Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial).

BACKGROUND AND OBJECTIVE: Cognitive-behavioural treatments (CBT) and physical group exercise (PE) have both shown promising effects in reducing disability and increasing work participation among chronic low back pain (CLBP) patients. A brief cognitive intervention (BI) has previously been demonstrated to reduce work disability in CLBP. The aim of this study was to test if the effect of BI could be further increased by adding either group CBT or group PE. METHODS: A total of 214 patients, all sick listed 2-10 months due to CLBP, were randomized to BI (n = 99), BI + group CBT (n = 55) or BI + group PE (n = 60). Primary outcome was increased work participation at 12 months, whereas secondary outcomes included pain-related disability, subjective health complaints, anxiety, depression, coping and fear avoidance. RESULTS: There were no significant differences between the groups in work participation at 12 months follow-up (χ2  = 1.15, p = 0.56). No significant differences were found on the secondary outcomes either, except for a statistically significant reduction (time by group) in pseudoneurology one domain of subjective health complaints (sleep problems, tiredness, dizziness, anxiety, depression, palpitation, heat flushes) (F2,136  = 3.109, p = 0.048) and anxiety (F2,143  = 4.899, p = 0.009) for the groups BI + group CBT and BI + group PE, compared to BI alone. However, these differences were not significant in post hoc analyses (Scheffé adjusted). CONCLUSION: There was no support for an effect of the added group CBT or group PE treatments to a brief cognitive intervention in this study of patients on sick leave due to low back pain. SIGNIFICANCE: Our study demonstrates that treatments that previously were found to be effective and are included in most treatment guidelines, such as group cognitive-behavior therapy and exercise, were not effective in this given context compared to a brief, cognitive intervention. This implies that an optimized brief intervention is difficult to outperform in patients on sick leave due to low back pain.

Job stress and coping strategies in patients with subjective food hypersensitivity.

Psychological distress may be causally related to multiple, unexplained somatic symptoms. We have investigated job stress, coping strategies and subjective health complaints in patients with subjective food hypersensitivity. Sixty-four patients were compared with 65 controls. All participants filled in questionnaires focusing on job stress, job demands and control, work environment, coping strategies and subjective health complaints. Compared with controls, patients scored significantly lower on job stress and job demands, and significantly higher on authority over job decisions. Coping strategies and satisfaction with work environment did not differ significantly between the two groups, but the patients reported significantly more subjective health complaints than the controls. Scores on job stress and job demands were generally low in patients with subjective food hypersensitivity. It is unlikely, therefore, that the patients' high scores on subjective health complaints are causally related to the work situation.

Depression and anxiety through the climacteric period: an epidemiological study (HUNT-II).

AIM: The aim of this study was to examine the prevalence of anxious and depressive symptoms related to menstruational status in a large community sample. METHOD: In the HUNT-II study all adults in Nord-Trøndelag County of Norway were asked about demographic factors, lifestyle, physical symptoms and somatic diseases, a total of 94,197 persons. Anxious and depressive symptoms were recorded by the Hospital Anxiety and Depression Scale (HADS). Of female persons invited aged 35-60 years (N = 19,677), 16,080 (82%) took part. The menstruation status were defined as pre-, peri- and postmenopausal periods, calculated as the time period from last menstruation to examination date. RESULTS: There was a significantly higher score on depression and anxiety in the peri- and the postmenopausal period compared to the premenopausal period. Comparing the postmenopausal period with the perimenopausal period, the score for depressive symptoms was somewhat higher while the score for anxious symptoms was somewhat lower. These differences did not reach significance. CONCLUSION: There was a general effect of age on the scores on HADS-D. For scores on HADS-A there was a peak in the score in the perimenopausal period, indicating a high degree of anxiety symptoms in this time period which is especially connected to fluctuations in the serum level of gonadal hormones.

A novel proton-dependent nucleoside transporter, CeCNT3, from Caenorhabditis elegans.

