Lesbian expectations and experiences with family doctors. How much does the physician's sex matter to lesbians?

OBJECTIVE: To identify the factors lesbian women find important in selecting a family physician and to describe their attitudes toward the sex of a physician. To determine their attitudes about disclosure of sexual orientation to physicians, their fears upon disclosing, and their actual experiences with disclosure. DESIGN: Anonymous, self-administered, written questionnaire survey of lesbians in the Fraser Valley. SETTING: Lesbian community in the Fraser Valley. PARTICIPANTS: Volunteer responses were obtained from 53 of 125 women attending gay and lesbian dances, on mailing lists of gay and lesbian advocacy groups, and known to me as lesbians. MAIN OUTCOME MEASURES: Demographic variables, attitudes toward family physicians, and experience of disclosing sexual orientation to their physicians. RESULTS: Most participants considered it important to disclose their sexual orientation to their family physicians, and most had. Although some feared lower quality health care upon disclosure, the group as a whole was not particularly concerned about a decrease in quality. Most preferred a female family doctor. While female physicians were more frequently ascribed such characteristics as openness, kindness, and an accepting manner, male physicians were more frequently ascribed such characteristics as intolerance and homophobia. When participants rated their perceptions of their doctors' reactions upon disclosure, however, there was no significant difference between male and female physicians. CONCLUSIONS: Most lesbians want to disclose their sexual orientation to their family physicians. Regardless of their own sex or sexual orientation, family physicians can provide valuable support to their lesbian patients.

A moderate form of hemophilia B is caused by a novel mutation in the protease domain of factor IXVancouver.

A genomic phage library was constructed using lymphocyte DNA from a patient with cross-reacting material-positive, moderately severe hemophilia B. The library was screened by using a full-length factor IX cDNA as a hybridization probe. DNA sequence analysis of the factor IX exons and intron/exon junctions revealed a single point mutation at nucleotide 31,311 of the gene. This mutation occurs in the protease domain of factor IXa and changes the codon for isoleucine 397 (ATA) to a threonine codon (ACA). The resulting abnormal protein has been named factor IXVancouver. Factor IXVancouver was isolated from the patient's plasma by barium citrate adsorption, affinity chromatography on a Ca2+-dependent antibody bound to agarose, and anion-exchange chromatography. On gel electrophoresis, the purified protein exhibited a normal molecular weight and a normal pattern of activation cleavages with bovine factor XIa. Kinetic studies on the purified protein indicated that the Km of factor IXaVancouver for human factor X was 3.4 times higher than that of normal factor IXa. The kcat of factor IXaVancouver was 12.5% of the kcat of normal factor IXa. Structural models of the protease domain of human factor IXa and of factor IXaVancouver were constructed, based on the homology of factor IXa with related serine proteases of known structure. The factor IXaVancouver model suggests that hydrogen bonding between the side chain hydroxyl group of threonine 397 and the carbonyl oxygen of tryptophan 385 reduces the ability of factor IXaVancouver to bind factor X in a configuration favoring catalysis.