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Psoriasis patients' acceptance of the vehicles used in topical therapy contributes to adherence to treatment plans and outcomes, but patient preferences for different vehicles have not been assessed. The purpose of this study was to develop a quantitative measure of patient preferences for different vehicles and to assess these preferences. Focus group sessions were conducted of patients with psoriasis to determine patient perceptions of the advantages and disadvantages of different topical psoriasis therapies. This information was used to derive a vehicle preference measure to assess different topical therapies. Twenty patients with psoriasis sampled different topical psoriasis medications, assessed the effects of the vehicles on quality of life (QOL), and completed the preference measure for each vehicle. The focus group sessions resulted in the development of a 7-item preference measure. The validity of the vehicle preference measure was demonstrated by good correlation with patient expectations of effects on QOL and by test-retest reliability. The foam and solution vehicles were preferred over the cream, gel, and ointment vehicles (P < .01). There was no significant difference between preferences for daytime and nighttime application of vehicles. Although validated measures of adherence to topical therapy are not yet available, the results of this study suggest that the characteristics of solution and foam may favor improved adherence to topical therapy.

Objective: Cloning of the ileal apical sodium-dependent bile acid transporter (ASBT) has identified a new pharmacological target for the modulation of plasma lipoproteins. The objective of this study was to determine whether a novel, specific, minimally absorbed ASBT inhibitor (SC-435) decreases LDL cholesterol through the alteration of plasma apoB kinetics., Methods and Results: Miniature pigs were treated for 21 days with 10 mg/kg/day of SC-435 or placebo. SC-435 decreased plasma cholesterol by 9% and LDL cholesterol by 20% with no effect on other lipids. Autologous (131)I-VLDL, (125)I-LDL, and [(3)H]-leucine were injected simultaneously to determine apoB kinetics. LDL apoB concentrations decreased significantly by 10% resulting entirely from an increase in LDL-apoB fractional catabolic rate. SC-435 had no effect on either total LDL apoB production or VLDL apoB converted to LDL. SC-435 increased VLDL apoB production by 22%; however, the concentration was unchanged as a result of increased VLDL apoB direct removal. SC-435 increased hepatic mRNA and enzymatic activity for both cholesterol 7alpha-hydroxylase and HMG-CoA reductase. Hepatic LDL receptor mRNA increased significantly, whereas apoB expression was unaffected., Conclusions: A low dose of the ASBT inhibitor, SC-435, significantly reduces plasma LDL cholesterol through enhanced LDL receptor-mediated LDL apoB clearance, secondary to increased expression of cholesterol 7alpha-hydroxylase.

Background: Individuals with psoriasis often report significant psychological distress, physical disability, social strain and reduced quality of life. Little is known about how they cope with the illness., Objective: The primary aim of this study is to determine whether patients' efforts to cope with psoriasis are associated with better or worse health-related quality of life (HRQL)., Methods: Focus groups identified seven commonly used coping strategies that were subsequently measured, along with HRQL and other variables, in a survey of 318 individuals with psoriasis., Results: Results revealed: (i) that psoriasis is associated with decrements in all quality of life domains that were assessed, and (ii) that commonly used coping strategies such as telling others about psoriasis, covering the lesions and avoiding people were associated with greater decrements in HRQL after controlling for covariates; however, telling others that psoriasis is not contagious was associated with smaller HRQL decreases., Conclusions: How patients cope with the social aspects of psoriasis is associated with their quality of life.

High levels of social support are reported to protect against major depressive episode (MDE), but little is known about how social support changes during MDE. In this study, we measured total social support and four subtypes of social support in 75 psychiatric inpatients at the time of admission and one year later. The four subtypes of social support were tangible support, affectionate support, positive social interaction, and emotional/informational support. The majority of the sample were women (81%) with a mean age of 53.7+/-14.9 years. The severity of depressive symptoms improved over the year and was accompanied by a significant increase in two types of social support -- positive social interaction, and emotional/informational support. There was no significant change in tangible support or affectionate support. Linear regression showed that changes in all four subtypes were correlated with changes in depressive severity after adjustment for age, gender, and baseline clinical characteristics. While Instrumental Activities of Daily Living (IADL) scores also improved throughout the period of observation, and while the change in IADL scores were significantly associated with changes in social support, change in IADL scores were no longer significantly associated with change in social support after adjustment for change in depression severity. These results suggest that supportive relationships improve after psychiatric hospitalization for MDE, and these changes are best explained by reduction in depression severity.

