Biomedical subjects

J Hardt

Publications and source records attributed to J Hardt.

At least 19 recordsLinked to original sources

PubMed2007

[Symptom checklists in patients with chronic pain].

Symptom checklists, in particular the SCL-90-R, are widely used in screening for psychological distress in patients with chronic pain. A detailed analysis reveals that this may lead to wrong diagnoses in many cases. The problem of using the SCL-90-R in patients with chronic pain is (a) that scale means are elevated due to items asking for pain-associated symptoms and (b) that there is a lack of specificity of the various dimensions of the SCL-90-R. Numerous short forms of the SCL-90-R are compared to the original one and analysed with respect to their applicability in patients with chronic pain. Other screening questionnaires not related to the SCL-90-R were analysed for the same purpose. As a result, the SCL-27, K9, HADS and PHQ are judged to be applicable for screening in patients with chronic pain.

Anxiety Disorders↗

PubMed2005

Psychosocial morbidity of Graves' orbitopathy.

OBJECTIVE: Ocular diseases markedly impair daily function. In Graves' orbitopathy (GO), an associated psychosocial burden is present due to disfiguring proptosis and/or diplopia, signs with significant impact on functional status and well-being. We have therefore surveyed and assessed the psychosocial morbidity of GO. DESIGN: A prospective controlled study on subjects with GO using internationally validated, self-reporting questionnaires. PATIENTS: One hundred and two consecutive patients with varying degrees of severity and activity of GO. Measurements Emotional distress, coping styles and quality of life (QoL) were assessed by the Hospital Anxiety and Depression Scale, by a German adaptation of the Ways-of-Coping Checklist, and with the 36-item Short Form, respectively. Stressful events in the 6 months preceding diagnosis were registered with the Life Experience Survey. QoL findings were compared to German reference values, as well as to 102 age- and gender-matched patients, each with type 1 diabetes (insulin-dependent diabetes mellitus, IDDM) and inflammatory bowel disease (IBD), respectively. RESULTS: Compared to the German reference population, all QoL scales were at a lower rate and were especially decreased in subjects with active and/or severe GO, orbital pain, diplopia and stressful life events. Compared to diabetics, psychosocial scales were considerably reduced in GO (z = -1 vs. 0.1, P < 0.001) and higher scores for depressive coping (2.32 vs. 1.71, P < 0.001) and trivializing (2.37 vs. 1.97, P < 0.006) were noted. In GO, depressive coping and trivializing were negatively correlated with the mental (r = -0.603 and r =-0.411, both P < 0.001) and physical (r = -0.487 and r = -0.354, both P < 0.001) components of QoL. Depressive coping also positively correlated with anxiety (r = 0.636) and depression (r = 0.590), respectively, both P < 0.001. Emotional distress noted in 46 subjects, mostly with active and severe GO, was associated with poor QoL. Anxiety and depression were present in 41 and 24 GO patients, respectively. The number of stressful events positively correlated with the scores of anxiety (r = 0.3335) and depression (r = 0.3178), both P = 0.001. Foremost emotional distress, but also diplopia, stressful events and depressive coping had a major impact on QoL (proportion of variance explained = 13.1%, P < 0.001, multiple regression analysis). More than 75% of the psychosocial impairment in GO (R2= 0.76, P < 0.001) was associated with seven variables only (e.g. depression and anxiety). Six months prior to GO onset, 74 patients experienced a mean of 4 (range 0-13) stressful life events. Subjects with optic neuropathy had more stressful events than those without nerve involvement (5.1 vs. 2.7, P = 0.0425). CONCLUSIONS: Psychosocial morbidity is present in severe and/or active GO, which negatively affects QoL. The patients are not only physically ill, they also exhibit emotional distress. Accompanying psychosomatic treatment is indicated among about half of all GO patients.

Adaptation, Psychological↗

PubMed2004

Adaptation to life after surgical removal of the bladder-an application of graphical Markov models for analysing longitudinal data.

