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1.
PLoS One ; 10(10): e0141843, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26512893

RESUMO

YHS-domains are small protein modules which have been proposed to bind transition-metal ions like the related TRASH-domains. They are found in a variety of enzymes including copper-transporting ATPases and adenylyl cyclases. Here we investigate a class IIIc adenylyl cyclase from Mycobacterium phlei which contains a C-terminal YHS-domain linked to the catalytic domain by a peptide of 8 amino acids. We expressed the isolated catalytic domain and the full-length enzyme in E. coli. The catalytic domain requires millimolar Mn2+ as a cofactor for efficient production of cAMP, is unaffected by low micromolar concentrations of Cu2+ and inhibited by concentrations higher than 10 µM. The full-length enzyme also requires Mn2+ in the absence of an activator. However, 1-10 µM Cu2+ stimulate the M. phlei adenylyl cyclase sixfold when assayed with Mn2+. With Mg2+ as the probable physiological cofactor of the adenylyl cyclase Cu2+ specifically switches the enzyme from an inactive to an active state. Other transition-metal ions do not elicit activity with Mg2+. We favor the view that the YHS-domain of M. phlei adenylyl cyclase acts as a sensor for copper ions and signals elevated levels of the transition-metal via cAMP. By analogy to TRASH-domains binding of Cu2+ probably occurs via one conserved aspartate and three conserved cysteine-residues in the YHS-domain.


Assuntos
Adenilil Ciclases/metabolismo , Cobre/metabolismo , Mycobacterium phlei/metabolismo , Domínios e Motivos de Interação entre Proteínas , Adenosina Trifosfatases/metabolismo , Adenilil Ciclases/química , Adenilil Ciclases/genética , Sequência de Aminoácidos , Domínio Catalítico , Proteínas de Transporte de Cátions/metabolismo , ATPases Transportadoras de Cobre , Ativação Enzimática , Expressão Gênica , Cinética , Dados de Sequência Molecular , Mycobacterium phlei/enzimologia , Mycobacterium phlei/genética , Alinhamento de Sequência
2.
Disabil Rehabil ; 37(18): 1683-91, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25354147

RESUMO

PURPOSE: The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension. METHOD: For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001-2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data. RESULTS: Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work. CONCLUSIONS: Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions. IMPLICATIONS FOR REHABILITATION: Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees. Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process. Few of the activities taken by the social insurance agency enhanced return to work.


Assuntos
Pensões , Reabilitação Vocacional , Retorno ao Trabalho , Licença Médica , Serviço Social , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suécia , Avaliação da Capacidade de Trabalho , Adulto Jovem
3.
J Rehabil Med ; 46(8): 798-805, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24847727

RESUMO

OBJECTIVE: To describe the frequency of reported sleeping, depression and pain problems, the severity of these problems and the degree of self-estimated difficulties in mental functions and activities in relation to the sleep disturbance and pain category group in patients on long-term sick-leave. DESIGN: Cross-sectional study. PATIENTS: A total of 1206 patients experiencing difficulty in resuming work. METHODS: Patient examinations by specialists in psychiatry, orthopaedic surgery and rehabilitation medicine. Validated questionnaires, including status regarding depression, sleep, pain and functioning were used. RESULTS: The prevalence of sleep disturbance was 83%; 74% of the patients with moderate/severe sleep disturbance also had moderate/severe pain problems and 26% had no/mild pain problems. Fifty-seven percent of the patients with no/mild sleep disturbance and 83% of the patients with moderate/ severe sleep disturbance also had depression. The degree of difficulty in performing the 6 selected International Classification of Functioning, Disability and Health activities and mental functions was higher for the category with moderate/severe sleep problems, compared with those with no/mild sleep problems. CONCLUSION: To optimize rehabilitation for patients on long-term sick-leave experiencing difficulties in returning to work, the results indicate a need also to focus attention on sleep problems and not only on pain and depression. This may entail the planning of measures to improve decision-making and concentration and alleviate lassitude, fatigability, sadness and pessimistic thoughts.


