BACKGROUND: Improved access to less invasive testing has resulted in more Americans being diagnosed with asymptomatic gallstones. The family physician has had to rely on community-based or referral patient studies to advise their office-based patients about treatment options. OBJECTIVE: To understand the natural history of asymptomatic gallstones discovered through a routine patient care process in a rural, office-based research network of 9 family physician practices. PARTICIPANTS AND METHODS: Nine family physician practices agreed to comb their records for medical records of patients found to have asymptomatic gallstones during their routine primary care practice. Medical records were then reviewed annually for 5 years for evidence of gallstone-related problems Results were compared with previous English-language literature studies. RESULTS: Asymptomatic gallstones were found in 32 patients (19 women [59%] and 13 men [41%] with an average age of 59.5 years). Symptoms developed in 8 patients (25%) after an average latency period of 3 years 5 months. Seven patients underwent cholecystectomy; there was no gallstone-related mortality in this group. One patient who developed a ruptured gallbladder required an emergency procedure. CONCLUSIONS: Routine office practice is detecting only a small percentage of the asymptomatic gallstones expected by community-based screening studies. While more of these patients became symptomatic than in general population studies, most patients with asymptomatic gallstones required no treatment. Those patients in family practice offices who are serendipitously found to have gallstones can generally be followed up conservatively.

Aged↗

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Acute viral hepatitis in Hanoi, Viet Nam.

A study of acute hepatitis was conducted in Hanoi, Viet Nam, from January 1993 to February 1995; 188 sera from clinical hepatitis cases were screened by enzyme-linked immunosorbent assay for immunoglobulin (Ig) M anti-hepatitis A virus (HAV), IgM anti-hepatitis B core antigen (HBc), IgG anti-hepatitis C virus (HCV), IgG anti-hepatitis E virus (HEV) and IgM anti-HEV. Additionally, 187 sera from control subjects, matched by age, sex and month of admission, with no recent history of hepatitis, were tested for comparative purposes. There was serological evidence of recent HAV (29%) and hepatitis B virus (24%) infection in 53% of cases (2 mixed infections), compared with 2% of controls. HCV infections were detected in 10% of cases (with no IgM anti-HAV or IgM anti-HBc) and in 1% of control sera. There was no significant difference in the proportion of IgG anti-HEV positive sera between cases (in the absence of IgM anti-HAV or IgM anti-HBc) (21%) and controls (14%); 3% of all case sera were IgM anti-HEV positive. Younger cases (< 20 years) were more likely to have recent HAV infections (41%) than those aged > or = 20 years (21%) (P < 0.01). In contrast, a higher percentage of adult cases had IgM anti-HBc, IgG anti-HCV and IgG anti-HEV (in the absence of recent HAV or HBV infection) than did children. No seasonal trend in hepatitis admissions was detected, nor an association between water-borne infections (HAV and HEV) and the warmer months. Hepatitis patients lived throughout Hanoi and surrounding areas, with no identifiable geographical clustering, regardless of serological marker.

Adolescent↗

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Processing of fusion proteins with immobilized factor Xa.

Factor Xa, with a cellulose-binding domain (CBD) fused to the C-terminus of the heavy chain (FXa-CBD), is active in solution and when immobilized on cellulose. A second derivative of factor Xa in which a hexahistidine tail is fused to the C-terminus of the heavy chain (FXa-H6) also retains activity when immobilized, in this case on Ni(2+)-NTA agarose. The stabilities and activities of of FXa-CBD and FXa-H6 immobilized on cellulose and Ni(2+)-NTA agarose, respectively, are similar. Immobilized factor Xa derivatives can be used to remove affinity tags from appropriate fusion proteins without contaminating the desired product with factor Xa.

Affinity Labels↗

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Suppressed anger and blood pressure: the effects of race, sex, social class, obesity, and age.

We studied 572 men and women who participated in a blood pressure screening program at a government unemployment office. Before having their blood pressures taken, the subjects completed a brief questionnaire that included two items measuring conflict over anger expression. Information was also obtained on obesity, race, sex, social class, and age. Across all subjects, systolic blood pressure was found to be significantly related to suppressed anger (p less than 0.016). Normotensive were twice as likely as hypertensives to be free of suppressed anger. This relationship remained after controlling for the covariates of age, social class, and obesity. The relationship between suppressed anger and systolic blood pressure was significant for white men, exhibited a trend in black men, and was not significant for women. In contrast to the systolic findings, suppressed anger was unrelated to diastolic pressure in all the analyses.

Adult↗

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Seroprevalence of West Nile, Rift Valley, and sandfly arboviruses in Hashimiah, Jordan.

We conducted a serosurvey among patients of a health center in Hashimiah, a Jordanian town of 30,000 inhabitants located near a wastewater treatment plant and its effluent channel. Serum samples from 261 patients >/=5 years of age were assessed for immunoglobulin G (IgG) and IgM antibodies against West Nile, sandfly Sicilian, sandfly Naples, and Rift Valley viruses; the seroprevalence of IgG antibodies was 8%, 47%, 30%, and 0%, respectively. Female participants were more likely to have been infected than male. Persons living within 2 km of the treatment plant were more likely to have been infected with West Nile (p=0.016) and sandfly Sicilian (p=0.010) viruses. Raising domestic animals within the house was a risk factor for sandfly Sicilian (p=0.003) but not for sandfly Naples virus (p=0.148). All serum samples were negative for IgM antibodies against the tested viruses. Our study is the first documentation of West Nile and sandfly viruses in Jordan and calls attention to the possible health hazards of living close to wastewater treatment plants and their effluent channels.