Graphical Markov models have been developed particularly for the analysis of observational data. They allow the control of various background variables when analysing theoretically relevant associations. This paper demonstrates the application and some advantages of graphical Markov models in comparison to conventional statistical analyses. The aim of the study was to identify patients at risk for developing decreased health-related quality of life (QoL) after cystectomy and to explore the influence of coping on QoL in this situation. Therefore, the method was applied to analyse the data of a prospective study, in which 81 patients with bladder cancer were interviewed pre-operatively and in a 1-year follow-up. QoL was assessed both times, and two basic coping strategies (active and depressive) were measured preoperatively. The explanatory variables of theoretical interest were active and depressive coping strategies. As a result of the analysis, relevant proportions of variance in the development of QoL could be explained by the suggested model (60 per cent in mental component, 40 per cent in physical component of QoL). Active coping was positively related to QoL, depressive coping negatively. These effects were linear in the physical component of QoL, moderated by working status and the type of urinary diversion in the mental component of QoL.

Adaptation, Psychological↗

PubMed2004

[Interdisciplinary diagnostics in the outpatient treatment department of an environmental medical centre - report on experience with 400 patients].

The medical diagnostics of 400 patients of an interdisciplinary environmental medical centre is presented. The basic diagnostics included a special environmental medical history using a questionnaire, physical examination, allergological examinations and human biomonitoring. The latter was carried out in order to quantify the internal exposure to environmental pollutants. The main focus was on the differential diagnostics which was supported by special medical divisions of the hospital. Allergic illnesses as well as results of human biomonitoring exceeding the reference ranges were found frequently. Unfortunately a link between external exposure, internal dose and symptoms can hardly be established in environmental medicine. However, in several cases we found a considerably increased internal exposure which allowed to identify the sources of exposure (for example, usage of dichlorobenzene, permethrin, pentachlorophenol). Eliminating the sources obviously improved the health status of some of the patients concerned.

Adolescent↗

PubMed2003

Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity.

Obesity is considered a primary risk factor for cardiovascular disease and related mortality. The current study aimed to investigate the efficacy of minimal invasive gastric banding (GB) surgery for reducing caloric intake in morbid obesity, and to analyze the effects of weight loss on body composition and metabolic and psychosocial outcomes. Twenty-six adult severely obese patients (mean body mass index [BMI], 48.1 kg/m(2); range, 42 to 56) underwent adjustable silicone laparoscopic GB. Nine additional obese patients who declined surgery were treated with metformin (2 g daily) and served as a small additional group (BMI, 50.5 kg/m(2); range, 41 to 68). Presurgery and 17 +/- 2.2 months postoperatively, body composition (fat mass [FM], lean body mass [LBM], body water) and serum parameters (lipids, glucose, thyrotropin-stimulating hormone [TSH]) were determined. Quality of life (QoL) was evaluated by a standardized self-rating questionnaire (Short Form-36 [SF-36]), and supplemented by measures of physical complaints and psychological distress. After GB, weight loss was 21 +/- 14.9 kg (14%, P <.001). It was associated with a decrease in FM by 14 +/- 8.6 kg (18%, P <.001), LBM by 4 +/- 2.7 kg (5%, P <.001), body water by 4 +/- 3.4 L (7%, P <.01), systolic blood pressure by 16 +/- 26.3 mm Hg (10%, P <.05), total cholesterol by 0.69 +/- 1.29 mmol/L (12%, P <.05), and low-density lipoprotein cholesterol (LDL-C) by 0.38 +/- 0.39 mmol/L (10%, P <.05). Highly significant interactions between surgery and time were noted for weight (P <.005), BMI (P <.005), and FM (P <.007, analysis of variance [ANOVA]). Preoperatively, 14 of 26 patients (54%) had high fasting blood sugar levels (type 2 diabetics) and 11 (42%) had impaired glucose tolerance, whereas postoperatively, for baseline glucose levels a trend to decrease was noted. Neither malabsorption nor anemia was observed. QoL improved after GB; in particular, physical functioning and well being increased (P <.01), and somatic complaints (eg, dyspnea and heart complaints, pain in legs and arms) markedly decreased (P =.008). In the metformin group, neither relevant weight loss nor a significant decrease of biochemical values was observed. Minimal invasive GB is a successful therapeutic tool for reducing FM in morbidly obese patients. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk.

Activities of Daily Living↗

PubMed2003

Observer independent analysis of cerebral glucose metabolism in patients with chronic fatigue syndrome.

