Translation, cultural adaptation and validation of the Systemic Lupus Erythematosus Activity Questionnaire (SLAQ) in a cohort of Italian systemic lupus erythematosus patients.

Introduction The Systemic Lupus Erythematosus Activity Questionnaire (SLAQ) is a patient-reported instrument for the assessment of disease activity in systemic lupus erythematosus (SLE). The aims of the present study are translation, cultural adaptation and validation of an Italian version: the SLAQit. Methods The process of translation and cultural adaptation followed published guidelines. SLAQit was pretested in a group of 35 SLE patients to evaluate acceptability, comprehension and feasibility. Internal consistency, test-retest validity and external validity were tested on consecutive SLE patients attending the clinic. Results In total, 135 SLE patients were enrolled in this study. The pilot test provided a 99.9% response rate and demonstrated feasibility and comprehensibility of the questionnaire. A good internal consistency was found among the three components of the score (SLAQ score, numerical rating scale (NRS), patient global assessment question (PGA); α = 0.79). SLAQit showed very high reliability (test-retest α > 0.8). NRS and PGA showed a strong positive correlation with both Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) ( p = 0.002 and p < 0.001, respectively) and European Consensus Lupus Measurement (ECLAM) scores ( p = 0.01 and p < 0.001, respectively), while the SLAQ score did not. A significant agreement was observed between the physician's intention to treat and both the NRS and PGA scores, while no significant association was reported with the SLAQ score. Conclusions SLAQit was demonstrated to be a reliable and valid instrument for self-assessment of disease activity in SLE patients.

Magnetic trapping of cold bromine atoms.

Magnetic trapping of bromine atoms at temperatures in the millikelvin regime is demonstrated for the first time. The atoms are produced by photodissociation of Br2 molecules in a molecular beam. The lab-frame velocity of Br atoms is controlled by the wavelength and polarization of the photodissociation laser. Careful selection of the wavelength results in one of the pair of atoms having sufficient velocity to exactly cancel that of the parent molecule, and it remains stationary in the lab frame. A trap is formed at the null point between two opposing neodymium permanent magnets. Dissociation of molecules at the field minimum results in the slowest fraction of photofragments remaining trapped. After the ballistic escape of the fastest atoms, the trapped slow atoms are lost only by elastic collisions with the chamber background gas. The measured loss rate is consistent with estimates of the total cross section for only those collisions transferring sufficient kinetic energy to overcome the trapping potential.

Production of cold bromine atoms at zero mean velocity by photodissociation.

The production of a translationally cold (T < 1 K) sample of bromine atoms with estimated densities of up to 10(8) cm(-3) using photodissociation is presented. A molecular beam of Br(2) seeded in Kr is photodissociated into Br + Br* fragments, and the velocity distribution of the atomic fragments is determined using (2 + 1) REMPI and velocity map ion imaging. By recording images with varying delay times between the dissociation and probe lasers, we investigate the length of time after dissociation for which atoms remain in the laser focus, and determine the velocity spread of those atoms. By careful selection of the photolysis energy, it is found that a fraction of the atoms can be detected for delay times in excess of 100 µs. These are atoms for which the fragment recoil velocity vector is directly opposed and equal in magnitude to the parent beam velocity leading to a resultant lab frame velocity of approximately zero. The FWHM velocity spreads of detected atoms along the beam axis after 100 µs are less than 5 ms(-1), corresponding to temperatures in the milliKelvin range, opening the possibility that this technique could be utilized as a slow Br atom source.

Papaya latex enzymes capable of detoxification of gliadin.

Assay of fractions obtained from ion exchange chromatography of papaya latex on CM Sephadex-C50, size exclusion chromatography on Sephacryl S-300 and size exclusion HPLC have provided an insight into the relative contributions of the gluten-detoxifying enzymes present. This outcome has been achieved by the use of the above chromatographic techniques, coupled with assays of lysosomal activity, protease activity using benzylarginine ethyl ester (BAEE) as substrate, prolyl endopeptidase (PEP) using glycylprolylnitroanilide and a prolidase assay using acetylprolylglycine. These procedures have shown that the activity in papaya latex is due largely to caricain and to a lesser extent, chymopapain and glutamine cyclotransferase. The presence of caricain and these other enzymes was confirmed by mass spectrometry of trypsin digests of the most active fraction obtained by CM Sephadex-C50 chromatography and size exclusion HPLC. Fractions rich in caricain would be suitable for enzyme therapy in gluten intolerance and appear to have synergistic action with porcine intestinal extracts.

