Gastroduodenal intussusception due to Peutz-Jeghers syndrome in infancy

A case of Peutz-Jeghers Syndrome (PJS) presenting in infancy with gastric-outlet obstruction is described. PJS may become symptomatic at any age and should be suspected when there are obstructive symptoms or gastrointestinal blood loss in a baby with a positive family history. Contrast studies and endoscopy are useful in diagnosis and surveillance. Treatment requires a combination of endoscopy and laparotomy/laparoscopy. Because of the reported cancer risk, we recommend surveillance from the age of diagnosis.

Psychometric evaluation of the 12-item Well-being Questionnaire for use with people with macular disease

This paper reports the evaluation of a generic measure of psychological well-being, the 12-item Well-being Questionnaire (W-BQ12), for use with people who have the chronic eye condition, macular disease (MD). The W-BQ12 was incorporated in a self-administered questionnaire which was completed by 1421 members of the Macular Disease Society (MD Society). Unforced factor analysis elicited the expected three factors representing constructs of positive well-being, energy and negative well-being. A forced single-factor solution supported use of the whole scale to measure total general well-being. High Cronbach's alpha coefficients demonstrated good internal consistency reliability in the entire scale (alpha = 0.87) and in subscales (alpha > 0.78). The factor structure matched that found in samples of people with diabetes for whom the W-BQ12 was first developed, indicating construct validity. Expected subgroup differences in the MD sample indicated significantly poorer well-being in women than in men and also in participants who were registered blind or partially sighted compared to those who were not registered. The W-BQ12 will be useful in measuring outcomes in rehabilitative and medical interventions and in researching factors affecting adjustment to MD.

Measurements of cosmic-ray low-energy antiproton and proton spectra in a transient period of solar field reversal

The energy spectra of cosmic-ray low-energy antiprotons ( *p's) and protons ( p's) have been measured by BESS in 1999 and 2000, during a period covering reversal at the solar magnetic field. Based on these measurements, a sudden increase of the *p/p flux ratio following the solar magnetic field reversal was observed, and it generally agrees with a drift model of the solar modulation.

Measurement of inclusive antiprotons from Au+Au collisions at square root of s(NN) = 130 GeV

We report the first measurement of inclusive antiproton production at midrapidity in Au+Au collisions at square root of s(NN) = 130 GeV by the STAR experiment at RHIC. The antiproton transverse mass distributions in the measured transverse momentum range of 0.25<p( perpendicular)<0.95 GeV/c are found to fall less steeply for more central collisions. The extrapolated antiproton rapidity density is found to scale approximately with the negative hadron multiplicity density.

d Macro and (3)He macro production in square root of s(NN) = 130 GeV Au+Au collisions

The first measurements of light antinucleus production in Au+Au collisions at the Relativistic Heavy-Ion Collider are reported. The observed production rates for d macro and (3)He macro are much larger than in lower energy nucleus-nucleus collisions. A coalescence model analysis of the yields indicates that there is little or no increase in the antinucleon freeze-out volume compared to collisions at CERN SPS energy. These analyses also indicate that the (3)He macro freeze-out volume is smaller than the d macro freeze-out volume.

The effect of the Gly16Arg polymorphism of the beta(2)-adrenergic receptor gene on plasma free fatty acid levels is modulated by physical activity

The lipolytic effects of catecholamines are mediated through members of the beta(2)-adrenergic receptor (BAR-2) family. Previous studies have suggested that genetic variants in the BAR-2 gene may be associated with obesity in some populations. To our knowledge, no studies have directly examined the effects of this polymorphism on circulating nonesterified fatty acid (NEFA) levels. To explore this issue further, a cohort of 604 Caucasian individuals (aged 40-65 yr) was genotyped for a common polymorphism in the BAR-2 gene (Gly16Arg), and the relationships between genotype, body mass index (BMI), NEFA, and lipid levels were examined. Women bearing the Arg16 allele had higher BMI values (P < 0.01) than Gly16Gly women. Women carriers of the Arg16Arg genotype had lower fasting plasma NEFAs (P < 0.01) and greater suppression of NEFAs (P < 0.01) after an oral glucose load than women bearing the Gly16 allele. In multivariate analysis after adjustment for age, sex, and smoking status, the interaction between the BAR-2 genotype and BMI in determining fasting NEFA concentrations was statistically significant (P < 0.05). The availability of objective measures of total energy expenditure in this population permitted the further examination of interactions, particularly that between genotype and physical activity. In the population as a whole, after adjustment for confounding by age, smoking, and BMI, the effect of the Arg16Arg genotype on the suppression of NEFA levels was modified by physical activity level (P for interaction <0.05). These data suggest the existence in this population of a gene-physical activity interaction on NEFA levels.

Administering cognitive-behavioral therapy for bulimia nervosa via telemedicine in rural settings

OBJECTIVE

This report describes the therapy of 2 women with bulimia nervosa who were treated using cognitive-behavioral therapy delivered via telemedicine.

METHOD

The telecommunication link was established using a 128-Kbps ISDN switchable data line.

RESULTS

Both cases were treated successfully and were doing well at 1-month follow-up.

DISCUSSION

These cases illustrate that this methodology may make it possible to deliver manual-based psychotherapies to patients with eating disorders in remote areas.

Work in progress. Integrating physicians' services in the home

OBJECTIVE

While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved.

DESIGN

A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont.

SETTING

Home care in London, Ont.

PARTICIPANTS

Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses.

METHOD

In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques.

MAIN FINDINGS

Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success.

CONCLUSION

Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians.