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Grothus S, Sommer A, Stahlschmidt L, Hirschfeld G, Höfel L, Linder R, Zernikow B, Wager J. Pediatric chronic pain grading-a revised classification of the severity of pediatric chronic pain. Pain 2024:00006396-990000000-00570. [PMID: 38595202 DOI: 10.1097/j.pain.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Abstract
ABSTRACT In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; Mage = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (Mage = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.
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Affiliation(s)
- Susanne Grothus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ariane Sommer
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business, CareTech OWL University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Lea Höfel
- Center for Pain Therapy for Young People, Garmisch-Partenkirchen, Germany
| | | | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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Jeckel J, Thiele C, Hirschfeld G, Teismann T, Schneider S, von Brachel R. Better Safe Than Sorry. A Scoping Review of Monitoring for Negative Effects in Preregistrations of Psychological Interventions. Clin Psychol Psychother 2024; 31:e2968. [PMID: 38562028 DOI: 10.1002/cpp.2968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
Although negative effects of psychological interventions are suspected to be common, they are rarely investigated. Experts and international guidelines agree that monitoring for negative effects in clinical studies is needed to make psychological interventions safer and to empower patients before they give their consent to participate. Therefore, monitoring should already be considered during planning and preregistration of a study. The aim of this scoping review was to find out how frequently studies on psychological interventions monitor their negative effects according to preregistrations and to investigate reasons why monitoring is not carried out. Preregistrations of psychological interventions on ClinicalTrials.gov were scrutinized for information on monitoring of negative effects and other study characteristics. In a survey, researchers of studies where no monitoring was reported were asked for reasons for not doing so. Overall, 2231 preregistrations of psychological interventions were found; of these, only 3.4% included explicit information on monitoring for negative effects. In the survey, more researchers reported having conducted monitoring, although the type of monitoring was often inadequate. The type of monitoring varied widely, and specific monitoring measurements were rarely used repeatedly. Monitoring for negative effects was more prevalent in studies investigating treatments versus low-threshold interventions, in studies conducted in Europe versus other continents and in more recent studies. Researchers reported lack of knowledge as the most frequent reason for not monitoring negative effects. Our results imply a lack of monitoring and inconsistent information on negative effects in preregistrations, with inconsistent use of the term monitoring and measurements, and a lack of knowledge among researchers. Improved knowledge and a standardized approach, starting with an adequate preregistration, would be helpful to routinely examine negative effects in psychological interventions to make them safer and better.
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Affiliation(s)
- Jacoba Jeckel
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Christian Thiele
- Faculty of Business, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Gerrit Hirschfeld
- Faculty of Business, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Ruth von Brachel
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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Tsze DS, Thiele C, Hirschfeld G, Dayan PS. Clinically significant differences in self-reported pain scores in children with headaches. Acad Emerg Med 2024. [PMID: 38400616 DOI: 10.1111/acem.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Changes in pain scores that represent clinically significant differences in children with headaches are necessary for study design and interpretation of findings reported in studies. We aimed to determine changes in pain scores associated with a minimum clinically significant difference (MCSD), ideal clinically significant difference (ICSD), and patient-perceived adequate analgesia (PPAA) in this population. METHODS We performed a secondary analysis of two prospective studies of children with headaches presenting to an emergency department. Two serial assessments were performed in children aged 6-17 and 4-17 years who self-reported their pain intensity using the Verbal Numerical Rating Scale (VNRS) and Faces Pain Scale-Revised (FPS-R), respectively. Children qualitatively described any endorsed change in pain score; those who received an analgesic were asked if they wanted additional analgesics to decrease their pain intensity. We used receiver operating characteristic curve-based methodology to identify changes in pain scores associated with "a little less" (MCSD) and "much less" (ICSD) pain and patients declining additional analgesics because they experienced adequate analgesia after treatment (PPAA). RESULTS We analyzed 105 children: 63.8% were female and the median (IQR) age was 13 (10-15) years. Ninety-eight children were analyzed for the VNRS and 101 were analyzed for the FPS-R. For the VNRS, raw change and percent reductions in pain scores associated with MCSD, ICSD, and PPAA were 2/10 and 25%, 4/10 and 56%, and 3/10 and 50%, respectively, and for the FPS-R, 2/10 and 25%, 4/10 and 67%, and 4/10 and 60%, respectively. The area under the curve (AUC) associated with a MCSD for both scales ranged from 94% to 98%; the AUC associated with an ICSD or PPAA for both scales ranged from 76% to 83%. CONCLUSIONS We identified changes in pain score associated with patient-centered outcomes in children with headaches suitable for designing trials and assigning clinical significance to changes in pain scores reported in studies.
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Affiliation(s)
- Daniel S Tsze
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Christian Thiele
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Peter S Dayan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Jagemann I, Wensing O, Stegemann M, Hirschfeld G. Acceptance of Medical Artificial Intelligence in Skin Cancer Screening: Choice-Based Conjoint Survey. JMIR Form Res 2024; 8:e46402. [PMID: 38214959 PMCID: PMC10818228 DOI: 10.2196/46402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/17/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND There is great interest in using artificial intelligence (AI) to screen for skin cancer. This is fueled by a rising incidence of skin cancer and an increasing scarcity of trained dermatologists. AI systems capable of identifying melanoma could save lives, enable immediate access to screenings, and reduce unnecessary care and health care costs. While such AI-based systems are useful from a public health perspective, past research has shown that individual patients are very hesitant about being examined by an AI system. OBJECTIVE The aim of this study was two-fold: (1) to determine the relative importance of the provider (in-person physician, physician via teledermatology, AI, personalized AI), costs of screening (free, 10€, 25€, 40€; 1€=US $1.09), and waiting time (immediate, 1 day, 1 week, 4 weeks) as attributes contributing to patients' choices of a particular mode of skin cancer screening; and (2) to investigate whether sociodemographic characteristics, especially age, were systematically related to participants' individual choices. METHODS A choice-based conjoint analysis was used to examine the acceptance of medical AI for a skin cancer screening from the patient's perspective. Participants responded to 12 choice sets, each containing three screening variants, where each variant was described through the attributes of provider, costs, and waiting time. Furthermore, the impacts of sociodemographic characteristics (age, gender, income, job status, and educational background) on the choices were assessed. RESULTS Among the 383 clicks on the survey link, a total of 126 (32.9%) respondents completed the online survey. The conjoint analysis showed that the three attributes had more or less equal importance in contributing to the participants' choices, with provider being the most important attribute. Inspecting the individual part-worths of conjoint attributes showed that treatment by a physician was the most preferred modality, followed by electronic consultation with a physician and personalized AI; the lowest scores were found for the three AI levels. Concerning the relationship between sociodemographic characteristics and relative importance, only age showed a significant positive association to the importance of the attribute provider (r=0.21, P=.02), in which younger participants put less importance on the provider than older participants. All other correlations were not significant. CONCLUSIONS This study adds to the growing body of research using choice-based experiments to investigate the acceptance of AI in health contexts. Future studies are needed to explore the reasons why AI is accepted or rejected and whether sociodemographic characteristics are associated with this decision.