Low magnetic moment PIN diodes for high field MRI surface coils.

Positive-intrinsic-negative (PIN) silicon diodes are commonly used in magnetic resonance imaging (MRI) coils to perform active or passive blocking and detuning, or to disable circuit functions. However, diode packages with large magnetic moments are known to cause image artifacts in high field MRI systems. In this study, diode packages with low magnetic moment were designed by compensating components of ferromagnetic nickel and paramagnetic tungsten with diamagnetic silver. The new diodes have an initial positive susceptibility up to fields of 1 T and a negative susceptibility from 1 to 7 T. Their magnetic moments are one to two orders of magnitude smaller than those of standard diodes; moments as small as 20 nJ/T at 7 T were achieved.

Acclimation of Respiratory O2 Uptake in Green Tissues of Field-Grown Native Species after Long-Term Exposure to Elevated Atmospheric CO2.

C3 and C4 plants were grown in open-top chambers in the field at two CO2 concentrations, normal ambient (ambient) and normal ambient + 340 [mu]LL-1 (elevated). Dark oxygen uptake was measured in leaves and stems using a liquid-phase Clark-type oxygen electrode. High CO2 treatment decreased dark oxygen uptake in stems of Scirpus olneyi (C3) and leaves of Lindera benzoin (C3) expressed on either a dry weight or area basis. Respiration of Spartina patens (C4) leaves was unaffected by CO2 treatment. Leaf dry weight per unit area was unchanged by CO2, but respiration per unit of carbon or per unit of nitrogen was decreased in the C3 species grown at high CO2. The component of respiration in stems of S. olneyi and leaves of L. benzoin primarily affected by long-term exposure to the elevated CO2 treatment was the activity of the cytochrome pathway. Elevated CO2 had no effect on activity and capacity of the alternative pathway in S. olneyi. The cytochrome c oxidase activity, assayed in a cell-free extract, was strongly decreased by growth at high CO2 in stems of S. olneyi but it was unaffected in S. patens leaves. The activity of cytochrome c oxidase and complex III extracted from mature leaves of L. benzoin was also decreased after one growing season of plant exposure to elevated CO2 concentration. These results show that in some C3 species respiration will be reduced when plants are grown in elevated atmospheric CO2. The possible physiological causes and implications of these effects are discussed.

Impact of divorce on locus of control orientation in adult women: a longitudinal study.

Using longitudinal data for adult women from the National Longitudinal Surveys of Labor Market Experience, this study examined the relation between getting divorced and changes in the individual's locus of control orientation. The sample contained 1,814 white women ages 32-46 years who were in their first marriage in 1969. Marital status and locus of control (an 11-item abbreviated version of Rotter's Internal-External Locus of Control Scale) were measured in 1969, 1972, and 1977. Based on previous literature on locus of control and life events and on divorce, stress, and mental health, the author hypothesized that divorced people, in comparison with those who remained married, would show a short-term increase in externality from 1969-1972, followed by a return over the next 5 years to levels of locus of control comparable to that of the group who remained married. It was also hypothesized that locus of control scores would not predict the likelihood of becoming divorced over the 8-year period. All three hypotheses were confirmed. The findings were discussed in the context of two larger theoretical issues: the influence of important life events on locus of control and the causal direction in the well-documented association between divorce and mental health.

The effect of glucocorticoids on osteoblast function. The effect of corticosterone on osteoblast expression of beta 1 integrins.

