General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway

<p>Abstract</p> <p>Background</p> <p>In most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic.</p> <p>Methods</p> <p>Statistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding.</p> <p>Results</p> <p>Most GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave.</p> <p>Conclusions</p> <p>The study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies.</p

Glucose-induced posttranslational activation of protein phosphatases PP2A and PP1 in yeast

The protein phosphatases PP2A and PP1 are major regulators of a variety of cellular processes in yeast and other eukaryotes. Here, we reveal that both enzymes are direct targets of glucose sensing. Addition of glucose to glucose-deprived yeast cells triggered rapid posttranslational activation of both PP2A and PP1. Glucose activation of PP2A is controlled by regulatory subunits Rts1, Cdc55, Rrd1 and Rrd2. It is associated with rapid carboxymethylation of the catalytic subunits, which is necessary but not sufficient for activation. Glucose activation of PP1 was fully dependent on regulatory subunits Reg1 and Shp1. Absence of Gac1, Glc8, Reg2 or Red1 partially reduced activation while Pig1 and Pig2 inhibited activation. Full activation of PP2A and PP1 was also dependent on subunits classically considered to belong to the other phosphatase. PP2A activation was dependent on PP1 subunits Reg1 and Shp1 while PP1 activation was dependent on PP2A subunit Rts1. Rts1 interacted with both Pph21 and Glc7 under different conditions and these interactions were Reg1 dependent. Reg1-Glc7 interaction is responsible for PP1 involvement in the main glucose repression pathway and we show that deletion of Shp1 also causes strong derepression of the invertase gene SUC2. Deletion of the PP2A subunits Pph21 and Pph22, Rrd1 and Rrd2, specifically enhanced the derepression level of SUC2, indicating that PP2A counteracts SUC2 derepression. Interestingly, the effect of the regulatory subunit Rts1 was consistent with its role as a subunit of both PP2A and PP1, affecting derepression and repression of SUC2, respectively. We also show that abolished phosphatase activation, except by reg1Δ, does not completely block Snf1 dephosphorylation after addition of glucose. Finally, we show that glucose activation of the cAMP-PKA (protein kinase A) pathway is required for glucose activation of both PP2A and PP1. Our results provide novel insight into the complex regulatory role of these two major protein phosphatases in glucose regulation

Perspectives on the use of transcriptomics to advance biofuels

As a field within the energy research sector, bioenergy is continuously expanding. Although much has been achieved and the yields of both ethanol and butanol have been improved, many avenues of research to further increase these yields still remain. This review covers current research related with transcriptomics and the application of this high-throughput analytical tool to engineer both microbes and plants with the penultimate goal being better biofuel production and yields. The initial focus is given to the responses of fermentative microbes during the fermentative production of acids, such as butyric acid, and solvents, including ethanol and butanol. As plants offer the greatest natural renewable source of fermentable sugars within the form of lignocellulose, the second focus area is the transcriptional responses of microbes when exposed to plant hydrolysates and lignin-related compounds. This is of particular importance as the acid/base hydrolysis methods commonly employed to make the plant-based cellulose available for enzymatic hydrolysis to sugars also generates significant amounts of lignin-derivatives that are inhibitory to fermentative bacteria and microbes. The article then transitions to transcriptional analyses of lignin-degrading organisms, such as Phanerochaete chrysosporium, as an alternative to acid/base hydrolysis. The final portion of this article will discuss recent transcriptome analyses of plants and, in particular, the genes involved in lignin production. The rationale behind these studies is to eventually reduce the lignin content present within these plants and, consequently, the amount of inhibitors generated during the acid/base hydrolysis of the lignocelluloses. All four of these topics represent key areas where transcriptomic research is currently being conducted to identify microbial genes and their responses to products and inhibitors as well as those related with lignin degradation/formation.clos

Splenectomy in Haematological Patients

In the period from January 1990 to July 1998 we performed splenectomy on 129 patients of whom 77 were males and 52 females. The average age of patients was 4l.7 years, ranging from 7 to 76 years old. 38 of these (equal to 29.4%) underwent emergency operation owing to trauma (25 males and 13 females). In 3 patients (2 .3%) splenectomy was necessary owing to the existence of localised enlargements (aneurysms) of the splenic artery. This palticular motivation has gradually been reduced because of the growing possibility of embolizing a peripheral enlargement,or aneurysms in one of the branches of the subdivisions ofthe splenic artery. In 88 patients (68.3%) splenectomy was necessary due to the manifestation of splenomegaly in the development of spherocytos is, idiopathic thrombocytopenic purpura, or Werlhofs disease, fibro-congestive splenomegaly or in the presence of haemolytic or auto-immune diseases, or other pathològy. Patients affected with lymphomata or chronic myeloproliferative disorders are a case apart. For these patients the advisability of performing splenectomy is relative, and strictly connected to their clinical histories, and to the accuracy of diagnoses. In our group 48 male patients and 40 females were involved. Many laparosplenectomies performed in the past have been rendered useless, owing to the accuracy of clinico-pathology diagnostic systems such as TAC and RMN in confirming the presence or not of splenic infiltration and in diagnosing splenic lesions of uncertain nature. We chose to operate using median laparotomy, which allows good exposure ofthe whole abdominal cavity, even iftechnical difficulties can sometimes be met with atthe level ofthe upper sector, in the case of a voluminous spleen attached to the diaphragm

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms Microcirurgia endoscópica transanal (TEM): um procedimento minimamente invasivo para o tratamento de neoplasias selecionadas do reto

Transanal endoscopic microsurgery (TEM) provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Based on review of the literature and in the authors experience, this review present the method and indications for TEM.<br>A microcirurgia endoscópica transanal (TEM) é procedimento alternativo minimamente invasivo ao tratamento cirúrgico radical para excisão de tumores benignos e malignos do reto. Ela oferece possibilidade operatória aos procedimentos cirúrgicos convencionais (ressecção anterior baixa ou amputações abdominoperineais), as quais acarretam alta morbimortalidade. Baseada na revisão da literatura e na experiência própria dos autores, esta revisão tem por objetivo apresentar o método e as indicações para a TEM