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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Psycho-Social-Medicine; VOL: 6; DOC02 /20090709/
    Publication Date: 2009-07-10
    Description: Objective: Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients. Method: Cut-off scores optimizing sensitivity, optimizing specificity and simultaneously optimizing both sensitivity and specificity were calculated for the PSWQ score by receiver operating characteristic analysis (ROC). Differences regarding pathological worry and depression measured by the PSWQ and the Beck Depression Inventory (BDI) across five diagnostic subgroups were examined by conducting one-way ANOVAs. The influence of depression on pathological worry was controlled by conducting an ANCOVA with BDI score as a covariate. Results: The ROC analysis showed an area under the curve of AUC=.67 (p=0.02) with only 54.4% of the patients correctly classified. Comparison of diagnostic subgroups showed that after controlling the influence of depression, differences referring to pathological worry between diagnostic subgroups no longer existed. Conclusions: Contrary to the earlier results we found that the use of the PSWQ as a screening instrument for GAD at least in a sample of psychotherapy inpatients is not meaningful. Instead of that, the PSWQ can be used to discriminate high from low worriers in clinical samples. Thus, the instrument can be useful in establishing e.g. symptom-oriented group interventions as they are established in behavioural-medicine inpatient settings. Furthermore, our findings stress the influence of (comorbid) depressive symptoms on the process of worrying.
    Description: Zielsetzung: Pathologisches Sich-Sorgen gilt als eines der Kernmerkmale der Generalisierten Angststörung (GAS). Der Penn State Worry Questionnaire (PSWQ) erfasst pathologisches Sich-Sorgen. In zwei früheren Studien wurde die Eignung des PSWQ als Screening-Instrument für GAS bei ambulanten Patienten und in nicht-klinischen Stichproben nachgewiesen. Die vorliegende Studie untersuchte die Eignung des PSWQ als Screening-Instrument für GAS bei stationären Patienten einer Klinik für Psychotherapie und Psychosomatik (N=237). Darüber hinaus wurden Patienten mit GAD sowie Patienten mit Depression und anderen Angststörungen hinsichtlich des pathologischen Sich-Sorgens und der depressiven Symptomatik in einer Substichprobe von N=118 Patienten miteinander verglichen. Methodik: Anhand einer Receiver Operating Characteristic Analysis (ROC) wurden Cut-off-Werte für den PSWQ bestimmt, zum einen mit einer Betonung der Sensitivitität, zum anderen der Spezifizität sowie einer Ausbalancierung beider. Unterschiede im pathologischen Sich-Sorgen und der depressiven Symptomatik, erfasst mit dem PSWQ und dem Beck Depressionsinventar (BDI) über fünf diagnostische Subgruppen, wurden anhand einfaktorieller Varianzanalysen untersucht. Der Einfluss der depressiven Symptomatik wurde anhand einer Kovarianzanalyse mit dem BDI als Kovariate untersucht. Ergebnisse: Die ROC Analyse ergab ein 'area under the curve' von AUC=,67 (p=0,02) mit nur 54,4% richtig klassifizierten Patienten. Ein Vergleich der diagnostischen Subgruppen im Hinblick auf das Sich-Sorgen zeigte, dass diese keine Unterschiede mehr aufwiesen, wenn der Einfluss der depressiven Symptomatik kontrolliert wurde. Fazit: Entgegen früheren Befunden scheint der PSWQ als Screening-Instrument für GAS zumindest in der untersuchten Stichprobe von stationären Patienten nicht geeignet zu sein. Der PSWQ kann jedoch dazu verwendet werden, Patienten mit ausgeprägtem Sich-Sorgen zu identifizieren und so die Zuweisung z. B. zu indikativen Gruppen in der stationären verhaltensmedizinischen Versorgung zu erleichtern. Darüber hinaus betonen die Ergebnisse den Einfluss von (komorbider) Depressivität auf den Prozess des Sich-Sorgens.