Prolonged treatment with glucocorticoids is known to produce osteoporosis, which is characterized by a decrease in bone mass. Therefore, we studied the effect of glucocorticoids on the formation of bone and on the expression of beta 1 integrins in a mineralizing organ culture of fetal rat parietal bone. Integrins are a family of integral membrane glycoproteins that mediate the adhesion of cells to extracellular matrix macromolecules and affect the growth and differentiation of cells. In situ hybridization with a 32P-labeled beta 1 integrin cDNA probe was performed on parietal bone, treated with or without 100-nanomolar corticosterone for ninety-six hours, to localize and assess the levels of beta 1 integrin mRNA quantitatively. Corticosterone decreased beta 1 integrin mRNA in the osteoblast layer but not in the periosteum. Northern blot analysis demonstrated a 62 per cent decrease in the levels of beta 1 integrin mRNA in the osteoblast layer of bone that had been stripped of its periosteum. Immunofluorescence microscopy confirmed these results, as they demonstrated a decrease in the levels of beta 1 integrin protein predominantly in the osteoblast layer. This effect was dependent on the concentration of corticosterone. During ninety-six hours of culture, the calcium content and the dry weight of control parietal bone increased 157 per cent and 57 per cent, respectively. However, treatment of these cultures with 100-nanomolar corticosterone inhibited calcification by 24 per cent. The administration of glucocorticoid had no significant effect on the DNA content or dry weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between risk of seroconversion of sentinel cattle to bluetongue viruses and Culicoides species (Diptera: Ceratopogonidae) in Queensland, Australia.

The association between risk of seroconversion of sentinel cattle to bluetongue viruses and the number of Culicoides brevitarsis Kieffer and C. wadai Kitaoka caught by light traps was investigated using survival analysis. Eight sentinel herds that seroconverted to bluetongue viruses between 1990 and 1994, and for which insect-trapping data were available, were selected for inclusion in the study. These herds were located at six sites along the eastern coast of Queensland, Australia, from approximately latitude 10 degrees South to 25 degrees South. C. brevitarsis was detected at all locations where sentinel herds were maintained, whereas C. wadai was detected at only two locations in northern Queensland where four sentinel herds were maintained during the study period. The mean number of C. brevitarsis and C. wadai caught per month was 230 and 21, respectively. A significant (P = 0.05) positive association was found between the risk of seroconversion of sentinel cattle to bluetongue viruses and the number of C. wadai caught in the same month.

Systems analysis and guidelines for behavioral scientists in family medicine.

A recurrent theme among behavioral scientists is the difficulty of being a nonphysician in a medical setting. Differences in training and in work roles can create misunderstanding between physicians and behavioral scientists; and being a minority in terms of profession can be isolating and demoralizing. To date, analyses have focused on the individual differences between the two groups and not on the context--the larger system--in which the two work. This article examines these systemic problems, particularly problems specific to family medicine. Coping methods which can be used by behavioral scientists are proposed to help them reduce the work stress they experience.

Developmental levels in family-centered medical care.

This paper describes a developmental sequence which many physicians seem to experience as they mature in their competence in family-centered medical care. The flow of the developmental levels is from information to affect to social systems. The paper concludes with implications for family systems curricula in family medicine residencies.

Risks and benefits of a family systems approach to medical care.

The "art of medicine" is struggling for survival in medical education, practice, and research. The authors embrace the biopsychosocial model as an ideal new paradigm for medicine and propose that the family systems approach provides the best available vehicle for applying the biopsychosocial model to everyday medical practice and research. Such an approach would require major changes in the way health care is delivered and offers both benefits and risks for family physicians to consider. One important change would involve the sharing of physicians' power in a health care system that emphasizes collaboration among individuals, families, and a variety of professionals. Such revolutionary changes should be approached with caution.

Levels of physician involvement with psychosocial concerns of individual patients: a developmental model.

BACKGROUND: Physician involvement in patients' psychosocial concerns is seen as desirable by practicing physicians and family medicine educators. Although the effectiveness of several approaches to psychosocial problems has been demonstrated, the skills required of the physician vary widely. We present a five-level developmental model of physician skills in addressing the psychosocial concerns of individual patients. METHODS: To validate the model, 171 outpatient office visits in a residency program were videotaped and rated according to the levels. The inter-rater agreement was 88%. RESULTS: Interviews with lower levels of psychosocial involvement occurred much more frequently than interviews rated at higher levels (48%, 34%, 16%, 2%, 0%, respectively). Involvement at each higher level added approximately two minutes to the length of the visit. The development of higher levels of physician involvement between the first and third year of residency training was not found in this sample. CONCLUSIONS: These results support the validity of the five-level sequence regarding the depth of physician involvement. Because the hierarchy can be used to reliably assess the degree of physician involvement with the psychosocial concerns of individual patients, the model offers potential applications for resident education and further research on the physician-patient relationship.

Does academic training background make a difference among practicing marriage and family therapists?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in practice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about their satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.

