Assessing physical symptoms during the postpartum period: reliability and validity of the primary health questionnaire somatic symptom subscale (PHQ-15)

Introduction: This study aimed at establishing the reliability and validity of the primary health questionnaire (PHQ-15) somatic symptom severity subscale for postpartum women.

Methods: Women (N?=?495) completed the PHQ-15 approximately 6 weeks postpartum during the baseline phase of a randomized controlled trial evaluating a writing intervention for postnatal health in England. Reliability was assessed using internal consistency statistics and convergent validity by comparing differences in self-reported physical health, health-related quality of life (QoL) and primary care usage by PHQ-15 symptom severity category.

Results: Cronbach’s α for the PHQ-15 was 0.73 and item-total statistics met recommended guidelines. Validity analyzes showed 6% of women reported severe symptoms, 17% medium, 50% low and 27% minimal symptoms. Women with severe symptoms reported poorer overall physical health, poorer physical health-related QoL and greater use of primary care. Women with severe symptoms also rated their baby’s health as worse and used primary care more for their baby.

Discussion: This study suggests the PHQ-15 has the potential to be a useful and valid measure of physical symptoms in postpartum women in high-income countries.     

Association Between Knee Pain,Impaired Function,and Development of Depressive Symptoms

Objectives

To examine the association between knee pain and function and depressive symptoms in older Japanese adults.

Design

Community‐based prospective cohort study.

Setting

Kurabuchi Town, Gumma Prefecture, Japan.

Participants

Individuals aged 65 and older (N = 573; n = 260 men, n = 313 women) without depressive symptoms participated in baseline examinations in 2005 and 2006; 95.6% participated in follow‐up interviews (2007–08).

Measurements

Degree of knee pain and functional impairment was assessed at baseline using a self‐administered questionnaire in Japanese based on an English version of the Western Ontario and McMaster Universities Osteoarthritis Index. The Geriatric Depression Scale was used to identify depressive symptoms in face‐to‐face home‐visit interviews conducted 2 years later, and the association between knee pain and functional impairment and depressive symptoms was assessed using logistic regression.

Results

During the 2‐year follow‐up, 11.9% of participants developed depressive symptoms, and pain and functional impairment were found to be associated with development of these symptoms. Pain at night while in bed (adjusted odds ratio (aOR) = 2.6, 95% confidence interval (CI) = 1.4–4.9) and difficulty putting on socks (aOR = 3.7, 95% CI: 1.8–7.5), getting into and out of a car (aOR = 3.4, 95% CI = 1.8–6.5), and taking off socks (aOR = 3.1, 95% CI = 1.5–6.5) were found to be most strongly associated with development of depressive symptoms.

Conclusion

Examining elderly people's responses to questions about pain at night and difficulties performing daily activities may be an efficient way of identifying those at high risk of developing depressive symptoms.     

Expériences de possession et symptômes dissociatifs chez un échantillon de sujets pratiquant l’exorcisme

Possession experiences remain poorly studied from a clinical viewpoint. The objective of this study was to evaluate psychic phenomena associated with these experiences of practicing exorcism. The study was conducted in natural settings by clinicians (psychiatrists, physicians, and psychologists) with a sample of subjects of Mexican nationality practicing exorcism rituals. After approval of the local religious authorities, evaluators attended exorcism practices performed by priests on 25 subjects who consented to the study. Subjects were observed by clinicians throughout the ritual. They were evaluated in the days preceding the ritual with clinical interviews and questionnaires for diagnostic purposes (Structural Clinical Interview for DSM [SCID], Brief Psychiatric Rating Scale [BPRS], Global Assessment of Functioning [GAF], Clinical Global Impression [CGI]). A second interview and assessment using the CGI was made one hour after the ritual. The results showed the presence of psychopathological syndromes and signs in the initial evaluation: dissociative symptoms and DSM Axis I or II disorders, with a moderate impact on the overall functioning of the subject. During the ritual dissociative states were identified, sometimes preceded by anxiety, such as are described in trance states. Post-ritual evaluation of the symptoms initially identified revealed that these had either significantly reduced or completely disappeared. The CGI severity was significantly decreased. This data allows better understanding of the psychopathology of these subjects describing their possession experiences and exorcism practices. It also shows the diagnostic complexity, in particular due to their cultural component. There remains a need for further research to better assess these phenomena and to understand the processes involved in the changes reported by the subjects after these rituals.     