    Keywords: worry ; Generalized Anxiety Disorder ; Penn State Worry Questionnaire ; depression ; inpatients ; ddc: 610
    Language: English
    Type: article
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    German Medical Science; Düsseldorf, Köln
    In:  50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie; 20050912-20050915; Freiburg im Breisgau; DOC05gmds385 /20050908/
    Publication Date: 2005-09-09
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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    Keywords: CANCER ; SURVIVAL ; Germany ; COMMON ; INFORMATION ; SYSTEM ; COHORT ; LONG-TERM ; TISSUE ; prognosis ; tumour ; NERVOUS-SYSTEM ; MALIGNANCIES ; DATABASE ; REGION ; LONG-TERM SURVIVAL ; REGIONS ; CHILDREN ; PROJECT ; time trends ; EUROPE ; neuroblastoma ; MALIGNANCY ; ONCOLOGY ; CHILDHOOD ; REGISTRY ; RE ; monitoring ; cancer registries ; PATIENT SURVIVAL ; methods ; EXTENT ; population-based ; IMPROVEMENT ; retinoblastoma ; ADOLESCENTS ; ACCIS ; bone tumours ; childhood cancer ; CHILDREN 1978-1997 ; period survival ; PIEDMONT ; POPULATION-BASED SURVIVAL ; soft tissue sarcomas ; UP-TO-DATE ; Wilms' tumour
    Abstract: Background: Prognosis for most types of childhood tumours has improved during the last few decades. In this article we estimate up-to-date period survival for less common, but important childhood malignancies in Europe. Methods: Using the database of the Automated Childhood Cancer Information System we calculated period estimates of 10-year survival for the 1995-1999 period for children aged 0-14 years diagnosed during 1985-1999 with tumours of the sympathetic nervous system (NS), retinoblastoma, renal tumours, bone tumours and soft tissue sarcomas in four European regions. Results: Ten-year period survival for 1995-1999 was 66% in children with tumours of the sympathetic NS, 96% for retinoblastoma, 87% for renal tumours, 58% for bone tumours and 61% for soft tissue sarcomas. The higher period estimates, as compared with cohort and complete estimates indicate recent improvement in survival for tumours of the sympathetic NS and to a lesser extent for retinoblastoma and renal tumours. Region-specific period survival estimates were lowest for Eastern Europe for renal, bone and soft tissue tumours, but not for the other two tumour groups. Conclusion: There have been further improvements in the 1990s in long-term survival of children diagnosed with several malignancies, albeit to a different extent in different European regions
    Type of Publication: Journal article published
    PubMed ID: 17804472
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    ISSN: 0304-8853
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-0428
    Keywords: Cyclosporin A ; Type 1 (insulin-dependent) diabetes mellitus ; immunotherapy ; C-peptide ; islet function ; remission of Type 1 diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the Canadian/European randomized controlled study on cyclosporin A (CsA) in recent onset Type 1 (insulin-dependent) diabetes, treatment with the immunosuppressive drug had increased and maintained Beta-cell function and clinical remission during the first 12 months. Following discontinuation of the study drug and double-blinding after a mean of 13.8 months former CsA patients doubled the daily insulin dose within 6 months reaching the level of former placebo patients. The difference in Beta-cell function between the two groups was also lost. Metabolic control (HbA1c) was transiently worse in the former CsA group. Adverse effects of cyclosporin A on systolic blood pressure, haemoglobin levels, serum potassium and creatinine levels also remitted during that time. We conclude that treatment with cyclosporin A for a mean of 13.8 months had no long-lasting effect on the course of Type 1 diabetes persisting beyond drug discontinuation.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-0428
    Keywords: Cyclosporin A ; Type 1 (insulin-dependent) ; diabetes mellitus ; children ; side effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Several studies have demonstrated the efficacy of cyclosporin A in modifying the initial course of Type 1 (insulin-dependent) diabetes mellitus in older children and adults but none have reported the effects in very young children. We treated 14 newly-diagnosed Type 1 diabetic patients aged 22 months to 95 months with cyclosporin A. Mean insulin dose at entry was 0.7±0.07 IU · kg−1 · day−1. Initial cyclosporin A dose was 10 mg · kg−1 · day−1. Insulin dose reached a nadir of 0.13 IU · kg−1 · day−1 by 180 days. Mean glucagon-stimulated connecting peptide levels were maximal at 6 months (0.75 nmol/l) and were maintained while on cyclosporin A. Insulin was discontinued in four patients for 4,12,15 and 30 months respectively. In five other patients the insulin dose was less than 0.15 IU · kg−1 · day−1 for at least 3 months. Glycated haemoglobin levels for all patients were within the normal range. Side effects included anorexia, stomach pains, poor weight gain, hypertrichosis, gum hyperplasia, mild anaemia and elevated creatinine. All patients have now discontinued cyclosporin A and all but one have been followed for 5 years after discontinuation. Reasons for discontinuing cyclosporin A included exposure to chicken pox (varicella), non-resolving otitis media, incomplete or no response and relapse. All side effects have resolved since the treatment was discontinued. Following discontinuation of cyclosporin A insulin requirements and glycated hemoglobin levels increased while glucagon-stimulated connecting peptide levels declined dramatically. In summary, a small number of very young patients treated with cyclosporin A achieved non-insulin requiring remissions while partial remissions occurred in several other patients and endogenous insulin production was maintained. Side effects to the drug occurred although there have been no long-term consequences.