Harvey Bunce

Proteinuria and hematuria in schoolchildren: Epidemiology and early natural history†

Over the past several decades screening for disease in large asymptomatic populations has increased, culminating most recently with a federal mandate for early, periodic screening, diagnosis and treatment of all children from low-income families. The present study of five consecutive examinations in over 12,000 schoolchildren shows the cumulative occurrence of proteinuria and hematuria to be surprisingly high (greater than 6%). Comparison of this large number of children with the few individuals in whom death occurs from chronic renal disease annually (less than 0.03%) suggests that the vast majority of these children with urinary abnormalities have either no renal disease or at most a self-limited condition. Observation of 512 children with proteinuria and 78 with hematuria for one to five years after initial detection and referral to their physician or clinic provides a measure of both contemporary management and early natural history. These observations suggest that there is a need to question the overall effectiveness of urinary screening and that early inclusion of roentgenographic and urologic investigations in management seems unwarranted. Rather, these children should be followed for long periods of time. Additional investigations are indicated when worsening of the abnormal findings or other evidence of renal or systemic disease occurs. If routine urinary screening is performed, it should be as one aspect of a multiphasic program by the primary physician so that it can be coupled with a clearly defined plan for follow-up and management of subjects with abnormal findings.

Comparing survival of responders and nonresponders after treatment: A potential source of confusion in interpreting cancer clinical trials

The comparison of survival distributions between patients who respond to therapy and those who do not can present methodologic and interpretational difficulties. Since assignment of patients to the responder or nonresponder groups is not random, statistical procedures that test the equality of survival distributions only demonstrate association between response and survival, not cause and effect. This association may have no relevance to the efficacy of treatment. The assignment of patients to response categories also represents a methodologic problem. Variability in the definition of a nonresponder and the handling of early deaths can both lead to varying conclusions concerning survival. In spite of these problems, statistical comparisons of survival distributions of responders and nonresponders are reported in approximately 20% of phase II and phase III clinical trials. Descriptive statistics may be more useful than inferential statistics in this situation.

Assessment of Type A Behavior in Preschoolers

Teachers and mothers of 219 four-year-old preschoolers assessed their children for Type A behavior pattern using the Matthews Youth Test for Health (MYTH). The sample was derived from five day care centers with Black, White, and Hispanic teachers and students from middle and lower class families. This study indicates that Type A behavior can be identified in four-year-old preschoolers on the basis of ratings by their teachers. A statistically significant difference was found between the ratings of Type A/B characteristics by teachers and those by mothers; however, these were not related to the sex or ethnicity of the children. Repeated measurements of Type A ratings in a subsample of the children at age five showed no significant change among boys or girls. However, repeated measurements at age six on a second subsample showed that boys had lower mean scores, i.e. were more Type B at age six than at age four.

CORRELATIONS OF THE MYERS-BRIGGS TYPE INDICATOR WITH OTHER PERSONALITY AND ACHIEVEMENT VARIABLES

This study determined correlations among the four scales of the Myers-Briggs Type Indicator and among these and other personality and achievement variables, and predictors of academic performance from personality and aptitude variables. 98 physician assistants and 61 pediatric nurse practitioners completed the Internal-External Locus of Control Scale, Intolerance of Ambiguity Scale, and Myers-Briggs Type Indicator on admission to and graduation from their respective programs. The Otis-Lennon Mental Ability Test and Nelson-Denny Reading Test were also given at admission to the physician assistant program. Grades at admission and graduation were available for both groups, and certifying examination scores were available for physician assistants who reported their scores. IQ, college science grades, and reading-rate predicted final grades at the end of the program and performance on the certifying examination for physician assistants. The Internal-External Locus of Control Scale and Intolerance of Ambiguity Scale predicted final grades at graduation for nurse practitioners.

Utilization of community mental health services in a Texas-Mexico border city

Abstract Previous research has documented substantial, underrepresentation of Mexican American clients in mental health facilities. Three major hypotheses have been proposed in the literature to account for their underutilization: (1) Mexican Americans have less need for services; (2) Mexican Americans use alternative treatment modes; and (3) there exists barriers to the utilization of these services by Mexican .Americans. The present study examines the utilization of a community mental health center in a predominantly Mexican American city where the effects of the identified barriers (language, social class. and cultural differences between client and therapist as well as economic barriers) are diminished. Findings of the present study indicate that under these conditions, Mexican Americans did achieve their expected utilization. An analysis of the marital status, employment status, income, age, and educational level of the clients is reported by ethnicity and sex. Major differences between Mexican American and Anglo American clients were socioeconomic in nature.

Variability of Water Urethral Closure Pressure Profiles

Water urethral closure pressure profiles were evaluated in 66 women for reproducibility between sequential studies in patients and 3 observers.