Measuring adherence to medical and behavioral interventions is important to clinicians and researchers since inadequate adherence can reduce the effectiveness of an intervention. Unfortunately, there is no gold standard for measuring adherence across health behaviors. Adherence needs to be defined situationally with parameters of acceptable adherence carefully delineated and appropriate to the health behavior being studied. Additionally, measurement methods must be valid, reliable, and sensitive to change; this paper reviews these criteria. Methods used to measure adherence to dietary interventions include 24-hour recalls, food diaries, and food frequency questionnaires. Direct and indirect calorimetry, doubly labeled water, and a variety of self-report methods can be used to measure adherence in physical activity interventions. Adherence to pharmacological interventions is assessed using self-report methods, biochemical measures, medication counts, and the automated pharmacy database review strategy. The strengths and weaknesses of these methods for measuring adherence to dietary, physical activity, and pharmacological interventions are reviewed. Control Clin Trials 2000;21:188S-194S

Objective: To evaluate the association between pain coping skills and disability among older adults with knee pain., Methods: Baseline measures from 394 older adults with knee pain and disability who participated in a 30-month observational study were analyzed. Pain coping skills were correlated with self-reported disability and walking distance after controlling for covariates of disability., Results: Pain coping skills were significantly associated with disability (P < 0.05) and distance walked (P < 0.05). Less catastrophic thinking and prayer, greater ignoring and reinterpretation of pain sensations, and stronger perceptions of pain control were associated with less disability and better physical function., Conclusion: Pain coping skills used by older adults with osteoarthritis and knee pain may play a significant role in determining disability.

Skin disease is common in the United States and accounts for a considerable fraction of all outpatient visits. Dermatologists care for more skin disease visits than any other single specialty, while still accounting for a minority of visits overall. The data presented in this introduction, from 1997, do not show a drastic drop in the number of visits to dermatologists as might be feared to occur with the growth in managed care. These visits for skin disease represent a considerable disease burden in the United States. Skin disease is not simply a cosmetic problem. As the data on psoriasis show, skin disease has a tremendous impact on HRQL. The magnitude of this impact on the individual patient is comparable to the impact of other medical disorders.

Background: Little is known about how the health-related quality of life (HRQL) associated with psoriasis compares with that of other patient populations., Objective: We describe HRQL associated with psoriasis and compare it with HRQL of patients with other major chronic health conditions. A second aim is to identify which specific aspects of psoriasis contribute most to HRQL., Methods: A total of 317 patients completed a non-disease-specific measure of HRQL. Responses were compared with those of patients with 10 other chronic health conditions. HRQL was regressed on ratings of 18 aspects of psoriasis., Results: Patients with psoriasis reported reduction in physical functioning and mental functioning comparable to that seen in cancer, arthritis, hypertension, heart disease, diabetes, and depression. Six aspects of psoriasis predicted physical functioning, and 5 different disease aspects predicted mental functioning., Conclusion: The impact of psoriasis on HRQL is similar to that of other major medical diseases. Different aspects of psoriasis are related to the different dimensions of HRQL supporting the need for multidimensional treatment models.

Evidence from animal, human cross-sectional, case-control, and prospective studies indicate that hormone replacement therapy (HRT) is a promising treatment to delay the onset of symptoms of dementia. The Women's Health Initiative Memory Study (WHIMS) is the first double-masked, randomized, placebo-controlled, long-term clinical trial designed to test the hypothesis that HRT reduces the incidence of all-cause dementia in women aged 65 and older. WHIMS, an ancillary study to the Women's Health Initiative (WHI) funded by the National Institutes of Health, will recruit a subgroup of women aged 65 and older from among those enrolling in the HRT trial of the WHI. The WHI clinical centers and 10 affiliated satellites plan to enroll approximately 8300 women into WHIMS over a 2-year period. Participants will be followed annually for 6 years, receiving cognitive assessments via the Modified Mini-Mental State (3MS) Examination. Women who screen positively for cognitive impairment on the basis of an educational and age-adjusted 3MS cutpoint proceed to more extensive neuropsychological testing and neurologic evaluation. Each woman suspected to have dementia then undergoes a series of laboratory tests that confirm the clinical diagnosis and classify the type of dementia. WHIMS is designed to provide more than 80% statistical power to detect a 40% reduction in the rate of all-cause dementia, an effect that could have profound public health implications for older women's health and functioning.

