Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.

Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes.

The dimensional structure of the SCL-90, a multidimensional self-report symptom inventory, was subjected to a con6rmatory empirical test with a sample of 1,002 psychiatric outpatients. A variation of factor analytic method termed a "Procrustes procedure" was utilized to compare the hypothesized nine-dimensional clinical-rational structure with the dimensional structure developed empirically. The hpothetical vs. empirical match was judged to be very good for eight of the nine hmensions, and moderate on the ninth and thereby makes a substantive contribution to the construct validity of the instrument.With regard t o the validation of psychological tests, most investigators recognize that construct validation is the most difficult and demanding form of validity to achieve. Guion (1974) has written, "Construct validity is not expressible in such simple terms as validity coefficients; it is a judgment based on many kinds of information: procedures followed in developing the test, results of experiments testing specific implications of the construct, and patterns of correlations with other measures [p. 2891." Beyond the issue of complexity, Messick (1975) has argued recently that construct validation should be viewed as the principal method of deriving meaning for our measures, "discussion of the meaning of a measure should center on the concept of validity and, specifically, on the coiicept of construct validity, for that is the evidential basis for inferring a measures's meaning [p. 9551."Thus, construct validation is deemed both complex and essential; its programmatic requirements create the impression of something of a psychometric decathalon. Investigations and exercises that demonstrate various aspects of domain sampling, convergent and discriminant correlations, multi-method trait assessments, and a spectrum of predictive, criterion-oriented evaluations must all be accomplished to demonstrate that, in fact, measurement operations are indicative of the underlying construct purported to exist. In addition, empirical findings derived from such procedures must coincide with the nomological network of relationships deducible from whatever theory surrounds the construct.

Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

Context.-Intensive treatment of type 1 diabetes results in greater weight gain than conventional treatment. Objective.-To determine the effect of this weight gain on lipid levels and blood pressure. Design.-Randomized controlled trial; ancillary study of the Diabetes Control and Complications Trial (DCCT). Setting.-Twenty-one clinical centers. Participants.-The 1168 subjects enrolled in DCCT with type 1 diabetes who were aged 18 years or older at baseline. Intervention.-Randomized to receive either intensive (n = 586) or conventional (n = 582) diabetes treatment with a mean follow-up of 6.1 years. Main Outcome Measures.-Plasma lipid levels and blood pressure in each treatment group categorized by quartile of weight gain. Results.-With intensive treatment, subjects in the fourth quartile of weight gain had the highest body mass index (BMI) (a measure of weight adjusted for height), blood pressure, and levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B compared with the other weight gain quartiles with the greatest difference seen when compared with the first quartile (mean values for the highest and lowest quartiles: BMI, 31 vs 24 kg/m 2 ; blood pressure, 120/77 mm Hg vs 113/73 mm Hg; triglyceride, 0.99 mmol/L vs 0.79 mmol/L [88 mg/dL vs 70 mg/dL]; LDL-C, 3.15 mmol/L vs 2.74 mmol/L [122 mg/dL vs 106 mg/dL]; and apolipoprotein B, 0.89 g/L vs 0.78 g/L; all PϽ.001). In addition, the fourth quartile group had a higher waist-to-hip ratio; more cholesterol in the very low density lipoprotein, intermediate dense lipoprotein, and dense LDL fractions; and lower high-density lipoprotein cholesterol and apolipoprotein A-I levels compared with the first quartile. Baseline characteristics were not different between the first and fourth quartiles of weight gain with intensive therapy except for a higher hemoglobin A 1c in the fourth quartile. Weight gain with conventional therapy resulted in smaller increases in BMI, lipids, and systolic blood pressure. Conclusions.-The changes in lipid levels and blood pressure that occur with excessive weight gain with intensive therapy are similar to those seen in the insulin resistance syndrome and may increase the risk of coronary artery disease in this subset of subjects with time.