In this study, we describe the cloning and characterization of a proton-dependent, broadly selective nucleoside transporter from Caenorhabditis elegans. Recently, we constructed a broadly selective nucleoside transporter which accepts both purine and pyrimidine nucleosides. Based on these studies, we hypothesized that CNTs with novel substrate selectivities exist in nature and that a CNT homolog in the C. elegans genomic database may function as a broadly selective nucleoside transporter. We cloned the cDNA for this transporter, termed CeCNT3 because of its broad selectivity, using polymerase chain reaction-based methods. CeCNT3 is predicted to have 575 amino acid residues (63.4 kDa) with 11 to 14 putative transmembrane domains and exhibits approximately 30% identity to members of the mammalian CNT family. This transporter exhibits a novel substrate selectivity, transporting a wide range of purine and pyrimidine nucleosides (inosine, guanosine, adenosine, uridine, and thymidine) but not cytidine. The apparent Km values for inosine and thymidine are 15.2 +/- 5.3 microM and 11.0 +/- 2.4 microM, respectively. Kinetic studies demonstrate that purine and pyrimidine nucleosides share a common recognition site in the transporter. In contrast to all known members of the mammalian CNT family, CeCNT3-mediated transport of nucleosides is proton-, but not sodium-, dependent. Mutation of tyrosine 332 in CeCNT3 decreased both the maximum uptake rate and apparent Km of thymidine, suggesting that this residue is in the domain of nucleoside recognition and translocation. The broad nucleoside specificity of CeCNT3 may be explained by this and other residues that restrict purine and pyrimidine nucleoside uptake and that discriminate among pyrimidine nucleosides.

[Prevention of femoral neck fractures in the Stovner district of Oslo]. / Forebygging av lårhalsbrudd i Oslo, Stovner bydel.

By collecting data on hip fractures among people over 66 years of age in the Stovner district of Oslo, we were able to evaluate a programme to prevent fall accidents in the elderly population. The programme has several approaches. It includes information for both the elderly and the personnel working with them on accident risk factors and identification and removal of risk factors at home. The incidence of hip fractures among those over 66 years of age in the Stovner district was reduced from 30/1,000 in 1990 to 16/1,000 in 1996. There was a significant downward trend during the whole period (p < 0.001). A similar reduction was not seen for the rest of Oslo. We believe that the programme has contributed to reducing the number of hip fractures. However, as several approaches were tried simultaneously, it is difficult to decide whether one particular approach was more efficient than the others.

[A local health center for adolescents]. / Lokal helsestasjon for ungdom.

A local centre for information to adolescents on sexual behaviour and use of contraceptives was opened in 1990 in the Stovner district of Oslo. At the end of 1993, the centre had recorded 975 visits. 248 of the 271 girls who had consulted the centre's doctor, had already had intercourse. No use or unsatisfactory use of contraceptives was reported by 40%. The two main reasons for contacting the centre were a need for contraceptives (58%) and fear of sexually transmitted diseases (21%). The findings indicate a need for this kind of centre for health information.

[Menarche and menstruation problems among teenagers in Oslo 1993]. / Menarke og menstruasjonsbesvaer blant tenåringsjenter i Oslo 1993.

Information on menarcheal age, menstruation habits and complaints was collected by means of questionnaires from 193 girls 14-17 years of age. Estimated median menarcheal age was 13.2 years. No statistical significant association was found between menarcheal age and physical activity or body mass. At the time of the data collection, 171 (95%) of the girls reported monthly menstruation while 29 reported loss of menstruation in more than three months during the period after menarche. 96 (52%) reported use of drugs against dysmenorrhoea, mainly paracetamol or non-steroid antiinflammatory drugs.

Chemical characterization of lipopolysaccharides from Legionella feeleii, Legionella hackeliae and Legionella jordanis.

Lipopolysaccharides (LPS) from Legionella feeleii serogroup 1, L. hackeliae serogroup 1 and L. jordanis were subjected to chemical analysis. All three LPS contained D-mannose, D-glucose, D-glucosamine, L-glycero-D-manno-heptose, 2-keto-3-deoxyoctonic acid and glycerol. In addition the LPS of L. feeleii was characterized by L-quinovose (tentatively identified) and L-fucosamine, L. hackeliae LPS by D-quinovosamine, D-galactosamine and D-galacturonic acid, and L. jordanis LPS by D-quinovosamine. Phosphorylated sugars were detected in all three LPS. The backbone sugar of the lipid A part was in each case 2,3-diamino-2,3-dideoxy-D-glucose substituted with a complex pattern of fatty acid, including 20-22 different amide-linked (non-branched and methyl-branched) 3-hydroxy fatty acids of chain-length ranging from 12 to 23 carbon atoms. The fatty acid patterns included also ester-linked nonhydroxylated entities and the uncommon 27-oxo-octacosanoic acid and 29-oxotriacontanoic acid. The LPS of L. hackeliae and L. jordanis also contained heptacosane-1,27-dioic and nonacosane-1,29-dioic acid, and their 2-hydroxy analogues were characteristic of L. jordanis LPS. SDS-PAGE patterns of the three LPS were distinctly different. Both L. feeleii and L. jordanis produced smooth-form LPS with characteristic ladder patterns, whereas L. hackeliae LPS were of more rough-type character.

Lipopolysaccharides of Legionella erythra and Legionella oakridgensis.