SFN-SIQ,SFNSL and skin biopsy of 55 cases with small fibre involvement

Purpose/aim of the study: To date, there are no validated screening scales for small fibre neuropathy. This study investigated the small-fibre neuropathy and the symptom inventory questionnaire as well as the small fibre neuropathy screening list for small fibre neuropathy diagnosis.

Methods: Fifty-five patients were divided into small fibre neuropathy and mixed fibre damage groups. Relevant scales, nerve conduction studies and skin biopsies were performed. Relationships between the intraepidermal nerve fibre density and different scales as well as the diagnostic and cut-off values (score at which Youden's index is largest) were determined.

Results: Compared with healthy Chinese participants, 20 patients were diagnosed with small fibre neuropathy. Intraepidermal nerve fibre density was moderately and highly correlated with the small fibre neuropathy–symptom inventory questionnaire and small fibre neuropathy screening list, respectively. The diagnostic values were moderate and high for the small fibre neuropathy–symptom inventory questionnaire (cut-off value = 5, sensitivity = 80%, specificity = 81.8%) and small fibre neuropathy screening list (cut-off value = 8, sensitivity = 94.1%, specificity = 90.9%), respectively. There were no significant differences in the visual analogue scale between the small fibre neuropathy group, mixed small and large fibre neuropathy group, pure large fibre neuropathy group and the normal group.

Conclusion: Small fibre neuropathy–symptom inventory questionnaire and small fibre neuropathy screening list represent potential small fibre neuropathy screening tools.

Abbreviations EMG electromyography

ENA anti-extractable nuclear antigens

ESR erythrocyte sedimentation rate

IENFD intraepidermal nerve fibre density

IGT impaired glucose tolerance

NCS nerve conduction studies

NDS neuropathy disability score

OGTT oral glucose tolerance test

PGP protein gene product

PN peripheral neuropathy

ROC receiver operating characteristic curve

ROC-AUC area under the ROC curve

SFN small fibre neuropathy

SFN–SIQ small-fibre neuropathy and symptom inventory questionnaire

SFNSL small fibre neuropathy screening list

VAS visual analogue scale

WHO World Health Organization

     

细胞因子和免疫球蛋白抗体在过敏性鼻炎小鼠早期无症状阶段和晚期有症状阶段表达的差异

目的 探讨白细胞介素（interleukin-4,IL-4）,IL-17,IL-6和免疫球蛋白抗体在过敏性鼻炎（allergic rhinitis,AR）早期无症状阶段的表达及与过敏症状的关系。方法 建立卵清蛋白（ovalbumin,OVA）诱导的AR小鼠模型,在激发早期（第16天）和激发晚期（第30天）观察鼻部症状,收集鼻黏膜检测干扰素-γ（interferon-γ,IFN-γ）、IL-4、IL-17和IL-6基因表达,收集血清检测IgE、IgG1、IgG2a抗体和IFN-γ、IL-4、IL-17和IL-6蛋白表达水平。结果 挠鼻和喷嚏的次数在激发晚期显著高于激发早期和对照组,而在激发早期与对照组比较,差异无统计学意义（P>0.05）。OVA-特异性IgE抗体在AR激发早期和晚期小鼠均显著高于对照组,但两组间差异无统计学意义（P>0.05）。OVA-特异性IgG1和IgG2a抗体、鼻黏膜IL-17和IL-6基因表达及血清IL-17和IL-6蛋白表达有相似趋势,即在AR激发早期和激发晚期阶段均显著高于对照组,且在激发晚期阶段显著高于激发早期阶段。鼻黏膜IL-4基因和血清IL-4蛋白水平在激发晚期阶段显著高于对照组。结论 IL-17、IL-6、过敏原特异性IgG1和IgG2a可能参与了AR早期无症状阶段的反应,且其表达水平可能与过敏症状的出现有关。     