OBJECTIVES: To evaluate cerebral glucose metabolism, assessed by 18-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with chronic fatigue syndrome (CFS), using an observer independent analytical approach; and to characterise any observed alterations by correlating them with neuropsychological deficits. METHODS: 26 patients (13 female, 13 male) were examined. They all fulfilled the CDC diagnostic criteria for CFS. Their ages ranged from 26 to 61 years (mean (SD) age, 43 (9.3) years). They underwent extensive psychometric testing including the hospital anxiety and depression scale (HADS) and the short form 36 item health questionnaire (SF-36). Brain FDG-PET was done in all the subjects. After stereotactic normalisation, single subject comparisons with an age and sex matched normal database (n = 18) and a group comparison between the patients and normal controls were undertaken, along with additional correlation analyses between brain metabolism and psychometric test scores. RESULTS: 12 of the 26 patients showed no significant decrease in FDG uptake compared with the controls. Of the remaining 14, 12 showed hypometabolism bilaterally in the cingulate gyrus and the adjacent mesial cortical areas. Five of these 12 patients also had decreased metabolism in the orbitofrontal cortex. The two remaining patients had hypometabolism in the cuneus/praecuneus. Correlation analyses showed significant correlations between some test scores (anxiety, depression, health related quality of life) but not fatigue and regional reductions in glucose metabolism. CONCLUSIONS: Although abnormalities in FDG-PET were only detectable in approximately half the CFS patients examined, and no specific pattern for CFS could be identified, PET may provide valuable information in helping to separate CFS patients into subpopulations with and without apparent alterations in the central nervous system.

Adult↗

PubMed2002

[Pyrethroid exposure following indoor treatments with a dog flea powder].

UNLABELLED: Pyrethroid exposure following indoor treatments with a dog flea powder. HISTORY: A 42 year old woman reported hair loss, gastrointestinal and non-specific symptoms. The patient has lived in a council flat and kept a dog who had been regularly treated with pyrethroid containing flea powder. INVESTIGATIONS: The biological monitoring of pyrethroid meta-bolites in urine was performed using gas chromatography-mass spectrometry. The values at admission and follow-up after 4 weeks were highly elevated. Inspection of the flat revealed a humid and cramped dwelling. TREATMENT: We recommended redevelopment and cleaning of the dwelling and the avoidance of ectoparasiticide use. CONCLUSION: To our knowledge this is the first documented case of high indoor pyrethroid exposure following the use of ectoparasiticides with domestic animals. Pyrethroids can cause neurotoxic symptoms and skin irritation. There are few data concerning chronic effects. The causal connection between pyrethroid exposure and symptoms remains unclear and poses a great problem in environmental medicine.

Adult↗

PubMed2002

Are childhood adversities relevant in patients with chronic low back pain?

Previous studies have found a high number of childhood adversities in patients with chronic low back pain, particularly in patients reporting persisting problems after back surgery. Our aim was to reproduce these results. Within the framework of a comprehensive diagnostic assessment and psychometric evaluation, 109 inpatients who had been treated for low back pain were examined in the orthopedics department of a German university hospital. Five risk factors investigated by Schofferman and his staff (Schofferman et al., 1993) were re-assessed in all of our patients using a structured biographical interview. The German chronic low back pain group was also compared with an age- and gender-matched control group of 109 non-chronic pain patients with respect to these childhood adversities and additional ones. Only approximately 11% of the German chronic low back pain sample demonstrated three or more risk factors, compared with more than 50% in Schofferman's sample, and 47.7% showed none of the five risk factors, compared to only 11% in the Schofferman sample. Moreover, no significant differences in distribution either in terms of the individual risk factors or their cumulative frequency were found in the German chronic low back pain group compared with an age and gender-matched control group without chronic pain. Childhood adversities do not occur frequently in a non-selected group of patients with chronic low back pain. Earlier results showing an increased likelihood of the occurrence of psychosocial risk factors could not be confirmed. As a consequence, further psychic or psychosomatic diagnostics of patients with chronic low back pain are needed to define diagnostic subgroups.

Absenteeism↗

PubMed2001

Ibuprofen interference in the determination of 3-phenoxybenzoic acid in urine.

