The Swedish CArdioPulmonary BioImage Study: objectives and design

Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.

Burnout and physical and mental health among Swedish healthcare workers

AIM

This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors.

BACKGROUND

Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes.

METHOD

A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout).

RESULTS

Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group.

CONCLUSION

Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout.

Does sickness presenteeism have an impact on future general health?

PURPOSE

The primary aim of this prospective study was to investigate whether working despite illness, so called "sickness presenteeism", has an impact on the future general health of two different working populations during a follow-up period of 3 years.

METHODS

The study was based on two bodies of data collected at a number of Swedish workplaces from 1999 to 2003. The first material comprised 6,901 employees from the public sector and the second 2,862 subjects from the private sector. A comprehensive survey was issued three times: at baseline, after 18 months and after 3 years. Apart from the explanatory variable sickness presenteeism, several potential confounders were considered. The outcome variable was good/excellent versus fair/poor self-reported health.

RESULTS

Sickness presenteeism at baseline was consistently found to heighten the risk of fair/poor health at both the 18-month and 3-year follow ups even after adjusting for the detected confounders.

CONCLUSIONS

To the best of the authors' knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health.

Reliability and factor structure of the Multidimensional Pain Inventory--Swedish Language Version (MPI-S)

The psychological assessment of chronic pain is often accomplished using questionnaires such as the (West Haven-Yale) Multidimensional Pain Inventory ((WHY)MPI) which is constructed to capture the multidimensionality of chronic pain. The (WHY)MPI theoretically originates from behavioural and cognitive behavioural theories of pain. It is divided into three parts and measures psychosocial and behavioural consequences of pain. This questionnaire has displayed satisfactory psychometric properties and translations of the original English version into German and Dutch have been demonstrated to be reliable and valid. The aim of this study was to test the reliability and factor structure of a Swedish translation of the (WHY)MPI, the MPI-S, and also to test the generalisability of the factor structure found for the (WHY)MPI. We performed analyses of internal consistency using Cronbach's alpha, and carried out a confirmatory factor analysis (CFA) employing LISREL-8 on a population of 682 patients suffering from chronic musculoskeletal pain. Test-retest analysis was accomplished on a sub-sample of 54 individuals taken from the aforementioned population. For sections 1 and 2 of the MPI-S the overall reliability and stability were good, and after the exclusion of four items, the factor structure was similar to other versions of the MPI. For section 3, despite removal of five questions, the proposed factor structure could not be replicated. This part of the inventory is designed to measure the extent of different types of activities, and our results suggest that this section may only be used for assessing general activity level. We conclude that, with a few adjustments, the analyses yielded satisfactory results for sections 1 and 2 of the MPI-S regarding its factor structure, reliability and generalisability. For section 3 the hypothesised factor structure could not be confirmed.

A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender?

The aim of the present study was to evaluate the outcome of a behavioral medicine (BM) rehabilitation program and the outcome of its two main components, compared to a 'treatment-as-usual' control group (CG). The study employed a 4x4 repeated-measures design with four groups and four assessment periods (pre-treatment, post-treatment, 6-month follow-up, and 18-month follow-up). The group studied consisted of subjects on sick leave identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomized to one of four conditions, which were: (1) behavior-oriented physical therapy (PT); (2) cognitive behavioral therapy (CBT); (3) BM rehabilitation consisting of PT+CBT (BM); (4) a 'treatment-as-usual' CG. The treatments were given over a period of 4 weeks, PT and CBT on a part-time basis and BM on a full-time basis. Outcome variables were sick leave, early retirement, and health-related quality of life (measured using the Short Form Health Survey, SF-36). The results showed that the risk of being granted full-time early retirement was significantly lower for females in PT and CBT compared to the CG during the 18-month follow-up period. However, the total absence from work (sick listing plus early retirement) in days over the 18-month follow-up period was not significantly different in the CG compared to the treatments. On the SF-36, women in CBT and BM reported a significantly better health-related quality of life than women in the CG at the 18-month follow-up. No significant differences for men were found on the SF-36 scales. In conclusion, the results revealed gender differences in the outcome of the treatments and that the components of this BM program yielded as good results as the whole program.

A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain

The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain.

Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures

OBJECTIVES

To evaluate the responsiveness of the EuroQol (EQ-5D) and Short-Form 36 (SF-36) instruments, i.e. their ability to capture clinically important changes, in elderly patients with a displaced femoral neck fracture. The study was part of a prospective randomised study comparing two different surgical procedures, internal fixation (IF) and total hip replacement (THP).

SETTING

University hospital.

