Biomedical subjects

Jochen Hardt

Publications and source records attributed to Jochen Hardt.

14 recordsLinked to original sources

PubMed2006

Validity, reliability and objectivity of the family history method in psychiatry: a meta analysis.

BACKGROUND: The family history is a widely used method in psychiatry; but data on the method's objectivity, reliability and validity shows partly diverging results. METHOD: In October 2005, a Medline search was conducted that yielded 7 studies regarding objectivity/reliability and 13 studies regarding validity. Results for six main groups of psychiatric diagnoses and any mental disorder were combined qualitatively for objectivity/reliability, and quantitatively for validity. RESULTS: Objectivity was generally high (kappa in the 0.80 range). Reliability was high for any mental disorder, schizophrenia, substance abuse and depression (kappa in the 0.70 range), and low or medium for anxiety (kappa between 0.30 and 0.50). Results on validity displayed an OR=148 for the family history for schizophrenia; OR=64 for mania/bipolar disorder; and OR's between 8 and 194 for substance abuse, between 3 and 37 for depression, between 5 and 350 for personality disorders, between 2.5 and 49 for anxiety, and between 2.4 and 9 for any mental disorder. CONCLUSION: There is clear evidence that the family history provides results that are better than chance for all disorders examined. But variance among diagnostic groups and among studies is considerable.

Family↗

PubMed2006

[The symptom checklist-27 in Germany].

The symptom-checklist SCL-27 is a short, multidimensional screening instrument for mental health problems. It contains six subscales, i. e. depressive, dysthymic, vegetative, agoraphobic, sociophobic symptoms, symptoms of mistrust and a global severity index (GSI-27). A survey is presented in two representative samples with overall more than 4500 subjects. The scales of the SCL-27 show satisfying reliability (Cronbach's alpha > 0.70 for all subscales and alpha > 0.90 for global severity) throughout, as well as a largely congruent six factor structure (Comparative Fit Index CFI = 0.91, Standardisized Root Mean square Residual SRMR = 0.04). While women presented with higher scores in the year 1996 on almost all subscales, this was no longer observed in 2003. Additionally, age-effects were less pronounced in 2003 than in 1996.

Adult↗

PubMed2006

Symptoms, course, and complications of abdominal attacks in hereditary angioedema due to C1 inhibitor deficiency.

OBJECTIVES: Recurrent abdominal attacks belong to the cardinal and most distressing symptoms of hereditary angioedema (HAE) due to C1 inhibitor deficiency. They are characterized by crampy pain, but may include vomiting, diarrhea, and other features. Detailed clinical data about the symptoms and course of abdominal attacks have not been reported. METHODS: We retrospectively observed a total of 33,671 abdominal attacks in 153 patients with HAE including a prospectively examined subgroup of 23 patients. Symptoms, course, frequency of attacks, and complications were analyzed. RESULTS: The relation of mild, moderate, and severe attacks was 1:1.4:5.6 in the prospective part of the study. Extra-abdominal symptoms preceded the abdominal symptoms. The mean maximal pain score was 8.4 (range 1-10). Vomiting occurred in 73% (24,696) and diarrhea in 41% (13,682) of the attacks. Circulatory collapse accompanied 4.4% (1,468) of the attacks, with loss of consciousness (LOC) occurring in 2.2% (739). Nine patients could clearly distinguish two types of abdominal attacks: vomiting and diarrhea. Rare complications included tetany, hemorrhagic stools, and intussusception of the colon. In 28% (43) of the patients, recurrent abdominal attacks had started before the characteristic swelling of the skin had ever occurred. A model is proposed to classify the severity of the attacks and to describe the clinical course. CONCLUSIONS: Abdominal attacks in HAE constitute a more disabling and complex syndrome than previously assumed. Our results add to the understanding of symptoms and course of HAE and may aid in the early recognition of an impending attack and improve clinical management.

Abdominal Pain↗

PubMed2006

Hereditary angioedema: new findings concerning symptoms, affected organs, and course.

