Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice.

BACKGROUND: Psoriatic arthritis commonly develops in psoriasis patients and, if undiagnosed, can lead to potentially avoidable joint damage and an increased risk of comorbidity and mortality. Increased awareness of PsA symptoms among dermatologists provides an opportunity for earlier diagnosis, more timely therapy and prevention of disability. OBJECTIVE: To provide Australian epidemiological data on the frequency of undiagnosed PsA among psoriasis patients in dermatology practice, and to investigate the impact of psoriasis on quality of life and work productivity. METHODS: Nine tertiary centre dermatology practices enrolled patients presenting with plaque psoriasis and no prior rheumatologist-confirmed PsA diagnosis. Patients were screened using the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire and were referred to a rheumatologist for assessment of PsA status using CASPAR criteria if they had a PASE score ≥44. RESULTS: Based on the composite and sequential application of PASE and CASPAR criteria, undiagnosed PsA among psoriasis patients in this study is 9% [95% CI: 6, 12]. The PPV of PASE in this setting is 26% [95% CI: 19, 34]. Nail involvement and chronic large plaque psoriasis were identified as independent positive predictors of PsA, whereas scalp psoriasis was an independent negative predictor of PsA. Patients with moderate-to-severe psoriasis (PASI ≥15) had lower quality of life scores than patients with less severe psoriasis. CONCLUSION: In this study, the frequency of undiagnosed PsA in Australian dermatology practice was 9% among plaque psoriasis patients with no prior PsA diagnosis. Compared with psoriasis alone, the impact of undiagnosed PsA on health-related quality of life of psoriasis patients is substantial.

The long and winding road: personal reflections of an anti-racism trainer.

This paper addresses the intense personal and professional preparation necessary for becoming an effective anti-racism trainer. The author draws upon diversity training models and theory, as well as personal experiences and reflections charted as a white man actively involved in this field over the past ten years.

puckered, a gene involved in position-specific cell differentiation in the dorsal epidermis of the Drosophila larva.

The final pattern of the cuticle of the Drosophila larva depends on the position-specific behaviour of the epidermal cells during their differentiation. This behaviour is dictated, in part, by the relative position of the cells during embryogenesis which allows them to receive and integrate signals from their neighbours. The translation of this 'positional information' into pattern might depend on the activity of genes that are able to integrate the outcome of cell interactions and transfer it to the genes responsible for cell differentiation. Mutations in the gene puckered cause spatially restricted defects during the differentiation of the larval epidermal cells. We present data that suggests puckered may be involved in linking positional information to cell differentiation.

Preliminary results on the inventory of therapeutic strategies.

The qualities of a new measure of therapists' interventions, the Inventory of Therapeutic Strategies (ITS), were examined in cognitive and brief dynamic psychotherapy. In contrast to other inventories, the ITS focuses on three types of therapist intentions (exploratory, supportive, and work-enhancing), and it also takes into account the content and object of exploratory strategies. In this preliminary study, ITS categories were found 1) to be reliably rated, 2) to be unrelated to the therapist's contribution to the alliance, 3) to differentiate cognitive and dynamic psychotherapy, and 4) to predict outcome, alone or in interaction with the alliance.

Depression in a Latino immigrant medical population: an exploratory screening and diagnosis.

Interviews with 48 Latino medical outpatients assessed depression via a brief self-report screening measure and a structured diagnostic interview. Twenty-eight percent of the sample received a DSM-III-R diagnosis of major depression. Validity information is provided for the screening measure, which can be used with Latino medical patients, a traditionally high-risk group for depressive disorders.

Complete nucleotide sequence of the bovine beta-casein gene.

The beta-casein gene is a member of a small gene family encoding the calcium-sensitive caseins, which are specifically synthesized and secreted by the mammary gland during lactation in response to both peptide and steroid hormones. The caseins are involved in the transport of calcium phosphate in milk, which is important for bone development in the infant mammal. We report here the organization and complete DNA sequence of the 8.5 kb long bovine beta-casein gene. Comparison with the rat beta-casein gene reveals that the exons of both genes correspond exactly. The 5' flanking sequences of all Ca-sensitive casein genes are conserved within the proximal 200 bp and contain several elements that probably function as cis-acting regulatory elements, including an octamer-like motif, and SV40-type core enhancer and a sequence that appears to be common to all lactoprotein genes. The latter sequence is flanked on either side by 12 bp direct repeats. These direct repeats are themselves each part of sequences that display two-fold symmetry. The first 30 nucleotides of the 3' flanking regions in the bovine and rat beta-caseins are well conserved, indicating that they are likely to be involved in the mechanism of 3' end processing of the primary transcript.

Human inhibin genes. Genomic characterisation and sequencing.

Inhibin is a gonadal hormone involved in the non-steroidal regulation of follicle stimulating hormone (FSH) secretion. Using the cDNAs coding for bovine inhibin A and B subunits we have identified inhibin genes within the human genome using Southern blot hybridisation techniques. The genes are likely to be present as single copies. Cloning and sequencing inhibin genes obtained from lambda libraries of human genomic DNA provide structural and sequence data on the human A and B genes. Comparison of the known inhibin gene sequences showed, in particular, that the B subunits have identical sequences in man, pigs and cattle thus demonstrating a remarkable evolutionary conservation in these genes.

Cloning and sequence analysis of cDNA species coding for the two subunits of inhibin from bovine follicular fluid.

The primary amino acid structures of the 43-kDa (A) and 15-kDa (B) subunits of the 58-kDa form of the hormone inhibin have been elucidated by cloning and analysis of cDNA species derived from bovine granulosa cell mRNA. The A subunit (Mr = 32,298) is a protein of 300 amino acids with two potential N-glycosylation sites and two potential proteolytic processing sites and has a pre-pro region of 60 amino acids. The mature B subunit (Mr = 12,977) is a protein of 116 amino acids synthesized from a separate mRNA. These data establish that a 31-kDa form of inhibin also isolated from bovine follicular fluid, with subunits of 20 kDa (Ac) and 15 kDa (B), is derived from the 58-kDa form by proteolytic processing of the A subunit.