Taking the edge off: why patients choose St. John's Wort.

BACKGROUND: The number of visits to alternative medicine practitioners in this country is estimated at 425 million, which is more than the number of visits to allopathic primary care physicians in 1990. Patients' use of St. John's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider. METHODS: We used open-ended interviews with key questions to elicit information. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 years) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quotes were reviewed for each key question for similarities and contextual themes. RESULTS: Four dominant decision-making themes were consistently noted. These were: (1) Personal Health Care Values: subjects had a history of alternative medicine use and a belief in the need for personal control of health; (2) Mood: all SJW users reported a depressed mood and occasionally irritability, cognitive difficulties, social isolation, and hormonal mood changes; (3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of "minor" depression, high risks of prescription drugs, and a perception of safety with herbal remedies; and (4) Accessibility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of SJW. Also of note was the fact that some SJW users did not inform their primary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW. CONCLUSIONS: SJW users report depression, ease of access to alternative medicines, and a history of exposure to and belief in the safety of herbal remedies. Users saw little benefit to providing information about SJW to primary care physicians.

Army family practice: does our training meet our needs?

OBJECTIVES: (1) To determine the perceived adequacy of residency training for current practice by Army family physicians; (2) to ascertain if differences exist by residency setting: medical center, medical activity, or civilian. METHODS: Surveys were mailed to the 334 family physicians in the Army in 1993. Training in various subject areas was rated as inadequate, adequate, or overly prepared. RESULTS: More than 75% of respondents felt prepared in 76% of general medical subjects (GM) but in only 39% of family medicine subjects (FM). There were no practice management subjects in which more than 75% felt adequately prepared. There were no differences in perceptions of GM or FM training between military- and civilian-trained respondents. CONCLUSIONS: Army and civilian residencies prepare family physicians for the medical aspects of practice. Early training in management subjects could be enhanced. Civilian and Army programs could improve training in family medicine subjects.

Progression of rheumatoid arthritis following bone marrow transplantation. A case report with a 13-year followup.

The progression of rheumatoid arthritis (RA) is documented in a patient receiving a sex-mismatched, allogeneic bone marrow transplant (BMT) for gold-induced marrow aplasia. DNA typing confirmed a high probability of a full donor engraftment (complete chimerism). Although the RA was in complete remission 2 years post-BMT, clinical, laboratory, histologic, and radiologic evidence of the recurrence of synovitis from 3-13 years post-BMT is presented. Implications of these observations for theories of the pathogenesis of RA and the future of immunotherapies are discussed.

The practice of obstetrics by Army family physicians.

BACKGROUND: There has been a dramatic decline nationwide in family physicians practicing obstetrics. This study describes the practice of obstetrics by Army family physicians in an environment relatively free of malpractice liability and other financial concerns. METHODS: A questionnaire was mailed to every family physician on active duty in the Army (n = 334) in 1993, with a final response rate of 79 percent (n = 265). RESULTS: Nearly 73 percent of Army family physicians practice obstetrics. Almost all believed they were adequately prepared to provide routine prenatal care (98 percent) and complicated obstetric care (84 percent). More than 95 percent of those assigned to a teaching facility delivered babies. Obstetric procedures that the majority performed included normal vaginal deliveries (100 percent), repair of third-degree (98 percent) and fourth-degree (93 percent) tears, insertion of fetal scalp electrodes (96 percent) and intrauterine pressure catheters (98 percent), interpretation of nonstress tests (97 percent) and contraction stress tests (83 percent), vacuum extractions (93 percent), pudendal or paracervical blocks (88 percent), first assist in Cesarean sections (80 percent), amnioinfusions (76 percent), and low-forceps deliveries (53 percent). Those who currently practice obstetrics were more satisfied with being a family physician compared with those who did not practice obstetrics (95 percent vs 86 percent, P < 0.02). CONCLUSIONS: The majority of Army family physicians perform a wide spectrum of obstetrics care. Those who practiced obstetrics were generally more satisfied with family practice than were those who did not practice obstetrics.

Army family physician satisfaction.

INTRODUCTION: As numbers of family physicians decrease in the Army, the Army needs to know how satisfied they are with being family physicians and military officers. What variables are associated with these satisfactions? METHODS: This was a cross-sectional mailed survey of Army family physicians (N = 334). The response rate was 82% (N = 274). The survey included questions with a Likert scale and was analyzed using Kruskal-Wallis, one-way analysis of variance, and logistic regression. RESULTS: Ninety-two percent were satisfied with being family physicians and 74% were satisfied with being military officers. The variables associated with satisfaction were rank (positively associated) and percent time in patient care (negatively associated). CONCLUSIONS: Army family physicians are more satisfied with being family physicians than they are with being military officers. They are, however, satisfied with both professions. The Army, as an organization, may want to explore how its system of rewards interplay with rank and amount of time in patient care to make them predictive of satisfaction.