PURPOSE: Hereditary angioedema (HAE) due to C1 inhibitor deficiency is clinically characterized by relapsing skin swellings, abdominal pain attacks, and life-threatening upper airway obstruction. Our aim was to examine a temporal and spatial pattern of the edema episodes by evaluating the long-term course of hereditary angioedema in order to establish a specific swelling pattern. SUBJECTS AND METHODS: Data were generated from 221 patients with C1 inhibitor deficiency by asking them about symptoms they experienced during their edema episodes. Documentation was accomplished through the use of standardized questionnaires. RESULTS: A total of 131110 edema episodes were observed. Clinical symptoms started at a mean age of 11.2 (SD 7.7) years. During the following cumulative 5736 years, only 370 (6.5%) symptom-free years occurred. Skin swellings, including extremity, facial, genital, and trunk swellings, and abdominal attacks occurred in 97.4% of all edema episodes of the disease. The other episodes were laryngeal edema (0.9%); edema of the soft palate (0.6%); tongue swellings (0.3%); headache episodes (0.7%); episodes affecting urinary bladder (0.3%), chest (0.2%), muscles (0.4%), joints (0.1%), kidneys (0.1%), and esophagus (0.05%), and were partly combined with other edema episodes. The per-patient analysis and the per-episode analysis revealed markedly discrepant results. On average, women had a more severe course of the disease than men. Patients with early onset of clinical symptoms were affected more severely than those with late onset. CONCLUSION: The described swelling pattern is specific for HAE and allows a tentative diagnosis based on clinical symptoms and the course of the disease.

Adolescent↗

PubMed2006

Reliability of retrospective assessments of childhood experiences in Germany.

The retrospective assessment of adverse childhood experiences is a widely used technique. Few studies report heterogeneous results about the reliability and objectivity. A sample of 100 patients was independently interviewed by means of the Mainz Structured Biographical Interview by two different interviewers with mean time lag of 2.2 years. Reliability of reports of family situation, physical abuse, sexual abuse, and protective factors was assessed. The results show moderate to good reliability for most childhood experiences. Divorce/separation of parents had a kappa of .95, severe sexual abuse a kappa of .64, and regular harsh physical abuse a kappa of .56; protective factors were in the .50 range. The key features for obtaining good reliability seem to be the concreteness of the question and accuracy of the coding categories. There is some, but little, evidence that sensitive issues such as sexual abuse are more prone to errors in assessment than simple ones.

Adult↗

PubMed2005

Treatment with C1 inhibitor concentrate in abdominal pain attacks of patients with hereditary angioedema.

BACKGROUND: Abdominal edema attacks in patients with hereditary angioedema are often extremely painful, associated with vomiting and diarrhea, and have a high potential for causing recurrent disability of the patient. STUDY DESIGN AND METHODS: Intraindividual comparison of retrospective data in 75 hereditary angioedema patients comprising 4,834 abdominal attacks treated with C1 inhibitor concentrate versus 17,444 untreated abdominal attacks. RESULTS: The mean duration of abdominal attacks was 92.0 hours (SD, 40.8 hr) when untreated compared to 39.9 hours (SD, 30.0 hr) when treated. Patients reported a mean maximal pain score of 8.6 (SD, 1.7; range, 1-10) for untreated attacks compared to 4.5 (SD, 2.9) when treated. Vomiting occurred in 83.3 percent of untreated attacks and in 6.0 percent of treated attacks, respectively. Diarrhea was reported in 41.8 percent of untreated attacks and in 11.0 percent of treated attacks, whereas cardiovascular collapse due to hypovolemia was observed in 3.5 percent of untreated attacks versus 0.1 percent in treated attacks. Mean time to relief of symptoms was 53.5 minutes when treated early compared to 114 minutes when treatment was delayed. No drug-related adverse or serious adverse events were observed as far as the injections were performed correctly. CONCLUSION: C1 inhibitor concentrate is highly effective and safe in treating abdominal attacks in patients suffering from hereditary angioedema.

Abdominal Pain↗

PubMed2004

[Symptom Checklist SCL-27].