Assuntos
Dor Crônica/psicologia , Transtorno Depressivo/psicologia , Fadiga/psicologia , Processos Mentais/fisiologia , Doenças Musculoesqueléticas/psicologia , Retorno ao Trabalho/psicologia , Licença Médica/estatística & dados numéricos , Transtornos do Sono-Vigília/psicologia , Adulto , Dor Crônica/complicações , Dor Crônica/etiologia , Estudos Transversais , Transtorno Depressivo/complicações , Transtorno Depressivo/etiologia , Fadiga/complicações , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/etiologia , Retorno ao Trabalho/estatística & dados numéricos , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Suécia , Fatores de Tempo
4.
Work ; 49(2): 245-55, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24004785

RESUMO

BACKGROUND: Studies indicate that long-term sickness absence reduces the ability to return to work (RTW). Multidisciplinary medical assessments (MMA) have been used as a method to receive a more versatile assessment of long-term sickness absentees (LTSA) and thereby a better basis for adequate medical and vocational rehabilitation, and an increasing ability to maintain or regain work capacity. OBJECTIVE: The objective of this study was to investigate the associations between the prognoses of LTSAs' future work capacity made at a MMA and the assessments of their work incapacity made by the Social Insurance Offices (SIO) two years later. PARTICIPANTS: 385 LTSAs referred to an MMA by SIOs in the Stockholm area in Sweden between 2001 and 2006. METHODS: Data was collected at the MMA on demographic factors, health, diagnoses, and future work capacity. Information on SIO decisions on sickness benefits and disability pension and what measures the SIO had taken was extracted from the case files at the SIOs. Descriptive statistics and multiple regression analyses were used to assess the associations between the prognosis and decisions on benefits, controlling for individual factors. RESULTS: Of those predicted to be able to maintain or regain work capacity, 68% received full-time benefits two years later. Work capacity was negatively affected by high age, full time sickness absence at MMA and number of physical symptoms at MMA. The prognosis at the MMA was not significantly related to work capacity when socio-demographic and health factors were controlled for. However, this was partly due to the fact that the MMA also included recommendations for vocational rehabilitation and that this factor had an effect on assessed work incapacity after two years. CONCLUSION: The prognosis of future work capacity evaluated at a multidisciplinary medical assessment correlated with actual work capacity two years later. However, a range of other factors were decisive for the result. The study shows that the link between the prognosis and recommendations for vocational rehabilitation should be followed by the SIOs responsible for enhancing RTW among individuals on long-term sick leave.


Assuntos
Absenteísmo , Comportamento de Doença , Avaliação da Capacidade de Trabalho , Adulto , Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Suécia
5.
J Rehabil Med ; 45(2): 186-91, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23138390

RESUMO

OBJECTIVE: To assess the associations between psychological factors and return to work among long-term sickness absentees. DESIGN: Longitudinal study with a 3-year follow-up. SUBJECTS: Long-term sickness absentees (n = 905) who had undergone a multidisciplinary medical assessment. METHODS: Three years after multidisciplinary medical assessment, return to work status (full, partial, or none) was determined according to whether the individuals received full, partial, or no sickness benefits. Multinomial logistic regression analyses were performed to assess the odds ratios with 95% confidence intervals for return to work related to indecision, lassitude, fatigability, reduced sleep, social functioning, emotional role limitations, and vitality. RESULTS: After adjusting for socio-demographic factors and medical diagnoses most of the studied psychological factors were significantly associated with full (odds ratios 2.13-1.50) and partial (odds ratios 2.25-1.63) return to work in the follow-up period. Low level of lassitude was associated with full return to work (odds ratio 1.72) even when the other psychological factors were controlled for. Similarly, low fatigability was associated with partial return to work (odds ratio 1.81). CONCLUSION: This study indicates that psychological factors are important for both full and partial return to work among long-term sickness absentees who have undergone a multidisciplinary medical assessment.