PATIENTS

A total of 110 patients, mean age 80 years with an acute displaced femoral neck fracture (Garden III and IV). The inclusion criteria were age > or = 70, absence of severe cognitive dysfunction, independent living status and independent walking capability.

INTERVENTION

The patients were randomised to IF or to a THR.

MAIN OUTCOME MEASUREMENTS

Health-related quality of life according to EQ-5D and SF-36. Responsiveness measured by the ability of the EQ-5D and the SF-36 to detect clinically relevant differences in the study population according to an external criterion (EC) for outcome (good or less good clinical outcome). Responsiveness was measured in terms of change scores, standardised effect size (SES) and standardised response mean (SRM).

RESULTS

The rated prefracture EQ-5D(index) scores and SF-36 scores showed good correspondence with the scores of age-matched Swedish reference populations. The relationship between the EC and EQ-5D(index) score and the SF-36 global score showed significant differences in both comparisons (p < 0.001). The responsiveness expressed with the SES and SRM were large for both the EQ-5D (1.37 and 0.90, respectively) and for the SF-36 global score (0.89 and 0.82, respectively). The correlation between the change scores for the SF-36 global score and the EQ-5D was 0.39 (p < 0.001).

CONCLUSION

The results showed high responsiveness for both the EQ-5D and the SF-36, indicating that both instruments are suitable for use as outcome measures in clinical trials in elderly hip fracture patients.

Reflecting peer-support groups in the prevention of stress and burnout: randomized controlled trial

AIM

This paper is a report of a study to test the effect of participating in a reflecting peer-support group on self-reported health, burnout and on perceived changes in work conditions.

BACKGROUND

Stress-related conditions are one of the most common causes for long-term sick-leave. There is limited evidence for the effectiveness of person-directed interventions aimed at reducing stress levels in healthcare workers. Prior research in the relationship between support and burnout show somewhat inconsistent results.

METHOD

A randomized controlled trial with peer-support groups as the intervention was conducted with 660 healthcare workers scoring above the 75th percentile on the exhaustion dimension of the Oldenburg Burnout Inventory. One hundred and fifty-one (22.9%) agreed to participate. The intervention started in 2002 with 51 participants (96.1% were women), 80 of whom constituted the control group. Potential differences in outcome measures 12 months after the intervention were compared using ancova, and data collected was completed in 2004. Qualitative content analyses were used to analyse reported experiences from group participation.

RESULTS

Statistically significant intervention effects were found for general health, perceived quantitative demands at work, participation and development opportunities at work and in support at work. Seven categories of experiences from participating were identified: talking to others in a similar situation, knowledge, sense of belonging, self-confidence, structure, relief of symptoms and behavioural change.

CONCLUSION

Peer-support groups using a problem-based method could be a useful and comparatively inexpensive tool in alleviating work-related stress and burnout.

Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up

OBJECTIVES

To identify risk factors for new episodes of sick leave due to neck or back pain.

METHODS

This prospective study comprised an industrial population of 2187 employees who were followed up at 18 months and 3 years after a comprehensive baseline measurement. The potential risk factors comprised physical and psychosocial work factors, health-related and pain-related characteristics and lifestyle and demographic factors. The response rate at both follow-ups was close to 73%.

RESULTS

At the 18-month follow-up, 151 participants reported at least one episode of sick-listing due to neck or back pain during the previous year. Risk factors assessed at baseline for sick leave due to neck or back pain at the follow-up were blue-collar work, back pain one or several times during the previous year, 1-99 days of cumulative sickness absence during the previous year (all causes except neck or back pain), uncertainty of one's own working ability in 2 years' time and the experience of few positive challenges at work. After 3 years, 127 participants reported at least one episode of sick leave due to back or neck pain during the year previous to follow-up. The risk factors for this pain-related sick leave were blue-collar work, several earlier episodes of neck pain, no everyday physical activities during leisure time (cleaning, gardening and so on), lower physical functioning and, for blue-collar workers separately, repetitive work procedures.

CONCLUSION

The most consistent risk factors for new episodes of sick leave due to neck or back pain found during both the follow-ups were blue-collar work and several earlier episodes of neck or back pain assessed at baseline. Preventive efforts to decrease sick leave due to neck or back pain may include measures to increase the occurrence of positive challenges at work and to minimise repetitive work procedures. An evidence-based secondary prevention of neck and back pain including advice to stay active is also warranted.

