The Liver in Systemic Lupus Erythematosus

A 12-month prospective study was undertaken to determine prevalenceand causes of clinical and subclinical liver disease in 260SLE patients and 100 controls, and to look for concordance between‘unexplained’ enzyme elevations and SLE activity.Hepatic status was assessed clini cally and by tests of liverfunction with additional tests where indicated. In 76 per centof patients there were no clinical or laboratory abnormalities.Liver enzyme elevations occurred in 23 per cent. In 15 per centthere were identifiable causes, and in 8 per cent the elevationswere ‘unexplained’, compared with none in the controls.Four patients had persistent ‘unexplained’ mildtransaminase elevations. Liver tissue available from 14 patientsrevealed no serious lesions. Data on 156 patients with morethan four assessments were analysed. In 12 of 15 patients with‘unexplained’ transaminase elevations, changes inSGPT levels were concordant with SLE activity. This study suggeststhat subclinical liver disease is a manifestation of SLE.     

Attachment disorders and disorganized attachment: Similar and different<noteref rid=n1>1</noteref>

Abstract

Parental mental representations of the child have been described in the clinical literature as potentially useful risk-indicators for the intergenerational transmission of violent trauma. This study explored factors associated with the quality and content of maternal mental representations of her child and relationship with her child within an inner-city sample of referred, traumatized mothers. Specifically, it examined factors that have been hypothesized to support versus interfere with maternal self- and mutual-regulation of affect: posttraumatic stress disorder (PTSD) and maternal reflective functioning (RF). More severe PTSD, irrespective of level of RF, was significantly associated with the distorted classification of non-balanced mental representations on the Working Model of the Child Interview (WMCI) within this traumatized sample. Higher Levels of RF, irrespective of PTSD severity, were significantly associated with the balanced classification of maternal mental representations on the WMCI. Level of maternal reflective functioning and severity of PTSD were not significantly correlated in this sample. Clinical implications are discussed.     

Creating a Science of Homelessness During the Reagan Era

Policy Points:

• A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States.
• These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness.
• This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net.

Context

A decade after the nation''s Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences’ role in the policy response to homelessness and how politics has shaped the federal research agenda.

Methods

Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness.

Findings

Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group''s health care needs. The Reagan administration''s opposition to funding “social research,” together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services.

Conclusions

The NIMH''s homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration''s policies and reflecting social and behavioral scientists’ long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.     

The pattern of food hypersensitivity in patients with onset after 10 years of age

One hundred and twelve patients with a history of immediate adverse reaction after food ingestion and positive skin test to food are presented with the result of food challenge. In all patients the symptoms started after 10 years of age; most presented with recurrent short-lasting urticarial rash, often accompanied by rhinitis. In the majority of the patients, skin tests were positive to multiple food allergens, but 67% of these responded to oral provocation by only one allergen. One-third of the patients had a history of allergic symptoms following exercise after meals, but in only one-third of these symptoms were reproducible in the laboratory. Fruit and vegetables were the main allergens responsible for food hypersensitivity. Food allergy can develop after the first 10 years of life. Fruit and vegetables are the main cause of food allergy in these patients, while milk and egg are the least common. These findings differ from those in early childhood where milk and eggs are the main allergens.     

Utility of subjective-effects measurements in assessing abuse liability of drugs in humans

Estimates of the likelihood that a drug will be abused have generally been based on the subjective effects engendered by that drug. With the development of standardized subjective effects questionnaires in the 1960s and 1970s, researchers have been able to carefully evaluate self-reported effects of drugs, generally making measures before and repeatedly after administration of a single dose of drug. The use of multiple doses under controlled laboratory conditions in which physiological measures are also taken, and both the investigator and the subject are blind to the dose administered, has been suggested as most likely to yield useful data about the abuse liability of a test compound. Although questions remain about the specific subjective effects measures to be used, there has been general agreement among researchers in this area that scores on scales from the Profile of Mood States, Addiction Research Center Inventory, and Visual Analog Scales which include measures of “high” or liking' all provide predictive utility. The addition of a measure of actual drug-taking to this predictive model appears to provide important information about the conditions under which these two behaviors (self-reported effects and drug self-administration) vary, and strengthens the model substantially.     

Family handedness in three generations predicted by the right shift theory

The hand preferences of Open University (OU) students and their relatives, including children, are described. As in earlier series, estimates of heritability are higher for mothers than fathers. There is no evidence of smaller heritability for paternal than maternal grandparents. The distribution of left-handedness in families is examined in the light of predictions of the right shift theory and on the assumption that the shift depends on a single gene. Good agreement is found between the observed and expected numbers of R x R, L x R and L x L families. Predictions are successful for both strict and generous criteria of sinistrality. Generation differences are found between OU students and their parents and between the students and their children. These are discussed from the viewpoint of a possible heterozygote advantage in intelligence. The higher proportion of sinistral children born to sinistral mothers than fathers can be partly accounted for by supposing that the right shift is more effective in females than males.