Assuntos
Absenteísmo , Avaliação da Deficiência , Transtornos Mentais , Retorno ao Trabalho/psicologia , Licença Médica , Adulto , Tomada de Decisões , Emoções , Fadiga , Feminino , Seguimentos , Humanos , Relações Interpessoais , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sono , Adulto Jovem
6.
J Multidiscip Healthc ; 4: 281-92, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21847350

RESUMO

OBJECTIVE: The aim was to describe the differences in symptoms, functioning and quality of life between women on long-term sick-leave due to protracted musculoskeletal pain with and without concomitant depression. DESIGN: Descriptive and comparisons with/without comorbid depression. METHODS: 332 female patients were examined by three specialist physicians in psychiatry, orthopedic surgery, and rehabilitation medicine and assigned to four groups according to the ICD-10 diagnoses: low back/joint disorders (LBJ, n = 150), myalgia (M, n = 43), fibromyalgia (FM, n = 87), or depression without somatic pain diagnosis (DE, n = 52). RESULTS: Patients with somatic pain conditions LBJ, M, or FM showed more activity-related difficulties if concomitant depression was present during the activities 'focusing attention', 'making decisions', and 'undertaking a single task'; and in the domains 'energy level', 'memory functions', 'emotional functions', and 'optimism/pessimism'. Patients with FM and concomitant depression perceived higher pain intensity than patients in group DE. No statistically significant differences in physically related activities were noted between each of the somatic pain conditions with and without coexisting depression. FM patients with coexisting depression reported fewer painful sites on their pain drawings compared with FM-patients without depression. Patients with LBJ or FM and concomitant depression reported lower quality of life in the dimensions vitality, social functioning, emotional role, and mental health. Comorbid depression affected disability and restricted working capacity by reducing mental activity and functioning but not by affecting physical activity problems. CONCLUSION: Women on long-term sick-leave, who have concomitant depression with LBJ or FM, also have more difficulties in focusing attention, making decisions, and carrying out tasks, and with memory functions and optimism/pessimism, as well as reduced quality of life in the dimensions of vitality, social functioning, emotional role, and mental health, than female patients without comorbid depression. As a consequence we suggest further efforts to integrate somatic and psychiatric interventions in the same rehabilitation program.

7.
J Multidiscip Healthc ; 4: 25-31, 2011 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-21468245

RESUMO

AIM: The aim was to describe how a multidisciplinary medical assessment changed the distribution of long-term sickness absentees between three different forms of social security support during a period of eleven years. METHODS: The study group (n = 1002) consisted of persons on long-term sickness absence who were referred to a multidisciplinary medical assessment by the Social Insurance Office in Stockholm, Sweden between 1998 and 2007. Register data from the years 1993-2008 were linked to the study group. A calculation was provided for the number of days per person and year on unemployment benefits, sickness benefits, and disability pension, five years before, during, and five years after the assessment. Also, differences in the average number of days per person and year were calculated with one-way analysis of variance. RESULTS: The number of days on sickness benefits increased up to the time of multidisciplinary medical assessment, from 69 to 218 days on average. After the assessment there was a decrease in the average number of days on sickness benefits, from 218 to 16 days. Before the assessment the number of days on disability pension was 21, but this increased after the assessment from 104 days to an average of 272 days five years after the assessment. There were age differences regarding number of compensated days, and these were particularly pronounced for disability days after the assessment. Further, there were significant differences between types of diagnosis in relation to average days on disability pension after the assessment. CONCLUSION: The study shows that after a multidisciplinary medical assessment there is a rapid increase in disability pension and a dramatic decrease in sickness benefits. The results indicate that for a large number of persons, a Social Insurance Office referral to an assessment does not improve their chances of returning to work, but rather seems to justify disability pension.

8.
Methods Enzymol ; 471: 115-23, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20946845

RESUMO

HAMP domains are the central signal converters in bacterial chemotaxis receptors and chemosensory histidine kinases. They link the signal input modules in these proteins, that is, the ligand-binding domains, to the output modules, for example, the histidine kinase domain. A similar architecture is present in the adenylyl cyclase (AC) Rv3645 from Mycobacterium tuberculosis, where a HAMP domain is positioned between the N-terminal membrane anchor and the C-terminal catalytic domain. Because the activity of the catalytic domain responds to alterations in the HAMP domain, a method has been developed which uses the catalytic domain of Rv3645 as a reporter to probe the HAMP domain function of diverse bacterial proteins. A strategy for construction of chimeras between a variety of HAMP domains and the catalytic domain of the AC Rv3645 is described. The enzymes are overexpressed in Escherichia coli and purified by Ni2+-affinity chromatography. AC activity of the chimeras is determined by a radiotracer method published earlier in the series. Results of the mutagenesis of the HAMP domain from the Af1503 protein of Archeoglobus fulgidus are shown as an example for the successful application of the method.