Sex pheromone components of the turnip moth,Agrotis segetum : Chemical identification, electrophysiological evaluation and behavioral activity

Analysis of female abdominal tips ofAgrotis segetum by means of GC-MS showed the presence of 13 aliphatic acetates and alcohols. (Z)-7-Dodecenyl acetate was found to be the main component in the extracts at amounts of about 1 ng/female. (Z)-9-Tetradecenyl acetate and (Z)-7-dodecenol were present to the extent of 49 and 19%, respectively, of the main component. Minor components could be identified as decyl acetate, (Z)-5-decenyl acetate, dodecyl acetate, (Z)-9-dodecenyl acetate, tetradecyl acetate, a tetradecenyl acetate, hexadecyl acetate, a hexadecenyl acetate, (Z)-5-decenol, and (Z)-9-tetradecenol. The presence and biological activity of decyl acetate, (Z)-5-decenyl acetate, and (Z)-7-dodecenyl acetate in the extracts could be detected by GC-EAD. Tested by EAG (Z)-5-decenyl acetate evoked the highest response among pheromone candidates, followed by (E)-5-decenyl acetate and (Z)-7-dodecenyl acetate. Single-cell recordings from 100 male antennal sensilla trichodea revealed receptorcells highly sensitive to (Z)-5-decenyl, (Z)-7-dodecenyl, (Z)-8-dodecenyl, and (Z)-9-tetradecenyl acetate as well as (Z)-5-decenol. The (Z)-5-decenyl, (Z)-7-dodecenyl, and (Z)-9-tetradecenyl acetate receptors were activated significantly also by female extracts. When tested in a tube olfactometer, a blend of decyl, (Z)-5-decenyl, (Z)-7-dodecenyl, and (Z)-9-tetradecenyl acetate evoked the same male response as did female glands.Tested in the field, this blend was more attractive than virgin females. Other authors previously reported many of the compounds identified in the present study. However, both quantitative and qualitative discrepancies exist among the various investigations, possibly due to the existence of geographical races.

Clustering patients on the basis of their individual course of low back pain over a six month period

Background

Several researchers have searched for subgroups in the heterogeneous population of patients with non-specific low back pain (LBP). To date, subgroups have been identified based on psychological profiles and the variation of pain.

Methods

This multicentre prospective observational study explored the 6- month clinical course with measurements of bothersomeness that were collected from weekly text messages that were sent by 176 patients with LBP. A hierarchical cluster analysis, Ward's method, was used to cluster patients according to the development of their pain.

Results

Four clusters with distinctly different clinical courses were described and further validated against clinical baseline variables and outcomes. Cluster 1, a "stable" cluster, where the course was relatively unchanged over time, contained young patients with good self- rated health. Cluster 2, a group of "fast improvers" who were very bothered initially but rapidly improved, consisted of patients who rated their health as relatively poor but experienced the fewest number of days with bothersome pain of all the clusters. Cluster 3 was the "typical patient" group, with medium bothersomeness at baseline and an average improvement over the first 4-5 weeks. Finally, cluster 4 contained the "slow improvers", a group of patients who improved over 12 weeks. This group contained older individuals who had more LBP the previous year and who also experienced most days with bothersome pain of all the clusters.

Conclusions

It is possible to define clinically meaningful clusters of patients based on their individual course of LBP over time. Future research should aim to reproduce these clusters in different populations, add further clinical variables to distinguish the clusters and test different treatment strategies for them.

Volatiles released from individual spruce bark beetle entrance holes Quantitative variations during the first week of attack

Volatiles released from individual entrance holes of eight spruce bark beetles (Ips typographus) were collected during the first week of attack on a resistant host tree. In order to quantify the release of the highly volatile 2-methyl-3-buten-2-ol (MB) from attacking males, a new method was developed with deuterated quantification standard released at the time of collection. The amounts of collected volatiles, as analyzed by GC and GC-MS, showed a large variation between individual holes and also between subsequent entrainments from the same hole. Most of the quantified compounds on the average have two maxima, with a pronounced intervening depression. The amounts of releasedcis-verbenol (cV) increased five times during the first two days, while the amounts of MB were consistently high. The attacked spruce tree was not taken by the beetles, and the average amounts of the two aggregation pheromone components, MB and cV, increased again after the first maxima. The first peak of oxygenated monoterpene, released in the beginning of the attack containing α-terpineol, terpinen-4-ol, bornyl acetate,trans-pinocarveol, and verbenone, was possibly due to spontaneous oxidation of monoterpene hydrocarbons from the tree. Microorganisms established in the gallery wall phloem probably participated in the production of oxygenated monoterpenes during the second increase.

The pollination of zygogynum (winteraceae) by a moth, sabatinca (micropterigidae): an ancient association?

