Recruitment of RNA polymerase to Class II CRP-dependent promoters is improved by a second upstream-bound CRP molecule.

Genetics and biochemistry have been exploited to investigate transcription activation by the Escherichia coli CRP (cAMP receptor protein) factor at promoters with a DNA site for CRP near position -41 and the effects of a second upstream-bound CRP molecule. We show that the upstream-bound CRP contributes to transcription activation by improving the recruitment of RNA polymerase.

Convergence criteria for scattering models of ultrasonic wave propagation in suspensions of particles.

Scattering models used to simulate the attenuation and phase velocity of an ultrasonic wave propagating through a suspension of particles involve the summation of an infinite series of partial waves. The accuracy of computation is influenced by the number of terms included in the harmonic series, and the number of terms required depends upon the scatterer size compared with wavelength. It is shown that the errors in modelled attenuation and phase velocity resulting from premature truncation can be significant when modelling higher values of particle diameter-frequency product. A useful and simple heuristic is presented, in which the number of terms in the summation of the infinite series needed for satisfactory convergence to a final value is a function of the particle diameter-frequency product and of the compressive wave velocity in the continuous phase.

Hoping and coping in young people who have been sexually abused.

BACKGROUND: Very little research has been conducted on the relationship between sexual abuse, reduced hopefulness and impaired coping. METHOD: The sample consisted of 22 abused young people (2 males (9%) and 20 females (91%)) and 29 nonabused young people (4 males (14%) and 25 females (86%)). Hopefulness, despair, depression, self-esteem, anxiety, number of negative life events and various parent, family and demographic variables were measured. The aim was to establish significant predictors of outcome, with outcome measured at the extreme end of the spectrum by self-injury and suicidal ideation and attempts. RESULTS: Depression predicted hopefulness and despair. Depression, anxiety, number of caregiver changes, despair and global personal hopefulness were significant predictors of outcome. Child sexual abuse itself was not a significant predictor of self-injury, suicidal ideation or suicide attempts in this sample. CONCLUSIONS: Each of the significant predictors of outcome, other than caregiver changes, has been linked to the learned helplessness paradigm. Depression and anxiety may be mediated by despair and hopefulness in their prediction of self-injury and suicidal attempts and ideation. To modify young people's long-term view of their futures and thereby reduce their vulnerability to depression and anxiety and in turn their tendency toward self-injury and suicide, something more than generic casework will be necessary. If self-injury, suicidal ideation and behaviour are to be effectively addressed, it is likely that anxiety and depression will need to be treated vigorously and attention will need to be paid to the perceived future.

Prior childhood sexual abuse in mothers of sexually abused children.

OBJECTIVE: To see if mothers who were sexually abused in their own childhood are at increased risk of their children being sexually abused and to see if prior sexual abuse in mothers affects their parenting abilities. METHOD: Sixty-seven mothers whose children had been sexually abused by others and 65 control mothers were asked about sexual abuse in their own childhood. The sexually abused children of mothers who had been sexually abused in their own childhood were compared with the sexually abused children of mothers who had not suffered child sexual abuse as children. Comparisons were made on self-esteem, depression and behavior in the children. RESULTS: Thirty-four percent of mothers of sexually abused children gave a history of sexual abuse in their own childhoods, compared with 12% of control mothers. Assessment of the sexually abused children for self-esteem, depression and behavior at the time of diagnosis, after 18 months and after 5 years showed no difference in any of these measures at any of the three time intervals between those whose mothers had suffered child sexual abuse and those whose mothers had not been abused. CONCLUSION: In this study, sexual abuse in a mother's own childhood was related to an increased risk of sexual abuse occurring in the next generation, although prior maternal sexual abuse did not effect outcome in children who were sexually abused.

Sexually abused children 5 years after presentation: a case-control study.

OBJECTIVE: A total of 68 sexually abused children and their nonoffending parents were reassessed 5 years after presentation and were compared with a cohort of children of similar age and sex who were not known to have been abused. METHOD: Outcome measures were behavior, depression, self-esteem, anxiety, eating problems, drug use, suicide attempts, self-injury, running away, criminal activity, and attributional style. Recent life events, demographics, family functioning, and mothers' mental health were taken into account when examining outcome. RESULTS: Although the abused children had experienced more negative life events, were from lower socioeconomic groups, had more changes in parent figures, and had mothers who were more psychologically distressed, multiple regression analysis showed that after allowing for these and other demographic factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior, had lower self-esteem, were more depressed or unhappy, and were more anxious than controls. Sexually abused children had significantly higher levels of bingeing, self-injury, and suicide attempts. CONCLUSIONS: It is clear that many children who are sexually abused have ongoing problems. Their ongoing problems may be indicative of false beliefs about themselves and the sexual abuse experience.

Five years after child sexual abuse: persisting dysfunction and problems of prediction.

OBJECTIVE: To assess change in behavior, depression, and self-esteem in sexually abused children after 5 years and to determine which factors predict later functioning. METHOD: Sixty-eight of 84 children and their nonoffending parents were reassessed after 5 years for depression, self-esteem, and behavior problems in the children; parental mental health; and family functioning. RESULTS: There were no significant changes in depression, self-esteem, or behavior over 5 years. Forty-three percent of the children were now sad or depressed, 43% had low self-esteem, and 46% had behavioral dysfunction. While some children improved, a nearly equal number deteriorated, with no clear pattern of change. The only abuse-related variables associated with 5-year functioning were further contact with the abuser, which was significantly associated with depression and self-esteem, and sexual abuse prior to intake, which was related to an increased incidence of behavior problems. Older children showed more depression and lower self-esteem but less behavioral dysfunction. Poor family functioning at 5 years was associated with low self-esteem and behavior problems. Treatment had no effect on depression, self-esteem, or behavior. Multivariate analysis showed that depression and self-esteem at intake were prognostic indicators of 5-year outcome. CONCLUSION: Many sexually abused children have continuing problems with behavior, self-esteem, and depression. Family and abuse-related variables do not appear to be good predictors of outcome, although sexually abused children who are sad or depressed and have low self-esteem at intake are likely to have continuing problems in these areas.