Assuntos
Proteínas de Bactérias/metabolismo , Proteínas de Membrana/metabolismo , Adenilil Ciclases/genética , Adenilil Ciclases/metabolismo , Proteínas de Bactérias/genética , Domínio Catalítico/genética , Domínio Catalítico/fisiologia , Proteínas de Membrana/genética , Mutação , Mycobacterium tuberculosis , Estrutura Terciária de Proteína , Proteínas Recombinantes , Transdução de Sinais/genética , Transdução de Sinais/fisiologia
9.
Scand J Public Health ; 38(6): 657-63, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20534634

RESUMO

AIMS: The aim was to study whether sick-leave diagnoses of long-term sickness absentees were modified after a multidisciplinary assessment and if modifications differed with type of medical specialty of the latest physician to sick-list the patient. METHODS: A sample of 635 long-term sickness absentees referred to a multidisciplinary assessment by Social Insurance Offices was included. Data were obtained through sickness certificates and medical records. Patients were examined by board-certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Descriptive statistics were used. RESULTS: The multidisciplinary assessment resulted in an increase from 1-2 to 2-3 diagnoses for most patients. Forty-five per cent of the male and 47% of the female patients had only somatic diagnoses at referral. After the multidisciplinary assessment these percentages were 20% and 29%, respectively. The rate of women and men given both psychiatric and somatic diagnoses increased from 30% at referral to about 55%. The shift from either only psychiatric or only somatic diagnoses to having these diagnoses in combination was associated with type of specialty of the physician who had sick-listed the patient. CONCLUSIONS: The study indicates that many patients on long-term sick-leave with unclear diagnoses may suffer from unrecognized, and therefore probably untreated, medical disorders and co-morbidity.


Assuntos
Absenteísmo , Transtornos Mentais/diagnóstico , Licença Médica , Avaliação da Capacidade de Trabalho , Adulto , Avaliação da Deficiência , Feminino , Humanos , Seguro Saúde , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Encaminhamento e Consulta , Suécia
10.
Mol Cell Biochem ; 334(1-2): 215-9, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19943185

RESUMO

Production of cGMP in bacteria has been studied since the early 1970s. From the beginning on it proved to be a challenging topic. In Escherichia coli the cGMP levels were two orders of magnitude lower than the corresponding cAMP levels. Furthermore, no specific cGMP receptor protein was identified in the bacterium and a physiological role of cGMP in the bacterium was not substantiated. Consequently in 1977, compelling evidence was given that cGMP is a by-product of E. coli adenylate cyclase in vivo. This may be the reason why also work on cGMP in other bacteria like Bacillus licheniformis and Caulobacter crescentus was not pursued any further. However, recent study on cGMP and guanylate cyclase in the cyanobacterium Synechocysis PCC 6803 brought cGMP signaling in bacteria back to attention. In Synechocystis cGMP levels are of similar magnitude as those of cAMP and deletion of the cya2 gene markedly reduced the amount of cGMP without affecting cAMP. A few months ago the Cya2 gene product has been biochemically and structurally characterized. It behaves as a specific guanylate cyclase in vitro and a single amino acid substitution transforms the enzyme into a specific adenylate cyclase. These data point toward the existence of a true bacterial cGMP-signaling pathway, which needs to be explored and established by future experiments.


Assuntos
Bactérias/metabolismo , GMP Cíclico/biossíntese , Transdução de Sinais
11.
J Biol Chem ; 285(3): 2090-9, 2010 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-19923210