Pyrethroid insecticides are widely used in agriculture and private households. Analysis of urine for pyrethroid metabolites is one way to detect human exposure to these insecticides and is carried out regularly as part of the Occupational and Environmental Medicine Monitoring Program recommended by the Deutsche Forschungsgemeinschaft (DFG). Samples are analyzed using GC-MS (selected ion monitoring) following acid hydrolysis, solid phase extraction, esterification with methanol/sulfuric acid, and liquid-liquid extraction. The metabolite, 3-phenoxybenzoic acid (3-PBA), can be derived from several pyrethroids and is, therefore, a useful diagnostic analyte; however, the presence of the over-the-counter drug, ibuprofen ((R,S)-2-(4-isobutylphenyl)propionic acid), interferes with this determination, even after the ingestion of only one 200-mg tablet. The interfering analyte is carboxy-ibuprofen which is not removed by the cleanup step. Experimental work shows that it takes two days for most of the ibuprofen to clear the body before 3-PBA can reliably be determined in urine.

Adult↗

PubMed2001

Health-related quality of life in patients with chronic fatigue syndrome: an international study.

OBJECTIVE: Chronic fatigue syndrome (CFS) has been reported worldwide. Our objectives were to determine if patients from different countries have similar profiles of impairments. METHODS: Health-related quality of life (HRQoL) was assessed in 740 CFS patients in the US, 82 in the UK, and 65 in Germany using the eight subscales of the Short-Form General Health Survey (SF-36). To examine the internal structure, factor analyses were performed. RESULTS: Overall, there was a remarkable similarity in HRQoL among all CFS patients, regardless of location. Patients scored two to three standard deviations below normal on six subscales and one standard deviation below normal on the other two subscales. Factor analysis suggested a two-factor model where the same six subscales constitute the first factor and the two others the second factor. CONCLUSION: HRQoL is poor in CFS patients from three countries. This study is a first step towards conducting further comparative cross-cultural and international studies.

Adolescent↗

PubMed2001

Cross-validation of the SCL-27: a short psychometric screening instrument for chronic pain patients.

We constructed a short multidimensional screening instrument for chronic pain patients based on the items contained in the Symptom Check List-90-Revised (SCL-90-R). The proposed dimensional structure of the SCL-90-R was recently shown to be irreproducible in chronic pain patients. As a consequence, the use of the Global Severity Index (GSI) was recommended, although it did not capture all information contained in the many items of the SCL-90-R. Based on an exploratory factor analysis, a six-dimensional structure using 27 items from the SCL-90-R was explored utilizing the data of 2780 chronic pain patients. A short form was prospectively tested on 581 patients in the same setting. Criteria for item selection were high convergent and low discriminant correlations. The assessment of the dimensions was kept short, but a minimum of four items were retained. A questionnaire yielding the dimensions (I) depressive symptoms, (II) dysthymic symptoms, (III) vegetative symptoms, (IV) agoraphobic symptoms, (V) symptoms of social phobia, and (VI) symptoms of mistrust was obtained. Additionally, the GSI of the SCL-90-R could be estimated precisely (r =0.96). The SCL-27 can be used for screening psychopathology in chronic pain patients. The scoring algorithm of the SCL-27 can be used for the 90-item form as well.

Adult↗

PubMed2001

Biological monitoring of exposure of the general population to the organophosphorus pesticides chlorpyrifos and chlorpyrifos-methyl by determination of their specific metabolite 3,5,6-trichloro-2-pyridinol.