The primitive and vesselless angiosperm Zygogynum (Winteraceae), which is restricted to New Caledonia, is pollinated by a moth, Sabatinca (Micropterigidae). Fossil records of both the moth and the plant families extend to the Early Cretaceous. Adult Sabatinca have grinding mandibles and usually feed on the spores of ferns and on pollen. The insects use the flowers as mating sites and eat the pollen which is immersed in a dense pollenkitt. This mode of pollination in which flowers serve as mating and feeding stations with floral odors acting as cues may have been common in the early evolution of flowering plants.

Cost effectiveness of two rehabilitation programmes for neck and back pain patients: A seven year follow-up

The cost effectiveness of work-oriented rehabilitation for persons on long-term sick leave needs to be assessed. This prospective observational study presents a follow-up seven years after rehabilitation using two different evidence-based work-oriented regimens. Individuals on sick leave for neck and back pain were referred to two rehabilitation programmes in Sweden. The first programme was a relatively low-intensity programme based on orthopaedic manual therapy and exercise programme (OMTP). The second programme was a full-time multidisciplinary programme (MDP). The primary outcome was sickness absence seven years after intervention. Cost effectiveness was calculated on the basis of loss of production due to sickness absence. The results show that participants referred to MDP and with less than 60 sick days before rehabilitation have reduced sickness absence after intervention as compared to matched controls. This corresponds to a cost reduction of about 94,494 EUR per referred individual. Further, the results indicate that participants of the OMTP who have more than 60 sick days before rehabilitation have a statistically significant increased risk of disability pension. This means increased cost in terms of loss of production of 44,593 EUR per referred individual. The results of this study show that MPD but not OMTP achieves the goal of working life-oriented rehabilitation. A direct comparison between the rehabilitation programmes strengthened the assumption that long-term sickness absence prior to rehabilitation is associated with more days on sick leave after rehabilitation. This analysis also indicated the importance of participants' pain self-efficacy beliefs and recovery beliefs on rehabilitation outcome.

Measuring outcome after wrist injury: translation and validation of the Swedish version of the patient-rated wrist evaluation (PRWE-Swe)

Background

There is a need for outcome measurement instruments for evaluation of disability after trauma. The Patient-Rated Wrist Evaluation (PRWE) is a self-administered region-specific outcome measuring instrument developed for use in evaluating disability and pain of the wrist. The aim of this study is to translate and to cross-culturally adapt the PRWE for use in a Swedish patient population. Moreover, we aim at investigating the PRWE in terms of validity, reliability and responsiveness.

Methods

We performed a translation and cross-cultural adaptation of the PRWE to Swedish (PRWE-Swe), utilising the process recommended by the American Association of Orthopedic Surgeons. A total of 124 patients with an injury to the wrist were included in the study. They filled in the PRWE and the DASH questionnaires at two separate occasions.

Results

Reliability of the PRWE in terms of internal consistency (Cronbach's alpha 0.97) and test-retest stability (intraclass correlation coefficient 0.93) were excellent. Face validity and content validity were judged as good. Criterion validity assessed as the correlation between the PRWE and the DASH was also good (Spearman's rho = 0.9). Responsiveness measured by the standardized response mean (SRM) was good with an SRM_PRWE of 1.29.

Conclusion

This Swedish version of the PRWE is a short and easily understood self-administered questionnaire with good validity, reliability, and responsiveness. Our results confirm that the PRWE is a valuable tool in evaluating the results after treatment of a wrist injury.

Monitoring of influenza virus hemagglutinin in process samples using weak affinity ligands and surface plasmon resonance

Surface plasmon resonance (SPR) was used to screen the interaction between a variety of affinity ligands and hemagglutinin (HA) from human influenza virus, with the aim of identifying low affinity ligands useful for the development of a rapid bioanalytical sensor. Three sialic acid-based structures and four lectins were evaluated as sensor ligands. The sialic acid-based ligands included a natural sialic acid-containing glycoprotein, human alpha1-acid glycoprotein (alpha1-AGP), and two synthetic 6'-sialyllactose-conjugates, with varying degree of substitution. The interaction of HA with the four lectin-based ligands, concanavalin A (Con A), wheat germ agglutinin (WGA), Maackia amurensis lectin (MAL), and Sambucus nigra agglutinin (SNA), showed a wide variation of affinity strengths. Affinity and kinetics data were estimated. Strong affinities were observed for Con A, WGA, alpha1-AGP, and a 6'-sialyllactose-conjugate with a high substitution degree, and low affinities were observed for MAL and a 6'-sialyllactose-conjugate with low substitution. The main objective, to identify a low affinity ligand which could be used for on-line monitoring and product quantification, was met by a 6'-sialyllactose-ovalbumin conjugate that had 0.6 mol ligand per mol carrier protein. The apparent affinity of this ligand was estimated to be 1.5+/-0.03 microM (K(D)) on the SPR surface. Vaccine process samples containing HA were analyzed in the range 10-100 microg HA mL(-1) and correlated with single-radial immunodiffusion. The coefficient of variation on the same chip was between 0.010 and 0.091.