RESUMO

The Escherichia coli chemoreceptors for serine (Tsr) and aspartate (Tar) and several bacterial class III adenylyl cyclases (ACs) share a common molecular architecture; that is, a membrane anchor that is linked via a cytoplasmic HAMP domain to a C-terminal signal output unit. Functionality of both proteins requires homodimerization. The chemotaxis receptors are well characterized, whereas the typical hexahelical membrane anchor (6TM) of class III ACs, suggested to operate as a channel or transporter, has no known function beyond a membrane anchor. We joined the intramolecular networks of Tsr or Tar and two bacterial ACs, Rv3645 from Mycobacterium tuberculosis and CyaG from Arthrospira platensis, across their signal transmission sites, connecting the chemotaxis receptors via different HAMP domains to the catalytic AC domains. AC activity in the chimeras was inhibited by micromolar concentrations of l-serine or l-aspartate in vitro and in vivo. Single point mutations known to abolish ligand binding in Tar (R69E or T154I) or Tsr (R69E or T156K) abrogated AC regulation. Co-expression of mutant pairs, which functionally complement each other, restored regulation in vitro and in vivo. Taken together, these studies demonstrate chemotaxis receptor-mediated regulation of chimeric bacterial ACs and connect chemical sensing and AC regulation.


Assuntos
Adenilil Ciclases/metabolismo , Proteínas de Bactérias/metabolismo , Membrana Celular/metabolismo , Células Quimiorreceptoras/metabolismo , Proteínas de Escherichia coli/metabolismo , Escherichia coli/enzimologia , Proteínas de Membrana/metabolismo , Proteínas Recombinantes de Fusão/metabolismo , Transdução de Sinais , Inibidores de Adenilil Ciclases , Adenilil Ciclases/química , Sequência de Aminoácidos , Ácido Aspártico/farmacologia , Proteínas de Bactérias/química , Células Quimiorreceptoras/química , Cianobactérias/enzimologia , Escherichia coli/citologia , Escherichia coli/metabolismo , Proteínas de Escherichia coli/química , Proteínas de Membrana/química , Proteínas Quimiotáticas Aceptoras de Metil , Dados de Sequência Molecular , Mycobacterium tuberculosis/enzimologia , Estrutura Terciária de Proteína , Receptores de Superfície Celular , Proteínas Recombinantes de Fusão/química , Alinhamento de Sequência , Serina/farmacologia
12.
Int J Rehabil Res ; 32(1): 20-35, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19648800

RESUMO

The number of patients with difficulty in resuming work after long-term sick leave has increased in several European countries including Sweden. The general aim of this study was a comprehensive description--based on multidisciplinary diagnostics and assessments--of patients with the common feature of marked difficulty in resuming working life after a long absence. A particular aim was to elucidate the possible effect of comorbidity on pain descriptors, disability, quality of life, assessed working ability and rehabilitation needs. Six hundred and thirty-five long-term sick leavers were referred from National Insurance Offices and consecutively accepted for investigation. Several self-report questionnaires were used. All patients were examined by three board-certified specialist physicians in psychiatry, orthopaedic surgery and rehabilitation medicine, respectively. Fifty-five percent of the patients had psychiatric-somatic comorbidity. The three most frequent combinations of diagnoses in the comorbidity group were fibromyalgia/myalgia and depressive episode, fibromyalgia/myalgia and recurrent depression, spinal pain and depressive episode, whereas the three most frequent in those with psychiatric diagnosis only were depressive episode, recurrent depression, phobias/anxiety. Differences in pain descriptors and in difficulties with activities were found among the three groups. All had lower health-related quality of life than references. Only one-sixth had no assessed working capacity and only 3% were assessed as able to resume work without rehabilitation; 80% were multidisciplinarily assessed as needing rehabilitation. Patients with psychiatric diagnoses, with or without concomitant somatic diagnoses, need medical rehabilitation or medical/vocational rehabilitation in combination to a greater extent than patients with somatic diagnoses only. This implies that medical rehabilitation programmes ought to adapt increasingly to the needs of patients with psychiatric-somatic comorbidity.


Assuntos
Doença Crônica/reabilitação , Emprego/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/epidemiologia , Doença Crônica/epidemiologia , Comorbidade , Depressão/epidemiologia , Feminino , Fibromialgia/epidemiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Medição da Dor , Pensões , Qualidade de Vida , Fatores de Tempo
13.
Psychoneuroendocrinology ; 34(10): 1526-32, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19525070

