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Biomedical subjects

P Bech

Publications and source records attributed to P Bech.

At least 55 records · Page 3Linked to original sources
PubMed2001

Reliability and validity of the Danish version of the Calgary Depression Scale for Schizophrenia.

Depressive symptoms within the range of schizophrenic syndromes constitute a major diagnostic and therapeutic problem. Earlier research has indicated that available depression scales are not adequate when examining mood disturbances in patients with schizophrenia. We have made an attempt to estimate the reliability and validity of the Danish version of the Calgary Depression Scale for Schizophrenia. The external validity has been analysed in relation to the Major Depression Inventory (MDI). The internal validity has been analysed by using Loevinger's coefficient of homogeneity as the primary statistic. For the inter-observer reliability the intra-class coefficients have been calculated. It was shown that a subscale of the Calgary scale has sufficient reliability and validity.

Adult↗
PubMed2001

The WHO Quality of Life (WHOQOL) Questionnaire: Danish validation study.

The objective of this pilot study was to evaluate the Danish translation of the WHO Quality of Life Questionnaire, the WHOQOL, by means of the psychometric properties of the Danish version. The translation method followed the WHO standard procedures, including forward and backward translation, focus group discussions, and assessment of response choice weighting through visual analogue scales. In the study we evaluated the applicability of the WHOQOL in patients with physical and mental disorders compared with a sample of healthy controls. The WHOQOL was compared with health-related quality of life questionnaire SF36 (Short Form 36). The internal consistency or homogeneity of the Danish WHOQOL was found adequate, and its applicability and its performance in distinguishing between population groups were satisfactory. The abbreviated version of WHOQOL-100, the WHOQOL-BREF, was analysed separately and was also found psychometrically valid. The WHOQOL is a questionnaire that is easy to administer, and it seems applicable for use.

Adult↗
PubMed2001

Morning and evening plasma melatonin and dexamethasone suppression test in patients with nonseasonal major depressive disorder from northern Greece (latitude 40-41.5 degrees ).

INTRODUCTION: The present study aimed to search for correlations between melatonin (MT) levels and the dexamethasone suppression test (DST) and clinical variables. METHODS: Fifty depressed patients aged 21-60 years took part in the study. The Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and the International Personality Disorders Examination were used for diagnosis. Psychometric assessment included the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale, the General Assessment of Funtioning Scale, the Newcastle scales and the Diagnostic Melancholia Scale. The DST and 9.00 and 23.00 h MT values were assessed. Statistical analysis included Student's t test, Pearson product moment correlation coefficient and forward stepwise multiple linear regression analysis. RESULTS: Melancholic patients had lower 23.00 h MT values in comparison to the rest of the patients and the atypical and 'undifferentiated' patients. CONCLUSION: The current study shows that low MT values were closely related to melancholic depression. Distinct quality of mood, psychomotor agitation or retardation and anorexia or weight loss seemed to be responsible for this relationship.

Adult↗
PubMed2000

Treatment outcome of chronic non-malignant pain patients managed in a danish multidisciplinary pain centre compared to general practice: a randomised controlled trial.

This randomised controlled study investigated the effect of outpatient multidisciplinary pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine chronic non-malignant pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P </= 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a pain diagnosis and a pain management plan by a pain specialist was not sufficient to enable the referring GP to manage severely chronic pain patients.

Adult↗
PubMed2000

Fatigue in the Danish general population. Influence of sociodemographic factors and disease.

OBJECTIVE: To measure the levels of fatigue in the general population, and to examine how disease and sociodemographic factors influence fatigue. DESIGN: Cross sectional questionnaire study in the Danish general population. SUBJECTS: A random, age stratified sample of 1608 people aged 20-77 with an equal gender distribution (response rate 67%). MAIN OUTCOME MEASURES: Five fatigue scales from the questionnaire Multidimensional Fatigue Inventory: General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation and Mental Fatigue. RESULTS: Fatigue scores were skewed towards absence of fatigue. The General Fatigue and Physical Fatigue scales showed the highest fatigue levels while the Reduced Motivation scale showed lowest levels. Gender differences in fatigue scores were small, but the variability among women was higher-that is, more women had high scores. A multiple linear regression analysis showed that respondents of low social status and respondents with a depression had high fatigue scores on all scales, independent of other factors. Chronic somatic disease had an independent direct effect on Mental Fatigue, but for the rest of the scales, the effect of somatic disease depended on age, gender and/or whether the person was living alone. For example, General and Physical Fatigue decreased with age among healthy people, whereas scores on these scales increased with age among those with a somatic disease. CONCLUSIONS: Physical and mental diseases play essential parts for the level of fatigue and as modulators of the associations between sociodemographic factors and fatigue. These interactions should be taken into account in future research on fatigue and sociodemographic factors and when data from clinical studies are compared with normative data from the general population.

Adult↗
PubMed2000

Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression.

