A Barrett's esophagus registry of over 1000 patients from a specialist center highlights greater risk of progression than population-based registries and high risk of low grade dysplasia

Barrett's esophagus (BE) arising from chronic gastro-oesophageal reflux (GERD) is the main pathologic precursor of esophageal adenocarcinoma (EAC). The risk of progression to high-grade dysplasia (HGD) and EAC is unclear, and recent population studies from Denmark and Northern Ireland suggest that this has been overestimated in the past. No data exist from the Republic of Ireland. A detailed clinical, endoscopic, and pathologic database was established in one center as a proposed pilot for a national registry, and initial and follow-up data were abstracted by a data manager. One thousand ninety-three patients were registered, 60 patients with HGD were excluded, leaving 1033, with a median age of 59 and 2 : 1 male to female ratio, and 3599 person-years of follow-up. The overall incidence of HGD/EAC was 1.33% per year overall, 0.85% if the first year is excluded. Within the first year after index endoscopy, 18 cases of HGD or EAC were identified, and 30 following the first year. Low-grade dysplasia (LGD) on index endoscopy was associated with an incidence of progression of 6.5% per year, and 3.1% when tertiary referrals were excluded. These data provide important demographic and clinical information on the population of Irish patients with BE, with incidence rates of progression higher than recently published population-based registry series, perhaps relating to sampling and pathological assessment. Low-grade dysplasia on initial biopsy is a significant proxy marker of risk of progression.

Consumer evaluation of an ecobehavioral program for families with children with developmental disabilities

The purpose of this research was to conduct a consumer evaluation of Project Ecosystems, an in-home ecobehavioral program serving families with children with developmental disabilities. A consumer satisfaction questionnaire was designed and validated to examine process, programmatic outcome, and to assess perception of staff performance across consumer groups. The questionnaires were distributed to parents, careproviders, Regional Center workers who provided the referrals to Project Ecosystems, and other professionals who worked with Project Ecosystems' staff. The questions were divided into process, outcome, and staff performance so each element could be separated in the analysis. The data suggest considerable satisfaction from the consumers of Project Ecosystems' services.

Estrogen reduces cholecystokinin-induced c-Fos expression in the rat brain

Recent reports have shown that estradiol increases the hypophagic effect of exogenous cholecystokinin-octapeptide (CCK). CCK is known to increase the expression of Fos, a marker of neuronal activation, in specific medullary and hypothalamic nuclei. The present experiment tested the hypothesis that as estradiol enhances that behavioral effects of CCK, there is a parallel amplification of CCK-induced Fos expression. Instead, estradiol pretreatment reduced the level of CCK-induced Fos expression in the nucleus of the solitary tract (NTS) and in the medial parvocellular region of the hypothalamic paraventricular nucleus (PVN). The number of Fos-containing cells in the supraoptic nucleus and other regions of the PVN were not affected by estradiol pretreatment. The results are consistent with the hypothesis that the NTS and/or the PVN may mediate the estrogen-induced increased sensitivity to peripheral inhibitory signals in the control of food intake.