The Symptom-Checklist-27 (SCL-27) forms a modification of the widely used Symptom-Checklist-90-R, with the latter demonstrating considerable shortcomings in psychometric properties. The SCL-27 is designed to screen for psychiatric symptoms in patients presenting somatic complaints. It contains the six subscales depressive, dysthymic, vegetative, agoraphobic, sociophobic symptoms and symptoms of mistrust. Additionally, a global severity index (GSI-27), similar to the GSI in the SCL-90-R is available. The subscales are short, the number of items varies between four and six. Psychometric properties and reference values based on a representative German sample of more than 2000 subjects are presented for the various subscales. All subscales show sufficient internal consistency with Cronbach's alpha > or = 0.70 and for the GSI-27 alpha is = 0.93. The correlation between GSI-27 and GSI is r = 0.93. Sex-specific cut-offs are presented to identify those patients, who need further examination.

Adolescent↗

PubMed2004

Validity of adult retrospective reports of adverse childhood experiences: review of the evidence.

BACKGROUND: Influential studies have cast doubt on the validity of retrospective reports by adults of their own adverse experiences in childhood. Accordingly, many researchers view retrospective reports with scepticism. METHOD: A computer-based search, supplemented by hand searches, was used to identify studies reported between 1980 and 2001 in which there was a quantified assessment of the validity of retrospective recall of sexual abuse, physical abuse, physical/emotional neglect or family discord, using samples of at least 40. Validity was assessed by means of comparisons with contemporaneous, prospectively obtained, court or clinic or research records; by agreement between retrospective reports of two siblings; and by the examination of possible bias with respect to differences between retrospective and prospective reports in their correlates and consequences. Medium- to long-term reliability of retrospective recall was determined from studies in which the test-retest period extended over at least 6 months. RESULTS: Retrospective reports in adulthood of major adverse experiences in childhood, even when these are of a kind that allow reasonable operationalisation, involve a substantial rate of false negatives, and substantial measurement error. On the other hand, although less easily quantified, false positive reports are probably rare. Several studies have shown some bias in retrospective reports. However, such bias is not sufficiently great to invalidate retrospective case-control studies of major adversities of an easily defined kind. Nevertheless, the findings suggest that little weight can be placed on the retrospective reports of details of early experiences or on reports of experiences that rely heavily onjudgement or interpretation. CONCLUSION: Retrospective studies have a worthwhile place in research, but further research is needed to examine possible biases in reporting.

Child↗

PubMed2003

Biological monitoring of workers after the application of insecticidal pyrethroids.

OBJECTIVES: Pyrethroids are applied as insecticides throughout the world. Human metabolism of pyrethroids results in urinary metabolites that are suitable for biological monitoring. The aim of the study was to evaluate individual exposure due to occupational application of pyrethroids as a precondition for the assessment of health risks. METHODS: Thirty-six workers who applied insecticides and other pesticides in Germany collected samples of their urine (24 h) after having used various pyrethroids (alpha-cypermethrin, cypermethrin, cyfluthrin, deltamethrin, tau-fluvalinate, permethrin, lambda-cyhalothrin) in agriculture, greenhouses or indoor pest control. Biological monitoring was carried out and metabolites were analysed in 61 urine samples by GC-MS: cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid ( cis-Cl(2)CA and trans-Cl(2)CA), cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid ( cis-Br(2)CA), 3-phenoxybenzoic acid (3-PBA) and 4-fluoro-3-phenoxybenzoic acid (FPBA). Forty-five urine specimens collected (24 h) from persons with no occupational exposure to pyrethroids served as controls. Concentrations were related to creatinine content and expressed as microgrammes per gramme creatinine. RESULTS: Control urine samples revealed a considerable background excretion of pyrethroid metabolites by the general population. The 95th percentile of the concentrations of Cl(2)CA and cis-Br(2)CA were 2.1 and 0.1 microg/g creatinine, respectively. FPBA was not detected in any control urine and was found in only one sample within the complete study. After occupational application of pyrethroids the highest concentrations of metabolites in urine samples were detected within the group of indoor pest-control operators. The maximum concentrations (median values) of Cl(2)CA, 3-PBA, and cis-Br(2)CA were 92.4 microg/g (1.8 microg/g), 57.5 microg/g (1.4 microg/g) and 1.1 microg/g (median below detection limit), respectively. Workers in greenhouses excreted metabolites with median concentrations as follows: 2.9 microg/g Cl(2)CA, 0.5 microg/g cis-Br(2)CA and 2.9 microg/g 3-PBA. Medians of the metabolite concentrations in specimens from agricultural workers were below the detection limit with regard to Cl(2)CA and cis-Br(2)CA, but the value was 0.6 microg/g for 3-PBA. Pest-control operators excreted significantly higher concentrations of Cl(2)CA and 3-PBA than workers in agriculture on a collective basis. Comparison of the excreted concentrations of metabolites with values of acceptable daily intake (ADI) of pyrethroids set by WHO revealed that the amount of pyrethroids that had been taken up during occupational application was not considerably higher than the ADI. CONCLUSIONS: As a consequence, we conclude that adverse health effects are not to be expected after workers' occupational exposure to pyrethroids in Germany, provided that the application is carried out properly. Good working practices need to be supported by adequate supervision with regard to occupational hygiene and medicine.