Cleptoparasitism and Odor Mimetism in Bees: Do Nomada Males Imitate the Odor of Andrena Females?

Identical chemical compounds are present in the Dufour gland secretion of female Andrena bees and in the cephalic secretion of many male Nomada bees. Females of Nomada parasitize the nests of Andrena. Many Nomada species confine their attacks to a single host species. In two such host-parasite pairs, Andrena haemorrhoa-Nomada bifida and Andrena carantonica-Nomada marshamella, all-trans farnesyl hexanoate was found to be the totally dominant component in respective secretions. In two other pairs, Andrena helvola-Nomada panzeri and Andrena clarkella-Nomada leucophthalma, geranyl octanoate is the major component. This pairwise odor correspondence is discussed in relation to critical points of contact in the life cycles of host and parasite, male and female.

Long-term, non-specific spinal pain: reliable and valid subgroups of patients

The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI ("adaptive coper", "dysfunctional" and "interpersonally distressed" patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from "significant others" than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.

The Short Musculoskeletal Function Assessment Questionnaire (SMFA)Cross-cultural adaptation, validity, reliability and responsiveness of the Swedish SMFA (SMFA-Swe)

The Short Musculoskeletal Function Assessment Questionnaire (SMFA) is designed to measure the functional status of patients with a broad range of musculoskeletal injuries and disorders. It has previously been validated for an American population. We have translated the SMFA into Swedish and tested the translated version (SMFA-Swe) as regards validity, reliability and responsiveness. Acute and elective cases (n = 298) were included in the study. The Swedish version of the SF-36 was used in the validation. We found that the SMFA-Swe was easy to use, that its reliability (internal consistency and stability) was good, that it correlated well with the SF-36 physical scores and that it was also sensitive to changes in musculoskeletal function over time. Orthopedic studies frequently use disease-specific outcome measures because they are sensitive to the disorder studied. However, there may also be a need to evaluate function in groups of patients with different or multiple musculoskeletal disorders and, in such situations, the SMFA can be useful. We conclude that the SMFA-Swe is a valid instrument and can be used in clinical research as well as clinical practice when focusing on patients with various musculoskeletal disorders.

Joint disorders at ages 70, 75 and 79 years--a cross-sectional comparison

The prevalence of back and joint complaints and of rheumatoid arthritis (RA), chondrocalcinosis (CC) and osteoarthritis (OA) was studied in three representative population subsamples aged 70, 75 and 79 years. The prevalence of back pain was 38% and of joint complaints 40%, both significantly higher in females. The prevalence of RA was not significantly different between the age groups. Chondrocalcinosis increased with age in females. Radiographic and clinical OA of knees was less prevalent with increasing age. Symptoms of wrist and finger OA occurred in 1-4% of females but not males. Enlargement of DIP joints occurred in 50% of females and 25% males. Radiographic OA of first MCP joints was more prevalent with age in males but not females. Obesity correlated with radiographic OA of knees in females. Clinical and radiographic OA of fingers and knees did not correlate with previous strenuous occupations.

Proteolytic modification of pig and rat liver pyruvate kinase type L including phosphorylatable site

The phosphorylated or phosphate-accepting site of pyruvate kinase from pig and rat liver was removed without inactivation by incubation with subtilisin. At different time intervals the subtilisin was inactivated with phenylmethylsulfonyl fluoride and the amount of remaining phosphorylatable or phosphorylated sites of pyruvate kinase estimated by incubation with an excess of [32P]-ATP and protein kinase. It was found that to get the same rate of modification the subtilisin concentration required to modify unphosphorylated pyruvate kinase was approximately ten times higher than that used for removal of the phosphorylated site of phosphorylated site of phosphorylated enzyme. It was shown that the proteolytically-modified pyruvate kinase had an increased apparent Km for phosphoenolpyruvate without a change in V, when compared to unmodified unphosphorylated and phosphorylated pyruvate kinase. The removal of the phosphorylated site was not associated with loss of the allosteric sites for ATP and Fru-1,6-P2. The possibility that phosphorylation of the pyruvate kinase increases its degradation rate in vivo is briefly discussed.