Development of a scale for measuring impaired control over alcohol consumption: a preliminary report.

Impaired control over drinking has occupied a central place in explanations of alcohol dependence since the late 18th century. Despite this key theoretical role, no instrument has been developed to directly assess the construct. This article describes the development of a three-part Impaired Control Scale (ICS), in which Part 1 measures the degree to which a subject has attempted to exercise control over drinking in the past 6 months; Part 2 measures the degree of success in controlling drinking over the past 6 months; and Part 3 measures the subject's belief in his or her ability to control drinking if it were attempted. Psychometric analysis showed that, despite difficulties reported in the literature, impaired control could be measured in a reliable fashion, with satisfactory discriminant and concurrent validity. Preliminary investigation of the relationship between the ICS and elements of the alcohol dependence syndrome suggests that the construct of impaired control is related to, but may be distinguished from, a general factor of alcohol dependence. While more research is needed to replicate these findings and to examine interrelationships among the various parts of the ICS, the scale may have both theoretical and practical value in research and treatment for alcohol dependence and its related problems.

Alcohol cue exposure directed at a goal of moderate drinking.

A novel form of moderation-oriented cue exposure treatment for alcohol dependence is illustrated in a single case study. Formal clinic-based cue exposure following a priming dose of the client's preferred beverage is succeeded by supervised and then unsupervised in vivo practice at resisting continued drinking in tempting situations. Improvements on a range of outcome measures seen up to 12-month follow-up were supported by the results of an analogue measure of desire to drink. The potential place of this form of treatment in the range of services offered to problem drinkers is discussed.

Importance of substance cues in relapse among heroin users: comparison of two methods of investigation.

Ninety-three heroin users in treatment rated the importance to their last relapse to heroin use of the 13 categories and subcategories of reasons for relapse identified by Marlatt and Gordon (1985). These subject ratings were compared with the consensual categorizations of two independent judges who coded subjects' descriptions of the same relapse episodes. The results showed that, when judges categorized subjects' open-ended responses to questions about their last relapse, temptations or urges in the presence of substance cues were accorded no importance as a reason for relapse, and these categorizations were similar in this respect to previously reported findings. In contrast, when subjects themselves directly quantified the importance of the various relapse categories in precipitating their last relapse, substance-related temptations or urges obtained the highest mean rating of all categories.

Australian Aborigines and alcohol: A review.

Following a summary of the relevant historical and legislative background, this article reviews the literature on: (i) rates of alcohol usage and problem drinking in Aboriginal populations; (ii) adverse effects of drinking; (iii) suggested causes of problem drinking among Aborigines; and (iv) treatment and preventive initiatives. The need to examine Aboriginal alcohol use in the wider context of socio-economic deprivation and rapid social change is emphasized. Key issues warranting further research attention are identified and, while recognizing the difficulties inherent in doing so, suggestions are made as to how the quality of research in the area might be raised. It is concluded that, without long-term planning and commitment of the necessary resources by government, little progress will be made in reducing the problems associated with Aboriginal use of alcohol.

Definitions of non-abstinent and abstinent categories in alcoholism treatment outcome classifications: a review and proposal.

Dispute about the relative frequencies of abstinent and non-abstinent outcomes following alcoholism treatment cannot be resolved in the absence of consensually-agreed definitions of such outcome categories. A review of influential outcome studies reveals wide differences in how controlled drinking and even abstinence have been defined and it is reasonable to suppose that this is partly responsible for striking variations in rates reported in the literature. Some requirements of a more satisfactory definitional scheme are described and a proposal made which, if accepted, might help to resolve issues relating to the frequency of non-abstinent outcomes.

Accuracy of diagnostic coding for Medicare patients under the prospective-payment system.

Reimbursement of hospitals by Medicare under the prospective-payment system is based on patients' diagnoses as coded at discharge. During the period October 1984 through March 1985, we studied the accuracy of the coding for diagnosis-related groups (DRGs) in hospitals receiving Medicare reimbursement. We used a two-stage cluster method to sample 7050 medical records from 239 hospitals that were stratified according to size. Using blinded techniques with reliability checks, medical-record specialists reabstracted the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to assign correct DRGs to discharged patients. The correct DRGs were then compared with those originally assigned by the physician and the hospital administration. The study revealed an error rate of 20.8 percent in DRG coding. Errors were distributed equally between physicians and hospitals. Small hospitals had significantly higher error rates. Previous studies had found that errors occurred randomly, so that half the errors benefited the hospital financially and half penalized the hospital. The present study found that a statistically significant 61.7 percent of coding errors favored the hospital. These errors caused the average hospital's case-mix index--a measure of the complexity of illness of the hospital's patients--to increase by 1.9 percent. As a result, hospitals received higher net reimbursement from Medicare than was supportable by the medical records. We conclude that "creep" does occur in the coding of DRGs, resulting in overpayment to hospitals for patients covered by Medicare.