BACKGROUND: Previous meta-analyses of fluoxetine as an antidepressant have many methodological problems, including diagnosis of major depression, validity of outcome measures and lack of intention-to-treat analyses. AIMS: To provide an estimate of the effect of fluoxetine compared with placebo and tricyclic antidepressants (TCAs), and to investigate reasons for early discontinuation from acute treatment. METHOD: Randomised trials were analysed using both intention-to-treat, efficacy and end-point. RESULTS: Fluoxetine was superior to placebo but effect size was low. In trials comparing fluoxetine v. TCA, the results for all trials and for the USA trials showed a trend in favour of fluoxetine. Those for the non-USA trials showed a trend in favour of TCA. When combined, the results showed that significantly fewer patients on fluoxetine discontinued treatment because of adverse events. CONCLUSION: Fluoxetine is superior to placebo, irrespective of the analytical approach use, whereas the results obtained v. TCAs depend on the approach used. Hence, the results should be interpreted in this light.

Antidepressive Agents, Second-Generation↗
PubMed1999

Amisulpride vs. risperidone in the treatment of acute exacerbations of schizophrenia. Amisulpride study group.

Amisulpride, a substituted benzamide with high selectivity for dopamine D3 and D2 receptors, was compared with the antipsychotic risperidone in patients with acute exacerbations of schizophrenia. The study was double-blind and involved 228 patients allocated, after a 3-6-day wash-out period, to amisulpride 800 mg (n = 115) or risperidone 8 mg (n = 113) for 8 weeks. Both treatments produced a marked improvement in schizophrenic symptomatology. Decreases in mean BPRS total score were 17.7 +/- 14.9 for amisulpride and 15.2 +/- 13.9 for risperidone, and all of the individual factors on the BPRS showed a numerically greater improvement in the amisulpride than in the risperidone patients. Both treatments were equally effective against positive symptoms on the PANSS positive syndrome subscale; however, there was a trend in favor of greater improvement in negative symptoms assessed on the PANSS negative subscale in patients receiving amisulpride with a decrease of 6.9 +/- 7.5 vs. 5.3 +/- 6.6 for risperidone (P = 0.09). Both drugs demonstrated good safety profiles, and scores on neurological scales (SAS, AIMS, and BAS) did not increase during treatment. A comparable proportion of patients received antiparkinsonian medication, 30 and 23% in the amisulpride and risperidone groups, respectively (P = 0.21). Patients receiving risperidone experienced an increase in body weight, which was significantly greater than for amisulpride (P = 0.026).

Acute Disease↗
PubMed1999

Anxiety and depression in breast cancer patients at low risk of recurrence compared with the general population: a valid comparison?

Breast cancer and its treatment have been associated with psychological morbidity. In this study our aim was to quantify the excess anxiety and depression resulting from breast cancer. We compared 538 newly diagnosed breast cancer patients at low risk of recurrence (87.0% responded) to 872 women randomly selected from the Danish general population (69.7% responded) using the Hospital Anxiety and Depression Scale (HADS). Contrary to expectations, the proportions classified as "cases" of anxiety and depression were not significantly different in the two groups. The breast cancer patients' mean HADS scores were significantly lower than those in the general population sample (anxiety, P = 0.021; depression, P < 0.001), indicating less anxiety and depression. However, we question the validity of this comparison. The HADS may not be suitable for use in the general population and there may be methodological problems in comparisons of groups whose life situations are very different.

Adult↗
PubMed1999

Health-related quality of life measurements in the assessment of pain clinic results.

Following the World Health Organization (WHO) classification of impairment, disability and subjective quality of life, chronic pain disorder has been examined. In this overview impairment has been restricted to non-malignant pain. Disability has been subdivided into disorder-oriented and ailment-oriented symptoms. The disorder-oriented symptoms are pain and depression, the latter emphasizing that pain is an unpleasant sensation. Both pain and depression are essentially subjectively reported symptoms which are unidimensionel, implying that they often are measured by use of visual analog scales. However, the Major Depression Inventory (MDI) and the Symptom Checklist 90 (SCL-90) are appropriate questionnaires itemizing the respective dimensions. The ailment-oriented symptoms have negative social well-being as their core-symptoms, including reduced role-functioning. The Short-Form (SF-36) is an appropriate scale in this respect. Subjective quality of life is essentially measuring positive well-being and the most appropriate measurement instrument is the Psychological Well-Being Schedule (PGWB) or its subscales, among which is the WHO (Five) well-being index.

Humans↗
PubMed1999

Internal and external validity of the WHO Well-Being Scale in the elderly general population.

The objectives of this study were (i) to evaluate the validity of the WHO Well-Being Scale in elderly subjects and (ii) to assess the influence of demographic variables on subjective quality of life. A sample of 254 elderly subjects completed the 22-item WHO Well-Being Scale. The scale had an adequate internal and external validity. However, the short 10-item and 5-item versions were equally valid. Low scores indicating decreased well-being were related to the presence of a psychiatric disorder or, independently, to poor living conditions. The Well-Being Scale and their short versions would appear to be useful instruments for identifying subjects with reduced subjective quality of life.