Psoriasis creates interpersonal difficulties for many sufferers, but little research has examined factors that contribute to the degree of social and psychological disability that a particular person experiences. In all, 318 psoriasis patients completed measures of psychological and social well-being, the severity of their psoriasis, and their dispositional level of fear of negative evaluation (FNE). Analyses showed that disease severity and FNE significantly predicted perceptions of being stigmatized, interpersonal discomfort, stress over others' reactions, distress regarding the observable symptoms of the disease, the degree to which psoriasis interfered with the patients' lives, and patients' quality of life. Furthermore, FNE exerted a particularly strong influence for patients who had severe cases of psoriasis.

Background: Psoriasis treatments are known to be costly, but little is known about the financial impact of psoriasis and the way in which it relates to the severity of the disease., Objective: This study was performed to obtain an estimate of the treatment costs faced by patients with psoriasis., Methods: A total of 578 anonymous mail surveys were distributed to patients with psoriasis; 318 surveys were returned (55%). Psoriasis severity was assessed with the previously validated Self-Administered Psoriasis Area Severity Index (SAPASI)., Results: The total and out-of-pocket expenses to care for psoriasis were correlated with psoriasis severity (r = 0.26, p = 0.0001). There were no sex (p = 0.9) or racial (p = 0.4) differences in total expenditures. Severity was correlated with how bothersome to the patient was the cost of treatment (r = 0.30, p = 0.0001), the time required for treatment (r = 0.38, p = 0.0001), and the time lost from work (r = 0.23, p = 0.0001). Lower quality of life at work and in money matters also correlated with severity of psoriasis. Higher family income was associated with less time spent caring for psoriasis and less interference with work around the home., Conclusion: As expected, the expenses caring for psoriasis are greater for patients with more severe disease. These costs and other financial implications are associated with lower quality of life for patients with more severe psoriasis.

Psoriasis is a chronic, disabling skin disease affecting up to 2 percent of the population. Little is known about how physical, psychological and social features of the illness interact to create a negative impact. In this article, a biopsychosocial model of the impact of psoriasis is described, and results from a survey of 317 psoriasis patients are presented. The types of functional disability, psychological distress and disease-related stressors are described for highly strained patients (i.e. those with disease-related suicidal ideation) and compared with less strained patients (i.e. those without suicidal ideation). As predicted by the model, significantly more disability, psychological distress and disease-related stressors are found among highly strained patients. Logistical regression analysis revealed that strain is more strongly associated with disability, distress and disease-related stress level than with disease severity. Implications for research and clinical interventions are discussed.

Phototherapy is highly effective in the therapy of psoriasis, but patient access to phototherapeutic facilities is not universal. Commercial tanning facilities are universal, but their efficacy in psoriasis treatment is unestablished. Our purpose was to conduct a study to assess the effect of a commercial tanning unit outfitted with nonprescription lamps on psoriasis. We conducted a 6-wk open study of 20 adult patients with stable psoriasis vulgaris. Clinical response was defined as a decrease in the Psoriasis Area Severity Index (PASI) or the Self-Administered PASI (SAPASI) by > or = 10%. There were 16 men and 4 women who participated with a mean (+/-SD) age of 43.0 +/- 14.8 y. Initial and final health-related quality of life information collected included the following instruments: the Brief Symptom Inventory (BSI), the Psoriasis-Related Stressor Scale (PRSS), and the Psoriasis Disability Scale (PDS). Side effects of tanning therapy were closely monitored. Fifteen subjects completed the entire 6-wk trial, and exit data on all subjects were used for analysis. The mean number of tanning sessions was 19 +/- 7.6 with a median of 19 and range of 3 to 29. Analysis of all 20 enrolled subjects found that 16 (80%) showed clinical response as measured by PASI, whereas 17 (85%) showed SAPASI response. Initial and final PASI scores decreased (p = 0.0001) from 7.96 +/- 1.77 to 5.04 +/- 2.5, and SAPASI scores also decreased (p = 0.02) from 11.8 +/- 4.4 to 7.9 +/- 7.7. When controlled for age and sex, a dose-response relationship was demonstrated with the PASI and SAPASI (p < 0.02). Decreases in the mean BSI and PRSS scales were demonstrated (p < 0.02), confirming the clinical significance of the reductions in disease severity scores. Episodes of mild burning occurred in 7 of 20 (35%) participants. Three subjects reported itching after one or two tanning sessions. This study showed that a tested commercial nonprescription tanning unit improved both psoriasis severity and health-related quality of life. Commercial tanning bed treatments may be a useful approach in patients unable to obtain office-based ultraviolet treatments.

