Assessment of two screening tools to identify psoriatic arthritis in patients with psoriasis.

BACKGROUND: Many patients with psoriasis have undiagnosed psoriatic arthritis. Low specificity is found with many PsA screening tools. A new instrument, the CONTEST questionnaire, was developed utilizing the most discriminative items from existing instruments. OBJECTIVE: The aim of this study was to compare the CONTEST and PEST screening tools. METHODS: People attending secondary care clinics with psoriasis, but not PsA, completed the questionnaires, were assessed for function and quality of life, and had a physical examination. Patients thought to have PsA were compared to those without. The performance of CONTEST and PEST was compared using area under the receiver operating curve (AUC), and sensitivity and specificity at the previously published cut-offs. RESULTS: A total of 451 dermatology patients were approached, 35% were reviewed and 27 (17%, 95% CI 12.3-21.7) had unidentified psoriatic arthritis. The sensitivity and specificity (95% CI) of PEST were 0.60 (0.42-0.78)/0.76 (0.69-0.83) and for CONTEST 0.53 (0.34-0.72)/0.71 (0.63-0.79). The confidence limits for the AUC overlapped (AUC for PEST 0.72 (0.61-0.84), for CONTEST 0.66 (0.54-0.77). CONCLUSIONS: PEST and CONTEST questionnaires performed equally well, with no superiority of the new CONTEST tool.

The pea chloroplast membrane-associated protein, IEP96, is a subunit of acetyl-CoA carboxylase.

Two forms of acetyl-CoA carboxylase (ACCase) have been characterized in pea (Pisum sativum L.) leaves; a heteromeric chloroplast enzyme and a homomeric, presumably cytosolic enzyme. The biotin carboxylase (BC), biotin carboxyl carrier protein (BCCP), and beta-carboxyltransferase (CT) subunits of the plastidial-ACCase have recently been characterized and cloned. To further characterize the carboxyltransferase, an improved assay for CT was developed and used to follow its partial purification. CT activity co-purifies with ACCase activity during gel permeation chromatography. However, upon anion-exchange chromatography or native PAGE, CT separates from the BC and BCCP subunits of plastidial-ACCase and ACCase activity is lost. In addition, it is demonstrated that a previously sequenced pea chloroplast cDNA of unknown function (IEP96) with a predicted molecular weight of 91 kDa encodes the alpha-CT subunit of the MS-ACCase. Antibodies raised against the first 404 amino acids of IEP96 protein detected a polypeptide with molecular weight of 91 kDa that co-eluted during gel permeation chromatography with plastidial CT and ACCase activities. These antibodies also immunoprecipitated the activities of both ACCase and CT with the concomitant precipitation of the beta-CT subunit. Furthermore, antibodies against beta-CT immunoprecipitated the IEP96 protein. Two-dimensional PAGE and DEAE purification of ACCase protein demonstrated that the beta-CT forms a tight association with the IEP96 protein. Pea leaf was fractionated into soluble and membrane fractions and the alpha-CT subunit was primarily associated with the membrane fraction. Together, these data demonstrate that IEP96 is the alpha-CT subunit of pea chloroplast ACCase.

Phosphopantethenylated Precursor Acyl Carrier Protein Is Imported into Spinach (Spinacia oleracea) Chloroplasts.

Acyl carrier protein (ACP) is an essential cofactor of fatty acid synthase. In plants, ACP is synthesized in the cytosol as a larger precursor protein and then is imported into the plastid where it is processed to a smaller mature form. The active form of ACP uses a covalently linked 4[prime]-phosphopantetheine prosthetic group derived from coenzyme A to covalently bind the acyl intermediates during fatty acid synthesis. The prosthetic group is added to ACP by holoACP synthase. This enzyme activity is associated with both the plastidial subcellular fraction and the soluble, or cytoplasmic, fraction. To gain further insight into potential in vivo pathways for the synthesis and maturation of ACP, in this study we examined whether precursor holoACP can be imported by isolated spinach (Spinacia oleracea) chloroplasts. Precursor holoACP containing a [35S]phosphopantetheine prosthetic group was prepared, and the radiolabel was used to demonstrate import of the phosphopantethenylated protein into isolated chloroplasts. In addition, timed chloroplast import assays indicated that in vitro import of the phosphopantethenylated protein is at least as efficient as import of the precursor apoprotein. Evidence was also obtained for a low level turnover of the prosthetic group among endogenous plastidial ACPs when coenzyme A was supplied exogenously.

Client types in different drug abuse treatments: comparisons of follow-up outcomes.

Differences in background characteristics of 1,812 Black and White male opioid addicts were used as the basis for defining profiles of "typical" clients assigned to methadone maintenance (MM), therapeutic community (TC), and outpatient drug-free (DF) programs. The three client types defined by these profiles, especially reflecting variations in criminal history and legal involvement, were compared using a composite outcome measure for drug use, criminality, and employment during the first year posttreatment. There were significant outcome differences among the client types, and the client type with greater criminal involvement had the poorest outcomes. The outcomes of clients in MM, TC, and DF treatments were not significantly different from one another, but they were significantly more favorable than those for clients in outpatient detoxification and a comparison intake-only group. The major finding, however, was the lack of evidence for an optimal match between client types and treatment types leading to better posttreatment outcomes of clients.

