The frequency of vitamin D deficiency in adults with Crohn's disease.

Background: Vitamin D deficiency is a putative, pathogenic cofactor in the increase in osteopenia and osteoporosis seen in patients with Crohn's disease.

Objective: To determine the frequency of low serum 25-hydroxy-vitamin D3 (25-OHD) levels and the associated alterations in bone mineral density in a cohort of adults with Crohn's disease.

Methods: 25-OHD levels were determined in 242 consecutive patients with Crohn's disease seen in two tertiary inflammatory bowel disease referral centres.

The Canadian C-spine rule performs better than unstructured physician judgment.

Study Objectives: We compare the predictive accuracy of emergency physicians' unstructured clinical judgment to the Canadian C-Spine rule.

Methods: This prospective multicenter cohort study was conducted at 10 Canadian urban academic emergency departments. Included in the study were alert, stable, adult patients with a Glasgow Coma Scale score of 15 and trauma to the head or neck.

Continuity of care and clinical effectiveness: treatment of posttraumatic stress disorder in the Department of Veterans Affairs.

Evaluation of the quality of outpatient treatment for patients with severe psychiatric or addictive disorders has often focused on the assessment of continuity of care (COC) as measured with administrative data. However, there has been little empirical evaluation of the relationship of measures of COC and treatment outcomes. This study used hierarchical linear modeling to examine the relationship between 6 indicators of COC and 6 outcome measures in a multisite monitoring effort for veterans with war-related posttraumatic stress disorder.

Managerial and environmental factors in the continuity of mental health care across institutions.

Objective: The authors examined the association of continuity of care with factors assumed to be under the control of health care administrators and environmental factors not under managerial control.

Methods: The authors used a facility-level administrative data set for 139 Department of Veterans Affairs medical centers over a six-year period and supplemental data on environmental factors to conduct two types of analysis. First, simple correlations were used to examine bivariate associations between eight continuity-of-care measures and nine measures of the institutional environment and the social context.

A population- and family-based study of Canadian families reveals association of HLA DRB1*0103 with colonic involvement in inflammatory bowel disease.

The aim of this study was to identify major histocompatibility complex alleles associated with the development and clinical features of inflammatory bowel disease (IBD). Genotyping at the human leukocyte antigen (HLA) DRB1 and DQB1 loci was performed on individuals from 118 Caucasian IBD sibling pair families and on 216 healthy controls. Both population- and family-based association tests were used to analyze data obtained on the entire study population and on clinical subgroups stratified by diagnosis, ethnicity, and disease distribution.

Familial aggregation of diabetes and hypertension in a case-control study of colorectal neoplasia.

Familial aggregation of diseases potentially associated with metabolic syndrome (diabetes mellitus, hypertension, and cardiovascular diseases) was assessed in a colonoscopy-based case-control study of colorectal neoplasia in Toronto and Ottawa, Canada, in 1993-1996. Each familial disease was analyzed by logistic regression using generalized estimating equations. Case probands had incident adenomatous polyps (n = 172) or incident (n = 25) or prevalent (n = 132) colorectal cancer (CRC), while control probands (n = 282) had a negative colonoscopy and no history of CRC or polyps.

Internet resources for occupational and environmental health professionals.

The Internet's global reach offers new powerful tools to professionals in Occupational and Environmental Health (OEH). The World Wide Web includes extensive free and commercially available reference materials on toxicology, regulatory issues, environmental epidemiology and prevention programs. Much of this especially useful content is inaccessible to general Web-based search engines.

Real-time, high-definition, three-dimensional microscopy for evaluating problematic cervical Papanicolaou smears classified as atypical squamous cells of undetermined significance.

Background: The perceived inadequacies of the cervical Papanicolaou (Pap) smear have been attributed to sampling, screening, or interpretive errors. Within this type of cytologic preparation, there are thick cell clusters in which the cells are obscured. It may not possible to evaluate these areas by conventional microscopy.

Somatostatin-28 regulates GLP-1 secretion via somatostatin receptor subtype 5 in rat intestinal cultures.

Five somatostatin receptors (SSTRs) bind somatostatin-14 (S-14) and somatostatin-28 (S-28), but SSTR5 has the highest affinity for S-28. To determine whether S-28 acting through SSTR5 mediates inhibition of glucagon-like peptide-1 (GLP-1), fetal rat intestinal cell cultures were treated with somatostatin analogs with relatively high specificity for SSTRs 2-5. S-28 dose-dependently inhibited GLP-1 secretion stimulated by gastrin-releasing peptide more potently than S-14 (EC(50) 0.