Objective: To better understand primary treatment recommendations and the variables that might influence treatment decisions of physicians who treat agitated dementia patients., Design: A written cross-sectional survey of three physician groups (geriatric psychiatrists, primary care physicians, and neurologists) who typically treat agitated dementia patients in community settings. We used a written clinical vignette describing a home-bound, agitated dementia patient to ask respondents to provide information regarding their primary treatment recommendation and to estimate the degree to which clinically relevant variables might influence their treatment recommendation. Using principal component analysis, the original set of clinical variables was collapsed into a smaller set of composite factors that better defined the fundamental constructs of the variables that influenced decision making. Analyses compared primary treatment recommendations and factors influencing treatment recommendations by physician groups., Participants: The pool of survey respondents consisted of a random selection of 207 primary care physicians from western North Carolina, 147 geriatric psychiatrists obtained from the roster of the 1991 American Association for Geriatric Psychiatry, and 120 neurologists obtained from the roster of the American Board of Medical Specialties. The response rate was 65% for geriatric psychiatrists, 38% for primary care physicians, and 33% for neurologists., Results: Differences in primary treatment recommendations by physician group were not found. Physicians, regardless of specialty, recommended neuroleptic medications as their primary intervention. When medication classes were collapsed into a single category, medications as a primary intervention exceeded 55% for all physician groups. Twenty-two percent of all respondents recommended psychosocial interventions as primary treatment strategies. The principal component analysis of clinical variables influencing treatment recommendations solved for five components that accounted for 64% of the variance. Comparing the five components by specialty groups failed to find significant differences, except for Factor 5, the "Hassle Factor." Primary care physicians were more likely to indicate that this component influenced their decision making than were the other physician groups., Conclusions: The findings indicate that physicians, regardless of specialty, are likely to use medication and to weight clinically relevant information in a similar fashion when managing agitated dementia patients.

Alternative therapies are known to be employed by dermatology patients. This study investigates the use of alternative medical treatments for psoriasis and the sociodemographic variables, conventional medical treatment, and psoriasis disease severity. Our study population consisted of 578 university dermatology clinic patients with psoriasis and data was analyzed from 317 (55 percent) questionnaire respondents. The majority of our sample were women (57 percent) and nonwhites represented 8 percent of our sample. Psoriasis severity was measured using the validated Self-Administered Psoriasis Area and Severity Index. Alternative medicine was used by 62 percent of respondents. Excluding sunlight and nonprescription tanning equipment, 51 percent used one or more of the remaining alternative therapeutic modalities. The psoriasis severity was worse in those who had tried herbal remedies, vitamin therapy, and dietary manipulation. With the exception of vitamin therapy, we observed no association between the intensity of conventional medical treatment and alternative treatment. The present or prior use of herbal remedies was correlated with the use of vitamin therapy and sunbathing, and dietary interventions were significantly correlated with vitamin therapy. Of the 113 (36 percent) who had used nonprescription tanning equipment for their psoriasis, 68 percent believed this modality was effective. We found that alternative medical therapies were widely utilized by subjects participating in this study. Clinicians need to continue to be aware of nonallopathic remedies employed by their patients to discover useful information about future therapies and to monitor for adverse effects.

