Objective
To evaluate fibromyalgia in the general population with emphasis on prevalence, dimensionality, and somatic symptom severity.
Methods
We studied 2,445 subjects randomly selected from the ...German general population in 2012 using the American College of Rheumatology 2010 preliminary diagnostic criteria for fibromyalgia, as modified for survey research, and the polysymptomatic distress scale (PSD). Anxiety, depression, and somatic symptom severity were assessed with the Patient Health Questionnaire (PHQ) series, and measures of symptoms and quality of life were assessed with the European Organization for Research and Treatment of Cancer questionnaire.
Results
The prevalence of fibromyalgia was 2.1% (95% confidence interval 95% CI 1.6, 2.7), with 2.4% (95% CI 1.5, 3.2) in women and 1.8% (95% CI 1.1, 2.6) in men, but the difference was not statistically significant. Prevalence rose with age. Fibromyalgia subjects had markedly abnormal scores for all covariates. We found smooth, nondisordered relationships between PSD and all predictors, providing additional evidence against the hypothesis that fibromyalgia is a discrete disorder and in support of a dimensional or spectrum disorder. There was a strong correlation (r = 0.790) between the PSD and the PHQ somatic symptom severity scale; 38.5% of persons with fibromyalgia satisfied the proposed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for a physical symptom disorder.
Conclusion
The modified 2010 diagnostic criteria do not result in high levels of fibromyalgia. PSD and fibromyalgia are strongly related to somatic symptom severity. There is evidence in support of fibromyalgia as a dimensional or continuum disorder. This has important ramifications for neurobiologic and epidemiology research, and for clinical diagnosis, treatment, and ascertainment of disability.
Abstract Objective The aim of this study was to present normative values for the Hospital Anxiety and Depression Scale (HADS). Methods A representative sample of the German general population ...(N=4410) was tested with the HADS. Results Females are more anxious than males, and older subjects are more depressed than younger subjects. The mean scores for anxiety / depression are 4.4 / 4.8 (males) and 5.0 / 4.7 (females). Using the cut-off 8+, the percentages of elevated anxiety and depression in the total sample are 21 % and 23 %, respectively. Regression analyses proved a linear but not a curvilinear age trend of anxiety and depression. Percentile rank norms are given for anxiety, depression, and the HADS total score. Conclusion The regression coefficients allow the calculation of expected mean scores for each age and gender distribution of any sample of patients. HADS mean scores are better suited to describe the degree of anxiety and depression in patient samples compared to percentages of subjects with elevated values.
Psychological distress is a common problem associated with cancer. The main objective of the present study was to test the Hospital Anxiety and Depression Scale (HADS) in a sample of Ethiopian cancer ...patients and to compare the results with those obtained from a sample in Germany. Data were collected from 256 cancer patients who visited the University of Gondar Hospital between January 2019 and June 2019 using the HADS, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and the Multidimensional Fatigue Inventory MFI-20. The reliability of the HADS was good, with Cronbach's α coefficients of 0.86 (anxiety), 0.85 (depression), and 0.91 (total scale). The Ethiopian cancer patients were more anxious (M = 7.9) and more depressed (M = 9.3) than the German patients (M = 6.8 for anxiety and M = 5.5 for depression). Only a weak level of measurement invariance was detected between the Ethiopian and the German sample. In the Ethiopian sample, anxiety and depression were associated with tumor stage (high levels in stage 4) and treatment (high levels for patients not receiving surgery and chemotherapy). Both anxiety and depression were significantly associated with all of the EORTC QLQ-C30 and MFI-20 scales. The HADS proved to be applicable for use with Ethiopian cancer patients. The high level of anxiety and depression present in that group indicates a need for psychosocial care.
The purpose of this survey is to bring some order into the growing literature on a type of graphs which emerged in the past couple of decades under a wealth of names and in various disguises in ...different fields of mathematics and its applications. The central role is played by Sierpiński graphs, but we will also shed some light on variants of these graphs and in particular propose their classification. Concentrating on Sierpiński graphs proper we present results on their metric aspects, domination-type invariants with an emphasis on perfect codes, different colorings, and embeddings into other graphs.
Abstract Background The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these ...questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. Methods : A German community sample ( n = 9721) with an age range of 18–80 years was surveyed using the GAD-7 and several other questionnaires. Results Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M = 4.07 vs. M = 3.01; effect size: d = 0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria.. Limitations The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. Conclusions The GAD-7 can be recommended for use in clinical research and routine.
Purpose The health state classifier EQ-5D of the Euro-QoL group has been expanded to a 5-level instrument (EQ-5D-5L), but studies on psychometric properties of this new instrument, applied to the ...general population, are rare. Methods A sample of 2,469 subjects, representatively selected from the German general population, was asked to fill in the EQ-5D-5L and several other questionnaires. Crude sum scores of the EQ-5D-5L were calculated and compared with scores derived from two sets of utilities, one from a German and one from a UK sample. Results The mean sum score (0–100 scale) was 91.5. Males reported better health states than females, and there was a nearly linear age trend. The list of the 45 most frequent health patterns (those with at least 0.2 % of the respondents) showed that almost half of the participants (47.5 %) responded being in the optimal health state, indicating a ceiling effect. Correlations between EQ-5D-5L scores and other questionnaires were very similar for all three scoring systems of the EQ-5D-5L. Finally, normative scores are given on the basis of sum scores. Conclusions The applicability of the EQ-5D-5L in the general population is limited because of the skewness. Sum scores are useful because of their simplicity, international generalizability, and construct validity.