Prolonged gastrointestinal transit in a patient with a glucagon-like peptide (GLP)-1- and -2-producing neuroendocrine tumor.

Neuroendocrine tumors overexpressing the proglucagon- derived peptides have been associated with severe constipation. The relationship between two of the intestinal proglucagon-derived peptides, glucagon-like peptide (GLP)-1 and -2, and delayed gastrointestinal transit, was characterized in a patient with a neuroendocrine proglucagon-derived peptide tumor. A 60-yr-old female presented with intractable constipation and intermittent vomiting.

Combined budesonide and antibiotic therapy for active Crohn's disease: a randomized controlled trial.

Background & Aims: Although antibiotics are frequently used to treat Crohn's disease, this practice is not supported by strong evidence from randomized trials.

Methods: We conducted a double-blind multicenter study of patients with active Crohn's disease of the ileum, right colon, or both. Patients were randomized to receive oral ciprofloxacin and metronidazole, both 500 mg twice daily, or placebo for 8 weeks.

Bone mineral density in Crohn's disease: a longitudinal study of budesonide, prednisone, and nonsteroid therapy.

Objective: Corticosteroids may contribute to the bone loss associated with Crohn's disease (CD). We investigated the effect on bone mineral density (BMD) of treatment with budesonide, a steroid with low systemic activity, and compared the outcome with prednisone and nonsteroid therapy in patients with CD.

Methods: Prospective annual BMDs of the lumbar spine (LS) and femoral neck (FN) were measured for 2 yr in 138 patients with quiescent CD treated with mean daily doses of 8.

Internet resources for occupational and environmental health professionals.

The Internet = s global reach offers new powerful tools to professionals in Occupational and Environmental Health (OEH). The World Wide Web includes extensive free and commercially available reference materials on toxicology, regulatory issues, environmental epidemiology and prevention programs. Much of this especially useful content is inaccessible to general Web-based search engines.

Continuity of care and clinical effectiveness: outcomes following residential treatment for severe substance abuse.

Background: Continuity of care (COC) has often been viewed as a crucial indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, the relationship between COC and clinical outcomes has received little empirical evaluation.

Research Design: This study used hierarchical linear modeling to examine the relationship between six indicators of COC and seven outcome measures addressing symptoms, substance abuse, and social functioning.

Solution-focused therapy. Counseling model for busy family physicians.

Objective: To provide family doctors in busy office practices with a model for counseling compatible with patient-centred medicine, including the techniques, strategies, and questions necessary for implementation.

Quality Of Evidence: The MEDLINE database was searched from 1984 to 1999 using the terms psychotherapy in family practice, brief therapy in family practice, solution-focused therapy, and brief psychotherapy. A total of 170 relevant articles were identified; 75 abstracts were retrieved and a similar number of articles read.

Diagnostic misclassification reduces the ability to detect linkage in inflammatory bowel disease genetic studies.

Background: Linkage data have now identified several inflammatory bowel disease (IBD) susceptibility loci but these data have not been consistently replicated in independent studies. One potential explanation for this is the possibility that patients enrolled in such studies may have been erroneously classified with respect to their diagnosis.

Aims: To determine the rate and type of misclassification in a large population of individuals referred for participation in an IBD genetics study and to examine the effect of diagnostic misclassification on the power to detect linkage.

The Canadian C-spine rule for radiography in alert and stable trauma patients.

Context: High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients.

Objective: To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients.

Design: Prospective cohort study conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography.

Pediatric migraine prophylaxis with divalproex.

We followed 23 patients with pediatric migraine, ranging in age from 7 to 17 years, who were treated with preventive divalproex sodium for migraine prophylaxis. Patients were evaluated for the presence or absence of comorbid psychiatric disorders or epilepsy to assess the possible differential effects of divalproex therapy. Doses ranged from 3.

Genetic variation in the 5q31 cytokine gene cluster confers susceptibility to Crohn disease.

Linkage disequilibrium (LD) mapping provides a powerful method for fine-structure localization of rare disease genes, but has not yet been widely applied to common disease. We sought to design a systematic approach for LD mapping and apply it to the localization of a gene (IBD5) conferring susceptibility to Crohn disease. The key issues are: (i) to detect a significant LD signal (ii) to rigorously bound the critical region and (iii) to identify the causal genetic variant within this region.