Because of the difficulty and expense of objectively measuring psoriasis severity, very little information exists on the severity of psoriasis in populations. We determined severity in a psoriasis patient population using the validated self-administered psoriasis area and severity index (SAPASI). This population consisted of 578 university dermatology clinic psoriasis patients, and data were analyzed from 317 (55%) questionnaire respondents. The majority of our sample was women (57%), and non-Caucasians represented a larger portion (8 %) in our sample compared with some previous studies. In our population, the reported frequencies of skin and joint symptoms were as follows: pruritus (95 %), skin burning (81 %), joint pain (69%), arthritis (51%), and psoriatic arthritis (20%). The SAPASI was significantly associated with severity of pruritus, burning, joint pain, and psoriatic arthritis. There was a significant negative correlation between the number of treatments employed and the SAPASI. This study provides results of a detailed measurement of the severity of psoriasis in a psoriasis patient population and relates this severity to population characteristics.

The self-administered psoriasis area and severity index (SAPASI) is a structured instrument for measuring the severity of psoriasis. This study examines the validity, reliability, and responsiveness of the SAPASI. Trained personnel performed a psoriasis area and severity index (PASI) assessment on the same day a SAPASI was obtained from 80 subjects. The validity of the SAPASI was demonstrated using the PASI as the standard (r2 = 0.59, p = 0.0001). Significant correlations were found between SAPASI and PASI for body surface area (r = 0.62-0.75), erythema (r = 0.39), induration (r = 0.24) and scale (r = 0.38). Test-retest reliability was assessed in 19 subjects with repeated evaluations within 2 d. Correlations between the first and second SAPASI scores (r = 0.82) were highly significant (p = 0.0001). Inter-rater reliability of SAPASI body surface area measurements among five raters was very high (intraclass correlation coefficient R = 0.953). The SAPASI was responsive to changes in severity over time as demonstrated by correlation with changes in PASI scores (r = 0.63, p = 0.0002). We conclude that this structured patient self-report instrument facilitates quantitative assessment of psoriasis.

To establish a direct link between IL-8 and inflammation in vivo, we first isolated the gene encoding rhesus macaque IL-8. The open reading frame directs the translation of a 101 amino acid (aa) precursor, which is 94% identical to human IL-8. Rhesus IL-8 was expressed in bacteria and purified to homogeneity with ion-exchange chromatography. Pure rhesus IL-8 was biologically active as measured by its ability to bind specifically to either rhesus (Kd = 0.5 nM) or human (Kd = 2 nM) IL-8 receptors and to promote in vitro chemotaxis of rhesus (EC50 = 2 nM) or human neutrophils (EC50 = 4 nM). Moreover, a mouse monoclonal antibody, DM/C7, which neutralizes human IL-8 activity, also recognized and neutralized (IC50 = 0.5-3.0 microgram/ml) rhesus IL-8 in vitro. Systemic administration of DM/C7 completely inhibited the dermal inflammation of rhesus ears induced by the external application of phorbol myristoyl acetate. These observations reveal that rhesus IL-8 is structurally and functionally similar to human IL-8 and suggests that IL-8 plays a prominent role in a primate model of inflammation.

Anticipation of regret for choosing the wrong option may directly affect physicians' choice of treatment. As part of a pilot survey of physician practices for agitated dementia patients, we asked geriatric psychiatrists, primary care physicians, and neurologists to estimate the degree of anticipated regret that they might experience in response to a series of brief case vignettes describing typical treatments and outcomes for agitated dementia patients. Eight written vignettes described physician action (ordering vs. not ordering), type of intervention (haloperidol vs. physical restraints), and outcome of the intervention (adverse patient outcome vs. adverse staff outcome). Regret was measured by using a five-point Likert scale. A full factorial regression model found that "not ordering" actions were associated with more regret than "ordering" actions, regardless of specialty, intervention, or outcome. Also, geriatric psychiatrists, compared with the other physician groups, expressed the least regret for ordering (and the most for not ordering) haloperidol., (Copyright © 1995 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