DNA typing for bone marrow engraftment follow-up after allogeneic transplant: a comparative study of current technologies.

DNA typing is widely used to document engraftment after allogeneic bone marrow transplantation (BMT). Most DNA typing procedures discriminate allogeneic engraftment on the basis of DNA length polymorphisms or sequence variations found in variable number of tandem repeat (VNTR) loci, or the presence of Y chromosome-specific DNA We have compared 3 types of VNTR analysis, their respective mode of allele detection and Y chromosome DNA detection in order to assess the strengths and limitations of each approach. Chimerism was assessed in 8 recipients after allogeneic BMT. Samples were subjected to 6 restriction fragment length polymorphism (RFLP) loci-analysis using radioactivity, 2 amplified fragment length polymorphism (AmpFLP) loci-analysis using a silver-stain mode of detection, 12 short tandem repeat (STR) loci-analysis using fluorescence detection and Y chromosome analysis. We evaluated each procedure for its ability to (1) discriminate sibling donor-recipient pairs in our samples; (2) generate a concordant chimerism diagnosis; and (3) detect and assess the contribution of minority components in mixed-chimera situations. In sex-mismatched BMTs with a female graft donor, Y chromosome probing has proven most efficient. In all other cases, AmpFLPs proved to be a rapid and efficient procedure with sufficient discriminating capability and sensitivity to warrant their use in clinical settings. STRs are rapid as well but require a larger loci complement to discriminate efficiently and they do not currently detect, under our conditions, all mixed chimeras. RFLPs are clearly superior at discriminating siblings but are time-consuming and serve best in cases where AmpFLP and STR analyses fail.

Expression of stem cell factor and c-kit mRNA in cultured endothelial cells, monocytes and cloned human bone marrow stromal cells (CFU-RF).

Previously, we have shown that conditioned medium from a subpopulation of human marrow stromal cells (CFU-RF) contain an activity able to stimulate the growth of macroscopic epo-dependent erythroid colonies. The ligand for the product of the c-kit proto-oncogene (also known as stem cell factor or SCF), among other activities, has been reported to have similar effects on erythroid colony growth. We have also presented data showing that SCF together with phytohemagglutinin-stimulated leukocyte conditioned medium can stimulate erythroid colony growth in the presence of antibodies to erythropoietin. Using the human SCF cDNA probe (K. Zsebo, Amgen Inc.) we now show that cells derived from CFU-RF colonies express SCF but not c-kit. Human umbilical vein endothelial cells were also found to express SCF and this expression was increased by addition of monocyte supernatant, IL-1 beta or thrombin. Cells of the human erythroleukemia cell line HEL were found to express c-kit but not SCF. Neither c-kit nor SCF mRNA were detected in phytohemagglutinin-stimulated lymphocytes. Together, these data support the view that the behaviour of proliferating erythroid stem cells in the marrow, which may express c-kit, could be regulated by membrane-bound SCF present on surrounding stromal cells.

The mouse Pgk-1 gene promoter contains an upstream activator sequence.

The Pgk-1 gene encodes the housekeeping enzyme, 3-phosphoglycerate kinase, and is ubiquitously expressed. This gene resides on the X chromosome in mammals and is always expressed except where it is silenced along with most other genes on the inactive X chromosome of female somatic cells or male germ cells. The Pgk-1 promoter is in a region rich in nucleotides G and C. This promoter can efficiently drive high levels of expression of reporter genes such as E. coli lacZ and neo. We have determined that the 120 bp upstream of the transcription start site functions as a core promoter. Upstream of this is a 320 bp region which enhances transcription from the core promoter in an orientation and position independent fashion. This 320 bp region does not enhance transcription from the core promoter of the SV40 early region. Nuclear proteins bind to this 320 bp fragment although the restricted regions to which binding can be demonstrated with gel mobility shift assays suggests that the activity of the enhancer may be mediated by factors which bind at multiple sites each with low affinity.

Coliform contaminated bedding and new infections.

Ten Holstein cows were bedded on fresh, uncured sawdust seeded with coliform broth culture. Escherichia coli concentrations were maintained at 10(6) colony-forming units/g for the 4-wk experimental period. Ten control cows were bedded with dry shavings. The elevated bacterial contamination caused an increase in contamination of teat ends; however, no new coliform infections occurred.