Endotoxin-mediated dendritic cell release from the intestine. Characterization of released dendritic cells and TNF dependence.

Dendritic cells (DC) acquire Ag in peripheral tissues and transport it to lymph nodes where they efficiently activate resting T cells. We have shown that i.v. endotoxin causes increased release of intestinal DC into lymph. In this paper we further characterize the release of DC and the properties of the released cells. A total of 50 micrograms of endotoxin injected i.v. causes an increase in DC output within 6 h that peaks between 12 and 24 h, with a maximum output of 8 to 15 times normal. At the same time lymphocyte output is markedly decreased. The increased output of DC is followed by a decrease to subnormal levels. The stimulated release of DC is almost totally blocked by a monoclonal anti-TNF-alpha Ab. A second injection of TNF-alpha does not result in further DC release. DC are not released from lymph nodes into efferent lymph by endotoxin. DC collected from lymph after endotoxin treatment show increased expression of the p55 IL-2 receptor and the OX48 Ag but otherwise resemble normal lymph DC. In functional assays they show no significant differences from normal in their ability to stimulate a MLR or to present Ags to sensitized T cells. Immunocytochemistry with the use of MRC OX62 suggests that the DC are released into lymph from the lamina propria of the small intestine. The stimulated release of DC mediated by TNF-alpha may be important in regulating Ag presentation in lymph nodes draining inflammatory sites.

Form C of the MHLC scales: a condition-specific measure of locus of control.

Form C of the Multidimensional Health Locus of Control (MHLC) scales is an 18 item, general purpose, condition-specific locus of control scale that could easily be adapted for use with any medical or health-related condition. Data from 588 patients with one of four conditions--rheumatoid arthritis, chronic pain, diabetes, or cancer--were utilized to establish the factor structure of Form C and to establish the reliability and validity of the resultant four subscales: Internality; Chance; Doctors; and Other (powerful) People. The alpha reliabilities of the subscales are adequate for research purposes. Data from the arthritis and chronic pain subjects established that the Form C subscales were moderately stable over time and possessed considerable concurrent and construct validity. Some discriminant validity of Form C with Form B of the MHLC was also demonstrated.

Staff involvement and special follow-up time increase physicians' counseling about smoking cessation: a controlled trial.

We compared the counseling behaviors of two groups of health maintenance organization physicians: one group received training about smoking cessation counseling; the other group received the same training plus staff support and appointment time specially designated for follow-up of smokers. We interviewed patients after their office visits to measure smoking counseling. The group receiving staff support and designated follow-up time counseled more and made more follow-up appointments about smoking.

Comparing the short and long versions of the Arthritis Impact Measurement Scales.

Evidence is presented for the utilization of a shortened version of the Arthritis Impact Measurement Scales. The results confirmed that the shortened versions retained adequate internal consistencies, test-retest reliabilities, and both concurrent and predictive validities over a 2 year period which were similar to the original longer versions.

Training physicians in counseling about smoking cessation. A randomized trial of the "Quit for Life" program.

STUDY OBJECTIVE: To test whether physicians who receive a continuing education program ("Quit for Life") about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke. DESIGN: Randomized trial with blinded assessment of principal outcomes. SETTING: Four health maintenance organization medical centers in northern California. SUBJECTS: Eighty-one internists assigned by blinded randomization to receive training (40) or serve as controls (41). Consecutive samples of smokers visiting each physician (mean, 25.6 patients per experimental and 25.2 per control physician). INTERVENTIONS: Internists received 3 hours of training about how to help smokers quit. Physicians and their office staff also were given self-help booklets to distribute free to smokers and were urged to use a system of stickers on charts to remind physicians to counsel smokers about quitting. MEASUREMENTS AND MAIN RESULTS: On the basis of telephone interviews with patients after visiting the physician, we determined that internists who attended the Quit for Life program discussed smoking with more patients who smoked, spent more time counseling them about smoking, helped more patients set dates to quit smoking, gave out more self-help booklets, and made more follow-up appointments to discuss smoking than did internists in the control group. One year later, the rate of biochemically confirmed, long-term (greater than or equal to 9 months) abstinence from smoking was 1% higher among all patients of trained internists than among patients of controls (95% CI, -0.1% to +2.3%), and 2.2% (+0.2% to +4.3%) higher among the patients who most wanted to quit smoking. CONCLUSIONS: This continuing education program substantially changed the way physicians counseled smokers. As a result, a few more patients who wanted to quit smoking achieved long-term abstinence.

