Experience of health complaints and help seeking behavior in employees screened for depressive complaints and risk of future sickness absence.

INTRODUCTION: The aim of this study was to examine the associations between on the one hand depressive complaints and risk of future sickness absence and on the other hand experience of health complaints and help seeking behavior in the working population. METHODS: Cross-sectional data were used from employees working in the banking sector (n = 8,498). The screening instrument included measures to examine the risk of future sickness absence, depressive complaints and help seeking behavior. RESULTS: Of employees reporting health complaints, approximately 80% had already sought help for these complaints. Experience of health complaints and subsequent help seeking behavior differed between employees with mild to severe depressive complaints and employees at risk of future sickness absence. Experience of health complaints was highest in employees identified with both concepts (69%) compared with employees identified at risk of future sickness absence only (48%) and with mild to severe depressive complaints only (57%). In those employees identified with one or both concepts and who had not sought help already, intention to seek help was about 50%. CONCLUSIONS: From a screening perspective, employees who do not experience health complaints or who do not have the intention to seek help may refuse participation in early intervention. This might be a bottleneck in the implementation of preventive interventions in the occupational health setting.

Synthesis and biological activity of aminoguanidine and diaminoguanidine analogues of the antidiabetic/antiobesity agent 3-guanidinopropionic acid.

3-Guanidinopropionic acid (1) has been demonstrated both to improve insulin sensitivity and to promote weight loss selectively from adipose tissue in animal models of non-insulin-dependent diabetes mellitus (NIDDM). However, 1 has also been shown to be a substrate for both the creatine transporter and creatine kinase, leading to marked accumulation in muscle tissue as the corresponding N-phosphate. The corresponding aminoguanidine analogue 2 was recently discovered to retain the antidiabetic activity of 1 while being markedly less susceptible to creatine-like metabolism, suggesting that it should have less potential to accumulate in muscle. Further structural modification of 2 was undertaken to investigate whether the antidiabetic potency could be augmented while maintaining resistance to creatine-like metabolism. Modifications such as alpha-alkylation, homologation, and bioisosteric replacement of the aminoguanidine all were detrimental to antidiabetic activity. However, the simple regioisomeric aminoguanidinoacetic acid 9 and diaminoguanidinoacetic acid analogue 7 were found to be equipotent to 2, leading eventually to the discovery of the significantly more potent diaminoguanidinoacetic acid regioisomers 52 and 53. Further attempts to modify the more active template represented by 52 led only to reductions in antidiabetic activity. Each of the new active analogues displayed the same resistance to creatine-like metabolism as 2. Further testing of 7, 9, and 53 in obese diabetic ob/ob mice confirmed that weight loss is induced selectively from adipose tissue, similar to the lead 1. Administration of 53 to insulin-resistant rhesus monkeys led to reductions in both fasting and post-prandial plasma glucose levels with concomitant reductions in plasma insulin levels, suggesting that the compound improved the action of endogenous insulin. Compounds 7 and 53 were selected for further preclinical development.

Synthesis and biological activity of analogues of the antidiabetic/antiobesity agent 3-guanidinopropionic acid: discovery of a novel aminoguanidinoacetic acid antidiabetic agent.

3-Guanidinopropionic acid (1, PNU-10483) has been demonstrated to both improve insulin sensitivity and to promote weight loss selectively from adipose tissue in animal models of non-insulin-dependent diabetes mellitus (NIDDM). However, 1 has also been shown to be a substrate for both the creatine transporter and creatine kinase, leading to marked accumulation in muscle tissue as the corresponding N-phosphate 4. In an effort to identify novel entities that maintain antidiabetic potency without susceptibility to creatine-like metabolism, an analogue program was undertaken to explore the effects of various structural modifications, including homologation, simple substitution, single atom mutations, and bioisosteric replacements for the guanidine and carboxylic acid. Overall, the scope of activity encompassed by the set of new analogues proved to be exceedingly narrow. Notable exceptions demonstrating equivalent or improved antidiabetic activity included the alpha-amino derivative 29, aminopyridine 47, isothiourea 67, and aminoguanidine 69. On the basis of its superior therapeutic ratio, aminoguanidine 69 was selected for preclinical development and became the foundation for a second phase of analogue work. Furthermore, in vitro studies demonstrated that 69 is markedly less susceptible to phosphorylation by creatine kinase than the lead 1, suggesting that it should have less potential for accumulation in muscle tissue than 1.

