Microalbuminuria is not a valuable marker for relapse in Crohn's disease.

BACKGROUND: Previous reports correlated microalbuminuria with disease activity in patients with Crohn's disease (CD). The aim of the present study is to determine the value of microalbuminuria as a marker for relapses in quiescent CD. METHODS: In a 1-year prospective maintenance trial with oral budesonide in patients with CD in remission, microalbuminuria was measured at randomization, after 2, 6 and 12 months, plus at the time of a relapse. The association of microalbuminuria with the course of disease was analyzed with logistic regression analysis. Time-dependent Cox regression was undertaken to study the association between microalbuminuria and relapse. RESULTS: We included a total of 139 patients. At randomization, microalbuminuria was present in 8 patients. During a 1-year follow-up, 29 patients relapsed and in 11% (3/29), microalbuminuria was present during the relapse. We found no statistically significant association between microalbuminuria and relapse (odds ratio 0.92, 95% confidence interval (CI) 0.76-1.13). Time-dependent Cox regression analysis also revealed no statistical predictive value for microalbuminuria (hazard ratio 1.29, 95% CI 0.37-4.39, p = 0.68). CONCLUSION: Microalbuminuria was moderately prevalent in quiescent CD patients, but it could not be associated with disease characteristics or the type of medication before randomization, nor as a predictor for relapses.

Residential treatment of disturbed children and adequacy of their subsequent adjustment: a follow-up study.

To study residential treatment outcome, a follow-up questionnaire sent to families of former child patients was used to assign them to categories of "good", "fair," or "poor" overall adjustment. The three groups were compared on variables such as presenting symptoms, duration of psychotherapy, amount of drug therapy, and prognosis on discharge; several therapist variables were also studied. Findings, some unexpected, are discussed.

Alcohol use and problem drinking in South Africa: findings from a national population-based survey.

OBJECTIVE: This study formed part of the South African National HIV, Incidence, Behaviour and Communication (SABSSM) 2008 survey, which included questions assessing the extent of alcohol use and problem drinking among South Africans. METHOD: A multistage random population sample of 15 828 persons aged 15 or older (56.3% women) was included in the survey. Alcohol use was assessed using the Alcohol Use Identification Test (AUDIT). Tabulation of data for different age groups, geolocality, educational level, income, and population group produced the estimates and associated confidence intervals. The odds ratios for these variables in relation to hazardous or harmful drinking were also computed. RESULTS: Current alcohol use was reported by 41.5% of the men and 17.1% of women. White men (69.8%) were most likely and Indian/Asian women (15.2%) least likely to be current drinkers. Urban residents (33.4%) were more likely than rural dwellers (18.3%) to report current drinking. Risky or hazardous or harmful drinking was reported by 9%: 17% among men and 2.9% among women. In men, risky drinking was associated with: the 20-54 year age group; the Coloured population group; lower economic status; and lower education. Among women, risky drinking was associated with: urban residence; the Coloured population group; lower education; and higher income. CONCLUSION: An increase in current, binge drinking and hazardous or harmful drinking prevalence rates was observed from 2005 to 2008 in South Africa. Multilevel interventions are required to target high-risk drinkers and to create awareness in the general population of the problems associated with harmful drinking. Future prospective studies are needed to assess the impact of problem drinking.

Voluntary consumption of substances of unknown palatability by vervet monkeys: a refinement.

BACKGROUND: Pure compounds and herbal medicines, had to be administered orally to vervet monkeys for testing. A reliable method was sought to avoid daily gavaging. METHODS: Substances were incorporated into the maize meal based diet of this facility for voluntary consumption. Food intake was monitored. RESULTS: In all but one case, consumption of the treated food was in excess of 90%. In all cases, the purpose of the study was achieved. Habituation was usually only required to the vehicle, and was accomplished by incremental increases to the desired concentration. Aversion was overcome by the addition of a small amount of honey. Plasma concentrations of a compound metabolite could be measured in one case after gavage and food consumption, and were similar for both methods. CONCLUSION: The method enables reliable voluntary consumption of diverse substances. Since stressful gavaging is avoided, it is a valuable contribution to the 3Rs.

Risks associated with environmental enrichment: intestinal obstruction caused by foraging substrate.

Questions are occasionally asked about the safety of enrichment techniques, considering that many novel ways are frequently employed to ensure environmental complexity. A juvenile male vervet monkey was found with a phytobezoar of straw obstructing the sigmoid colon. The straw was foraging substrate, which is used in communal cages. Due to the extent of the resulting necrosis in the sigmoid and descending colon, the monkey had to be killed. This is the only individual to have suffered a harmful effect from the foraging substrate from amongst 120 vervet monkeys, which have been permanently housed on straw for over 5 years.