胰岛素自身免疫综合征的临床特点分析并文献复习

目的　分析胰岛素自身免疫综合征（IAS）的临床特点,结合文献提高对本病的认识。方法　经郑州大学第一附属医院病案室计算机检索2007年1月—2017年5月内分泌与代谢病科确诊为IAS的患者共10例,回顾性总结患者的临床特点,包括一般资料、临床症状、既往史、实验室检查及影像学检查、治疗及随访情况。结果　10例IAS患者中男、女各5例;年龄21~74岁,60岁及以上6例;低血糖发作时间多在夜间及凌晨;5例有含巯基药物服用史,3例有胰岛素应用史,2例无明显诱因;口服葡萄糖耐量试验（OGTT）结果提示糖尿病4例,糖耐量受损3例,糖耐量正常1例;10例患者血清胰岛细胞抗体（ICA）及谷氨酸脱羧酶抗体（GADA）均阴性,而胰岛素自身抗体（IAA）均阳性。所有患者血清胰岛素水平明显升高,并与C肽水平升高不匹配。10例患者均予少食多餐、高纤维素低碳水化合物饮食,其中3例患者加用阿卡波糖,6例患者应用糖皮质激素治疗;5例有含巯基药物服用史患者,均停用相应药物,均未再发作低血糖。完成随访9例,失访1例,随访时间为1~12个月,其中8例患者未再出现低血糖症状。结论　IAS为少见的内分泌疾病,尤其在老年人中高发,临床上对高胰岛素血症性低血糖症患者,应常规检测IAA,以避免漏诊、误诊及不必要的手术。     

肾综合征出血热55例临床特征分析

目的　总结肾综合征出血热（HFRS）的临床特征,提高对本病的认识,减少漏诊。方法　回顾性分析2010年1月—2016年12月郑州大学第一附属医院确诊的55例HFRS住院患者的一般资料、临床表现、实验室检查结果、并发症、治疗方法及结局,并探讨影响HFRS患者预后的因素。结果　临床表现：55例患者中发热53例（96.4%）,消化道症状（腹痛、腹胀、恶心、呕吐）48例（87.3%）,少尿28例（50.9%）,皮肤黏膜充血出血27例（49.1%）,腰痛21例（38.2%）,头痛20例（36.4%）,休克11例（20.0%）,肌肉痛9例（16.4%）,眼眶痛4例（7.3%）。实验室检查结果：血小板计数减少48例（87.3%）,白细胞计数升高45例（81.8%）,尿蛋白阳性45例（81.8%）。并发症：肾功能不全49例（89.1%）,肝损伤49例（89.1%）,凝血功能障碍17例（30.9%）,胰腺炎2例（3.6%）,脑出血1例（1.8%）。死亡2例（3.6%）。单因素Logistic回归分析结果示休克持续时间为HFRS患者预后的危险因素〔OR（95%CI）=2.078（1.008,4.282）,P=0.047〕。结论　HFRS出现典型临床表现者少,易并发肝脏、肾脏及血液系统不同程度损伤,休克持续时间为HFRS患者预后的危险因素。     

增生硬化性IgA肾病伴贫血患者的临床病理特征及预后研究

目的　分析增生硬化性IgA肾病（IgAN）伴贫血患者的临床病理特征及预后。方法　选取2012年1月—2016年6月在郑州大学第一附属医院行肾脏穿刺活检诊断为增生硬化性IgAN的患者261例为研究对象。按照贫血的诊断标准,将患者分为贫血组（100例）和非贫血组（161例）。收集患者一般资料、实验室检查结果、肾组织病理检查指标,以肾活检日期为起点,随访至2017-06-01。采用Kaplan-Meier法绘制生存曲线,进行Log-rank检验;采用多因素Cox比例风险模型分析贫血对增生硬化性IgAN患者预后的影响。结果　贫血组患者估算肾小球滤过率（eGFR）、清蛋白、血钙低于非贫血组,尿素、血肌酐、血磷、24 h尿蛋白定量、肾小球总硬化比例、肾小管萎缩/间质纤维化≥25%发生率高于非贫血组（P<0.05）。中位随访时间为11（6,21）个月,两组患者生存曲线比较,贫血组患者肾脏累积生存率低于非贫血组（χ2=30.307,P<0.001）。CKD3期不同贫血程度患者肾脏累积生存率比较,差异有统计学意义（χ2=22.066,P<0.001）。多因素Cox比例风险模型分析显示,贫血〔HR=2.864,95%CI（1.611,5.093）〕、24 h尿蛋白定量〔HR=1.164,95%CI（1.065,1.272）〕、肾小球总硬化比例〔HR=3.858,95%CI（1.120,13.290）〕、肾小管萎缩/间质纤维化〔HR=1.902,95%CI（1.070,3.383）〕是增生硬化性IgAN进展至终末期肾脏病（ESRD）的危险因素（P<0.05）。结论　增生硬化性IgAN伴贫血患者的临床病理表现相对较严重,肾脏累积生存率较低,且贫血是增生硬化性IgAN病情进展的独立危险因素。