The aim was to describe and explore the food-related work and eating habits of older community-dwelling women, with Parkinson’s disease, rheumatoid arthritis or stroke or without these diseases. The major focus is on health perceptions, eating habits and meal support. A theoretical framework based on cultural and health theories was adopted. A total of 91 women between 64 and 88 years were visited in their homes, a food survey was performed consisting of a 24h recall and an estimated three-day food diary was introduced. Seventy-two of the women also took part in qualitative interviews with an ethnographic approach. Approximately one week later, another 24h recall was carried out at a second visit, or for the non-disabled women by telephone. The analyses revealed that many women were influenced by the prevailing health message and tried to eat a healthy diet. It was also important to them to enjoy their preferred foods, but this gave some women a bad conscience, while others perceived their usual foods as wholesome to eat. Health promotion for older women needs to incorporate the women’s own cultural context, their perceptions of food-related health, and their wish to adhere to their usual habits. Women with disease, frailty and who had become alone reported simplified food-related work and poor eating habits. However, management of these duties was highly valued, and women strove to cook by themselves as long as possible when disability became a threat. This resulted in a trend towards less nourishing cooked meals for women with disabilities. Thus, many women with these diseases living at home need support with their meals. This has to be planned in collaboration with the woman and build on her cultural values. The help must be performed with respect for the woman’s sense of order, be given sufficient time, and acknowledge her self-determination.

To diagnose rheumatoid arthritis (RA) during the early stages of the disease is often difficult. The disease course shows great inter-individual variation from mild, self-limiting to very severe destruc-tive disease with extra-articular manifestations. Early aggressive treatment with potentially toxic drugs has been shown to improve the long-term outcome. Thus, it is desirable to make an early reliable di-agnosis and to identify those patients who would benefit from being treated most aggressively. The aim of this thesis was to evaluate laboratory and clinically markers of inflammation as predic-tors of disease course, to compare dual-energy X-ray absorptiometry (DXA) and conventional radiog-raphy (CR) as measures of joint destruction and to investigate the significance of antibodies against cyclic citrullinated peptide (anti-CCP antibodies), rheumatoid factors (RFs) and HLA shared epitope (SE) alleles for the relative risk of future development of RA and as predictors of disease severity in patients with early RA. Patients with RA of recent onset are included in the early RA programme at the Department of Rheumatology, University Hospital, Umeå and are followed longitudinally. The prediction of markers of inflammation for bone loss and radiological outcome was analyzed in the first 43 patients recruited. Radiographs of hands and feet (Larsen score) and bone mineral density (BMD) in hands (DXA), were assessed at baseline, after 1 and 2 years. The disease activity was evaluated clinically and by labora-tory tests. Radiological damage increased significantly during the study and was particularly corre-lated with Larsen score at baseline. BMD in hands decreased significantly in postmenopausal women and the decrease was greater than in healthy matched controls. Radiological progression and bone loss in hands was retarded by an early response to therapy. In a case-control study within the Medical Biobank and the Maternity cohort of Northern Sweden, patients from the early RA programme were identified among blood donors from whom samples had been collected years before onset of symptoms. The prevalence of anti-CCP antibodies and RFs (IgA-RF, IgG-RF and IgM-RF) was investigated in samples from 83 individuals (pre-patients) and com-pared with matched controls. SE alleles were assessed in a sub-group of 59 individuals. Anti-CCP antibodies and RFs preceded onset of RA by several years and increased in prevalence closer to dis-ease onset. Anti-CCP antibodies and IgA-RF significantly predicted the onset of RA. The combination of anti-CCP antibodies and SE alleles was associated with a high relative risk for future development of RA. In a later co-analysis between the register of patients in the early RA programme (n=138) and the Medical Biobank and the Maternity cohort, 93 pre-patient samples were identified. The significance of SE alleles and of the presence of anti-CCP antibodies and RFs before and at disease onset for disease activity and severity was studied. Radiographs of hands and feet were assessed at baseline and after 2 years (Larsen score). The presence of anti-CCP antibodies in pre-patient samples and at baseline was associated with radiological damage, as was presence of all RFs at baseline. A higher titre of anti-CCP antibodies was associated with greater radiological progression. The titre was lowered by a therapeutic response. In multiple logistic regression analyses anti-CCP antibodies, IgA-RF, ESR and swollen joint count predicted greater radiological progression, whilst a therapeutic response predicted a lesser pro-gression. In conclusion, anti-CCP antibodies and IgA-RF are predictors for future onset of RA and for radio-logical destruction and progression. The combination of anti-CCP antibodies and SE alleles is associ-ated with a high relative risk for future RA. Therapeutic response decreases the radiological progres-sion and the bone loss in hands and lowers the titre of anti-CCP antibodies. Conventional radiography is a better measure of joint destruction than DXA.

