Failure to detect Trichinella spiralis p43 in isolated host nuclei and in irradiated larvae of infected muscle cells which express the infected cell phenotype.

Infection by Trichinella spiralis induces host muscle cells to become repositioned within the cell cycle and to lose differentiated skeletal muscle characteristics. Antibodies to a 43-kDa excretory-secretory (ES) protein (p43) also bind to infected host cell nuclei. Neither the identity of these nuclear antigens nor their role in inducing the infected cell phenotype is known. To address these issues, infected cell nuclei were isolated and nuclear antigens analyzed with several antibody preparations to p43. Four antibody preparations to p43 recognized 43-, 45-, 50-, 67- and 71-kDa proteins in ES extracts. The prominent proteins recognized by these antibodies in host nuclear antigen extracts were 71, 79, 86 and 97 kDa. Less prominent proteins of approximately 43 and 45 kDa were detected in nuclear extracts. However, antibodies which specifically recognized p43 failed to bind detectably with in situ and isolated host nuclei and nuclear extracts. Expression of p43 was analyzed in host cells infected by newborn larvae irradiated with 60Co. This treatment prevented expression of detectable levels of p43 in resulting muscle larvae, while infected muscle cells displayed typical infected cell characteristics. However, anti-p43 antibodies which recognized multiple ES and nuclear proteins did stain nuclei of irradiated larva-infected cells, albeit at reduced levels. The results raise doubts that p43 is required for induction of the infected cell phenotype. Nevertheless, nuclear antigens recognized by anti-p53 antibodies remain as candidates for influencing this phenotype.

Psychological problems. How are they managed in general practice?

This article was written to answer questions raised by the Australian Morbidity and Treatment Survey (AMTS) which suggested that general practitioners are failing to diagnose and manage psychiatric illness. The article explains how the data should be interpreted, and what it tells us about the management of psychological problems in general practice in Australia.

The management of acute bronchitis in general practice: results from the Australian Morbidity and Treatment Survey, 1990-1991.

Acute bronchitis is the fifth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.

The management of URTI in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Upper respiratory tract infection is the second most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.

A comparison of country and metropolitan general practice.

This paper is a summary of a report of a comparison of country and metropolitan general practice undertaken by the Family Medicine Research Unit, University of Sydney, and published as a supplement to the Medical Journal of Australia. The identified differences were not consistent across small medium and large country towns. The morbidity patterns were similar between all areas, but country GPs were generally busier and undertook more hospital and procedural work.

The diagnostic difficulties of abdominal pain.

When the patient presents with the words, "I've got a pain in the gut", what are the most common diagnoses and how often does the problem remain undiagnosed? This paper describes what usually happens at encounters initiated by patient presentation of abdominal pain and is based on the results of the Australian Morbidity and Treatment Survey 1990-1991.

The management of osteoarthritis in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Osteoarthritis is the fourth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

Recruiting general practitioners for survey research.

Recruitment is often a lengthy process and sometimes a frustrating one. It is not simply a matter of contacting those selected and asking for this participation. After obtaining a list from which to select a sample, a contact list must be created, initial contact must be made and direct contact initiated, often requiring great powers of persuasion. It is often difficult to convince someone that your project is important. However, the time and energy expended is ultimately worth it. Just one positive enthusiastic response is enough to make you forget all the difficulties. What could be done to make it simpler in the future? Some kind of list, regularly updated, of all general practitioners would make researchers' jobs much easier by providing a reliable and current sampling frame. It would also promote general practice as a specialty. The problem of a definition of general practice is currently being considered. Overall, there needs to be more recognition of the time practitioners put in to such surveys and the additional demands it places on their already busy lives. General practice research has to be designed to fit into the practitioner's schedule. Researchers should co-ordinate their projects so that repeated requests are not made to the same practitioner. To some extent this problem is being tackled in New South Wales at present by the Royal Australian College of General Practitioners and University researchers. There is also a need for feedback from participating practitioners as to their own thoughts about the direction and design of general practice research. This would help to encourage continued participation and create goodwill for future surveys.(ABSTRACT TRUNCATED AT 250 WORDS)

The management of arthritis in general practice. Results from the Australian morbidity and treatment survey, 1990-1991.

Arthritis is the ninth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.

Morbidity and treatment in general practice in Australia.

More detailed analysis of this data will continue. It will be combined with other more specific studies to provide a more focused view of some aspects of general practice. Requests for individual analyses of selected data will be accepted by the Family Medicine Research Unit. Contact Helena Britt on (02) 745 2633. The Unit has provided Australian Family Physician with 500 copies of the full report for distribution to interested practitioners. Such copies can be obtained by contacting Mrs Judy Brook, Secretary, Australian Family Physician, 2nd Floor, 70 Jolimont Street, Jolimont 3002. Fax: (03) 289 1211. Telephone: (03) 654 3000.

The management of asthma in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Asthma is the third most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

Psychometric evaluation of the Russian Language version of the Resilience Scale.

The Resilience Scale (RS) was developed by Wagnild and Young (1993) to measure a personality characteristic or coping resource that facilitates adaptation. The RS, however, has not been evaluated with foreign-born populations. Therefore, the purpose of this study was to report the factor structure, internal consistency, and concurrent validity of a Russian language version of the RS in a sample of 450 recent former Soviet immigrants. The 25-item 2-factor solution obtained by Wagnild and Young (1993) was not supported by the Russian data. However, a modified 12-item Russian language version of the RS was, for the most part, reliable and valid: The standardized factor loadings and goodness of fit indices obtained from confirmatory factor analysis were acceptable, the internal consistency of one of the two subscales was very good, and the correlations between scores from the RS subscales and various measures of constructs that are theoretically linked with adaptation were in the expected direction and statistically significant.

