Dyspepsia consulters and patterns of management: a population-based study.

BACKGROUND: Although dyspepsia is common, management patterns in the United States are unknown. AIM: To determine the pattern of dyspepsia evaluation and treatment over 20 years in a population-based cohort, and test the hypothesis that the management was influenced by dyspepsia subgroup and gender. METHODS: The validated Bowel Disease Questionnaire was mailed to a random sample of Olmsted County, Minnesota residents (1988-1990). Of the 835 survey respondents, 213 subjects were identified as having dyspepsia according to Rome I Criteria. The medical chart of each dyspeptic subject who had not denied research authorization (n = 206) was reviewed to identify all episodes of care for dyspepsia symptoms 10 years before and 10 years after the date the Bowel Disease Questionnaire was completed. Of these 206 subjects (mean age 47 years, 48% female), 34% had ulcer-like dyspepsia, 32% had dysmotility-like dyspepsia, and 37% had reflux-like dyspepsia. RESULTS: Nearly half (n = 98, 48%) had episodes of care for dyspepsia symptoms over 20 years. Of these 98 subjects, 49% had upper gastrointestinal endoscopy, 4% motility studies and 12% were tested for Helicobacter pylori. At the first visit of the episode of care closest to Bowel Disease Questionnaire completion, 72% were seen in primary care, 16% in emergency medicine and 2% in gastroenterology. In addition, 13% were referred to gastroenterology clinic within this episode. During the study period, 70% were given an 'acid' diagnosis, 7% a 'motility' diagnosis and 54% a 'functional' diagnosis; 78% received acid suppression agents (28% proton pump inhibitors), 18% psychotropic agents and 7% prokinetic agents. No significant association was found between gender and test usage, specialty referral or type of treatment, although women were three times less likely to receive proton pump inhibitors (odds ratio 3.3, 95% CI: 1.2-9.1). Symptom severity, frequency and pattern were risk factors for health care seeking in dyspepsia. CONCLUSIONS: Delivery of care for dyspepsia was similar among dyspepsia subgroups and in men and women.

Entitlement in codependency: developmental and therapeutic considerations.

The purpose of this article is to explore the way in which narcissism is manifest within codependent individuals. Although codependent clients present themselves as needy, self-effacing, and overly deferent to others, many of their behavior patterns are actually a manifestation of a subtle form of narcissistic entitlement. Codependents see others as extensions of themselves, rather than as individuals in their own right, and frequently have unrealistic expectations about their relationships. Successful treatment must include an understanding of the developmental underpinnings of their symptoms. Effective psychotherapy also involves maintaining a difficult balance-holding out the expectation of mature adult functioning while simultaneously understanding and accepting clients' initial inability to relate in such a fashion.

Assessing the acquisition of incidental information by secondary-age students with mental retardation: comparison of response prompting strategies.

The effectiveness and efficiency of four response prompting conditions (progressive time delay, progressive time delay with a descriptive consequent event, system of least prompts, and system of least prompts with a descriptive consequent event) were compared. Students with moderate to severe mental retardation were taught to read functional recipe words. Maintenance and students' acquisition of incidental information were assessed when it was (a) embedded in the prompts of the system of least prompts procedure, (b) included in the descriptive praise statements following correct performance with the progressive time delay and system of least prompts procedures, and (c) not presented. A multiple probe design across behaviors, replicated across subjects, was used. Results indicated that (a) each of the procedures produced criterion level responding: (b) efficiency data on traditional measures were roughly equal; (c) maintenance checks showed no differential effects related to the instructional condition; and (d) incidental information was acquired, although it was not directly targeted for instruction.