Adolescent↗

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Entry of US medical school graduates into family practice residencies: 1991-1992 and 11-year summary.

This is the 11th report prepared by the American Academy of Family Physicians on the percentage of each medical school's graduates entering family practice residency programs. Approximately 10.3% of the 15,499 graduates of US medical schools between July 1990 and June 1991 were first-year residents in family practice in October 1991. This compares to 10.7% the previous year. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1991 at 15.3%; the Middle Atlantic and New England regions continued with the lowest percentages. Graduates from publicly funded medical schools were more than twice as likely as those from privately funded schools to be first-year residents in family practice in October 1991, 12.9% compared to 6.2%. Approximately half of medical school graduates entering their first year of family practice residency training in October 1991 selected a program in the same state as their medical schools. This report includes the average percentage for each medical school for the last 11 years, as well as the number and percentage of graduates from osteopathic schools who entered ACGME-accredited family practice residency programs.

Family Practice↗

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Results of the 1992 National Resident Matching Program.

After 4 years of declining fill rates through the National Resident Matching Program (NRMP), 74 more positions in family practice residencies were filled in 1992 than in 1991, including 24 more filled with US seniors. The March fill rate (67.5%) increased for the first time since 1987, while the July fill rate (90.7%) increased for the first time since 1984. The Mountain and Pacific regions had the highest fill rates (89.1% and 88.5%, respectively) through the NRMP. Community-based, unaffiliated and university-affiliated programs filled 71.0% and 70.3% of positions offered through the NRMP. University-based and community-based, university administered programs filled 63.8% and 61.0% of positions offered through the NRMP. The other commonly defined primary care specialties of internal medicine and pediatrics also filled increased numbers of positions offered through the NRMP. This is the first year since 1984 in which all three primary care specialties matched more positions than in the previous year. The demand for family physicians in the United States is increasing. Evidence presented here suggests that 1992 may mark the beginning of a new trend toward increased interest in careers in family practice.

Family Practice↗

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Entry of US medical school graduates into family practice residencies: 1990-1991 and ten-year summary.

This is the tenth report prepared by the American Academy of Family Physicians on the percentage of each medical school's graduates who entered family practice residency programs. Approximately 10.7% of the 15,433 graduates of United States medical schools between July 1989 and June 1990 were first-year residents in family practice in October 1990. This compares to 10.8% in the previous year. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1990; the Middle Atlantic and New England regions continued with the lowest percentages. Medical school graduates from publicly funded medical schools were nearly twice as likely to be first-year residents in family practice in October 1990 as were graduates from privately funded schools. The percentages for each medical school have varied substantially from year to year in the 10 years that the AAFP has reported this information. The average percentage for each medical school for the last 10 years, as well as the cumulative percentage for each medical school, are reported.

Career Choice↗

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Entry of US medical school graduates into family practice residencies: 1989-1990 and nine-year summary.

This is the ninth report prepared by the American Academy of Family Physicians on the percentage of each medical school's graduates who entered family practice residency programs. Approximately 10.8% of the 15,646 graduates of United States medical schools between July 1988 and June 1989 were first-year residents in family practice in October 1989. This compares to 10.7% in the previous year. The West North Central region reported the highest percentage of medical school graduates who are first-year residents in family practice programs in October 1989; the Middle Atlantic and New England regions continued with the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in October 1989 than were graduates from privately funded schools. The percentages for each medical school have varied substantially from year to year in the nine years that the AAFP has reported this information. The average percentage for each medical school for the last nine years, as well as the cumulative percentage for each medical school, are reported.

Family Practice↗

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Entry of U.S. medical school graduates into family practice residencies: 1988-1989 and eight-year summary.

This study continues a series of reports from the American Academy of Family Physicians on the percentage of each medical school's graduates who enter family practice residency programs. Approximately 10.7% of the 15,947 graduates of United States medical schools between July 1987 and June 1988 were first-year residents in family practice in October 1988. This compares to 12.0% in the previous year. The Mountain region reported the highest percentage of medical school graduates who are first-year residents in family practice programs in October 1988; the Middle Atlantic and New England regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in October 1988 as were graduates from privately funded medical schools. The percentages for each medical school have varied substantially from year to year in the eight years that the AAFP has reported this information. The average percentage for each medical school for the last eight years, as well as the cumulative percentage for each medical school, are reported. Although school-specific percentages may show wide year-to-year variations, the total percentage of U.S. medical school graduates entering family practice residencies has been generally stable near 12.0% in the previous seven years. The decline to 10.7% for 1987-88 is cause for careful review.

Career Choice↗

PubMedDate not supplied

Political and legislative influences on primary care.

Explore the source record for details and available documents.

Politics↗

PubMedDate not supplied

Rites of spring for medicine: discontent, discontinuity, and discovery.

Explore the source record for details and available documents.

Aged↗