RESUMO

The research on thyroid hormones and personality traits is quite sparse and mainly focused on male forensic psychiatric populations in which the relationship between thyroid hormones and psychopathy and aggression-related personality traits has been reported. The suicidal temperament hypothesis suggests that certain personality traits such as aggression, anxiety proneness, impulsivity, and low socialization may render an individual vulnerable to the risk of suicide. The aim of this study was to investigate personality traits assessed by the Karolinska Scales of Personality (KSP) in relation to hormones in the hypothalamic-pituitary-thyroid (HPT) axis in 100 euthyroid suicide attempters. Standard multiple regression analyses were performed with TSH, T3, T4, and the T3/T4 ratio, respectively, as the dependent variable and KSP factors (Anxiety Proneness, Aggressiveness, and Impulsivity) and subscales (Detachment, Social Desirability, and Socialization) as independent variables. In men, but not in women, the regression model of the T3/T4 ratio was significant and the results suggested that high scores on Aggressiveness and low ones on Detachment were associated with a low T3/T4 ratio. These results indicate that HPT function may be related to Aggressiveness and Detachment in male suicide attempters.


Assuntos
Personalidade/fisiologia , Tentativa de Suicídio/psicologia , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Caracteres Sexuais
14.
Scand J Public Health ; 37(1): 35-42, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19141553

RESUMO

AIMS: In Sweden, the Social Insurance Offices each year refer long-term sickness absentees to comprehensive investigations to clarify medical conditions. However, there is a lack of scientific knowledge about these patients and their morbidity. The aim was to characterize a population of these sickness absentees regarding prevalence of somatic and psychiatric diagnoses and possible associations with sociodemographic, lifestyle, and health characteristics. METHODS: A cross-sectional study was made up of 635 sickness absentees below the age of 64, who the local Social Insurance Offices in Stockholm County, Sweden, referred to a special unit for multidisciplinary investigation. Data was obtained from questionnaires and medical records. The patients were examined by board certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Relative risks were estimated by use of modified Poisson regression to assess the associations between characteristics and diagnose outcomes. RESULTS: About 80% of the patients had more than one diagnosis. The vast majority had a psychiatric diagnosis, and approximately 55% had that in combination with at least one somatic diagnosis. An increased risk for being given a psychiatric diagnosis was found for men and unemployed people. In addition, lack of social life and friends and self-reported mental health problems were associated with psychiatric diagnoses but also among those who were given somatic diagnoses in combination with psychiatric diagnoses. Increased risks for somatic diagnoses were found for women and for patients with a higher education. CONCLUSIONS: Long-term sickness absentees referred to multidisciplinary investigations display high co-morbidity of psychiatric and somatic diagnoses and are a heterogeneous group with diverse sociodemographic and medical characteristics.


Assuntos
Transtornos Mentais/complicações , Doenças Musculoesqueléticas/complicações , Dor/complicações , Licença Médica , Adulto , Consumo de Bebidas Alcoólicas , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Dor/diagnóstico , Dor/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Suécia/epidemiologia , Fatores de Tempo
15.
J Multidiscip Healthc ; 2: 23-37, 2009 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-21197344

RESUMO

OBJECTIVE: The aim was to gain knowledge of fibromyalgia (FM) patients on long-term sick leave and with particular difficulties in resuming work, and to compare them with patients with myalgia, back or joint diagnoses, and depression. METHODS: Patients were identified by and referred from social insurance offices and were multidisciplinarily examined by three board-certified specialists in psychiatry, orthopedic surgery and rehabilitation medicine. Ninety-two women were diagnosed with FM only. Three female comparison groups were chosen: depression, back/joint diagnoses, and myalgia. RESULTS AND CONCLUSIONS: Ceaseless pain was reported by 73% of FM patients, 54% of back/joint diagnoses patients, 43% of myalgia patients, and 35% of depression patients. The distribution of pain (>50%) in FM patients was to almost all regions of the body, and in depression patients to the lower dorsal neck, upper shoulders and lumbosacral back but not in the anterior body. Reduced sleep was more evident in FM patients. FM patients did not meet more criteria for personality disorder than patients with the other somatic pain conditions. The most common dimension of "personality traits" of somatic pain conditions was the "obsessive compulsive" but at a level clearly below that indicating a personality disorder. More FM patients experienced disabilities, the most common being in the mobility and domestic-life areas.