The development of a short generic version of the Sickness Impact Profile.

This study concerns the development of a short version of a well-known and much used clinimetric instrument called the Sickness Impact Profile (SIP). The SIP is a generic measure of functional status. Based on findings of a principal components analysis of over 800 SIPs from a multi-diagnostic population, a selection of 68 items divided over 6 dimensions was made and initially tested. As no support was found for the statistical validity of the categorical structure of the original SIP, a new structure, discovered through principal components analysis, was used as the basis for selecting items. Comparison of the scores on the selection with information provided by the original SIP showed very promising results: the 68 item selection may serve as a valid short SIP-version.

Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68.

In this study, the Sickness Impact Profile (SIP) and the SIP68 are studied for their ability to detect changes in health-related behavioral status. Methodological approaches toward responsiveness are invented and discussed. Next, literature findings on the responsiveness of the SIP are presented and judged for their validity. The SIP appeared to be able to demonstrate changes in the expected direction and in accordance with changes detected by other instruments. Using data from seven different longitudinal projects in populations with different diagnoses, the responsiveness of both the SIP136 and the SIP68 are subsequently studied and compared. In all populations, changes in functional status were indicated by both instruments. In terms of effect sizes, the SIP136 and the SIP68 do not differ significantly in their responsiveness. Moreover, changes detected by both SIPs appear to be valid representations of changes in health-related functional status.

Predictors of professional and non-professional community care for care-dependent adults.

The increasing number of elderly people in most industrialized countries makes reforms in health care necessary. However, knowledge of factors that determine the use of care is scarce. The study described in this article focuses on predictors of the diversity of professional and non-professional care used by care-dependent adults who live in the community. A group of 177 care-dependent adults was identified by means of a large scale telephone survey in the Dutch community of Tegelen. Potential predictors of the diversity of professional and non-professional care were derived from Andersen's Behavioral Model of Health Services [4,5] and Litwak's Task Specifity Model [12]. Both models proved to be valuable for the explanation of variance in the diversity of care. Potential predictors derived from the two models could account for 21% of the variance for total care, 25% of the variance for professional care, and 34% of the variance for non-professional care.

Longitudinal study on quality of life and social support in cancer patients.

The aim of the present study is to acquire insight into the changes of quality of life, social networks, and social support of cancer patients during the first year after diagnosis, as well as into the relation between social support and the changes in quality of life. Newly diagnosed cancer patients (n = 51) were followed for 1 year. Semistructured personal interviews and questionnaires were used to gather data. On the average, patients' functioning improved and the amount of physical complaints decreased over the year. Psychological complaints and the global evaluation of life, however, did not change significantly over time. The patients were supported by small, dense networks, consisting mostly of family members. Size of the networks as well as the amount of emotional support showed some decrease over time. It appeared that emotional support was positively related to quality of life. Moreover, a tendency was found to indicate that patients with a deterioration in quality of life perceived a larger decrease in emotional support than patients with a positive course. The amount of perceived instrumental support did not change significantly. There is a tendency that patients who were functioning worse had a greater need for instrumental support. Although these findings indicate relations between types of support and quality of life, we cannot make statements on the causality of these relations.

[Activity level, boredom, health and participative climate in nursing homes]. / Activiteiten, verveling, gezondheid en het ervaren participatief klimaat in verzorgingshuizen.

In this paper an analysis is presented of factors accounting for differences in levels of boredom and activities of residents of homes for the aged. Eighty respondents in two homes for the aged were interviewed. Results indicate that residents with a positive perception of the participatory climate report lower levels of boredom but do not participate in activities more often than other residents. Moreover, persons who report psychological distress report higher levels of boredom. Other factors such as age, gender and level of activity do not seem to be related to boredom. It also appears that actual participation in activities is only predicted by age and two health indicators: health perception and ADL/HDL score. Persons who are younger and persons who report a better health situation participate more often in activities.

[Women of the middle generation and informal care for the elderly]. / Vrouwen van een middengeneratie en informele zorg voor ouderen.