The overall aim of this thesis was to describe subjects with chronic obstructive pulmonary disease (COPD) from different perspectives. Focus was on patients at the time of diagnosis, impact of the disease in comparison to other chronic diseases, factors associated with good health and quality of life (QoL), and diagnostic spirometry in clinical practice. Methods: Qualitative method, grounded theory, was used to analyse patients´ perspectives at the time of diagnosis in a primary care setting (n=10). Public health surveys in the general population were used to compare chronic diseases (n=10,755) and analyse factors associated with health outcomes in COPD (n=1,475). Medical records and spirometry reports, from primary and secondary care, were analysed to assess diagnosis of COPD in clinical practice (n=533). Results: In clinical practice, 70% of patients at the time of diagnosis of COPD lacked spirometry results confirming the diagnosis. Factors related to consequences of smoking, shame and restrictions in physical activity (PA) in particular, were described by patients at the time of diagnosis of COPD. In general subjects with COPD (84%), rheumatoid arthritis (74%) and diabetes mellitus (72%) had an activity level considered too low to maintain good health. In COPD, the most important factor associated with good health and quality of life was a high level of PA. Odds ratios (OR (95%CI)) varied from 1.90 (1.47-2.44) to 7.57 (4.57-12.55) depending on the degree of PA, where subjects with the highest PA level had the best health and QoL. Conclusions: Subjects with COPD need to be diagnosed at an early stage, and health professionals should be aware that feelings of shame could delay patients from seeking care and thus obtaining a diagnosis. The use of spirometry and the diagnostic quality should be emphasised. In patients with COPD greater attention should be directed on increasing the physical activity level, as patients with a low level of physical activity display worse health and quality of life.

Rheumatoid arthritis (RA) is an autoimmune disease affecting approximately 1% of the population in the western world. It is characterised by a tissue specific attack of cartilage in peripheral joints. Collagen induced arthritis (CIA) is one of the most commonly used animal models for (RA), with similar symptoms and histopathology. CIA is induced by immunisation of mice with type II collagen (CII), and the immunodominant part was previously found to be located between residues 256-270. This thesis describes the interaction between the MHC molecule, glycopeptide antigens from CII and the T cells that is essential in development of CIA. The glycopeptide properties for binding to the mouse MHC molecule Aq have been studied, as well as interaction points in the glycopeptide that are critical for stimulation of a T-cell response. The thesis is based on five studies. In the first paper the minimal glycopeptide core, that is required for binding to the Aq molecule while still giving a full T cell response was determined. The second paper studied the roles of amino acid side-chains and a backbone amide bond as T-cell contact points. In the third paper the hydrogen bond donor-acceptor characteristics of the 4-OH galactose hydroxyl group of the glycopeptide was studied in detail. In the fourth paper we established a structure activity relationship (QSAR model) for (glyco)peptide binding to the Aq molecule. Finally, the stereochemical requirements for glycopeptide binding to the Aq molecule and for T-cell recognition was studied in the fifth paper. The study was performed using collagen glycopeptide analogues, which were synthesised on solid phase. Amide bond and hydroxyl group isosteres were introduced for study of hydrogen bond donor-acceptor characteristics. Statistical methods were used to design a representative peptide test set and in establishing a QSAR model. The results give a deeper understanding of the interactions involved in the ternary MHC-glycopeptide-T cell complex. This information contributes to research directed towards finding new treatments for RA.