Agriculture↗

PubMed2003

Clinical studies of sudden upper airway obstruction in patients with hereditary angioedema due to C1 esterase inhibitor deficiency.

BACKGROUND: Hereditary angioedema due to C1 esterase inhibitor deficiency is clinically characterized by recurrent and self-limiting skin, intestinal, and laryngeal edema. Asphyxiation by laryngeal edema is the main cause of death among patients who die of hereditary angioedema. This study describes the age at which laryngeal edema first occurs, the time between onset and full development, and the effectiveness of therapy and prophylaxis. METHODS: Information on 123 patients with hereditary angioedema was obtained from medical histories and reports by the general practitioners, emergency physicians, and hospitals involved. RESULTS: Sixty-one patients (49.6%) experienced a total of 596 laryngeal edema episodes. The ratio of laryngeal edema episodes to skin swellings and abdominal pain attacks was approximately 1:70:54 in patients who had laryngeal edema. The mean (SD) age at the first laryngeal edema was 26.2 (15.3) years. Nearly 80% of the laryngeal edemas occurred between the ages of 11 and 45 years. The mean interval between onset and maximum development of laryngeal edema was 8.3 hours. A total of 342 laryngeal edemas cleared spontaneously without treatment, and 208 laryngeal edemas were successfully treated with C1 esterase inhibitor concentrate. Despite long-term prophylactic treatment with danazol, 6 patients developed subsequent laryngeal edemas. CONCLUSIONS: Laryngeal edema may occur at any age, although young adults are at greatest risk. In adults, the interval between onset of symptoms and acute risk of asphyxiation is usually long enough to allow for use of appropriate emergency procedures. To prevent a fatal outcome, it is essential to instruct patients and their relatives about the first signs of laryngeal edemas and the necessary procedures to follow.

Adolescent↗

PubMed2003

Determinants of health-related quality of life in patients with persistent somatoform pain disorder.

BACKGROUND: Health-related quality of life (HRQOL) has been investigated widely in patients with chronic pain, but no study has focused particularly on the situation of patients with persistent somatoform pain disorder. AIMS: To survey the impairments of patients with somatoform pain disorder (ICD-10: F45.4) and to predict pain-related impairments and HRQOL on the basis of coping styles. METHODS: A consecutively recruited sample of 100 patients (65% female) was examined in a cross-sectional study. Questionnaires were administered to assess pain intensity (visual analogue scale), pain-related disabilities (Pain Disability Index), quality of life (Short-Form Health Survey-36), and ways of coping with pain (Coping Strategies Questionnaire). To predict pain-related impairments and HRQOL, a multiple linear regression analysis was carried out. RESULTS: HRQOL of patients with somatoform pain is strongly and significantly reduced compared with the general population. Among the coping measures, Increasing Pain Behaviors and Catastrophizing have a negative influence on patients' pain-related impairments and the physical components of HRQOL. The mental component of HRQOL was predicted solely by Catastrophizing. No positive effect of active coping styles on health-related outcome variables could be observed. CONCLUSION: Patients with persistent somatoform pain disorder feel severely impaired. A clear pattern emerges for negative effects of the coping styles Increasing Pain Behaviors and Catastrophizing, while the identification of beneficial coping failed.