In this study women are described as caregivers of both younger and older generations, the so called "sandwich generation', "women in the middle' or "middle generation'. The aim of this article was to collect data indicating the size of this phenomenon and to explore whether women in the middle provide less family care for the elderly than other caregivers. Women in the middle were defined as those women who have dependent children and give help to their parents (-in-law). In 1994 a random sample was drawn among a cohort of women aged 40-54. A telephone survey was carried out (N = 933). It appeared that almost half of the respondents (45%) gave parent care, usually 1-2 mornings/afternoons per week. A considerable proportion of the cohort (29%) were women-in-the-middle. These respondents differed in few respects from other respondents. They were relatively young and worked fewer hours per week outdoors. From this study it could not be concluded that women-in-the-middle provide less parent care than other caregivers. They appeared to spend about the same amount of time on parent care, were as often the primary caregiver of their parents(-in-law) and experienced a similar caregiver burden as often as other caregivers. However, they provided less often very intensive care.

[Family care for Moluccan ans Dutch elderly persons: a comparative study of readiness and expectations]. / Familiezorg voor Molukse en Nederlandse ouderen: een vergelijkend onderzoek naar bereidheid en verwachtingen.

Care expectations of Moluccan and Dutch elderly (n = 48), and the willingness of their children (n = 25) to provide care are explored. It appeared, that Moluccan elderly received more family care than the Dutch comparison group. Moluccan children were considered to be responsible for the care of the elderly as well as for arranging additional care. Dutch elder persons stressed that they didn't want to become a 'burden' to their children, and were more willing to call in professional help. However, all elderly persons were reluctant concerning the involvement of professional care. Dutch elder persons stressed their loss of independency. For Moluccan elderly, professional care did not fit in with their traditional (care) beliefs. In general, Moluccan children were more willing to provide care than Dutch children. However, many of them expected problems in combining family life, a job and the care of their parents. In this respect opinions of Moluccan and Dutch children were more alike than those of their parents.

[Job satisfaction of physicians in academic and general hospitals]. / De arbeidssatisfactie van artsen in academische en algemene ziekenhuizen.

Based on a study of 20 medical departments (general surgery, internal medicine, radiology) an analysis is presented of variables which may account for differences in work satisfaction. The results show: (a) (experienced) work load correlates negatively with work satisfaction; (b) satisfied physicians define their medical domain more broadly than dissatisfied physicians. Besides, they do not regard their salary as an important aspect of their work. In general, radiologists are most satisfied with their work, internists least; medical specialists are more satisfied than residents. In the discussion it is argued that hospital physicians prefer regularity in their work, combined with a professional work climate. In terms of the growing bureaucratization of the physician's work it is concluded that satisfaction is positively influenced by standardization of work processes and negatively by external pressures which limit professional autonomy.

Calmodulin: an introduction.

Calmodulin is the most widely distributed and most versatile member of a family of calcium-binding proteins which probably serve as receptors for the Ca2+ signal. Through the regulation of a wide variety of intracellular enzymes, calmodulin plays a key role in many physiological processes. An understanding of the different mechanisms by which calmodulin exerts its influence is beginning to emerge and an interesting hypothesis regarding the interrelationship between the cAMP and Ca2+ second messenger systems has recently been put forward.

Chemical modification studies on the Ca2+-dependent protein modulator: the role of methionine residues in the activation of cyclic nucleotide phosphodiesterase.

Methionine residues have been implicated in the activation of cyclic nucleotide phosphodiesterase by the Ca2+-dependent protein modulator [Walsh, M., & Stevens, F.C. (1977) Biochemistry 16,2742-2749]. Treatment of the modulator with N-chlorosuccinimide in the presence of Ca2+ resulted in selective oxidation of methionine residues at positions 71,72, 76, and, possibly, 109 in the modulator sequence. These residues lie on the surface of the molecule exposed to solvent. This modification has several effects on the modulator protein: (1) the Ca2+-binding properties of the oxidized modulator are changed with apparent loss of high-affinity binding sites, (2) the oxidized protein no longer interacts with phosphodiesterase, and (3) troponin C like activities, viz., Ca2+-dependent change in mobility on urea-polyacrylamide gel electrophoresis and formation of a urea-stable complex with troponin I, are lost upon oxidation of the modulator. The phosphodiesterase binding domain of the modulator protein appears to be located between the second and third Ca2+-binding loops, a region of the molecule known from previous partial proteolysis studies [Walsh, M., Stevens, F.C., Kuznicki, J., & Drabikowski, W.(1977), J. Biol. Chem. 252, 7440-7443] to be exposed in the presence of Ca2+.

Purification and characterization of a Ca2+-binding protein in Lumbricus terrestris.