Darbo metu buvo išnagrinėta įvairių faktorių (kovariančių) įtaka reumatoidiniu artritu sergančio 531 ligonio mirtingumui. Buvo taikomas vienas iš regresinių išgyvenamumo modelių – Cox’o modelis. Iš minėtos 531 ligonio imties mirę buvo 32 ligoniai. Iš pradžių buvo tiriama ligonių imtis laiko nuo ligos pradžios aspektu. Šiuo atveju prognozuojantys veiksniai buvo amžius, kada liga buvo diagnozuota (AMZDGN), lytis (LYTKOD), gydymas Metotreksatu (GYD_MTX) ir gydymas Azatriopinu/Imuranu (AZA_IMUR). Vėliau, tiriant ligonių mirtingumą kaip amžiaus funkciją, nustatyti svarbiausi lemiantys veiksniai buvo šie: ligonių lytis (LYTKOD) ir gydymas Azatriopinu/Imuranu (AZA_IMUR). Gauti rezultatai, t.y. ligonių išgyvenamumą lemiančios kovariantės (veiksniai), beveik visiškai sutampa su gydytojų nurodytais. Tai dar kartą patvirtina matematinių statistinių modelių, šiuo atveju nagrinėjamo Cox‘o modelio, taikymo realiame gyvenime, svarbą. Kitai duomenų imčiai, t.y. vėžiu sergančių ligonių duomenų aibei, buvo taikomas Persikertančių mirimų intensyvumų (SCE) modelis, t.y. tikrinama Cox‘o modelio adekvatumo duomenims hipotezė. Hipotezė buvo atmesta, nes minėtiems duomenims Cox‘o modelis negalioja. Pagrindinis darbo rezultatas yra šis: gautas kriterijus Cox‘o modelio adekvatumui tikrinti, naudojant nupjautus iš kairės ir cenzūruotus iš dešinės duomenis, sudarytos programos kriterijui realizuoti. Reumatoidinio artrito ligonių duomenų aibei, t.y. nupjautiems iš kairės ir cenzūruotiems iš dešinės... [toliau žr. visą tekstą] / In this work the Cox proportional hazards model was applied to investigate the influence of various factors (covariates) to mortality of rheumatoid arthritis patients of Vilnius. In the first case, the sample of 531 patients was analysed. Analysing survival of patients of the sample as function of time from the beginnig of the disease, the prognostic factors were LYTKOD (the sex of patients), AMZDGN (patients‘ age, when the rheumatoid arthritis was diagnosed), GYD_MTX (treatment with metotrexat) and AZA_IMUR (treatment with Azatriopin/Imuran). When survival was analysed as function of age then the prognostic factor were LYTKOD (the sex of patients) and AZA_IMUR (treatment with Azatriopin/Imuran). The results are almost identical to those, which doctors suggested. This fact confirms the importance of using mathematical statistical models to solve the problems of the real life. In this case, the importance of using the Cox model. On the other hand, Simple cross-effects (SCE) model was aplied for the sample of canser patients. In the case of this model the hypothesis of Cox model fiting for canser patients‘ data was rejected. The most important result of this work is that the criterion of Cox model fitting to left truncated and right censored data was constructed. Also a program of SAS for the criterion was created. The the hypothesis of Cox model fiting for the rheumatoid arthritis patients wasn‘t rejected, because Cox model fit for these data.

No description available.

Le criblage virtuel est largement employé pour la recherche de nouveaux médicaments.La sélection de structures pour les méthodes de criblage virtuel basées sur la structure reste problématique. Nous avons montré que les propriétés physico-chimiques du site de liaison, critères simples et peu coûteux en temps de calcul, pouvaient être utilisées pour guider celle-ci.L’évaluation des méthodes de criblage virtuel, critique pour vérifier leur fiabilité, repose sur la qualité de banques d’évaluation. Nous avons construit la NRLiSt BDB, n’incluant que des données vérifiées manuellement et prenant en compte le profil pharmacologique des ligands. Une étude à l’aide du logiciel Surflex-Dock montre qu’elle devrait devenir la base de données de référence, pour l’évaluation des méthodes de criblage virtuel et pour rechercher de nouveaux ligands des récepteurs nucléaires. L’application d’un protocole hiérarchique de criblage in silico/in vitro, a permis d’identifier de nouveaux composés inhibiteurs de l’IL-6, potentiellement utilisables dans le traitement de la polyarthrite rhumatoïde. Les résultats in vitro devront être confirmés par des tests in vivo. / Virtual screening is widely used in drug discovery processes.Structure selection in structure-based virtual screening methods is still problematic. We showed that simple and “low cost” binding site physico-chemical properties could be used to guide structure selection.The evaluation of virtual screening methods, necessary to ensure their reliability, relies on benchmarking databases quality. We created the NRLiSt BDB, gathering only manually curated data and taking into account ligands pharmacological profiles. A study using Surflex-Dock showed that the NRLiSt BDB should become the reference, both for the evaluation of virtual screening methods and for the identification of new ligands of the nuclear receptors.The use of a in silico/invitro hierarchical approach screening allowed to identify new IL-6 inhibitors, that could be used in rheumatoid arthritis treatment. In vitro results should be confirmed in vivo.