Trichinella spiralis: inhibition of muscle larva growth and development is associated with a delay in expression of infected skeletal muscle characteristics.

Infection of skeletal muscle cells by Trichinella spiralis induces host cells to reenter the cell cycle and these cells subsequently become persistently suspended in apparent G2/M. To investigate the role of the parasite in this process, parasite growth and development within the infected cell was inhibited by irradiation of newborn larvae (48 and 80 krad) prior to infection of host muscle cells. Although larvae entered skeletal muscle cells, irradiation inhibited their subsequent growth and stichosome development, including development of alpha and beta stichocytes. A distinct delay in cell cycle reentry was demonstrated for irradiated larva-infected muscle cells, indicating an interaction between parasite and host factors affecting this host process. Despite effects on stichosome development and this delay, infected muscle cells reentered the cell cycle, expressed increased levels of acid phosphatase, were inhibited in myosin heavy-chain expression, and developed collagen capsules. The results indicate that normal alpha and beta stichocyte development is not required for inducing the infected cell characteristics studied. The model system may be useful in analysis of parasite products that are candidates for regulating various aspects of the infected cell phenotype.

Reasons for encounter and diagnosed health problems: convergence between doctors and patients.

This study of 521 encounters in 25 urban general practices in Australia, compares both patient and doctor reported reasons for encounter (RFE) and diagnoses. Although doctors and their patients generally agreed on the overall distribution of RFE and diagnoses that arose, there was disagreement in at least 30% of paired comparisons within individual encounters. There was better agreement for RFE than for diagnoses. This may have been partly due to differences in the classification systems used. However, it suggests that diagnoses recalled by patients at later household interview are at best only a rough approximation of the diagnoses recorded by the doctor. These findings are important both for patient care and for the conduct of general practice morbidity research.

A comparison of country and metropolitan general practice.

OBJECTIVE: To provide a description of country general practice in Australia, and to determine the extent to which country and metropolitan general practice differ in terms of the characteristics of the practitioners, the morbidity managed, treatments provided and the availability of support services. METHOD: A survey requiring the recording of details of all direct and indirect patient encounters on encounter forms by a sample of general practitioners (GPs). Each GP recorded for two one-week periods separated by an interval of six months, between October 1990 and October 1991. The recording weeks were spread as evenly as possible throughout the year. SAMPLE: Participants were drawn from a list of medical practitioners in Queensland, NSW and Victoria who provided more than 1500 general practice Medicare items of service during the previous year. The sample was stratified within States by population of postcode, into metropolitan areas and three country strata: "small country towns" (population less than 5000); "medium country towns" (5000-15,000); and "large country towns" (more than 15,000). The total country sample is referred to as "country areas". Planned sample size was 180 country GPs (20 in each stratum in each State) and 60 metropolitan GPs (20 in each of the three State capital cities). The final data set was weighted to be representative of the distribution of the source population. DATA COLLECTION: The variables studied included: GP characteristics; practice isolation factors; patient age, sex and status to the practice; patient reasons for encounter (up to three per encounter); problems managed (up to four); drugs prescribed and other treatments provided (up to four per problem); tests and investigations ordered and referrals made at these encounters; and planned follow-up. Data were centrally coded. Participation rate: The final sample of 231 GPs (177 country and 54 metropolitan) recorded information during 435 recording weeks (336 country and 99 metropolitan). These practitioners represented 50.7% of those contacted and available, the response rate being better in country (57.5%) than in metropolitan (36.5%) areas. A practice profile questionnaire which included questions regarding the doctor and the practice was completed by 97.4% of participants, while a questionnaire on distance from support services was completed by 93.8% of country participants. The final weighted data set included 51,741 encounters with country GPs and 11,351 with metropolitan GPs. RESULTS: The general practitioners: Country GPs were less likely to be female or to conduct consultations in a language other than English, and were more likely to do some work on a salaried or sessional basis. GPs from small country towns were older, more likely to be in solo practice, and more likely to belong to a professional organisation. "Remoteness" of towns: Nearly all towns were within 25 km of a hospital, but far fewer small and medium country towns were within 50 km of a base hospital than large country towns. X-ray services were almost universally available within 50 km, and with the exception of small country towns so were pathology services. Access to medical specialists and to a lesser degree other health professionals decreased with population size--patients in 30% of small towns had to travel over 100 km to see many specialists and some health professionals. Self-reported procedural work: GPs in small and medium country towns were more likely than those in large towns to report performing procedural work, the largest difference being in the area of em

How representative are patients in general practice morbidity surveys?

This study examined differences arising from the sampling of patients from general practice and household surveys. When 25 general practitioners, who agreed to participate in one week morbidity survey in inner western Sydney, were compared with all general practitioners (192) identified in the area, they were not significantly different in terms of socio-demographic variables and practice details. When the demographic characteristics of a sample of patients at 539 encounters with the 25 participating general practitioners were compared with those of a sample of 500 patients identified from a household survey who had consulted with any general practitioner within 2 weeks of the interview, few differences were found. Few significant differences were found in the reasons for encounter and diagnoses treated as recalled by the patients of the two groups. No differences were found in management--specifically prescription, investigations and referral--or with respect to health status. This study suggests that sampling of patients from randomly selected general practitioners can produce useful representative samples for studies of morbidity even when doctor participation rates are as low as 29%.