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 81 (1986), S. 11-26 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The therapeutic management of cerebellar astrocytomas is almost exclusively surgical. Although a few patients survive for long periods without treatment, the majority die without surgery. Total excision is advised to prevent recurrence which almost always follows non-total removal of tumour. Moreover, radical excision is feasible since the cerebellum has a remarkable capacity to compensate after large amounts of tissue have been removed. Morbidity is related to damage to the deep cerebellar nuclei, infiltration of the brain stem, secondary adhesions, and infection. Tumours may not be macroscopically visible at the time of first operation which in turn emphasizes the need for a detailed radiological work-up using, in particular, the CT scan. Biopsy alone, decompression alone, and/or aspiration are usually followed by rapid recurrence and no more than 30% of patients thus treated are recurrence-free five years after surgery. Approximately 40% of patients have subtotal resections and, of these, only 35% are recurrence-free five years post-operatively. Despite the high risk of recurrence following subtotal removal, subtotal excision may still be followed by prolonged survival since two thirds of the patients in the present study were still alive ten years or more after surgery. This is due in part to the unpredictable behaviour of cerebellar astrocytomas, a fact clearly demonstrated by serial CT studies of patients with partially excised tumours which demonstrate that residual tumour may occasionally regress or even remain static for many years. Total removal, when possible, is the treatment of choice and was carried out in 41% of patients in the present study. Ninety-five per cent of patients were free of recurrence for 25 years or more following total removal. In fact, recurrence following total removal has only rarely been recorded and is more often found when the initially excised tumour contains atypical and/or malignant features. Still, a benign histology does not preclude recurrence even when a total macroscopic excision has been achieved. This again emphasises the unpredictable nature of these tumours and the need for long-term radiological follow-up. Overall, operative mortality should be around 5% and even less for unilateral, hemispheric, circumscribed, nodular cerebellar astrocytomas. Conversely, the operative mortality for tumours of the vermis may approach 30% and generally increase with each subsequent operation, being maximal in the first post-operative month. Radiotherapy does not reduce the rate of recurrence nor prolong the overall survival period to death in patients with subtotal removal of tumour. There may also be an attendant risk of radio-necrosis and radiation-induced malignancy. Nevertheless, radiotherapy may still have a place in the treatment of these tumours since there is still some evidence to suggest that craniospinal irradiation may reduce the risk of tumour dissemination from malignant cerebellar astrocytomas. Recurrence in cerebellar astrocytomas has been defined in different ways. Thus, some consider it to be the appearance of tumour following cyst aspiration, whilst others regard it to be the reappearance of tumour following either subtotal or total removal. Thirty-five recurrences were noted in the present study after all modes of surgery and the tumours recurred from 2 to 21 years postoperatively. From previous studies, it is clear that most tumours recur within three to five years and that late recurrences may be of two types. The first is an “unpredictable form” which behaves in a manner unrelated either to the extent of surgery or the type of histology. The second arises from a malignant change in an initially benign tumour. Long-term clinical and radiological follow-up at six month intervals is essential since the CT scan is able to detect tumours before they become symptomatic and because detection will, at the earliest stages, possibly allow the removal of recurrent tumour before brain stem infiltration has occurred. When the first operation is a simple aspiration, decompression, or subtotal removal and recurrence takes place, it may still be possible to remove tumour totally and prolong survival greatly through reoperation.
    Type of Medium: Electronic Resource
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