B cells have a central role in the pathogenesis of collagen-induced arthritis (CIA), an animal model of the autoimmune disease rheumatoid arthritis. In this report, a specific subset of an innate type of B cells, B-1 B cells, have been studied for the involvement in CIA. The B-1 B cells were shown to produce small amounts of collagen-specific antibodies upon stimulation in vitro, suggesting that they play a minor role in the development of CIA. This report also includes how marginal zone B cells, another innate type of B cells with natural collagen-reactivity, can be identified in the medullary sinuses of lymph nodes of collagen-immunized mice, implying involvement in auto antigen trapping.

La polyarthrite rhumatoïde (PR) est une maladie auto-immune chronique. Elle est caractérisée par une inflammation persistante touchant de multiples petites articulations, causant douleurs, rougeurs, gonflements et déformations. Des études menées auprès de patients et d’animaux ont démontré que certains auto-anticorps, cytokines et enzymes tissue-déstructives sont des médiateurs importants dans le développement de la PR. Au cours des deux dernières décennies, les traitements de fond (DMARDs en anglais) ont été démontrés très efficaces pour traiter la PR. D'autre part, des effets secondaires ont été rapportés pour ces traitements, par exemple l'augmentation du risque d'infections opportunistes. L’objectif de ce travail est d’acquérir des connaissances sur le rôle du TL1A (TNF-like molécule 1 A; TNFSF15) et son partenaire Nob1 (Pno1 ; YOR145c) dans la pathogenèse de la PR afin de découvrir de nouveaux médicaments contre ces molécules dans l'avenir. TL1A est un membre de la famille du TNF. Il déclenche des signaux co-stimulateurs via le récepteur de mort 3 (DR3) et induit la prolifération ainsi que la production des cytokines pro inflammatoires par les lymphocytes. Des données multiples suggèrent l'implication de la cascade TL1A-DR3 dans plusieurs maladies auto-immunes. Donc, nous avons proposé les hypothèses suivantes:1) la production locale de TL1A dans les articulations est un composant d’un cercle vicieux qui aggrave la PR; 2) dans la PR, la production de TL1A dans les organes lymphoïde augmente la production d’auto-anticorps pathogénique. Au cours de ce travail, nous avons démontré que la TL1A aggrave la maladie chez les souris où l’arthrite a été induite par le collagène (AIC). Par ailleurs, nous avons constaté que l’expression de TL1A est élevée dans les tissus atteints de PR ainsi que dans les ganglions lymphatiques drainant de la souris AIC. Mécaniquement, nous avons découvert que la TL1A est induite par le TNF-α et IL-17 produits par les cellules T in vitro. Ces résultats montrent directement que les TL1A-DR3 jouent un rôle essentiel dans la pathogenèse de la PR. De plus, afin de poursuivre notre étude, la TL1A a été génétiquement supprimée dans les souris (TL1A KO). Nous avons montré que les souris TL1A KO n’ont aucune anomalie apparente et aucun dysfonctionnement du système immunitaire dans des conditions normales. Cependant, ces souris manifestent des AIC améliorées et une réduction significative des niveaux d'anticorps, anti-collagène du type II i dans le sérum. Nous avons trouvé que les ganglions lymphatiques de drainage (dLNs) de souris KO étaient plus petites avec une cellularité inférieure comparativement aux souris WT de 14 jours après l’immunisation. De plus, nous avons découvert que le DR3 a été exprimé par les cellules plasmatiques dans l’étape de la différenciation terminale et ces cellules surviennent mieux en présence de TL1A. La conclusion de cette étude apporte des nouvelles connaissances sur le rôle de TL1A qui amplifie les réponses humorales d’AIC. Nous avons suggéré que TL1A pourrait augmenter la réponse d’initiation d'anticorps contre collagène II (CII) ainsi que prolonger la survie des cellules plasmatiques. Une autre molécule qui nous intéresse est Pno1. Des études antérieures menées chez la levure ont suggéré que Pno1 est essentielle pour la néogénèse du protéasome et du ribosome Le protéasome étant crucial pour la différenciation terminale des cellules plasmatiques pendant les réponses humorales chez les mammifères, nous avons donc supposé que Pno1 joue un rôle dans la production d'anticorps pathogenique dans la PR via la voie du protéasome. Nous avons donc généré des souris génétiquement modifiées pour Pno1 afin d’étudier la fonction de Pno1 in vivo. Cependant, une mutation non-sens dans le Pno1 provoque une létalité embryonnaire à un stade très précoce chez les souris. D'autre part, une réduction de 50% de Pno1 ou une surexpression de Pno1 n’ont aucun effet ni sur le fonctionnent des cellules T et B, ni sur les activités du protéasome ainsi que sur la réponse humorale dans l’AIC. Ces résultats suggèrent que Pno1 est une molécule essentielle sans redondance. Par conséquent, il n’est pas une cible