Sequence Communication: The amino acid sequence of protein AA from a burro (Equus asinus)

The primary structure of amyloid fibril protein AA of a burro has been determined by Edman degradation. The 80 amino acid residue long protein shows strong resemblance to that of other mammalian AA-proteins and differs from equine protein AA at 5 positions: Burro/horse positions 20 (Q/N), 44 (R,Q, K/K,Q), 59 (G,L/C;,A), 61 (Q/E) and 65 (N/R).     

Book Received

The anxious or depressed patient not only disrupts his own life but also distresses his family and the community. The physician, then, must consider many factors before deciding whether to use psychotherapy, drugs, hospitalization, or a combination of these. He should also counsel the patient's family and marshal community resources to help his patient.     

Introducing the editorial board

One of the most important contributions made to any medical journal is that of its board of editorial consultants. In the February issue we began to lntroduce the members of our Editorial Board. Each month we will publish brief profiles of a few more of these distinguished physicians so that ali of you may become a little more familiar with th ose whose dedicated labor does so much to make this journal possible.     

Rheumatologic Disorders Due to Immune Complexes

Circulating autologous immune complexes are considered responsible for the vasculitis of systemic lupus erythematosus and of seropositive rheumatoid arthritis and appear to contribute to the vasculitis of one form of cryoglobulinemia. Complexes of virus and immunoglobulin probably cause half of the cases of polyarteritis nodosa.     

NT-proBNP to exclude heart failure in primary care – a pragmatic,cluster-randomized study

Abstract

Heart failure (HF) is difficult to recognize in primary care. N-terminal pro B-type natriuretic peptide (NT-proBNP) can be used as a rule-out test in HF due to its high negative predictive value. We aim to determine whether the number per 1000 patients of HF diagnoses increase among patients referred from primary care to an outpatient HF clinic, if general practitioners (GPs) were offered NT-proBNP in a real-life setting. All GP practices covered by Randers Regional Hospital were randomized to an intervention group (34 GP practices) and a control group (35 GP practices) in this pragmatic, cluster-randomized controlled trial. The main outcome was the number of patients referred to echocardiography and diagnosed with HF in each group. The number of patients per 1000 diagnosed with HF in the two groups was the same (0.09 (0.02–0.16) vs. 0.14 (0.07–0.21), p?=?.3541). A total of 700?NT-proBNP analyses, of which 611 were unique, were requested from 31 GP practices in 17.5?months. A total of 184 patients were referred to echocardiography on suspicion of HF. The number of patients per 1000 referred in the intervention group was significantly higher (p?p?=?.019). Hence, increased diagnostic effectiveness could not be shown in this real-life setting.     

Sick-listing habits among general practitioners in a Swedish county

Objective - To describe sick-listing habits in general practice, how common it is and for how long and for what diagnoses it is granted. Design - Medical audit study. Setting - Primary health care. Subjects - 53 general practitioners (GPs) registering all cases during a 2-week period when sick-listing was considered. Main outcome measures - Percentage of GP consultations that involved sick-listing, number of days of certified sick-leave, percentage of partial sick-listing, GP sex differences. Results - 9% of all consultations included a consideration about sick-listing, and in only 6% of these instances was a certificate not issued. The median length of the certified sickness period was 14 days. Musculoskeletal problems were by far the most common diagnosis. Female patients were more often partially sick-listed than males. Female GPs sick-listed a larger proportion of their patients than male GPs. Risk factors for long certification periods were in fact associated with long certification periods. Even in cases where the GP would not recommend sick-listing a certificate was issued in 87%. Conclusions - Patients appear to have a strong influence on sick-listing practice, and there are important sex differences among GPs in this practice.     

Prevention of cardiovascular disease within the primary health care system: Feasibility of a prevention programme within the Sollentuna primary health care catchment area

Objective - To integrate prevention of cardiovascular disease within the primary health care.

Design - A prevention programme which combines population and individual high-risk strategy.

Setting - The Primary Health Care in Sollentuna, Stockholm, Sweden.

Main outcome measure - Characteristics of, and risk factor prevalence among, persons registered in the prevention programme.

Results - During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15–60 years, were registered in the prevention programme. 90% were ?60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol ?5.2 mmol/1, and 33% and 22% had a diastolic blood pressure ?90 mmHg.

Conclusion - The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.