The Psoriasis Area and Severity Index (PASI) is used by dermatologic investigators to assess psoriasis disease severity. PASI measures are time-consuming and require trained personnel. We developed and evaluated a structured PASI-like instrument for self-measurement of psoriasis disease severity for use in future large-scale epidemiologic studies. The instrument consisted of a silhouette of a body for patients to shade in affected areas and of three modified visual analog scales for recording the redness, thickness, and scaliness of an average lesion. The resulting "patient PASI" score was compared to investigator PASI measurements in 43 patients with mild to severe psoriasis. Patients and investigator also recorded a subjective global severity score. The patient PASI score was highly predictive of the investigator PASI score (r2 = 0.71, p < 0.0001) and the investigator global score (r2 = 0.37, p < 0.0001). The patient global score was also predictive of the investigator PASI (r2 = 0.18, p < 0.0053) and the investigator global score (r2 = 0.10, p < 0.044), but these relationships exhibit wide predicted confidence intervals. Following the initial evaluation by 18.4 +/- 9.1 d of therapy, one-way t tests for paired samples (pre and post) showed significant improvements in the patient PASI (p < 0.003) and investigator PASI (p < 0.05). We conclude that although patients' overall scores may not allow for accurate prediction of clinical disease severity in a single individual, this structured instrument facilitates prediction of psoriasis disease severity in a population.

Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member--of any relation--reduces the risk of entry.

Self-control skills are coping responses that help to organize one's own behavior and to manage cognitive and emotional responses that disrupt ongoing, adaptive behavior. The concept of self-control is applied to the chronically stressful caregiving experience. The present study examined the relationship between caregivers' role-specific burden and their self-control skillfulness. Forty-four caregivers of cognitively impaired spouses were assessed. Demographic characteristics, psychiatric symptomatology, role-specific burden, functional impairment of their spouse, and dispositional self-control skillfulness were measured. Highly skillful caregivers reported lower burden, fewer memory and behavior problems for their care recipient, and fewer psychiatric symptoms than less skilled caregivers. Hierarchical multiple regression analyses revealed that self-control skillfulness was associated with caregiver burden net the effects of covariates including age, education, memory and behavior problems of the care recipient, and caregivers' psychological distress. Results suggest that self-control skills may play an important role in caregiving and may help to explain why some caregivers adapt better than others to their role.

The rat sciatic nerve does not possess a high potential for regeneration through silastic tubes when the interstump nerve gap is greater than 10 mm. In this study, the effect of NGF treatment on regeneration of the rat sciatic nerve in 10- and 15-mm silastic chambers was compared. In addition, regeneration in 15-mm silastic chambers was compared to regeneration in 15-mm semipermeable chambers. Sections of tubing were implanted and filled with NGF or a control solution of cytochrome C (Cyt. C). Tube implants were removed at various postoperative times and regeneration was assessed histologically and behaviorally. NGF treatment promoted regeneration success rate. It enhanced the initial outgrowth of nonneuronal cells and neuronal fibers into the chamber producing more cellular, organized regenerates. At 2 weeks, in 10-mm chambers, NGF-treated regenerates had fourfold more unmyelinated fibers than controls. At 3 weeks, NGF-treated regenerates possessed threefold more myelinated fibers than controls. After 4 weeks all regenerates had similar numbers of myelinated nerves at the chamber's midpoint. This initial "head start" was sustained peripherally as indicated by the earlier return of sensory function (response to a noxious temperature stimulus) in NGF-treated animals. Finally, regeneration success rate in 15-mm semipermeable tubes is greater than that in 15-mm silastic chambers (NGF and Cyt. C). However, regenerates in silastic chambers possessed twofold more myelinated fibers than regenerates in semipermeable chambers. The positive effects of NGF on neural regeneration and recovery of sensory function provide support for the potential use of NGF in treating peripheral nerve injuries.

The role of self-efficacy in the prediction of relapse following alcoholism treatment was examined in a 12-month follow-up evaluation. Self-efficacy was assessed at intake to inpatient treatment and again at discharge. The drinking status of male alcoholics completing treatment then was assessed during six intervals over the course of the posttreatment year. Results indicated a significant increase in self-efficacy from intake to discharge. Additional analyses showed that lower intake self-efficacy ratings were associated with relapse by either 6- or 12-months posttreatment. Discharge self-efficacy, on the other hand, was not related to relapse status at either posttreatment point. A subsequent analysis of the pattern of relapses across the six follow-up intervals was conducted using survival analysis. Results revealed that only intake self-efficacy was predictive of the follow-up interval during which a relapse occurred. Individuals high in self-efficacy at intake showed the greatest resistance to relapse across time. The maintenance of aftercare further reduced the risk of relapse. The results are discussed with respect to self-efficacy theory and the problem of ceiling effects in posttreatment self-efficacy assessments.