Medical interviewing by exemplary family physicians.

BACKGROUND: Little is known about the extent to which models of ideal physician-patient interviews are actually practiced by physicians. This study examined physician-patient communication during medical interviews by exemplary family physicians. METHODS: We performed a cross-sectional study of verbal exchanges using 300 transcripts of office visits made to two groups of family physicians: 9 exemplars and 20 controls. The exemplars were family physicians with fellowship training in family therapy; the control group consisted of a convenience sample of board-certified family physicians with no special training in communication skills or counseling. Data were collected from June 1995 to July 1996. Physician statements were rated according to the Level of Physician Involvement model, which measures physicians' abilities to collaborate with patients and address the psychosocial concerns of patients and their families. Patient satisfaction ratings were obtained by a research assistant immediately after the visit. RESULTS: Compared with the control physicians, the exemplars showed higher levels of psychosocial involvement with patients during routine office visits. In particular, they involved patients more in the medical interview, offered more emotional support, and showed more family involvement. Despite this greater depth of involvement, the length of office visits did not differ between the two physician groups. CONCLUSIONS: Our findings show that exemplars were more involved with their patients and provided more family-oriented care than community physicians. Exemplars routinely applied a biopsychosocial approach, collaborating with patients and addressing psychosocial topics without sacrificing efficiency, while community physicians focused on biomedical issues.

Levels of physician involvement with patients and their families. A model for teaching and research.

BACKGROUND: We present an educational model that describes physician skills for addressing psychosocial concerns of patients, ranging from basic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy levels of physician involvement with individual patients and levels of involvement with families. METHODS: Ten faculty family physicians were videotaped during 200 office visits. Interviews were categorized according to the model, with a 79% interrater agreement. RESULTS: Most visits involved the lower three levels of physician involvement (41%, level 1; 35.5%, level 2; and 23%, level 3). Discussion of family context occurred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher levels were associated with longer visits--about 3 minutes more for each additional level. CONCLUSIONS: This investigation suggests that the levels of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the study of physician interview skills appropriate to family medicine.

What do patients really want? Redefining a behavioral science curriculum for family physicians.

This study replicates the design reported by Schwenk et al and addresses a key methodologic issue in their paper. The original questionnaire by Schwenk et al was administered to one half of the sample of patients, while the other half completed a reworded questionnaire asking what they "want" in the area of psychosocial help, as opposed to what they think their family physician "would" do (the original wording). The hypothesis was that expectations for physician involvement will be higher if patients are asked what they want as opposed to what they expect. Patients were asked to complete a four-page questionnaire, alternating the questions described by Schwenk et al with the reworded questionnaire, in which they were required to rank the level of involvement requested from their physician regarding 45 psychosocial problems (level 1 = no involvement, level 4 = major involvement). Results using the originally worded questionnaire closely paralleled findings of Schwenk et al, whereas asking people what they "wanted" showed statistically significant differences in 18 of the 45 items. The paper concludes with discussion of patient preferences vs patient expectations, with implications for the behavioral science curriculum.

Effect of spouse support and health beliefs on medication adherence.

This study addressed the issue of social support for patients' adherence to medical regimens. Social support of wives was assessed by structured interview of 150 male participants in the Coronary Primary Prevention Trial, their wives, and medical staff. In addition, wives were interviewed about their beliefs related to their husbands' health and participation in the trial. Unobtrusive packet counts were used as the measure of adherence. The participants were classified as having high spouse support if wife support scores were in the top one third of the distribution and as having low spouse support if scores were in the bottom one third as measured from inquiry of the participant, the spouse, and the staff. The adherence of men having low support averaged 70 percent, significantly lower than the high-support group, which averaged 96 percent. The correlations between spouses' health beliefs and their level of support were significant for three of four health belief variables. In particular, highly adhering men had wives who believed more strongly in the benefits of the Coronary Primary Prevention Trial.

Urinary sheaths: assessment, prescription and evaluation.

Urinary sheaths are a common solution to male urinary incontinence, but can be a source of much anxiety and discomfort if incorrectly fitted. This article discusses the process of assessment that must precede the prescription of a urinary sheath system. Assessment of bladder function and correct fitting and sizing are essential. The article also discusses the range of urinary sheath systems available, some of the problems that may arise in their use, and the processes of evaluation that should accompany use.