appropriée pour le développement de médicaments thérapeutiques. En conclusion, nos études ont révélé que la TL1A n’est pas essentielle pour maintenir les fonctions du système immunitaire dans des conditions normales. En revanche, il joue un rôle critique dans la pathogenèse de la PR en favorisant l'inflammation locale et la réponse humorale contre des auto-antigènes. Par conséquent, une inhibition de la TL1A pourrait être une stratégie thérapeutique pour le traitement de la PR. Au contraire, Pno1 est essentiel pour la fonction normale des cellules. Une délétion totale pourrait entraîner des conséquences graves. Il n’est pas une cible appropriée pour développer des médicaments de la PR. / Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterized by persistent inflammation of multiple small joints, which manifests pain, redness, swelling, and deformation. Studies with patients and animal models have found that autoantibodies, cytokines and tissue-destructive enzymes are important mediators of the pathogenesis of RA. In the past two decades, biologic disease-modifying antirheumatic drugs (DMARDs) have achieved great success in the treatment of RA. On the other hand, they are also associated with adverse effect like increasing the chance of opportunistic infections. The aim of present work was to investigate the roles of TNF-like molecule 1A (TL1A; TNFSF15) and partner of Nob1 (Pno1; YOR145c) in the pathogenesis of RA for developing novel drugs based on these molecules in the future. TL1A is a member of the TNF superfamily. It triggers costimulatory signals though death receptor 3 (DR3) and induces the proliferation and pro-inflammatory cytokine production in lymphocytes. Multiple lines of evidence suggest the implication of TL1A-DR3 signaling in several autoimmune diseases. Therefore, We hypothesized that 1) local TL1A production in the joints is a component of a vicious circle aggravating RA; 2) in RA, TL1A production in lymphoid organs enhances pathogenic autoantibody production. We demonstrated that the TL1A aggravates disease in murine collagen-induced arthritis (CIA). Moreover, we found elevated TL1A expression in RA-affected tissues, as well as in the draining lymph nodes (dLNs) of CIA mice. Mechanistically, we discovered that TL1A induces TNF-α and IL-17 production by T cells in vitro. These findings provided direct evidence that TL1A-DR3 signaling plays a critical role in the pathogenesis of RA. TL1A knockout (TL1A KO) mice were generated to further our study. We showed that TL1A KO mice have no visual anomaly, and no malfunction of immune system under a normal circumstance. However, they display ameliorated CIA and significantly reduced anti-Collagen II antibody levels in sera. We found that the draining lymph nodes (dLNs) from KO mice were smaller in size and lower in cellularity compared with their WT counterparts 14 days after immunization. Furthermore, we discovered that terminally differentiated plasma cells express DR3 and they survive better in the presence of TL1A. Our findings in this study present novel knowledge about the role of iii TL1A promoting the humoral responses in CIA; we suggest that TL1A could elevate the initial Ab response against Collagen II (CII), as well as prolong the survival of plasma cells producing such pathogenic Abs. Another molecule we were interested in present study is Pno1. Previous studies conducted in yeast suggest that Pno1 is essential to the proteasome and ribosome neogenesis. Since proteasome is crucial for the terminal differentiation of plasma cells during the humoral response in mammals, we hypothesized that Pno1 plays a role in the pathogenic Ab production in RA by affecting the proteasome assembly. For this purpose, we generated pno1 gene- modified mice to investigate the function of Pno1 in vivo. However, null-mutation in pno1 causes embryonic lethality in mice at a very early stage. On the other hand, a half amount reduction or overexpression of Pno1 is neither harmful nor useful to the T and B cell function, proteasome activities as well as humoral immune responses in CIA. These findings suggest that Pno1 is a vital molecule with no redundancy and is absolutely required for cell function, but animals can function normally with a small fraction of the normal Pno1 expression level. Thus, it might not be an appropriate target for developing therapeutic drugs. In conclusion, our studies suggest that TL1A seems not essential in maintaining the immune functions under normal circumstances, but plays critical roles in the pathogenesis of RA by promoting local inflammation and humoral immune responses against autoantigens. Therefore, inhibiting TL1A could be a propitious therapeutic strategy for treating RA. In contrast, Pno1 is vital to the normal cell function, and its disruption could cause disastrous consequences. Thus, it might not be a good drug target for treating RA.