To evaluate the factors controlling migration of leukocytes into pulmonary airway epithelium, we determined the biochemical mechanisms responsible for the regulation of intercellular adhesion molecule-1 (ICAM-1) expression on cultured monolayers of human tracheal epithelial cells (HTECs) or SV40 virus-transformed human bronchial epithelial cells (BEAS-2B). Validation experiments with human umbilical vein endothelial cells (HUVECs) demonstrated little detectable ICAM-1 expression on unstimulated cells or on cells incubated with interferon-gamma (IFN-gamma), but HUVEC monolayers responded to interleukin-1 beta (IL-1 beta) or tumor necrosis factor-alpha (TNF-alpha) with significant increases in ICAM-1 and ICAM-1-dependent adherence of polymorphonuclear leukocytes (PMNs). HTEC monolayers also exhibited no significant basal ICAM-1 expression but, in contrast to HUVEC monolayers, had marked increases in ICAM-1 expression and ICAM-1-dependent PMN adherence only after incubation with IFN-gamma (and not after IL-1 beta or TNF-alpha) treatment. BEAS-2B cells also exhibited relatively selective IFN-gamma stimulation of ICAM-1 expression and ICAM-1-dependent PMN adherence but (like late passage HTEC) showed significant basal ICAM-1 expression. Differences in IFN-gamma effect on ICAM-1 levels between HUVEC and HTEC monolayers were not due to differences in number or responsiveness of IFN-gamma receptors, because both cell types exhibited a similar number of receptors and other IFN-gamma-dependent responses of HUVECs remained active. In all analyses, ICAM-1 mRNA levels correlated closely with detection of ICAM-1 on the cell surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-sectional studies have revealed a high prevalence of comorbid psychological problems among geriatric medical patients, a low rate of detection by primary care professionals, and greater psychosocial dysfunction and poorer physical health associated with comorbidity. Less is known about the course and impact of psychiatric comorbidity. Psychiatric status, physical health status, psychosocial functioning, and health care utilization for a sample of geriatric patients (n = 102) were assessed on admission to a medical hospital and again one year later. Results revealed a very stable and high prevalence of comorbid psychological problems, especially depression, a low rate of treatment by mental health professionals, greater physical impairment consistently associated with psychiatric comorbidity, but few health care utilization differences. A closer look at depression revealed that it typically began in late life and did not readily resolve.

The authors examined the sensitivity and specificity of a modified version of the Research Diagnostic Criteria (RDC) for major, minor, and intermittent depressive disorder in 150 elderly male medical inpatients. Four somatic RDC symptoms were replaced with four nonsomatic symptoms. The sensitivity of the modified criteria was 87%, the specificity was 97%, and 96% of patients were correctly classified. Misclassifications were of mildly depressed patients. These results provide empirical support for the use of alternative, nonsomatic depressive symptoms when somatic symptoms are ambiguous indicators of depression.

Three experiments were conducted to evaluate the accuracy of urine ultraviolet fluorescent tests for riboflavin, which has been used as a tracer for medication compliance in several clinical drug trials. Observer accuracy in discriminating riboflavin-positive or negative urine samples was found to vary with the method of observation, dose of riboflavin, observer experience, and time postingestion. The results showed that, while the 5-mg dose used in previous clinical trials was too small to permit reliable assessment of compliance, larger doses of riboflavin could produce nearly 100% accuracy for minimally trained observers who used a matching-to-sample observation procedure. The findings are discussed in terms of the potential clinical and research applications of this type of simple but reliable compliance assessment procedure.

An evaluation of physicians' (medical residents) knowledge revealed that whereas they considered detection and treatment of comorbid depression to be important, they knew few of the diagnostic criteria and etiological factors, rarely screened their patients for depression, and viewed current treatments as only marginally efficacious. Implications for graduate training are discussed.