Time off work due to scaphoid fractures and other carpal injuries in The Netherlands in the period 1990 to 1993.

This study assessed the epidemiology, treatment, disability and time off work due to carpal injuries in the Netherlands in the period from 1990 to 1993. Most injuries were scaphoid fractures and carpal instabilities were rare. The time off work was considerable (mean, 155 days; median, 105 days; range, 12-1708 days). Patients with non-scaphoid fractures had the shortest time off work, followed by those with scaphoid fractures; patients with carpal instabilities had the longest time off work. Despite the significant time off work, the prognosis for return to work was excellent.

Basal Mg(2+)-dependent ATPase activity of rat liver microsomes is not influenced by ambient free Ca2+.

The potent inhibitor of Ca2+, Mg(2+)-ATPase activity, thapsigargin, has been used to investigate the effect of ambient free Ca2+ on basal Mg(2+)-dependent ATPase activity in rat liver microsomes. Thapsigargin non-competitively inhibited both Ca(2+)-stimulated ATP-dependent Ca2+ uptake and Ca(2+)-stimulated Mg(2+)-dependent ATPase activity. At a concentration of 1 microM, thapsigargin completely inhibited the Ca(2+)-pump activity, without affecting Mg(2+)-dependent ATPase activity measured in the absence of Ca2+. Increasing the ambient free Ca2+ concentration did not alter the basal Mg(2+)-dependent ATPase activity. The data presented indicate that ATPase activity measured in the absence of Ca2+ is a reliable measure for the basal Mg(2+)-dependent ATPase activity and that, consequently, the Ca(2+)-stimulated Mg(2+)-dependent ATPase activity can indeed be defined as the difference between the ATPase activity measured in the presence and the absence of Ca2+.

Cadmium ion is a non-competitive inhibitor of red cell Ca(2+)-ATPase activity.

In the presence as well as in the absence of calmodulin, Cd2+ inhibits the human erythrocyte plasma membrane Ca(2+)-ATPase activity non-competitively with Ki = 2 nM, whereas ATP-dependent Ca(2+)-transport across the red cell membrane was found to be inhibited competitively by Cd2+ (Verbost, P.M., Flik, G., Pang, P.K.T., Lock, R.A.C. and Wendelaar Bonga, S.E. (1989) J. Biol. Chem. 264, 5613-5615). In this study it will be argued that Cd2+ also inhibits Ca(2+)-transport non-competitively, and that the discrepancy with previous conclusions most probably relies on use of an incorrect computer program that calculates the free concentrations of Ca2+ and Cd2+ at the experimental conditions applied for measurement of Ca2+ uptake.

Rheumatologists and their patients who seek alternative care: an agreement to disagree.

Alternative treatment, such as homoeopathy, acupuncture and spiritual healing, are popular among patients with rheumatic diseases. Rheumatologists are therefore likely to be confronted with patients who make use of less orthodox health care. Patients' and rheumatologists' views on the subject and on the rheumatologists' role, however, have not yet been assessed. A questionnaire on alternative medicine was sent to all 101 practising Dutch rheumatologists (response rate: 70%). After the results had been analysed 17 rheumatologists, seven rejecting alternative medicine and ten accepting it, handed out a questionnaire to a sample of their patients: 1466 patient questionnaires were distributed (response rate: 80%). Of the respondents 43% had visited an alternative practitioner at least once for their rheumatism and 26% in the year before the survey was held. Hand healers, homoeopaths and acupuncturists were most often visited. Rheumatologists, on their part, were not too enthusiastic about these visits. Only patients' visits to spa treatment centres were welcomed by a majority of them; visits of their patients to manipulative therapists, acupuncturists and homoeopaths were judged positively by a large minority, whereas other therapies were strongly disapproved. Nevertheless, most patients informed their rheumatologist about their visiting an alternative practitioner. A surprisingly low percentage of these patients noticed that the rheumatologist did not sympathize with it. Although many patients paid a visit to an alternative practitioner because regular care did not really help them, their satisfaction with the alternative treatment turned out to be less than their satisfaction with the rheumatologists' help.(ABSTRACT TRUNCATED AT 250 WORDS)

CHELATOR: an improved method for computing metal ion concentrations in physiological solutions.

An algorithm is presented for the calculation of metal ion concentrations from given total metal concentrations (and vice versa) in physiological media containing metal-chelating compounds. In such media, conditions differ from those used for stability constant determination of metal-chelator equilibria; therefore calculated metal ion concentrations are incorrect. We recompute stability constants to reflect the effects of ionic strength and temperature of physiological solutions. Twelve different equilibria can be considered per metal-chelator pair. The computer program also calculates the contribution of ionized species of metals, chelator, complexes and pH buffers to ionic strength. Measurements with a Ca-selective electrode and with fura-2 show that calculated ionic Ca2+ concentrations are correct from 10 nM up to the millimolar range. The importance of the correct calculation of metal ion concentrations in physiological experiments is demonstrated by data, and derived kinetic parameters, on Na+/Ca2+ exchange and the ATP-dependent Ca2+ pump of enterocyte plasma membrane vesicles. The program is written in Turbo Pascal and will run on IBM-compatible computers. It is menu-driven and supports the use of a Microsoft mouse.

Alternative medicine and general practitioners in The Netherlands: towards acceptance and integration.

A questionnaire on alternative medicine was sent to 600 general practitioners in the Netherlands. Most of the 360 (60%) GPs who replied expressed on interest in alternative practice; and 47% revealed that they used one or more alternative methods themselves, most often homoeopathy. However, the number of patients given alternative treatment by each doctor was small. Almost all (90%) of the GPs referred patients to alternative practitioners. There is no reason to assume that GPs make use of alternative methods just to meet their patients' wishes. A majority of the respondents thought that these therapies included ideas and methods from which the regular methods might benefit. Actual contacts with alternative practitioners are mostly limited to those practicing acupuncture, homeopathy and manipulative medicine with a regular medical or paramedical education. The integration of alternative medicine within the medical system goes hand in hand with its acceptance by general practitioners. Contact with medically or paramedically qualified practitioners has hardly any legal implications for individual general practitioners.