Darbo tikslas. Įvertinti sergančiųjų reumatoidiniu artritu darbingo amžiaus žmonių gyvenimo kokybės sąsajas su sveikatos paslaugų prieinamumu Prienų rajone. Uždaviniai. Įvertinti sergančiųjų reumatoidiniu artritu darbingo amžiaus žmonių klinikinę charakteristiką ir sąsajas su socialiniais – ekonominiais veiksniais. Ištirti sergančiųjų reumatoidiniu artritu darbingo amžiaus žmonių savarankiško judėjimo ir apsitarnavimo galimybes. Įvertinti sergančiųjų reumatoidiniu artritu darbingo amžiaus žmonių gydymo įstaigos pasiekiamumo ir aptarnavimo galimybes. Įvertinti sergančiųjų reumatoidiniu artritu gyvenimo kokybės ir skausmo intensyvumo sąsajas su aptarnavimu ir sveikatos priežiūros paslaugų prieinamumo galimybėmis. Tyrimo metodika. Kiekybinis momentinis tyrimas. Anketinė apklausa, naudota SF – 36, DAS 28 ir paruoštas bendrojo pobūdžio klausimynas. Analizuojamosios imties dydis – 67 reumatoidiniu artritu sergantys asmenys. Atsako dažnis – 74,4 proc. Gautiems duomenims apdoroti naudota SPSS 22.0. Rezultatai. Tyrime dalyvavo 61,2 proc. moterų ir 38,8 proc. vyrų. Patenkinamai savo sveikatos būklę dažniau vertino dirbantys respondentai, gyvenantys santuokoje, kaime. Nustatyta, kad sąnarių skausmas dažnai vargina 50,7 proc. respondentų, sąnarių sutinimas – 40,3 proc. tiriamųjų, rytinis sąnarių sustingimas – 34,3 proc. apklaustųjų, sąnarių judesių ribotumas – 52,2 proc. Nedirbantys, gaunantys mažas pajamas respondentai dažniau teigė turintys daugiau sutinusių ir skausmingų sąnarių... [toliau žr. visą tekstą] / Aim of the study. To evaluate the quality of life and its links with accessibility to healthcare services for working age patients with rheumatoid arthritis in Prienai region. Objectives. To evaluate the clinical characteristics and their links to the social - economic factors for working age patients with rheumatoid arthritis. To analize the self-movement and the self-service capabilities for working age patients with rheumatoid arthritis. To evaluate the reach of medical institutions and the service capabilities for working age patients with rheumatoid arthritis. To evaluate the quality of life, the intensity of pain and their links with accessibility to healthcare services for working age patients with rheumatoid arthritis. Methods. Quantitative cross sectional research. The size of the sample under analysis – 67 patients with rheumatoid arthritis. The frequency of the response is 74,4 %. The statistical analysis of data was performed using statistical package SPSS Statistics 22.0. Results. 61,2% women and 38,8% man participated in the study. Working in, living in marriage, living in the village respondents their health evaluated satisfactory more often. The pain of joints more often suffer 50,7% of respondents, the swelling of joints – 40,3%, morning stiffness – 34,3%, limitation of joint movement – 52,2%. The unemployed, with low incomes respondents affirmed about the swollen and the painful joints more often. Respondents living in the village and the employed... [to full text]