thickenings and duplications of the basement membrane, as well as swelling of the endothelial cells can be found. There are rarely signs of atrophy in the islet cells lying in clusters. Only the granular structure of the B-cells diverges from the norm. From our morphological findings a delayed and diminished hormone output after pancreatic duct occlusion can be deduced, whereby, compared to earlier short-term experiments of our own, no significant progression of the peri- and intra-insular fibrosis can be determined.

Overcoming resistance to power sharing.

Power is a fundamental necessity for human development. Not only do people have a right to seek power, they have the duty to do so, if some force prevents them from pursuing their full development or promoting the development of persons dependent on them. Pope John Paul II, in his encyclical On Human Work, defends workers' right to seek power by forming unions to defend their vital interests and by striking if necessary. The bishops, through their pastoral letter on Catholic Social Teaching and the U.S. Economy, and the National Council of Churches in the United States also affirm this right. A refusal to share power usually means that the power holder perceives the purpose of power as "getting things done" rather than "helping people to grow." Resistance to power sharing can be attributed to three possible attitudes: Management's view that the sharing of power is a "gift" that can be withdrawn at any time; The perception of board members who come from the capitalist system that power sharing does not work; Adherence by management personnel in government to the theory that power holders' authority derives from the will of the people. Human service workers unquestionably can benefit from power sharing. The persons most in need of their services, however, also are powerless and must be considered in any discussion of a potential strike. Withholding services from these groups--the poor, minorities, children, the elderly, and the disabled--can result in a tragic tension, pitting the powerless against the powerless.

New models for decision making in moral theology.

The way that the Christian tradition faces moral issues is being reshaped. Rather than focusing solely on Scripture and tradition as the basis for resolving ethical issues, decision makers should investigate human experience as well, some contemporary theologians recommend. In contrast to a traditional notion of natural law, which analyzes "human nature," the revisionist approach analyzes human experiences to discover what is authentic in them. This process looks not only at the physical structure of an act but also at its intentionality and its effect on the parties involved. Absolute material norms do not exist, according to the revisionist school. Instead one must examine an act's effects on a person's relationship to God, to others, to the physical world, and to oneself to determine whether it is morally right or wrong. Although this theological trend could be disconcerting to those who serve on ethics committees--since it does not rely on clear-cut rules--and may make decision making more difficult, its value lies in its potential to bring Christians closer to a divine understanding of reality.

DNA-DNA Homology, Murein Types and Enzyme Patterns in the Type Strains of the Genus Bifidobacterium.

DNA-DNA homology and several phenotypical characteristics, such as murein (peptidoglycan) type and patterns of carbohydrate fermentation, and isoenzymes of L-lactate dehydrogenase and of transaldolase in the type strains of all species of the genus Bifidobacterium listed in the Approved Lists of Bacterial Names are determined. A key for identifying the different species, based on murein types, isoenzyme patterns and fermentation of pentoses, gluconate, maltose and melezitose is presented.

Dog bites. A neglected problem in accident prevention.

Dog bites are a common but neglected pediatric problem. To clarify the epidemiology of dog bites and to learn if parents would welcome counseling aimed at preventing bites, 455 families (960 children) in a Denver pediatric practice were surveyed. One hundred ninety-four children (20.2%) had been bitten at least once, with the majority of bites occurring before the child was aged 5 years. Forty-three percent of the bites prompted a visit to a physician and 16.5% received sutures. German shepherds were responsible for 17% of the incidents, more than expected relative to their popularity as pets. The dogs usually were owned by a neighbor (40.2%) or the victim's family (31%). Approximately half of the bites were believed to be unprovoked. Seventy-seven percent of the parents believed that dog bite prevention warranted discussion with their physician. Dog bites are an important pediatric problem, and parents should be counseled accordingly during well-child visits.