16.
Disabil Rehabil ; 31(2): 131-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18608401

RESUMO

OBJECTIVE: The aim was to investigate the results of multidisciplinary investigations of long-term sickness absentees regarding diagnoses, degree and prognoses of work incapacity, and need of rehabilitation measures and whether this was associated with socio-demographic factors. METHOD: A cross-sectional study of 545 long-term (>1 year) sickness absentees referred to multidisciplinary investigations by the Social Insurance Office. Data was obtained from questionnaires and medical records. The patients were examined by specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine who afterwards agreed on diagnoses, work incapacity, time to return to work (RTW), and rehabilitation measures. Descriptive statistics and logistic regression were used for description and analyses of data. Data on age, country of birth, education, employment and marital status were included. RESULTS: The prevalence of psychiatric diagnoses was 72%, and 58% of the patients had that in combination with somatic diagnoses. Most patients were assessed to be capable of RTW within 6 - 24 months after further rehabilitation measures. Higher age was associated with a negative prognosis of RTW and those patients were less often recommended additional rehabilitation. CONCLUSION: Despite long-term sickness absence and high rates of psychiatric and somatic diagnoses in combination, RTW was considered possible for most patients after further rehabilitation measures.


Assuntos
Absenteísmo , Licença Médica/estatística & dados numéricos , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Registros Médicos , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
17.
Curr Opin Struct Biol ; 18(6): 667-72, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19054664

RESUMO

Out of six classes of adenylyl cyclases all class III enzymes convert ATP to cAMP in a catalytic centre moulded into an interface of bacterial homodimers and eukaryotic (pseudo)heterodimers. Formation of the catalytic centre, therefore, requires meticulous coordination of catalytic amino acids. Regulation of adenylyl cyclase activity via subtle or profound reorientation processes within the dimer interface is demonstrated on the basis of four class III adenylyl cyclase structures, a mammalian heterodimer, a mycobacterial holoenzyme that is pH regulated, another mycobacterial isoform that reorients upon substrate binding and a cyanobacterial cyclase activated by bicarbonate. Thus the interface of class III adenylyl cyclases is a like scaffold used in the regulation of activity by intrinsic and extrinsic signaling modules.


Assuntos
Adenilil Ciclases/química , Adenilil Ciclases/metabolismo , Proteínas de Bactérias/química , Proteínas de Bactérias/metabolismo , Transdução de Sinais , Spirulina/enzimologia , Animais , Bicarbonatos/metabolismo , Biocatálise , Concentração de Íons de Hidrogênio , Mamíferos/metabolismo , Membranas/enzimologia , Mycobacterium/enzimologia , Ligação Proteica , Multimerização Proteica , Estrutura Terciária de Proteína , Especificidade por Substrato
18.
Biochem J ; 415(3): 449-54, 2008 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18620542

RESUMO

Class I adenylate cyclases are found in gamma- and delta-proteobacteria. They play central roles in processes such as catabolite repression in Escherichia coli or development of full virulence in pathogens such as Yersinia enterocolitica and Vibrio vulnificus. The catalytic domain (residues 2-446) of the adenylate cyclase of E. coli was overexpressed and purified. It displayed a V(max) of 665 nmol of cAMP x mg(-1) x min(-1) and a K(m) of 270 microM. Titration of the metal cofactor Mg(2+) against the substrate ATP showed a requirement for free metal ions in addition to the MgATP complex, suggesting a two-metal-ion mechanism as is known for class II and class III adenylate cyclases. Twelve residues which are essential for catalysis were identified by mutagenesis of a total of 20 polar residues conserved in all class I adenylate cyclases. Five essential residues (Ser(103), Ser(113), Asp(114), Asp(116) and Trp(118)) were part of a region which is found in all members of the large DNA polymerase beta-like nucleotidyltransferase superfamily. Alignment of the E. coli adenylate cyclase with the crystal structure of a distant member of the superfamily, archaeal tRNA CCA-adding enzyme, suggested that Asp(114) and Asp(116) are the metal-cofactor-ion-binding residues. The S103A mutant had a 17-fold higher K(m) than wild-type, demonstrating its important role in substrate binding. In comparison with the tRNA CCA-adding enzyme, Ser(103) of the E. coli adenylate cyclase apparently binds the gamma-phosphate group of ATP. Consistent with this function, the S103A mutation caused a marked reduction of discrimination between ATP- and ADP- or AMP-derived inhibitors.