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Affiliation(s)
- Inga Jagemann
- School of Business, University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
| | - Ole Wensing
- School of Business, University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
| | - Manuel Stegemann
- School of Business, University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
| | - Gerrit Hirschfeld
- School of Business, University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
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Brailovskaia J, von Brachel R, van Hall F, Teismann T, Hirschfeld G, Margraf J. A dual-factor model perspective on depressed inpatients: examining the dynamics of mental health and therapy outcomes. Front Psychiatry 2024; 14:1295032. [PMID: 38274438 PMCID: PMC10808683 DOI: 10.3389/fpsyt.2023.1295032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Background The dual-factor model of mental health posits that mental health and mental illness constitute two distinct axes; accordingly the model identifies four mental health groups: (1) complete mental health, (2) troubled, (3) vulnerable, (4) symptomatic but content. Yet, only a few studies investigated effectiveness of therapy on both dimensions of mental health simultaneously. Against this background, the present study aimed to determine proportions and changes of group assignments in depressed inpatients undergoing therapy. Method N = 1,044 depressed inpatients (age in years: M = 53.36, SD = 9.81, range: 17-83) completed a pre- and a post-treatment survey including questionnaires on depression, anxiety, and positive mental health. A total of n = 328 persons completed the survey also at 6-month and 12-month follow-up assessments. Results In the classification that included depression symptoms and positive mental health, 49% of the participants were classified as troubled and 13.2% were classified as completely mentally healthy at the pre-treatment assessment. At the post-treatment, 9.5% were classified as troubled and 55.7% were classified as completely mentally healthy. In the classification that included anxiety symptoms and positive mental health, 21.9% of the participants were classified as troubled and 14.2% were classified as completely mentally healthy at the pre-treatment assessment. At the post-treatment, 3.7% were classified as troubled and 56.1% were classified as completely mentally healthy. About 10 to 20% of patients showed an improvement in depression/anxiety and positive mental health, whereas another 10 to 20% showed a reduction in depression/anxiety, but only a minor increase in positive mental health between pre- and post-treatment. Conclusion Findings are in line with past research inspired by the dual-factor model in showing that enhancing positive mental health and alleviating psychopathology do not always co-occur in treatment. It is therefore important to implement measures of both psychopathology and positive mental health in therapy outcome studies, and to promote interventions targeting both psychopathology and positive mental health.
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Affiliation(s)
- Julia Brailovskaia
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
- DZPG (German Center for Mental Health), Partner Site Bochum/Marburg, Bochum, Germany
| | - Ruth von Brachel
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | | | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | | | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
- DZPG (German Center for Mental Health), Partner Site Bochum/Marburg, Bochum, Germany
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Thiele C, Hirschfeld G. An observational study on the adherence to study registrations in German interventional and observational studies from various fields. PeerJ 2023; 11:e16015. [PMID: 37780396 PMCID: PMC10538302 DOI: 10.7717/peerj.16015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/10/2023] [Indexed: 10/03/2023] Open
Abstract
Background The registration of studies, especially in the case of clinical trials, is required by the declaration of Helsinki and the policies of various scientific journals. However, numerous analyses have found considerable discrepancies between published articles and accompanying trial registrations. The aim of this study is to assess such discrepancies for a sample of studies with recruiting locations in Germany. Additionally, the association between the adherence to registrations and possible involvement of Coordinating Centers for Clinical Studies (KKS) as well as Universities of Excellence was tested. Methods For a sample of 376 interventional or observational study registrations, we found 115 published articles. Subsequently, we searched for discrepancies in the study design, the key inclusion criteria, the interventions, the blinding, and a primary and a secondary outcome. Results We found discrepancies in 26% of all studies, most frequently in the secondary outcomes, where 16.5% of the secondary outcomes per study that were registered in most detail had discrepancies. When running regression models for adherence discrepancies, the only variable that had a statistically significant association with better adherence was registration on ClinicalTrials.gov. The association of potential involvement of a KKS with adherence ratings was positive, too, but statistically insignificant. Conclusions In summary, the amount of discrepancies between registrations and published articles remains elevated.
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Affiliation(s)
- Christian Thiele
- University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
| | - Gerrit Hirschfeld
- University of Applied Sciences and Arts Bielefeld, Bielefeld, Germany
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Dogan M, Hirschfeld G, Blankenburg M, Frühwald M, Ahnert R, Braun S, Marschall U, Zernikow B, Wager J. A randomized controlled trial on long-term effectiveness of a psychosocial aftercare program following pediatric chronic pain treatment: Who benefits the most? Eur J Pain 2022; 26:1746-1758. [PMID: 35762280 DOI: 10.1002/ejp.1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/07/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND For pediatric chronic pain patients, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. The treatment's short-term effectiveness can be improved by an additive psychosocial aftercare (PAC). However, neither the program's long-term effectiveness nor the patients in particular need have been investigated yet. METHODS This study aimed at determining the long-term effects of PAC and detecting predictors of treatment outcome within a multicenter randomized controlled trial measured at five time points up to twelve months after discharge. At inpatient admission to IIPT, patients (N=419, 14.3 years of age, 72.3% female) were randomly assigned to intervention or control group. After IIPT discharge, the intervention group received PAC, whereas the control group received treatment as usual (TAU). Patient-reported outcomes included pain and emotional characteristics. Clinicians assessed potential psychosocial risk factors and their prognosis of treatment outcome. Statistical analyses included mixed-models and univariable logistic regressions. RESULTS Data at the 12-month follow-up (n=288) showed a significant benefit of PAC compared with TAU; the majority (59.0%) of patients in the PAC-group reported no chronic pain compared to 29.2% of TAU-patients (p<.001). Patients with a single parent specifically benefited from PAC compared to TAU. Clinicians were able to make a reliable prognosis of treatment outcome, but did not successfully predict which patients would benefit the most from PAC. CONCLUSIONS Study results suggest that PAC is highly effective irrespective of patient characteristics, but particularly for patients with single parents. Its broad implementation could help to improve the long-term outcomes of youth with severely disabling chronic pain.