Complementary and Alternative Medicine (CAM) has become increasingly popular among cancer patients. The prevalence of CAM use differs worldwide and depends on different sociodemographic and medical ...characteristics. Findings on predictors for CAM use and its benefits for quality of Life (QoL) have been inconclusive in recent studies.
The aim of the study was to determine the prevalence and methods of CAM use in breast cancer (BC) and gynecological cancer (GC) patients, to compare CAM users vs. non-CAM users regarding their sociodemographic and medical characteristics, and to investigate the relationship between CAM use and QoL.
In a sub-analysis from a multicenter, cross-sectional study in Germany, we examined 1,214 female cancer patients (897 with BC and 317 with GC). We obtained data from self-reports via standardized questionnaires and measured QoL with the EORTC QLQ-C30.
In total, 565 of the 1,214 patients (46.5%) used some form of CAM. Its use was higher in BC than in GC patients (48.6% vs. 40.7%). In both cancer groups, the users evaluated CAM as being helpful (BC: 60.8%, GC: 59.6%) The most frequently used CAM methods were vitamins/minerals/micronutrients, homeopathy, and mistletoe therapy. CAM users are younger, more highly educated, and financially better off than non-CAM users. They are also characterized by having been diagnosed with cancer a longer time ago, being at more advanced stages of the disease, and experiencing higher distress levels. CAM use is significantly associated with a lower global health status/ QoL in GC patients. Predictors for CAM use are: high level of vocational education, middle or high monthly income, time span since diagnosis of more than 12 months, the status of currently ongoing chemotherapy or hormone therapy treatment, and distress.
Our data support the findings of previous studies and highlight the need to develop a consistent CAM definition with respect to comparability and evaluation of CAM services. More longitudinal studies are desirable to establish viable associations between CAM use and relevant outcomes such as QoL or disease management.
Fatigue is a frequent debilitating symptom associated with cancer. However, scientific data on cancer-related fatigue is scarce in developing nations. This work examines psychometric properties of ...the multidimensional fatigue inventory (MFI-20) and analyzes the level of fatigue among Ethiopian patients with cancer in comparison with data from Germany.
A sample of 256 patients with cancer drawn from a hospital in Ethiopia was examined with the MFI-20 and the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30). A comparative sample of 780 German patients with cancer served as the control.
The MFI-20 scales and total score showed acceptable reliability (α = 0.60-0.93) with a considerable convergent validity between MFI-20 and the EORTC QLQ-C30 fatigue scale (
= 0.67-0.75). The Ethiopian patients with cancer reported higher levels of fatigue than the German patients. Analyses of variance showed that Ethiopian patients with cancer who were illiterate, having advanced cancer, and those who did not receive either surgery or chemotherapy reported especially high levels of fatigue.
The MFI-20 is a fairly reliable and valid instrument to be used with Amharic speaking patients with cancer. The high level of fatigue in these patients implies that appropriate cancer care is needed in developing countries.
Introduction
Having a better understanding of predictors of cancer-related fatigue makes it easier to early identify patients at risk of suffering from long-term fatigue. The aim of this longitudinal ...study was to identify factors that predict long-term fatigue 6 months after discharge from a rehabilitation clinic using a multidimensional conceptualization.
Method
A mixed sample of cancer survivors (
N
= 948) were recruited while in-patient at a rehabilitation clinic. The follow-up survey was administered 6 months after they were discharged from the clinic. Fatigue was assessed with the EORTC QLQ-FA12. Predictive values were estimated using hierarchical multiple linear regression analyses.
Results
Mean fatigue scores were 20.7 (cognitive fatigue), 30.9 (emotional fatigue), and 53.2 (physical fatigue) at baseline and significantly lower at follow-up (Cohen’s
d
0.12–0.31). Baseline levels of fatigue and depression were identified as important predictors of all dimensions of fatigue. Partnership and time since diagnosis predicted only the levels of physical fatigue. The regression models explained between 36% and 45% of variance in fatigue.
Conclusion
Levels of fatigue in early stages as well as psychosocial issues could enable clinicians to identify patients with elevated long-term fatigue and thus to provide optimal care for improving patients’ quality of life. Findings of different associates of individual dimensions of fatigue support the multidimensional concept of fatigue.
The SCL-K-9 is the latest short version of the multidimensional Symptom-Checklist 90-R. Up to now, its psychometric properties have not been clarified sufficiently as the nine items have not yet been ...presented exclusively in a representative sample. Therefore, psychometric properties, model fit values as well as norm-values were analyzed.
For the sample, N = 2,507 participants aged 14 to 92, n = 1,379 women and n = 1,128 men, and a mean age of 48.79 (SD = 17.91), were selected from the general population by random-route sampling. Confirmatory factor analyses applying full information maximum likelihood (FIML) tested the model fit. The reliability estimations and effect sizes were reported.
The items' discriminative power ranged between .49 to .65, and the Cronbach's Alpha was α = .87, which stands for a good reliability of the SCL-K-9. Norm values as well as gender and age specificities were presented in this section. The CFA with all nine items loading on one latent factor resulted in a good fit. There was evidence of invariance across age and gender groups.
Based on these results, the short screening version SCL-K-9 of the Symptom-Checklist 90-R showed good reliability and good model fit; specific norm values could be determined. Further studies should evaluate the usefulness of the standardization in clinical samples.
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