Smoking counseling and preventive medicine. A survey of internists in private practices and a health maintenance organization.

Physicians could help a large number of patients quit smoking by taking time to advise them about quitting, helping them plan a date to quit, giving them self-help materials, following up, and referring some to smoking cessation programs. To determine the attitudes and practices of internists concerning smoking cessation and selected preventive medical practices, we surveyed a random sample of internists in private practice and in a large health maintenance organization (Kaiser-Permanente Medical Group) in the San Francisco Bay area. Overall, internists consider counseling about smoking to be at least as worthwhile as many other practices, such as screening for breast cancer, and more worthwhile than periodic physical examinations. Despite these beliefs, 57% to 65% of internists reported that they spend two minutes or less counseling smokers during new patient visits. Many internists never use recommended strategies for counseling about smoking: 33% to 44% never help patients plan dates to quit, 68% to 75% never make follow-up appointments with patients primarily about smoking, and 27% to 48% never give smokers self-help pamphlets about quitting. Although they believe that counseling about smoking is worthwhile, internists are not doing as much as they could to help their patients quit.

Internists and nicotine gum.

Nicotine gum may be a useful aid to help patients quit smoking. The effectiveness of the gum and incidence of side effects may depend on using the gum properly. To describe internists' current practices of prescribing nicotine gum and other drugs for smoking cessation, we surveyed randomly selected internists. Most internists prescribe nicotine gum to fewer than 25% of patients who try to quit smoking. Contrary to current recommendations, nearly half of internists would suggest gum to help patients cut down on smoking, and a majority would limit its use to less than three months. There is no evidence that sedatives are useful for smoking cessation, but one fourth of internists had recently prescribed them for that purpose. There is a widespread need for physician education about how to use nicotine gum more effectively.

Correlates of a clinical classification schema for the arthritis helplessness subscale.

We examined the categorization of the helplessness subscale of the Arthritis Helplessness Index (AHI) into clinical ranges analogous to laboratory values, and the predictive validity of these cutoff scores over a 2-year period. Data were obtained via questionnaires mailed every 6 months over 5 time periods to 368 patients who had been diagnosed as having rheumatoid arthritis. The results demonstrate that patients classified as low helpless were distinct from those classified as normal. In turn, those classified normal were distinct from high helpless patients on numerous measures of beliefs, affect, behavior, and symptom severity. Even after 2 years, the 5-item helplessness subscale identified distinct clinical courses for these 3 groups.

Factor structure of the Arthritis Helplessness Index.

The factor structure of the Arthritis Helplessness Index (AHI) was examined using principal components factor analysis with varimax rotation. Data for the initial factor analysis came from a longitudinal study of 368 patients with rheumatoid arthritis (RA). Two slightly negatively correlated (r = -0.21) subscales emerged: internality and helplessness. This analysis was cross-validated twice. Findings reveal that the 2 subscales of the AHI are more reliable and valid than the total score. The 5 item helplessness subscale, in particular, appears to be a highly valid indicator of the degree to which patients with RA feel overwhelmed by their disease.

Distribution of alpha-melanocyte-stimulating hormone in the rat brain: evidence that alpha-MSH-containing cells in the arcuate region send projections to extrahypothalamic areas.

The distribution and concentration of alpha-MSH in the rodent brain has been determined by radioimmunoassay. The limbic system contained substantial quantities of alpha-MSH. Forty per cent of the alpha-MSH present in the brain was localized in the hypothalamus, with the highest concentration of alpha-MSH in the arcuate nucleus. More than 40% of the extrahypothalamic alpha-MSH in the brain was found in the following areas: midbrain (16%), preoptic area (13%), septum (7%), and thalamus (7%). To determine the source of the hypothalamic and extrahypothalamic alpha-MSH, the anterior hypothalamic preoptic area of the brain was surgically separated from more caudal diencephalic structures, and the arcuate region of the hypothalamus was surgically isolated from the remainder of the brain. Following these deafferentations, no significant reduction in hypothalamic alpha-MSH levels was observed; however, a significant reduction in extrahypothalamic alpha-MSH level was demonstrated. This dramatic decrease of alpha-MSH in extrahypothalamic areas of the rodent brain strongly suggests that the bulk of the extrahypothalamic alpha-MSH arises from neuronal perikarya in the arcuate region. These findings are consistent with the hypothesis that a population of neuronal cell bodies producing alpha-MSH originate in the arcuate region of the hypothalamus and that they send axonal projections to many areas of the limbic system and brain stem.