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Affiliation(s)
- Meltem Dogan
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Markus Blankenburg
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Michael Frühwald
- University Children's Hospital Augsburg, Swabian Children's Pain Center, Augsburg, Germany
| | - Rosemarie Ahnert
- University Children's Hospital Augsburg, Swabian Children's Pain Center, Augsburg, Germany
| | - Sarah Braun
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, Wuppertal, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Thiele C, Hirschfeld G. Registration quality and availability of publications for clinical trials in Germany and the influence of structural factors. PLoS One 2022; 17:e0267883. [PMID: 35533182 PMCID: PMC9084529 DOI: 10.1371/journal.pone.0267883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Analyses of clinical trial registries (CTRs) offer insights into methodological problems of published research studies, e.g., non-publication and outcome-switching. Here, we use CTRs as a tool to evaluate clinical studies conducted in Germany and test how their registration quality is associated with time and structural factors: Coordinating Centers for Clinical Trials (KKS) and Universities of Excellence. Methods We searched ClinicalTrials.gov, the DRKS, and the ICTRP for clinical trials recruiting participants in Germany. As a measure for the methodological quality, we assessed the proportion of trials that were pre-registered. In addition, the registration quality and availability of publications relating to the trials were manually assessed for a sample (n = 639). Also, the influence of the structural factors was tested using regression models. Results We identified 35,912 trials that were conducted in Germany. 59% of trials were pre-registered. Surprisingly, Universities of Excellence had lower pre-registration rates. The influence of KKS was unclear and also difficult to test. Interventional trials were more likely to be pre-registered. Registration quality improved over time and was higher in interventional trials. As of early 2021, 49% of trials that started until the end of 2015 have published scientific articles. 187 of 502 studies on ClinicalTrials.gov for which we found published articles did not reference any in the registry entry. Discussion The structural predictors did not show consistent relationships with the various outcome variables. However, the finding that the study type and time were related to better registration quality suggests that regulatory regimes may have an impact. Limitations of this non-pre-registered study were that no modifications to registry entries were tracked and the coarse measure of KKS involvement.
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Affiliation(s)
- Christian Thiele
- University of Applied Sciences Bielefeld, Faculty of Business, CareTech OWL – Center for Health, Welfare and Technology, Bielefeld, Germany
- * E-mail:
| | - Gerrit Hirschfeld
- University of Applied Sciences Bielefeld, Faculty of Business, CareTech OWL – Center for Health, Welfare and Technology, Bielefeld, Germany
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Thiele C, Hirschfeld G, von Brachel R. Clinical trial registries as Scientometric data: A novel solution for linking and deduplicating clinical trials from multiple registries. Scientometrics 2021. [DOI: 10.1007/s11192-021-04111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractRegistries of clinical trials are a potential source for scientometric analysis of medical research and serve important functions for the research community and the public at large. Clinical trials that recruit patients in Germany are usually registered in the German Clinical Trials Register (DRKS) or in international registries such as ClinicalTrials.gov. Furthermore, the International Clinical Trials Registry Platform (ICTRP) aggregates trials from multiple primary registries. We queried the DRKS, ClinicalTrials.gov, and the ICTRP for trials with a recruiting location in Germany. Trials that were registered in multiple registries were linked using the primary and secondary identifiers and a Random Forest model based on various similarity metrics. We identified 35,912 trials that were conducted in Germany. The majority of the trials was registered in multiple databases. 32,106 trials were linked using primary IDs, 26 were linked using a Random Forest model, and 10,537 internal duplicates on ICTRP were identified using the Random Forest model after finding pairs with matching primary or secondary IDs. In cross-validation, the Random Forest increased the F1-score from 96.4% to 97.1% compared to a linkage based solely on secondary IDs on a manually labelled data set. 28% of all trials were registered in the German DRKS. 54% of the trials on ClinicalTrials.gov, 43% of the trials on the DRKS and 56% of the trials on the ICTRP were pre-registered. The ratio of pre-registered studies and the ratio of studies that are registered in the DRKS increased over time.
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von Glischinski M, von Brachel R, Thiele C, Hirschfeld G. Not sad enough for a depression trial? A systematic review of depression measures and cut points in clinical trial registrations. J Affect Disord 2021; 292:36-44. [PMID: 34091381 DOI: 10.1016/j.jad.2021.05.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patient reported outcomes are central to the evaluation of behavioral, drug, or somatic interventions focusing depression. Continuous measures are mostly interpreted with cut points that serve as inclusion criteria and define remission. The present review provides an overview of measures (BDI; BDI-II; CESD; HADS; HAMD-17; MADRS; PHQ-9; QIDS) and cut points in clinical trials on depression and tests for systematic differences concerning varying types of interventions. METHODS We analyzed 2632 trials registered via clinicaltrials.gov registered between 2000/01/01 - 2019/12/31 that used one or more pre-specified measures of depression of which 1600 reported cut points for either inclusion of participants or the definition of clinical remission. RESULTS The included studies more often used clinician-administered scales than self-report questionnaires as criterion for the inclusion of study participants and for the definition of clinical remission. Clinician administered scales are dominating in drug trials, while self-report questionnaires are primarily used in behavioral trials. This trend accelerated during the last 20 years. Compared to studies on behavioral therapies, studies with drug or other interventions used higher cut points to include patients. Comparisons between the interventions revealed highly significant differences in the used cut points of MADRS, HAMD-17 and PHQ-9. CONCLUSIONS Choice of measure and cut points is an important aspect of trial design and should be homogenized in order to make trials of different types of interventions more readily comparable. Similarly, systematic differences between treatment types in how patients are included and how remission is defined also hamper the comparisons between different treatment modalities.
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Affiliation(s)
| | - Ruth von Brachel
- Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Christian Thiele
- University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
| | - Gerrit Hirschfeld
- University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
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Dogan M, Hirschfeld G, Blankenburg M, Frühwald M, Ahnert R, Braun S, Marschall U, Pfenning I, Zernikow B, Wager J. Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2127024. [PMID: 34570203 PMCID: PMC8477265 DOI: 10.1001/jamanetworkopen.2021.27024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients. OBJECTIVE To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. INTERVENTIONS Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. MAIN OUTCOMES AND MEASURES The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. RESULTS A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P < .001). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that PAC improved pain-related and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects. TRIAL REGISTRATION German Clinical Trials Register ID: DRKS00015230.