Personality and attitudes of child care workers, psychotherapists, and parents of children in residential treatment.

The PARI, MMPI, F-Scale, and Dogmatism Scale were administered to (a) parents of child psychiatric patients, (b) psychotherapists, and (c) child care workers. Similarities and differences among these three groups were found on measures of hostility and control in child-rearing, general authoritarianism and dogmatism, anxiety, repression, dominance, and ego-strength. The findings have important implications for increased understanding of (a) interpersonal relations among adults collaborating in the treatment process, and (b) interactions between adults in these roles and children under their guidance.

Childhood psychosis. The problem of differential diagnosis.

In a study of 66 former child psychiatric patients, Form E-1 of Rimland's Diagnostic Check List (DCL) was found to be an effective instrument for differentiating autistic, other psychotic, and nonpsychotic disturbed children. Follow-up study revealed more favorable outcomes in nonpsychotic cases, with significant association between DCL scores and improvement following discharge. Scores indicative of autism on the DCL were also significantly associated with being of the Jewish faith.

Self-esteem, ethnic identity, and behavioral adjustment among Anglo and Chicano adolescents in West Texas.

This study provides a comparison of similarities and differences with respect to ethnic identity between Anglo and Chicano adolescents from Texas. A path analysis model was used to test a theoretical assumption concerning proposed antecedents and consequences of self-esteem. Research instruments included the Rosenberg Self Esteem Scale, the Semantic Differential (scales for Myself and My Ethnic Group) and the McGuire White Measure of Social Status. Results were consistent with the interpretation that there is a relationship between being Chicano and having lower self-esteem, lower behavioral adjustment, and higher ethnic esteem. The prediction that ethnic esteem would mediate between ethnic group and self-esteem was upheld. Variables such as ethnic group membership per se and sex appear as or more important to the prediction of behavioral level. Clinical implications include recognizing that Chicanos low in self-esteem or behavioral adjustment should not automatically be considered unusual. The problems faced by this group are considered as having something in common with other groups of people who have more problems, lesser status, fewer resources, and fewer sources of available help.

Integration of a behavior modification program into a traditionally oriented residential treatment center for children.

The historical background and early contributions of the Emma Pendleton Bradley Hospital, the first psychiatric hospital for children in the United States, are described. The focus of this report is on the incorporation of the treatment modality of behavior modification into this traditional psychoanalytically oriented program. Beginning with exploratory studies in the mid-1960s, in recent years within the residential center there has been a separate Autistic Unit, in which the major treatment strategy is consistent application of behavior modification principles and programs. Changes that have occurred in the course of developing the behavior modification program are discussed to show some of the positive and negative aspects of introducing such a radical change into a traditional setting. Case studies are included to reveal both the failures and the successes that have been encountered in treating psychotic children with either psychotherapy or behavior therapy. Description of the current status of the program shows that treatment is comprehensive, including psychodynamic and behavioral approaches, medication when warranted, and special education. The role of parents in the program is now very different from that ascribed to them in traditional psychoanalytically guided treatment.

Sonographic evaluation of gluteus medius and minimus tendinopathy.

Our objective was to describe the sonographic appearance of the gluteus medius and minimus tendons in normal subjects, and to illustrate the spectrum of sonographic findings in gluteus tendinopathies. Sonography was performed in 20 asymptomatic volunteers. Seventy-five consecutive patients (59 women, 16 men; mean age 57.1 years) presented with pain and point tenderness over the greater trochanter. There were 43 right hips and 32 left hips. Ten patients provided a history of a traumatic incident with subsequent symptoms (mean duration 3.2 months). All patients underwent sonography to assess the site and severity of injury, and to discriminate tendinosis from partial and complete tear. Calcific foci, bony change, and fluid in the trochanteric bursae were noted. Twenty-two patients subsequently underwent surgery. Fifty-three (53 of 75) patients showed sonographic evidence of gluteus medius tendinopathy. Twenty-eight patients were thought to have tendinopathy without discrete tear. Sixteen patients had partial tears and 9 full-thickness tears. Gluteus minimus tendinopathy was detected in 10 of 75 patients. Foci of tendinopathy and partial tears were more common in the deep and anterior portions of the gluteus medius tendon attachment. Eight patients had fluid pooling in the trochanteric bursae. Findings were confirmed in 22 patients at surgery. Sonography can identify gluteus medius and minimus tendinopathy and provides information about the severity of the disease.