Adaptation, Psychological↗

PubMed2002

Psychosocial factors in subjects with thyroid-associated ophthalmopathy.

General agreement has emerged that the perceptions of patients of how they are feeling and how they are able to function in daily life should be included in the evaluation and monitoring of the effects of disease and treatment. Thyroid-associated orbitopathy (TAO), an inflammatory autoimmune eye disease, affects 50%-60% of patients with Graves' hyperthyroidism. Having blurred vision and/or diplopia has a detectable and significant impact on functional status and well-being, especially in role limitations caused by physical health problems. Therefore, to assess the impact of TAO on quality of life, we performed a descriptive study on consecutive ophthalmopathy patients with varying degrees of severity of TAO. General quality of life was assessed using a brief, internationally accepted, and standardized general questionnaire: the Medical Outcomes Study (MOS-36). In comparison to a large German reference group, low scores on the MOS-36 were found. Marked and significant differences from the control group were especially observed for the following items: vitality, social functioning, mental health, health perceptions, and body pain. MOS-36 did not correlate with the duration or severity of the ophthalmopathy. These results demonstrate the impact of a common visual symptom on health status and well-being, as measured by the MOS-36. In addition, comparison of the impact of various symptoms and conditions provides important and potentially clinically relevant information. In conclusion, we have shown that TAO has a large influence on the quality of life of these patients. The negative impact on well-being seems not to be related to the usual clinical assessment. These findings underscore the need for quality of-life measurements in prospective and controlled clinical trials.

Adolescent↗

PubMed2002

[Long-term effects of adverse childhood experiences - Actual evidence and needs for research1/2].

There is evidence from some prospective and several retrospective studies that early biological and psychosocial stress in childhood is associated with long-term vulnerability to various mental and physical diseases. In the last few years research findings have accumulated on those emotional, behavioural and psychobiological factors which are responsible for the mediation of these lifelong consequences. They are the cause of an increased risk of somatization and other mental disorders. Particularly anxiety, depression and personality disorders often result in high-risk behaviour that itself is associated with physical disease (cardiovascular disorders, stroke, viral hepatitis, type 2 diabetes, chronic lung diseases) as well as with aggressive behaviour. A survey on the current knowledge of how these various factors interact is presented and a bio-psychopathological model of vulnerability is educed. Implications for future research are outlined and contrasted to actual political trends in Germany.

Adolescent↗

PubMedDate not supplied

Prevalence of psychiatric disorders in an onset cohort of adults with type 1 diabetes.

BACKGROUND: Previous studies indicate a high prevalence of psychiatric disorders in adults with type 1 diabetes mellitus. The aim of our study was to determine if newly diagnosed adults with type 1 diabetes already have an elevated rate of psychiatric disorders at the beginning of their physical illness. METHODS: The authors consecutively recruited 313 newly diagnosed, adult inpatients with type 1 diabetes (age 17-40 years) from 12 hospitals. A national, representative population sample of 2046 persons of a similar age range served as the reference group. Psychiatric disorders were measured in both groups using structured interviews that provided diagnoses according to DSM-IV. RESULTS: There was a point prevalence of 12.5% for psychiatric disorders in the sample. The most frequent conditions were anxiety and affective disorders. Subjects with type 1 diabetes demonstrated a rate of major depressive episodes twice that of the reference group (5.8% vs 2.7%, p < 0.003; corrected for confounders). Apart from this finding, there was no significantly increased prevalence of psychiatric disorders in the diabetes sample as compared to the general German population. CONCLUSION: The rate of major depressive episodes in the new onset cohort of type 1 diabetes patients was double that of the population as a whole. However, the hypothesis, that newly diagnosed type 1 diabetes patients have more psychiatric disorders than the general population, was not confirmed.

Adult↗