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Affiliation(s)
- Meltem Dogan
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, Witten/Herdecke University School of Medicine, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Markus Blankenburg
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Michael Frühwald
- University Children’s Hospital Augsburg, Swabian Children’s Pain Center, Augsburg, Germany
| | - Rosemarie Ahnert
- University Children’s Hospital Augsburg, Swabian Children’s Pain Center, Augsburg, Germany
| | - Sarah Braun
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, Wuppertal, Germany
| | - Ingo Pfenning
- Techniker Krankenkasse, Techniker Health Insurance, Hamburg, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, Witten/Herdecke University School of Medicine, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, Witten/Herdecke University School of Medicine, Witten, Germany
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Hirschfeld G, von Glischinski M, Thiele C. Optimal Cycle Thresholds for Coronavirus Disease 2019 (COVID-19) Screening-Receiver Operating Characteristic (ROC)-Based Methods Highlight Between-Study Differences. Clin Infect Dis 2021; 73:e852-e853. [PMID: 33354720 PMCID: PMC7799283 DOI: 10.1093/cid/ciaa1883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | | | - Christian Thiele
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
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Velten J, Hirschfeld G, Meyers M, Margraf J. Psychometric Properties of a Self-Report Version of the Sexual Interest and Desire Inventory-Female (SIDI-F-SR). J Sex Med 2021; 18:990-995. [PMID: 33903043 DOI: 10.1016/j.jsxm.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Sexual Interest and Desire Inventory-Female (SIDI-F) is a clinician-administered scale that allows for a comprehensive assessment of symptoms related to Hypoactive Sexual Desire Dysfunction (HSDD). As self-report questionnaires may facilitate less socially desirable responding and as time and resources are scarce in many clinical and research settings, a self-report version was developed (Sexual Interest and Desire Inventory- Female Self-Report; SIDI-F-SR). AIM To assess the psychometric properties of the SIDI-F-SR and to investigate the agreement between the SIDI-F and SIDI-F-SR. METHODS A total of 170 women (Mage = 37, SD = 11, range = 20-69) with HSDD answered the SIDI-F, administered by a clinical psychologist via telephone, first, followed by the SIDI-F-SR, delivered as an Internet-based questionnaire. A subset of 19 women answered the SIDI-F-SR twice over a period of 14 weeks. OUTCOMES Convergent validity of the SIDI-F-SR was assessed via correlations with the desire subscale of the Female Sexual Function Index and the Female Sexual Distress Scale Revised. Internal consistency and test-retest reliability as well as intraclass correlation and predictors of absolute agreement between SIDI-F and SIDI-F-SR were examined. RESULTS Test-retest-reliability was good (r = 0.74). Convergent validity was low but comparable between SIDI-F and SIDI-F-SR. Internal consistency of the SIDI-F-SR was acceptable (α = 0.76) and comparable to the SIDI-F (α = 0.74). When corrections for the restriction of range were applied, internal consistency of the SIDI-F-SR increased to 0.91. There was high agreement between SIDI-F and SIDI-F-SR (ICC = 0.86). On average, women scored about one point higher (indicated more desire) in the self-report vs the clinician-administered scale. CLINICAL IMPLICATIONS The SIDI-F-SR can be used in settings where time and resources are limited. Whether the clinical cutoff point for the SIDI-F is adequate for the SIDI-F-SR has yet to be determined. STRENGTHS AND LIMITATIONS Large sample of diverse women with HSDD. Lack of control groups (ie, healthy controls, women with other sexual dysfunctions). CONCLUSION The SIDI-F-SR showed promising psychometric properties in a sample of women with HSDD. Velten J, Hirschfeld G, Meyers M, et al. Psychometric Properties of a Self-Report Version of the Sexual Interest and Desire Inventory-Female (SIDI-F-SR). J Sex Med 2021;18:990-995.
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Affiliation(s)
- Julia Velten
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany.
| | - Gerrit Hirschfeld
- Faculty of Business and Health, CareTech OWL Center for Health, Welfare and Technology, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Milena Meyers
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
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14
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Neß V, Könning A, Hirschfeld G, Wager J. Adolescents' Explanatory Models for Headaches and Associations with Behavioral and Emotional Outcomes. Children (Basel) 2021; 8:234. [PMID: 33803573 PMCID: PMC8002924 DOI: 10.3390/children8030234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Abstract
More than one-third of adolescents experience recurrent headaches. Usually, these headaches are of primary origin and modulated by different biological and psychosocial factors. While parents are often consulted in scientific research and medical care about the nature of their child's headache, it is unclear to what extent parents and their children agree upon the factors that cause them. Adolescents' own attributions of headaches have rarely been investigated, and it is unclear how those attributions affect behavioral and emotional outcomes. In the present study, adolescents with chronic headaches (N = 248) and their parents (N = 120) rated the influence of various biological and psychosocial factors on the adolescents' headaches. Associations between these factors and several behavioral and emotional outcomes were examined. The most frequently reported factor by both samples was stress; however, concordance between parents and adolescents was generally low. The factor "other disease" was significantly associated with medication consumption and school absence. This study is one of the first to provide insights into adolescents' own attributions of headaches. Furthermore, the significant associations of the factor with behavioral outcomes reveal the importance of understanding personal explanatory models of headache. Future studies should examine associations between subjective headache causes and the individual's experience of the disorder to improve headache interventions.
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Affiliation(s)
- Verena Neß
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.K.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.K.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Gerrit Hirschfeld
- CareTech OWL Center for Health, Welfare and Technology, Faculty of Business, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany;
| | - Julia Wager
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.K.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
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Könning A, Rosenthal N, Friese M, Hirschfeld G, Brown D, Wager J. Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data. Eur J Pain 2020; 25:88-106. [DOI: 10.1002/ejp.1661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Könning
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
| | - Nicola Rosenthal
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
| | - Michelle Friese
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
| | - Gerrit Hirschfeld
- Department for Business and Health University of Applied Sciences Bielefeld Bielefeld Germany
| | - Donnamay Brown
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
| | - Julia Wager
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
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17
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von Brachel R, Hirschfeld G, Berner A, Willutzki U, Teismann T, Cwik JC, Velten J, Schulte D, Margraf J. Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care: A 5- to 20-Year Follow-Up Study. Psychother Psychosom 2020; 88:225-235. [PMID: 31121580 DOI: 10.1159/000500188] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/08/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Long-term follow-ups several years after receiving cognitive behavioral therapy (CBT) are scarce and most of the existing literature describes follow-up data of randomized-controlled trials. Thus, very little is known about the long-term effects of CBT in routine care. METHODS We investigated psychological functioning in a sample of 263 former outpatients who had received CBT for a variety of mental disorders such as depression, anxiety-, eating- or somatoform disorders 8.06 (SD 5.08) years after treatment termination. All participants completed a diagnostic interview as well as the Brief-Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Effect sizes and response rates according to Jacobson and Truax [J Consult Clin Psychol 1991;59:12-9] were calculated from pre- to posttreatment and from pretreatment to follow-up assessment. RESULTS Pre- to posttreatment effect sizes ranged between 0.75 (BDI) and 0.63 (BSI) and pretreatment to follow-up effect sizes were 0.92 (BDI) and 0.75 (BSI). Of all patients, 29% (BDI) and 17% (BSI) experienced clinically significant change at posttreatment and 42% (BDI) and 24% (BSI) at follow-up. CONCLUSION The results point to the long-term effectiveness of CBT under routine conditions for a wide array of problems, especially when compared to the long-term effects of medical treatment. It is noteworthy that the results at follow-up were even better than at posttreatment, indicating further improvement. However, about a quarter of the patients did not respond sufficiently to therapy, neither concerning short-term nor long-term effects.