A Ca2+-binding protein which is capable of activating mammalian Ca2+-activatable cyclic nucleotide phosphodiesterase has been purified from Lumbricus terrestris and characterized. This protein and the Ca2+-dependent protein modulator from bovine tissues have many similar properties. Both proteins have molecular weights of approximately 18,000, isoelectric points of about pH 4, similar and characteristic ultraviolet spectra, and similar amino acid compositions. Both proteins bind calcium ions with high affinity. However, the protein from Lumbricus terrestris binds 2 mol of calcium ions with equal affinity, Kdiss = 6 X 10(-6) M, whereas the Ca2+-dependent protein modulator from bovine tissues binds 4 mol of calcium ions with differing affinities. Although the Ca2+-binding protein of Lumbricus terrestris activates the Ca2+-activatable cyclic nucleotide phosphodiesterase from mammalian tissues, we have failed to detect the existence of a Ca2+-activatable phosphodiesterase activity in Lumbricus terrestris. The activation of phosphodiesterase by the Ca2+-binding protein from Lumbricus terrestris is inhibited by the recently discovered bovine brain modulator binding protein (Wang, J. H., and Desai, R. (1977) J. Biol. Chem. 252, 4175-4184). Since the modulator binding protein has been shown to associate with the mammalian protein modulator to result in phosphodiesterase inhibition, it can be concluded that the Lumbricus terrestris Ca2+-binding protein also associates with the bovine brain modulator binding protein. Attempts to demonstrate the existence of a similar modulator binding protein in Lumbricus terrestris have been unsuccessful.

Community nursing in Belgium, Germany and The Netherlands.

This paper contains a comparative study on community nursing in the Netherlands, Belgium and Germany, carried out in the region around Maastricht, where the borders of the three countries meet. The well-known problem of comparative studies (the incomparability of concepts and data) has been solved by using the same measuring instruments in the three countries. The comparison between the countries was on three aspects: the level of care dependency of the patients, the type and number of services provided and the nurses' job interpretation and job satisfaction. During 1 week in June or September 1991, 89 community nurses made records of all their home visits and nursing activities. In total the community nurses paid 5165 home visits to provide care to 1796 patients. The results indicate that both the level of care dependency of the patients as well as the type of care provided differs between the three countries. Belgian community nurses have the highest number of patients with a high level of care dependency. Curative services like technical nursing care and domestic care are most frequently provided by the German and Belgian community nurses. Informing, educating and supporting care is most frequently provided by the Dutch community nurses. The German community nurses spend less time on administration activities. With respect to job interpretation and job satisfaction the following results were found. The Dutch community nurses mentioned in their job interpretation many more preventive tasks, whereas the German community nurses more often mentioned domestic tasks. Concerning the hygienic and technical tasks, no significant differences were found between the three countries. Finally, job satisfaction is lowest in the Netherlands. Dutch community nurses are less satisfied with the work organization and the possibilities of autonomy and professionalization than the German and Belgian community nurses.

Implementing coordination of care--task performance and problems encountered.

In recent years the effects of interventions in the field of coordination of care have been well reported. However, the implementation of coordination of care is hardly addressed. This article focuses on the implementation of coordination of care for the elderly in three community settings in The Netherlands. A group of 38 professional and non-professional care-givers functioned as coordinators during a period of one year. Open interviews with coordinators, minutes from group meetings and forms and logbooks were used as sources of data. Major problems during implementation involved conflicting roles, preserving the client's privacy, lack of recognition and the perception that coordination was not always necessary. Coordinators had no difficulty in making a care inventory and in organizing care. On the other hand, introducing oneself as a coordinator, and planning and evaluating are tasks that need more attention in future interventions.

Circular dichroism studies on Ca2+-dependent protein modulator oxidized with N-chlorosuccinimide.

The structural features and Ca2+-binding properties of native and N-chlorosuccinimide-oxidized modulator protein were compared by circular dichroism. In the presence of Ca2+,the far-UV spectra of native and oxidized modulator protein are virtually indistinguishable, indicating that oxidation of surface methionine residues does not alter the overall conformation of the molecule. In the absence of Ca2+, however, the circular dichroism spectra of native and oxidized modulator are different with calculated helical contents of 40% and 26%, respectively. As judged by circular dichroism titration studies, the native modulator contains both high-(Kd = 1.9 X 10(-7) M) and low-affinity (Kd = 4 X 10(-4) M) Ca2+-binding sites, whereas the modified modulator appears to possess only low-affinity sites (Kd = 3.8 X 10(-4) M). The reduced secondary structure in Ca2+-free oxidized modulator protein may account for the absence of high affinity Ca2+ binding sites.