Assuntos
Adenilil Ciclases/química , Adenilil Ciclases/metabolismo , Proteínas de Escherichia coli/química , Proteínas de Escherichia coli/metabolismo , Escherichia coli/enzimologia , Trifosfato de Adenosina/metabolismo , Adenilil Ciclases/isolamento & purificação , Sequência de Aminoácidos , Sítios de Ligação , Catálise , Escherichia coli/metabolismo , Cinética , Dados de Sequência Molecular , Mutagênese Sítio-Dirigida , Mutação , Conformação Proteica , Serina/genética , Serina/metabolismo , Relação Estrutura-Atividade
19.
J Rehabil Med ; 40(1): 15-22, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18176732

RESUMO

OBJECTIVE: The aim of this study was to evaluate the economic consequences of an 8-week multiprofessional rehabilitation programme for patients with persistent pain. SUBJECTS: A group of 67 patients following the programme and a comparison group of 322 patients. METHODS: The effect on return to work was estimated using 3 different methods: (i) a matched sample approach; (ii) regression analysis; and (iii) propensity score matching. The economic benefit of the programme was estimated as a reduction in production losses due to sick-leave. This benefit was compared with the actual cost of the programme. RESULTS: The benefit of the programme was estimated to be euro3,799-7,515 per treated patient and year. The total cost of the programme was estimated to be euro5,406 per patient. Based on these figures the total cost of the programme, including costs for patients remaining on sick-leave, had been recovered when the successfully rehabilitated patients had worked for 9-17 months. Any additional work after that yielded net economic benefits. CONCLUSION: Since other studies indicate that a large proportion of the patients working after one year also work after 3 and 6 years, we conclude that this multiprofessional rehabilitation programme for patients with persistent pain most likely generates substantial net economic gains.


Assuntos
Doenças Musculoesqueléticas/reabilitação , Dor/reabilitação , Adulto , Doença Crônica , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Dor/psicologia , Equipe de Assistência ao Paciente , Reabilitação Vocacional/economia , Licença Médica , Fatores Socioeconômicos , Fatores de Tempo
20.
Int J Rehabil Res ; 30(3): 255-60, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17762774

RESUMO

The aim of this study was to examine the relationship between pain extent, severity of depressive symptoms and recommended rehabilitation measures in long-term sick-listed patients. In this cross-sectional study, the medical records of 228 long-term sick-listed patients consecutively referred to a multidisciplinary setting were examined retrospectively. Three specialists in psychiatry, orthopaedic surgery and rehabilitation medicine had made joint rehabilitation recommendations into the four different groups: (i) back to work without rehabilitation; (ii) vocational rehabilitation or adjusted work; (iii) medical rehabilitation and (iv) sick pension. Each patient filled in a pain drawing as a measure of pain extent and the self-administered Montgomery-Asberg-Depression-Rating Scale for evaluating the severity of depressive symptoms. Ninety-five percent of the patients had ongoing pain and 53% had depression. No statistically significant difference was seen between the outcome groups regarding the pain extent. A statistically significant difference was seen between the back to work without any rehabilitation and vocational rehabilitation or adjusted work groups in Montgomery-Asberg-Depression-Rating Scale score versus the medical-rehabilitation and sick-pension groups [P<0.001 between groups (chi(2) test); P<0.05 within groups (Tukey-Kramer Honestly Significant Difference test)]. In conclusion, two-thirds of the patients were assessed to need medical rehabilitation. These patient groups could be separated from the ones who were assessed to be able to go back to work without medical rehabilitation by the severity of the ongoing depression, but not by the pain extent alone. It was found that the combination of severity of depression and pain extent provided more information than the severity of depression alone.


Assuntos
Depressão/psicologia , Pessoas com Deficiência/reabilitação , Determinação de Necessidades de Cuidados de Saúde , Dor/psicologia , Estudos Transversais , Pessoas com Deficiência/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Escalas de Graduação Psiquiátrica , Reabilitação Vocacional , Estudos Retrospectivos , Índice de Gravidade de Doença , Licença Médica , Suécia
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