The chemical composition of lipopolysaccharides from Legionella erythra and Legionella oakridgensis was analysed. Sodium dodecyl sulfate polyacrylamide gel electrophoresis showed both lipopolysaccharides to have a smooth-type character. The polysaccharide part of both lipopolysaccharides contained D-mannose, D-glucose, D-glycero-D-mannoheptose, L-glycero-D-manno-heptose, 2-keto-3-deoxyoctonic acid, L-fucosamine, D-glucosamine, and glucosamine phosphate. In addition, L-rhamnose, glycerol phosphate, and glucose phosphate were identified in the polysaccharide part of L. erythra lipopolysaccharide. The main sugar identified in the lipid A part of both lipopolysaccharides, 2,3-diamino-2,3-dideoxy-D-glucose, was found to be substituted with a complex fatty acid composition including at least 16 different amide-linked 3-hydroxy fatty acids. Both lipopolysaccharides contained nonhydroxy fatty acids and the uncommon 27-oxo-octacosanoic acid, 29-oxotriacontanoic acid, and 27-hydroxyoctacosanoic acid. The lipopolysaccharide of L. oakridgensis also contained 29-hydroxytriacontanoic acid. The dioic long-chain acids heptacosane-1,27-dioic acid and nonacosane-1,29-dioic acid were only present in the lipopolysaccharide of L. erythra.

[Has sex education in schools resulted in later sexual debut? Experiences with a local preventive program]. / Har samlivsundervisning i ungdomsskolen ført til senere seksualdebut? Erfaringer fra et lokalt forebyggende tiltak.

Schoolteachers, nurses and doctors in primary health care in Stovner district, Oslo, have developed a new programme of sexual education for teenagers 14-16 years of age. The aim of the programme is to increase the knowledge about sexually transmitted diseases, reproduction and prevention of pregnancy and to open up for discussions within the classes about love, ethics, sexual abuse and sexual pressure. To evaluate the programme, pupils in the 9th grade in 1991 and 1993 (about 16 years old) answered a self-administered questionnaire. The answers showed an increase in knowledge about sexually transmitted diseases and reproduction, and a reduction in the percent of pupils who had sexual intercourse. The result should be cautiously interpreted, since changes in sexual knowledge and practices over time may have been caused by factors other than the intervention.

Composition of 2,3-dihydroxy fatty acid-containing lipopolysaccharides from Legionella israelensis, Legionella maceachernii and Legionella micdadei.

Lipopolysaccharides (LPS) from Legionella israelensis, L. maceachernii and L. micdadei were analysed for chemical composition. The main sugar of the lipid A fractions was in each case 2,3-diamino-2,3-dideoxy-D-glucose. Lipid A of L. israelensis also contained a substantial amount of D-glucosamine. In each lipid A fraction a complex fatty acid pattern was detected. This comprised at least 19 different 3-hydroxy fatty acids (amide-linked), three 2,3-dihydroxy fatty acids (amide-linked), non-hydroxy fatty acids (ester-linked) as well as long-chain (omega-1)-oxo, (omega-1)-hydroxy and (1,omega)-dioic fatty acids (ester-linked). In addition, L. maceachernii and L. micdadei contained alpha-hydroxylated long-chain (omega-1)-oxo and (1,omega)-dioic fatty acids. The polysaccharide parts of L. maceachernii and L. micdadei LPS were similar and contained mainly L-rhamnose, L-fucose, D-mannose, D-glucose, L-fucosamine, D-glucosamine, 2-keto-3-deoxy-octonic acid (Kdo) as well as the rare octose yersiniose A. The corresponding composition of L. israelensis LPS was simpler and consisted mainly of L-rhamnose and 3-amino-3,6-dideoxy-D-mannose. LPS of L. israelensis and L. micdadei contained, in addition, 2-keto-octonic acid linked to Kdo. Phosphorylated sugar constituents were detected in all three LPS, whereas ethanolamine was found only in LPS from L. maceachernii. The SDS-PAGE band pattern of L. micdadei differed from the two others in a higher proportion of the low molecular mass constituents.

Chemical composition of lipopolysaccharides from Legionella bozemanii and Legionella longbeachae.