In this study we determined the concentrations of 3,5,6-trichloro-2-pyridinol (TCPyr) in urine samples from the general population. TCPyr is a specific metabolite of the organophosphorus pesticides chlorpyrifos and chlorpyrifos-methyl. By the introduction of a new sensitive analytical method a limit of quantification (LOQ) of 0.1 microgram per litre urine could be achieved, a tenfold improvement of recent methods. Extraction of TCPyr from the urine and the clean up process were carried out by automatic steam distillation. Separation and quantitative analysis were performed using capillary gas chromatography and mass selective detection in selected ion monitoring mode. The excretion of TCPyr was studied by analysing spontaneous urine samples from 5 women and 45 men between the ages of 22 and 57 (median: 40 years) living in Mecklenburg-Vorpommern (Germany) who were not occupationally exposed to organophosporus pesticides. TCPyr was detected in all specimens and the concentrations were quantified. The median excretion was 1.4 micrograms/l (range: 0.12 to 124.8 micrograms/l), the 95th percentile 11.3 micrograms/l. Under the worst case assumption that all TCPyr measured in urine originated from the intake of intact pesticides and not (less toxic) breakdown products, a TCPyr concentration of 1.4 micrograms/l urine corresponds to a daily intake of approximately 2.5 micrograms chlorpyrifos/chlorpyrifos-methyl. The intake at the 95th percentile would be about 23 micrograms chlorpyrifos/chlorpyrifos-methyl per day. According to FAO/WHO the acceptable daily intake (ADI) is 10 micrograms per kg bodyweight and day for both chlorpyrifos and chlorpyrifos-methyl.

Adult↗

PubMed2001

Impaired health-related quality of life in inflammatory bowel diseases: psychosocial impact and coping styles in a national German sample.

BACKGROUND: The purpose of this study is to give a detailed survey of the disease-specific and generic quality of life (HRQOL) of adult patients suffering from inflammatory bowel disease (IBD) in Germany. METHODS: 1322 patients suffering from IBD were examined in a cross-sectional study. A questionnaire assessing disease-specific and generic quality of life, coping, and hopelessness was sent to members of the German Crohn/Colitis association. RESULTS: Compared to the general population, the generic HRQOL in IBD patients is significantly reduced. Active coping has a negative influence on patients' generic physical HRQOL during an active phase (beta = -0.31), while this association is not present in the case of patients in remission (beta = -0.02, interaction: P = 0.0003). Depressive coping is strongly and negatively associated with assessment of the physical (beta = -0.39, P < 0.0001) and mental (beta = -0.66, P < 0.0001) HRQOL. Disease-specific burdens are mainly reported in the physical dimension. CONCLUSION: The pattern of psychosocial impact of disease in German IBD patients is largely congruent with the one observed in the USA and Canada, but shows some specific differences. The a priori unexpected finding that active coping was associated with poor HRQOL in active IBD status illustrates the importance of considering different determinants of HRQOL in terms of their mutual interaction.

Adaptation, Psychological↗

PubMed2000

Quality of life in patients with bladder carcinoma after cystectomy: first results of a prospective study.

This study reports the changes in the quality of life (QoL) of 44 patients observed prospectively from pre-surgery to one year post-surgery. Two kinds of surgeries were compared: continent and incontinent urinary diversion. In most areas the QoL returned to the prior level within one year after surgery. However, patients were restricted in their physical activity, sexual activity, and emotional well-being. Using individual weights for different aspects of life (Fragen zur Lebenszufriedenheit--Module FLZM), QoL was higher than when using an unweighted measurement (Short Form 36, MOS). Two trends for the different developments in the QoL were established: general life satisfaction and social functioning tended to improve after a continent diversion but decreased after an incontinent diversion. The perceived global satisfaction with both kinds of diversion was high--75% of the patients would choose the same kind of diversion again.

Aged↗

PubMed2000

The symptom check-list, SCL-90-R: its use and characteristics in chronic pain patients.

The SCL-90-R is a widely-used questionnaire for self-report of psychological distress and multiple aspects of psychopathology, as part of the evaluation of chronic pain patients and other non-psychiatric populations. The aim of this study is the presentation of clinical results of this multidimensional questionnaire in a convenience sample of 3540 chronic pain patients treated in a multidisciplinary pain centre. Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), single scale factor analyses and Cronbach's alphas are used to assess the internal structure and correlation to other instruments (CES-D, STAI, MPSS) to assess construct validity. It is shown that the 9 dimensions postulated by Derogatis et al. (1977 a) cannot at all be distinguished in chronic pain patients. The use of single subscores of the SCL-90-R, often employed as a screening instrument for specific diagnoses, such as depression, is at least questionable in chronic pain patients.