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Affiliation(s)
- Ruth von Brachel
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany,
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Arleta Berner
- Faculty of Psychology and Psychotherapy, University Witten-Herdecke, Witten, Germany
| | - Ulrike Willutzki
- Faculty of Psychology and Psychotherapy, University Witten-Herdecke, Witten, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jan Christopher Cwik
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Julia Velten
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Dietmar Schulte
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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18
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von Brachel R, Bieda A, Margraf J, Hirschfeld G. Longitudinal Measurement Invariance of the Brief Symptom Inventory (BSI)-18 in Psychotherapy Patients. European Journal of Psychological Assessment 2020. [DOI: 10.1027/1015-5759/a000480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Brief Symptom Inventory (BSI)-18 is a widely-used tool to assess changes in general distress in patients despite an ongoing debate about its factorial structure and lack of evidence for longitudinal measurement invariance (LMI). We investigated BSI-18 scores from 1,081 patients from an outpatient clinic collected after the 2nd, 6th, 10th, 18th, and 26th therapy session. Confirmatory factor analysis (CFA) was used to compare models comprising one, three, and four latent dimensions that were proposed in the literature. LMI was investigated using a series of model comparisons, based on chi-square tests, effect sizes, and changes in comparative fit index (CFI). Psychological distress diminished over the course of therapy. A four-factor structure (depression, somatic symptoms, generalized anxiety, and panic) showed the best fit to the data at all measurement occasions. The series of model comparisons showed that constraining parameters to be equal across time resulted in very small decreases in model fit that did not exceed the cutoff for the assumption of measurement in variance. Our results show that the BSI-18 is best conceptualized as a four-dimensional tool that exhibits strict longitudinal measurement invariance. Clinicians and applied researchers do not have to be concerned about the interpretation of mean differences over time.
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Affiliation(s)
- Ruth von Brachel
- Mental Health Research & Treatment Center of Ruhr-University Bochum, Germany
| | - Angela Bieda
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Germany
| | - Jürgen Margraf
- Mental Health Research & Treatment Center of Ruhr-University Bochum, Germany
| | - Gerrit Hirschfeld
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Germany
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Hirschfeld G, von Brachel R, Thiele C. Screening for health-related quality of life in children and adolescents: Optimal cut points for the KIDSCREEN-10 for epidemiological studies. Qual Life Res 2019; 29:529-536. [PMID: 31620984 DOI: 10.1007/s11136-019-02324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Generic measures of health-related quality of life are important in pediatrics. Here, we try to establish optimal cut points for the self-report and parental-report versions of the KIDSCREEN-10. METHOD We re-analyzed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study. In total, data from 2566 children, 2136 younger adolescents, and 2740 older adolescents were used. The KIDSCREEN-10 was contrasted to three different anchors: the strength and difficulties questionnaire, self-rated general health, and chronic diseases. A kernel-based method and bootstrapping were used to determine the optimal cut points and their variability. RESULTS We found large differences in HRQoL between children with vs. without mental health problems but there is only medium-to-small differences in HRQoL between children with vs. without chronic diseases and children with self-rated good vs. poor physical health. Acceptable levels of classification accuracy were found in relation to mental health problems for all versions (AUCs between 0.77 and 0.79), but only for the parental-report version in relation to general health and for no version in relation to chronic diseases. Cut points identified as optimal differed systematically between parental-report versions (cut point = 41.13) and self-report for younger (cut point = 42.52) and older adolescents (cut point = 40.29). CONCLUSION The results aid the interpretation of KIDSCREEN-10 in epidemiological studies. Specifically, we suggest a cut point of 41 should be used to interpret the parental-report version of the KIDSCREEN and 40 and 42, respectively, for young and older adolescents.
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Affiliation(s)
- Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany.
| | - Ruth von Brachel
- Mental Health Research & Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Christian Thiele
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
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Hirschfeld G, Thiele C. Cloud-based simulation studies in R - A tutorial on using doRedis with Amazon spot fleets. Stat Med 2019; 38:3947-3959. [PMID: 31049978 DOI: 10.1002/sim.8188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/15/2019] [Accepted: 04/08/2019] [Indexed: 11/09/2022]
Abstract
Simulation studies are helpful in testing novel statistical methods. From a computational perspective, they constitute embarrassingly parallel tasks. We describe parallelization techniques in the programming language R that can be used on Amazon's cloud-based infrastructure. After a short conceptual overview of the parallelization techniques in R, we provide a hands-on tutorial on how the doRedis package in conjunction with the Redis server can be used on Amazon Web Services, specifically running spot fleets. The tutorial proceeds in seven steps, ie, (1) starting up an EC2 instance, (2) installing a Redis server, (3) using doRedis with a local worker, (4) using doRedis with a remote worker, (5) setting up instances that automatically fetch tasks from a specific master, (6) using spot-fleets, and (7) shutting down the instances. As a basic example, we show how these techniques can be used to assess the effects of heteroscedasticity on the equal-variance t-test. Furthermore, we address several advanced issues, such as multiple conditions, cost-management, and chunking.
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Affiliation(s)
- G Hirschfeld
- University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - C Thiele
- University of Applied Sciences Bielefeld, Bielefeld, Germany
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21
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Tsze DS, Hirschfeld G, Baeyer CL, Suarez LE, Dayan PS. Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain. Acad Emerg Med 2019; 26:1002-1013. [PMID: 30636350 DOI: 10.1111/acem.13683] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Identifying changes in pain score associated with clinically meaningful outcomes is necessary when using self-report measures to assess pain in children. We aimed to determine the changes in pain score associated with a minimum clinically significant difference (MCSD), ideal clinically significant difference (ICSD), and patient-perceived adequate analgesia (PPAA) and to evaluate for differences based on initial pain intensity and patient characteristics. METHODS This was a cross-sectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain Scale-Revised (FPS-R), respectively. Children qualitatively described any endorsed change in pain score; those who received an analgesic were asked if they wanted additional analgesics to decrease their pain intensity. We used a receiver operating characteristic curve-based methodology to identify changes in pain score associated with "a little less" and "much less" pain (MCSD and ICSD, respectively) and patients declining additional analgesics because of adequate analgesia (PPAA). RESULTS We enrolled 431 children with painful conditions. For the VNRS, raw change and percent reductions in pain scores associated with MCSD, ICSD, and PPAA were 2/10 and 20%, 3/10 and 44%, and 2/10 and 29%, respectively, and for the FPS-R, 2/10 and 33%, 4/10 and 60%, and 4/10 and 40%, respectively. Raw change in pain scores increased with increasing initial pain intensity, but percent reductions remained stable. There were no significant differences based on patient characteristics such as age, sex, and race/ethnicity. CONCLUSION Our findings provide patient-centered outcomes in children that are suitable for designing trials and are generalizable across patient characteristics.
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Affiliation(s)
- Daniel S. Tsze
- Department of Emergency Medicine Division of Pediatric Emergency Medicine Columbia University College of Physicians and Surgeons New York NY
| | - Gerrit Hirschfeld
- Faculty of Business and Health University of Applied Sciences Bielefeld BielefeldGermany
| | - Carl L. Baeyer
- Faculty of Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Leonor E. Suarez
- Department of Emergency Medicine Division of Pediatric Emergency Medicine Columbia University College of Physicians and Surgeons New York NY
| | - Peter S. Dayan
- Department of Emergency Medicine Division of Pediatric Emergency Medicine Columbia University College of Physicians and Surgeons New York NY
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Hartmann AS, Cordes M, Hirschfeld G, Vocks S. Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder. Psychiatry Res 2019; 272:349-358. [PMID: 30599438 DOI: 10.1016/j.psychres.2018.12.132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
Abstract
Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.