Drug use and crime during a four-year posttreatment follow-up.

Follow-up interview data for 1,155 opioid addicts showed that about three-fourths of the sample reported some criminal behavior during a 4-year period after leaving drug abuse treatment. Males had a higher prevalence of "major" crimes (including crimes against persons, robbery, mugging, burglary, theft, or dealing drugs) than did females, while females reported a higher percentage engaged in the so-called "victimless" crimes (primarily based on prostitution or pimping). Criminal behavior was primarily profit-related and strongly associated with drug use, especially opioid drugs. Drug users reported more criminal behavior than nonusers, and criminality and drug use increased and decreased together among persons who showed changes in drug use during the follow-up period.

Drug abuse treatment readmissions and outcomes. Three-year follow-up of DARP patients.

Temporal patterns of drug abuse treatment reentry and other outcome measures were examined over a three-year period based on a national follow-up sample of persons admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969 to 1972. Follow-up treatment modes included methadone maintenance, residence in a therapeutic community, outpatient drug-free treatment, outpatient detoxification treatment, and a comparison group whose members completed intake only and did not return for treatment in the DARP. Treatment readmission patterns were examined in relation to outcome measures for illicit drug use, alcohol use, employment, and criminality over time. The findings showed there were reliable associations between readmission patterns and posttreatment outcomes, which suggested there were beneficial effects of drug abuse treatment.

Treatment re-entry and outcomes of opioid addicts during a four-year follow-up after drug abuse treatment in the United States.

Post-treatment outcome measures during a four-year follow-up period were examined in relation to readmissions to drug abuse treatment. The sample included 1,174 opioid addicts admitted during 1972-1973 to 26 different treatment programmes throughout the United States that participated in the Drug Abuse Reporting Program (DARP). Admissions to methadone maintenance programmes, therapeutic communities, outpatient drug-free treatments, and outpatient detoxification programmes were studied, as well as a comparison group which completed admission procedures but did not return for treatment at the DARP agency. The examination of temporal patterns of treatment and outcome indicators presenting drug use, criminality, and productive activities during the four-year follow-up period showed that there were beneficial effects associated with treatment.

Treatment histories of clients treated for drug abuse.

History of drug abuse treatments was examined for clients included in a national follow-up study based on admissions to the Drug Abuse Reporting Program (DARP) during 1969-1972. Clients were sampled from DARP methadone maintenance, therapeutic community, outpatient drug-free, and outpatient detoxification programs, as well as an intake only comparison group. Pre-DARP treatment was reported by 40% of the total sample, with detoxification being the most common. Treatments in the first three years after DARP were reported by 51%, with methadone maintenance being the most common. There was an overall trend toward methadone maintenance as the predominant treatment after DARP regardless of the type of treatment a client received in the DARP, and approximately one-third of the total sample reported no other treatments either before or after DARP.

Follow-up evaluation of treatment of drug abuse during 1969 to 1972.

A sample of 3,131 persons from approximately 25,000 admitted to drug abuse treatment programs in the Drug Abuse Reporting Program during 1969-1972 were followed up in 1975-1976. Treatment groups included methadone hydrochloride maintenance, therapeutic community, outpatient drug free, outpatient detoxification, and a comparison group that completed intake but did not enter treatment. Outcome criterion measures (drug use, employment, criminality, and treatment readmissions) based on the first year after treatment were more favorable in the methadone maintenance, therapeutic community, and outpatient drug-free groups than in the outpatient detoxification and intake-only groups. Evaluation of differential outcomes and their relationships with pretreatment and during-treatment measures within each group indicated that pretreatment criminal history, during-treatment performance, and length of time in treatment were significantly related to posttreatment outcomes.

Illicit drug use and return to treatment: follow-up study of treatment admissions to DARP during 1969-1971.

The present study was based on follow-up data on 1,409 persons interviewed 4 to 6 years after admission to drug treatments in the Drug Abuse Reporting Program (DARP). The admissions to DARP occurred in 1969-1971, and for most persons the follow-up data included 3 or more years after termination of DARP treatment. The focus of this study was on illicit drug use of former DARP clients, taking into account if and when they reentered drug treatment after termination of DARP treatment. The results showed that a significant drop in opioid and nonopioid (but not marijuana) drug use generally occurred upon entry into other, post-DARP treatments, and that these beneficial effects of treatment tended to continue beyond the end of treatment. Overall, 42% of the sample had no further drug treatment during the first 3 years after DARP, and almost half (42%) of this group used no opioid or nonopioid drugs at all during this time. Comparisons between DARP treatment groups also indicated that therapeutic community clients had the lowest rate of return to post-DARP treatments.

A national follow-up study to evaluate the effectiveness of drug abuse treatment: a report on cohort 1 of the DARP five years later.

Preliminary findings for the first cohort of a national follow-up study of drug users admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969-1971 are reported. From a sample of 1,853 selected for follow-up, 87% were located and interviews were completed for 77%. Gross tabulations are shown comparing several outcome measures based on pre-DARP treatment, the posttreatment period, and for the 2 months before interview. Sixty-one percent of all patients returned to treatment at some time after DARP termination. Decreases in drug use, expecially of opioids, were substantial and were generally accompanied by improvements in other outcome measures as well. Plans for more detailed and informative analysis of these and related DARP data are addressed.