Adult↗
PubMed1998

[Pain epidemiology and health-related quality of life in patients with chronic non-malignant pain].

This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients referred to a Danish multidisciplinary pain centre. Mean pain intensity was 71.6 (SD 18.5) on the VAS scale. HRQL was evaluated using the questionnaires: SF-36, HAD and PGWB. Compared with the normal population (NP) both physical, psychological and social well-being was severely reduced, and 58% were found to have a depressive or anxiety disorder. Sixty-three percent of the patients had neurogenic pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants. At referral 73% were treated with opioids. Mean opioid consumption was 64 mg of morphine per day. Patients had used the health care system five times more often than the NP (p < 0.001). The study showed that HRQL of chronic non-malignant pain patients is among the lowest observed for any medical condition.

Adult↗
PubMed1998

Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment.

This article describes the methods adopted by the International Quality of Life Assessment (IQOLA) project to translate the SF-36 Health Survey. Translation methods included the production of forward and backward translations, use of difficulty and quality ratings, pilot testing, and cross-cultural comparison of the translation work. Experience to date suggests that the SF-36 can be adapted for use in other countries with relatively minor changes to the content of the form, providing support for the use of these translations in multinational clinical trials and other studies. The most difficult items to translate were physical functioning items, which used examples of activities and distances that are not common outside of the United States; items that used colloquial expressions such as pep or blue; and the social functioning items. Quality ratings were uniformly high across countries. While the IQOLA approach to translation and validation was developed for use with the SF-36, it is applicable to other translation efforts.

Cross-Cultural Comparison↗
PubMed1998

The Danish SF-36 Health Survey: translation and preliminary validity studies.

This article reports on the Danish translation of SF-36 and discusses the procedures used for translation improvement, translation evaluation, and scale evaluation. We followed the standard procedures of the International Quality of Life Assessment (IQOLA) Project including forward and backward translation, independent assessment of translation quality, assessment of response-choice weighting through visual analogue scale (VAS) investigations, and psychometric testing of the translated questionnaire. We found that backward translation, independent quality assessment, and VAS studies provided useful information for translation improvement. The Danish SF-36 received a favorable translation evaluation by independent rating; however, interrater agreement was low. Preliminary validity studies generally supported the internal consistency and homogeneity of the Danish SF-36, and the questionnaire performed satisfactorily in distinguishing depressive patients from nonpatients. On the basis of this and other studies, we recommend use of the Danish SF-36 in research.

Denmark↗
PubMed1998

The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.

Cross-Cultural Comparison↗
PubMed1998

Differential item functioning in the Danish translation of the SF-36.

Statistical analyses of Differential Item Functioning (DIF) can be used for rigorous translation evaluations. DIF techniques test whether each item functions in the same way, irrespective of the country, language, or culture of the respondents. For a given level of health, the score on any item should be independent of nationality. This requirement can be tested through contingency-table methods, which are efficient for analyzing all types of items. We investigated DIF in the Danish translation of the SF-36 Health Survey, using two general population samples (USA, n = 1,506; Denmark, n = 3,950). DIF was identified for 12 out of 35 items. These results agreed with independent ratings of translation quality, but the statistical techniques were more sensitive. When included in scales, the items exhibiting DIF had only a little impact on conclusions about cross-national differences in health in the general population. However, if used as single items, the DIF items could seriously bias results from cross-national comparisons. Also, the DIF items might have larger impact on cross-national comparison of groups with poorer health status. We conclude that analysis of DIF is useful for evaluating questionnaire translations.

Adolescent↗
PubMed1998

Comparison of Rasch and summated rating scales constructed from SF-36 physical functioning items in seven countries: results from the IQOLA Project. International Quality of Life Assessment.

Rasch models for polytomous items were used to assess the scaling assumptions and compare item response patterns in the 10-item SF-36 physical functioning scale (PF-10) for general population respondents in Denmark, Germany, Italy, the Netherlands, Sweden, the United Kingdom, and the United States. The Rasch model of physical functioning developed in the United States was compared to models for other countries, and each country was compared to a multinational composite. Strong scale congruence across the seven countries was demonstrated; items that varied between countries and from the composite may reflect unique cultural response patterns or differences in translation. Scoring algorithms based on the Rasch model for each country were superior to the current Likert scoring in tests of relative validity (RV) in discriminating among age groups in all countries. In relation to the Likert PF-10 scoring (RV = 1.00), scores estimated using the Rasch rating scale model achieve a median RV of 1.31 (range: 1.01-1.59), while the Rasch partial credit model attained a median RV of 1.44 (range: 1.01-2.23). Rasch models hold good potential for improving health status measures, estimating individual scores when responses to scale items are missing, and equating scores across countries.

Aged↗