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Affiliation(s)
- Andrea S Hartmann
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany.
| | - Martin Cordes
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany
| | - Gerrit Hirschfeld
- Faculty of Economics and Health, Department of Applied Psychology, Division of Research Methods and Diagnostics, University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
| | - Silja Vocks
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany
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Lin M, Hirschfeld G, Margraf J. Brief form of the Perceived Social Support Questionnaire (F-SozU K-6): Validation, norms, and cross-cultural measurement invariance in the USA, Germany, Russia, and China. Psychol Assess 2018; 31:609-621. [PMID: 30589275 DOI: 10.1037/pas0000686] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study evaluates a brief, cross-cultural scale that maps a wide range of social resources, useful in large-scale assessments of perceived social support. The Brief Perceived Social Support Questionnaire (Fragebogen zur Sozialen Unterstützung Kurzform mit sechs Items, F-SozU K-6) was examined in representative and university student samples from the United States (Nrepresentative = 3038), Germany (Nrepresentative = 2007, Nstudent = 5406), Russia (Nrepresentative = 3020, Nstudent = 4001), and China (Nstudent = 13,582). Cross-cultural measurement invariance testing was conducted in both representative and student samples across countries. Scores on the F-SozU K-6 demonstrated good reliability and strong model fit for a unidimensional structure in all samples, with the exception of poor model fit for German students. The scores on F-SozU K-6 correlated negatively with scores on depression, anxiety, and stress measures and positively with scores on positive mental health measures. Norms for gender and age groups were established separately based on each representative sample. Cross-cultural measurement invariance testing found partial strong measurement invariance across three general population samples and three student samples. Furthermore, a simulation study showed that the amount of invariance observed in the partial invariance model had only a negligible impact on mean comparisons. Psychometric findings across diverse cultural contexts supported the robustness and validity of the F-SozU K-6 for cross-cultural epidemiologic studies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Muyu Lin
- Department of Clinical Psychology and Psychotherapy
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von Glischinski M, von Brachel R, Hirschfeld G. How depressed is “depressed”? A systematic review and diagnostic meta-analysis of optimal cut points for the Beck Depression Inventory revised (BDI-II). Qual Life Res 2018; 28:1111-1118. [DOI: 10.1007/s11136-018-2050-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
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25
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von Glischinski M, Willutzki U, Stangier U, Hiller W, Hoyer J, Leibing E, Leichsenring F, Hirschfeld G. Liebowitz Social Anxiety Scale (LSAS): Optimal cut points for remission and response in a German sample. Clin Psychol Psychother 2018; 25:465-473. [DOI: 10.1002/cpp.2179] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - U. Willutzki
- Department of Psychology; Witten/Herdecke University; Witten Germany
| | - U. Stangier
- Clinical Psychology and Psychotherapy; Goethe University Frankfurt; Frankfurt Germany
| | - W. Hiller
- Institute of Psychology; University of Mainz; Mainz Germany
| | - J. Hoyer
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - E. Leibing
- Center of Psychosocial Medicine; University of Goettingen; Goettingen Germany
| | - F. Leichsenring
- Clinic of Psychosomatics and Psychotherapy; Justus-Liebig-University Giessen; Giessen Germany
| | - G. Hirschfeld
- Department of Quantitative Methods; Osnabrück University of Applied Sciences; Osnabrück Germany
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26
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Bölte J, Hösker TM, Hirschfeld G, Thielsch MT. Electrophysiological correlates of aesthetic processing of webpages: a comparison of experts and laypersons. PeerJ 2017; 5:e3440. [PMID: 28603676 PMCID: PMC5463973 DOI: 10.7717/peerj.3440] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 05/18/2017] [Indexed: 11/20/2022] Open
Abstract
We investigated whether design experts or laypersons evaluate webpages differently. Twenty participants, 10 experts and 10 laypersons, judged the aesthetic value of a webpage in an EEG-experiment. Screenshots of 150 webpages, judged as aesthetic or as unaesthetic by another 136 participants, served as stimulus material. Behaviorally, experts and laypersons evaluated unaesthetic webpages similarly, but they differed in their evaluation of aesthetic ones: experts evaluated aesthetic webpages as unaesthetic more often than laypersons did. The ERP-data show main effects of level of expertise and of aesthetic value only. There was no interaction of expertise and aesthetics. In a time-window of 110–130 ms after stimulus onset, aesthetic webpages elicited a more negative EEG-amplitude than unaesthetic webpages. In the same time window, experts had more negative EEG-amplitudes than laypersons. This patterning of results continued until a time window of 600–800 ms in which group and aesthetic differences diminished. An interaction of perceiver characteristics and object properties that several interactionist theories postulate was absent in the EEG-data. Experts seem to process the stimuli in a more thorough manner than laypersons. The early activation differences between aesthetic and unaesthetic webpages is in contrast with some theories of aesthetic processing and has not been reported before.
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Affiliation(s)
- Jens Bölte
- Department of Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Thomas M Hösker
- Department of Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Gerrit Hirschfeld
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany
| | - Meinald T Thielsch
- Department of Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
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27
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Schmidt D, Seehagen S, Hirschfeld G, Vocks S, Schneider S, Teismann T. Repetitive Negative Thinking and Impaired Mother–Infant Bonding: A Longitudinal Study. Cogn Ther Res 2016. [DOI: 10.1007/s10608-016-9823-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Bieda A, Hirschfeld G, Schönfeld P, Brailovskaia J, Zhang XC, Margraf J. Universal happiness? Cross-cultural measurement invariance of scales assessing positive mental health. Psychol Assess 2016; 29:408-421. [PMID: 27322203 DOI: 10.1037/pas0000353] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research into positive aspects of the psyche is growing as psychologists learn more about the protective role of positive processes in the development and course of mental disorders, and about their substantial role in promoting mental health. With increasing globalization, there is strong interest in studies examining positive constructs across cultures. To obtain valid cross-cultural comparisons, measurement invariance for the scales assessing positive constructs has to be established. The current study aims to assess the cross-cultural measurement invariance of questionnaires for 6 positive constructs: Social Support (Fydrich, Sommer, Tydecks, & Brähler, 2009), Happiness (Subjective Happiness Scale; Lyubomirsky & Lepper, 1999), Life Satisfaction (Diener, Emmons, Larsen, & Griffin, 1985), Positive Mental Health Scale (Lukat, Margraf, Lutz, van der Veld, & Becker, 2016), Optimism (revised Life Orientation Test [LOT-R]; Scheier, Carver, & Bridges, 1994) and Resilience (Schumacher, Leppert, Gunzelmann, Strauss, & Brähler, 2004). Participants included German (n = 4,453), Russian (n = 3,806), and Chinese (n = 12,524) university students. Confirmatory factor analyses and measurement invariance testing demonstrated at least partial strong measurement invariance for all scales except the LOT-R and Subjective Happiness Scale. The latent mean comparisons of the constructs indicated differences between national groups. Potential methodological and cultural explanations for the intergroup differences are discussed. (PsycINFO Database Record
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Affiliation(s)
- Angela Bieda
- Department of Clinical Psychology and Psychotherapy, Mental Health Research & Treatment Center, Ruhr-Universität Bochum
| | - Gerrit Hirschfeld
- Department of Quantitative Methods, Osnabrück University of Applied Sciences
| | - Pia Schönfeld
- Department of Clinical Psychology and Psychotherapy, Mental Health Research & Treatment Center, Ruhr-Universität Bochum
| | - Julia Brailovskaia
- Department of Clinical Psychology and Psychotherapy, Mental Health Research & Treatment Center, Ruhr-Universität Bochum
| | - Xiao Chi Zhang
- Department of Clinical Psychology and Psychotherapy, Mental Health Research & Treatment Center, Ruhr-Universität Bochum
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy, Mental Health Research & Treatment Center, Ruhr-Universität Bochum
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29
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Ruhe AK, Wager J, Hirschfeld G, Zernikow B. Household income determines access to specialized pediatric chronic pain treatment in Germany. BMC Health Serv Res 2016; 16:140. [PMID: 27102117 PMCID: PMC4840873 DOI: 10.1186/s12913-016-1403-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/18/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Families with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain. METHODS Families presenting to a specialized pain center (N = 1,001) provided information on 'household income, 'parental education' and 'occupation' to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75% catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area. RESULTS The SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75% catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. 'Household income' predicted travel distance (OR 1.32 (1.12-1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area. CONCLUSIONS In Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.