Adult↗

PubMed2000

Immunocytochemical evidence suggesting that diamine oxidase catalyzes biosynthesis of gamma-aminobutyric acid in antropyloric gastrin cells.

gamma-Aminobutyric acid (GABA) is a neurotransmitter that also occurs in a few non-neuronal cell types, where it may serve as a paracrine modulator. GABA is biosynthesized from glutamate by glutamate decarboxylase (GAD) and from putrescine via diamine oxidase (DAO). GAD is demonstrable in several GABA-positive cell types but is undetectable in the GABA-containing gastrin cells and somatostatin cells of the antropyloric mucosa of the stomach. Using two antisera raised against synthetic peptides corresponding to two different regions of rat DAO, we now demonstrate strong reactivity for DAO in gastrin-positive cells of the rat antropyloric mucosa, whereas somatostatin-positive cells as well as other structures of the antrum are unreactive. Western blotting analysis of antrum and colon demonstrate that both antisera react with a single band of 85 kD, consistent with the predicted molecular weight of DAO. Expression of DAO mRNA in the antrum is demonstrated by reverse transcriptase polymerase chain reaction (RT-PCR). Our results strongly indicate that gastrin cells produce GABA via DAO-catalyzed oxidation of putrescine, and experimental data moreover suggest that the biosynthesis of GABA is regulated by the prandial state. Because GABA modulates release of somatostatin, these results point to a new mechanism of paracrine interaction between gastrin cells and somatostatin cells.

Amine Oxidase (Copper-Containing)↗

PubMed1999

Neuropsychological profiles of FMR-1 premutation and full-mutation carrier females

The present French-German investigation of fragile-X syndrome (fra-X) was undertaken to disentangle genetic from environmental effects on cognitive performance as assessed with the following measures: Wechsler Adult Intelligence Scale-Revised (WAIS-R), Wisconsin Card Sorting Test, Trail-Making Test, Tower of Hanai, Verbal Fluency Test, Stroop Test, short-term and consolidation memory, and the d2 task. Groups with different genotypes (n = 11 mothers with a full mutation in the FMR-1 gene of fra-X children; n = 65 mothers with a premutation in the FMR-1 gene of fra-X children; n = 18 siblings of these mothers with normal CGG repeats) and with different psychosocial stressors from fra-X families (n = 14 siblings with a premutation but without affected children of their own) were examined. A group of mothers of non-fra-X autistic children (n = 39) formed an external control group. Previous findings were replicated concerning cognitive performance of FMR-1 full-mutation carrier mothers, who were characterized by lower overall IQ and poorer performance than the group of mothers with the FMR-1 premutation in verbal and performance subtests of the WAIS-R, tests of executive-frontal lobe functioning, and tests of sustained attention. Carriers of the FMR-1 premutation, whether they were mothers of affected children or not,performed in a similar way on all neuropsychological tasks to the intrafamilial control group without CGG amplification. On the basis of these results, it is concluded that there is no neuropsychological evidence of reduced cognitive performance of FMR-1 premutation carriers compared with performance of two control groups with normal CGG repeats. Furthermore, the psychosocial burden of raising fra-X children does not exert an environmental effect on neuropsychological test performance.

Journal Article↗

PubMed1999

Determination of metabolites of pirimicarb in human urine by gas chromatography-mass spectrometry.

The analytical method described permits the determination of 2-dimethylamino-5,6-dimethyl-4-hydroxypyrimidine (DDHP), 2-methylamino-5,6-dimethyl-4-hydroxypyrimidine (MDHP) and 2-amino-5,6-dimethyl-4-hydroxypyrimidine (ADHP) in human urine. These hydroxypyrimidines are metabolites of pirimicarb (2-dimethylamino-5,6-dimethylpyrimidin-4-yldimethylcarbamate ) which is applied as insecticide. The analytes are extracted into a mixture of diethyl ether and acetonitrile. Pentafluorobenzyl bromide serves as derivatising reagent. The derivatives are analysed using capillary gas chromatography with mass selective detection. 2-Amino-4-hydroxy-6-methylpyrimidine and 4-hydroxy-6-trifluoromethylpyrimidine are used as internal standards. The detection limits are 0.5 microg/l (DDHP), 1 microg/l (MDHP) and 4 microg/l (ADHP), respectively. The method was used for analysing seven urine samples collected from workers who had applied pirimicarb. The three metabolites were found in every sample in concentrations up to 60 microg/l.

Carbamates↗