Lipopolysaccharides (LPS) from Legionella bozemanii serogroup 1 and Legionella longbeachae serogroup 1 were subjected to chemical analyses. The lipid A part of both LPSs contained 2,3-dideoxy-2,3-diamino-D-glucose as major constituents and D-glucosamine and glycerol as minor constituents of the sugar backbone structure. Both LPSs exhibited a very complex fatty acid composition. Twenty amide-linked 3-hydroxy fatty acids were detected in LPS of L. longbeachae, whereas seventeen were encountered in LPS of L. bozemanii. Both LPSs contained nine ester-linked nonhydroxy fatty acids and the unique long-chain fatty acids 27-oxo-octacosanoic acid, 29-oxo-triacontanoic acid, heptacosane-1,27-dioic acid and nonacosane-1, 29-dioic acid. SDS-PAGE showed that L. bozemanii produced smooth-form LPS, whereas L. longbeachae LPS was mainly of the R-type. Composition analyses were in accordance with these electrophoretic patterns. D-Quinovosamine and L-fucosamine constituted 80 mol% of the polysaccharide part of L. bozemanii LPS. Other sugars identified were D-glucosamine, D-mannose, D-glucose, L-rhamnose, D-glycero-D-manno-heptose, L-glycero-D-manno-heptose, 2-keto-3-deoxy-octonic acid and glycerol. The polysaccharide chain from LPS of L. longbeachae appeared to be shorter, but composed of the same sugars except L-fucosamine. Both LPSs contained glycerol phosphate and glucosamine phosphate and L. longbeachae LPS contained in addition glucose phosphate.

Hydroxy-fatty acid profiles of Legionella species: diagnostic usefulness assessed by principal component analysis.

Twenty-nine species (76 strains) of members of the genus Legionella were analyzed for their cellular hydroxylated fatty acids (OH-FAs). The individual patterns were unusually complex and included both monohydroxylated and dihydroxylated chains of unbranched or branched (iso and anteiso) types. Comparison of the strain profiles by SIMCA (Soft Independent Modelling of Class Analogy) principal component analysis revealed four main groups. Group 1 included Legionella pneumophila plus L. israelensis strains, and group 2 included L. micdadei and L. maceacherneii strains. These two closely related groups were characterized by the occurrence of di-OH-FAs and differed mainly in the amounts of 3-OH-a21:0, 3-OH-n21:0, 3-OH-n22:0, and 3-OH-a23:0. Group 3 (13 species) was distinguished by i14:0 at less than 3%, 3-OH-3-OH-n14:0 at greater than 5%, 3-OH-n15:0 at greater than 2%, and minute amounts of OH-FAs with chains longer than 21:0. Group 4 (12 species) was heterogeneous. Its main characteristics were the presence of 3-OH-n12:0 and 3-OH-n13:0, 3-OH-i14:0 at greater than 5%, as well as significant amounts of 3-OH-a21:0 and 3-OH-n21:0. The groupings obtained by OH-FA profiles were found to reflect DNA-DNA homology groupings reasonably well, and the profiles appear to be useful for differentiation of Legionella species.

Gas chromatography of mycobacterial fatty acids and alcohols: diagnostic applications.

Capillary gas chromatography of cellular fatty acids and alcohols has been used as a routine method for a period of two years in the mycobacterial diagnostic laboratory of Statens institutt for folkehelse, Oslo, Norway. All mycobacteria (165 isolates) other than Mycobacterium tuberculosis (MOTT) and 24 randomly selected M. tuberculosis isolates were studied. Twelve characteristic lipid constituents allowed the construction of a diagnostic scheme. Without exceptions, all 36 examined isolates belonging to the M. tuberculosis-complex were characterized by a relatively high concentration level of hexacosanoic acid (mean: 4%, range: 1-13%), low level of tetracosanoic acid (mean: 1%, range: 0.1-3%), lack of methylbranched acids other than tuberculostearic acid, and lack of fatty alcohols. Members of the MAIS-complex (73 isolates) were all characterized by the general presence of the fatty alcohols 2-octadecanol (mean: 2%, range: 0.1-5%) and 2-eicosanol (mean: 7%, range: 2-21%), relatively high levels of tetracosanoic acid (mean: 5%, range: 1-15%) and lack (or trace) of hexacosanoic acid and methylbranched acids other than tuberculostearic acid. All 16 isolates of M. gordonae were easily recognized by their unique lack of tuberculostearic acid and their content of 2-methyl-tetradecanoic acid (mean: 5%, range: 2-12%), and the M. xenopi isolates were the only examined strains containing the fatty alcohol 2-docosanol (mean: 9%, range: 2-13%). The six M. malmoense strains contained the two unique constituents 2-methyl eicosanoic acid (mean: 3%, range: 1-4%) and 2,4,6-trimethyl tetracosanoic acid (mean: 3%, range: 2-4%). The ten strains of M. kansasii were characterized by 2,4-dimethyl tetradecanoic acid (mean: 5%, range: 1-11%), whereas the seven strains of M. marinum shared 2,4-dimethyl hexadecanoic acid (mean: 4%, range 0.2-12%) as a specific marker.