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Affiliation(s)
- Ann-Kristin Ruhe
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany.
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany
| | - Gerrit Hirschfeld
- Faculty of Economics and Social Sciences, University of Applied Sciences Osnabrück , Caprivistr. 30A, 49076, Osnabrück, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany
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30
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von Glischinski M, Teismann T, Prinz S, Gebauer JE, Hirschfeld G. Depressive Symptom Inventory Suicidality Subscale: Optimal Cut Points for Clinical and Non-Clinical Samples. Clin Psychol Psychother 2016; 23:543-549. [DOI: 10.1002/cpp.2007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/24/2015] [Accepted: 01/05/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - S. Prinz
- Ruhr Universität Bochum; Bochum Germany
| | | | - G. Hirschfeld
- Osnabrück University of Applied Sciences; Osnabrück Germany
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31
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Brachel RV, Windgassen A, Hötzel K, Hirschfeld G, Vocks S. Was passiert nach dem letzten Klick? Zeitschrift für Klinische Psychologie und Psychotherapie 2016. [DOI: 10.1026/1616-3443/a000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bisherige Studien zeigen, dass internetbasierte Interventionen kurzfristig die Veränderungsmotivation bei Essstörungen verbessern können. Zur Stabilität dieser Effekte ist jedoch wenig bekannt. Fragestellung: Wie entwickeln sich die Veränderungsmotivation, die Essstörungspsychopathologie und das Selbstwertgefühl 8 Wochen nach Abschluss eines internetbasierten Motivationsprogramms? Methode: Neunzig Frauen bearbeiteten den Stages of Change Questionnaire for Eating Disorders, den Eating Disorder Examination-Questionnaire und die Rosenberg Self-Esteem-Scale unmittelbar (Post) sowie 8 Wochen nach Abschluss der Intervention (Katamnese). Ergebnisse: Es zeigten sich stabile Effekte in der Veränderungsmotivation sowie im Selbstwertgefühl. Zusätzlich zeigten sich in der Essstörungspsychopathologie signifikante Verbesserungen. Schlussfolgerungen: Die Studie belegt die längerfristige Wirksamkeit eines internetbasierten Motivationsprogramms für Frauen mit Essstörungen.
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Affiliation(s)
- Ruth von Brachel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Anja Windgassen
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Katrin Hötzel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | | | - Silja Vocks
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
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Hirschfeld G, Blankenburg MR, Süß M, Zernikow B. Overcoming pain thresholds with multilevel models-an example using quantitative sensory testing (QST) data. PeerJ 2015; 3:e1335. [PMID: 26557435 PMCID: PMC4636408 DOI: 10.7717/peerj.1335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022] Open
Abstract
The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants’ responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals’ ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals’ criterion for giving a “painful” response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice.
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Affiliation(s)
- Gerrit Hirschfeld
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück , Osnabrück , Germany
| | - Markus R Blankenburg
- Chair for Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University , Witten/Herdecke , Germany ; Department for Pediatric Neurology, Psychosomatic and Pain Medicine, Center for Child and Adolescent Medicine Olgahospital, Klinikum Stuttgart , Stuttgart , Germany
| | - Moritz Süß
- Department for Psychology, University Düsseldorf , Düsseldorf , Germany
| | - Boris Zernikow
- Chair for Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University , Witten/Herdecke , Germany ; German Pediatric Pain Centre-Children's Hospital Datteln, Witten/Herdecke University , Germany
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33
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Uhlig CE, Böhringer D, Hirschfeld G, Seitz B, Schmidt H. Attitudes Concerning Postmortem Organ Donation: A Multicenter Survey in Various German Cohorts. Ann Transplant 2015; 20:614-21. [PMID: 26477674 DOI: 10.12659/aot.894385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts. MATERIAL AND METHODS Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family. RESULTS Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants' attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information. CONCLUSIONS Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem.
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Affiliation(s)
| | - Daniel Böhringer
- Department of Ophthalmology, Eye Center, University Hospital, Freiburg, Germany
| | - Gerrit Hirschfeld
- Department of Psycholinguistic and Neurosciences, University Clinics, Münster, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg Saar, Germany
| | - Hartmut Schmidt
- Department of Transplantation, University Clinics, Münster, Germany
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34
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Hechler T, Kanstrup M, Holley AL, Simons LE, Wicksell R, Hirschfeld G, Zernikow B. Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain. Pediatrics 2015; 136:115-27. [PMID: 26101358 PMCID: PMC9923588 DOI: 10.1542/peds.2014-3319] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT. METHODS Cochrane, Medline/Ovid, PsycInfo/OVID, PubMed, PubPsych, and Web of Science were searched. Studies were included if (1) treatment was coordinated by ≥3 health professionals, (2) treatment occurred within an inpatient/day hospital setting, (3) patients were <22 years, (4) patients experienced debilitating chronic pain, (5) the study was published in English, and (6) the study had ≥10 participants at posttreatment. The child's pain condition, characteristics of the IIPT, and 5 outcome domains (pain intensity, disability, school functioning, anxiety, depressive symptoms) were extracted at baseline, posttreatment, and follow-up. RESULTS One randomized controlled trial and 9 nonrandomized treatment studies were identified and a meta-analysis was conducted separately on pain intensity, disability, and depressive symptoms revealing positive treatment effects. At posttreatment, there were large improvements for disability, and small to moderate improvements for pain intensity and depressive symptoms. The positive effects were maintained at short-term follow-up. Findings demonstrated extreme heterogeneity. CONCLUSIONS Effects in nonrandomized treatment studies cannot be attributed to IIPT alone. Because of substantial heterogeneity in measures for school functioning and anxiety, meta-analyses could not be computed. There is preliminary evidence for positive treatment effects of IIPT, but the small number of studies and their methodological weaknesses suggest a need for more research on IIPTs for children.
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Affiliation(s)
- Tanja Hechler
- German Paediatric Pain Centre, Children's Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany;
| | - Marie Kanstrup
- Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden;,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Amy Lewandowski Holley
- Division of Psychology, Institute on Development and Disability, Oregon Health and Science University, Portland, Oregon
| | - Laura E. Simons
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Rikard Wicksell
- Behavior Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden;,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gerrit Hirschfeld
- German Paediatric Pain Centre, Children’s Hospital Datteln, Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Witten, Germany;,University of Applied Sciences, Osnabrueck, Osnabrueck, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children’s Hospital Datteln, Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health–School of Medicine, Witten/Herdecke University, Witten, Germany
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35
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Hirschfeld G, von Glischinski M, Knop C, Wiesel T, Reinehr T, Aksu F, Blankenburg M, Hirsch J, Zernikow B. Difficulties in screening for peripheral neuropathies in children with diabetes. Diabet Med 2015; 32:786-9. [PMID: 25640325 DOI: 10.1111/dme.12684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 01/27/2023]
Abstract
AIMS To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children. METHODS A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the 'gold standard' for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods. RESULTS A total of 43 (49%) children (aged 6-18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%. CONCLUSION The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
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Affiliation(s)
- G Hirschfeld
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück
- German Paediatric Pain Centre, Children's Hospital Datteln, Datteln
| | | | - C Knop
- Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln
| | - T Wiesel
- Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln
| | - T Reinehr
- Witten/Herdecke University, Witten
- Pediatric Diabetology and Endocrinology, Children's Hospital Datteln, Datteln
| | - F Aksu
- Witten/Herdecke University, Witten
- Pediatric Neurology, Children's Hospital Datteln, Datteln
| | | | - J Hirsch
- Institute of Medical Biometrics and Epidemiology, Witten/Herdecke University, Witten, Germany
| | - B Zernikow
- German Paediatric Pain Centre, Children's Hospital Datteln, Datteln
- Witten/Herdecke University, Witten
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36
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Hirschfeld G, Wager J, Zernikow B. Physician consultation in young children with recurrent pain-a population-based study. PeerJ 2015; 3:e916. [PMID: 25945310 PMCID: PMC4419529 DOI: 10.7717/peerj.916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/07/2015] [Indexed: 11/20/2022] Open
Abstract
Background. Recurrent pain is a common experience in childhood, but only few children with recurrent pain attend a physician. Previous studies yielded conflicting findings with regard to predictors of health care utilization in children with recurrent pain. Methods. The present study analyzes data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study comprising n = 2,149 children (3-10 years old) with recurrent pain to find robust predictors. We used multiple logistic regressions to investigate age, gender, socio-economic status (SES), migration background, pain intensity, pain frequency, pain-related disability, mental health problems, and health-related quality of life (HRQL) as predictors for visiting a doctor due to pain. Results. Overall, young girls with high pain-related disability, intensity, frequency, and migration background were more likely to attend a physician. Pain-related disability had the largest impact. Socioeconomic status, health-related quality of life and mental health problems were not systematically related to health care utilization. An analysis of the variability of these results indicated that several hundred participants are needed until the results stabilize. Conclusions. Our findings highlight the importance of pain-related disability and frequency in assessing the severity of recurrent pain. Generic predictors and demographic variables are of lesser relevance to children with recurrent pain. On a methodological level, our results show that large-scale studies are need to reliably identify predictors of health care utilization.
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Affiliation(s)
- G Hirschfeld
- Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrück , Osnabrück , Germany ; German Paediatric Pain Centre, Children's Hospital Datteln , Germany
| | - J Wager
- German Paediatric Pain Centre, Children's Hospital Datteln , Germany ; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University , Germany
| | - B Zernikow
- German Paediatric Pain Centre, Children's Hospital Datteln , Germany ; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University , Germany
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37
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Tsze DS, Hirschfeld G, von Baeyer CL, Bulloch B, Dayan PS. Clinically significant differences in acute pain measured on self-report pain scales in children. Acad Emerg Med 2015; 22:415-22. [PMID: 25773461 DOI: 10.1111/acem.12620] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/06/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale-Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics. METHODS This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS-R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with "a little less" and "much less" pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic-based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain intensity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain. RESULTS A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain intensity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain. CONCLUSIONS The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain intensity, therefore limiting their potential generalizability.
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Affiliation(s)
- Daniel S. Tsze
- Department of Pediatrics; Columbia University College of Physicians and Surgeons; New York NY
| | - Gerrit Hirschfeld
- Faculty of Business Management and Social Sciences; University of Applied Sciences Osnabrück; Osnabrück Germany
| | - Carl L. von Baeyer
- Departments of Psychology and Pediatrics; University of Saskatchewan; Saskatoon Saskatchewan
- Departments of Clinical Health Psychology and Pediatrics and Child Health; University of Manitoba; Winnipeg Manitoba Canada
| | - Blake Bulloch
- Division of Emergency Medicine; Phoenix Children's Hospital; Phoenix AZ
| | - Peter S. Dayan
- Department of Pediatrics; Columbia University College of Physicians and Surgeons; New York NY
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Hirschfeld G, Brachel RV, Thielsch M. Selecting items for Big Five questionnaires: At what sample size do factor loadings stabilize? Journal of Research in Personality 2014. [DOI: 10.1016/j.jrp.2014.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Subjective perceptions of websites can be reliably measured with questionnaires. But it is unclear how such scores should be interpreted in practice, e.g. is an aesthetics score of 4 points on a seven-point-scale satisfactory? The current paper introduces a receiver-operating characteristic (ROC)-based methodology to establish meaningful cut points for the VisAWI (visual aesthetics of websites inventory) and its short form the VisAWI-S. In two studies we use users' global ratings (UGRs) and website rankings as anchors. A total of 972 participants took part in the studies which yielded similar results. First, one-item UGRs correlate highly with the VisAWI. Second, cut points on the VisAWI reliably differentiate between sites that are perceived as attractive versus unattractive. Third, these cut points are variable, but only within a certain range. Together the research presented here establishes a score of 4.5 on the VisAWI which is a reasonable goal for website designers and highlights the utility of the ROC methodology to derive relevant scores for rating scales.
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Affiliation(s)
- Gerrit Hirschfeld
- a German Paediatric Pain Centre , Children's Hospital Datteln , Dr.-Friedrich-Steiner Str. 5, 45711 Datteln , Germany
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Uhlig CE, Koch R, Promesberger J, Hirschfeld G, Schmidt H, Seitz B, Reinhard T, Böhringer D. Attitudes toward postmortem cornea donation in Germany: a multicenter survey. Graefes Arch Clin Exp Ophthalmol 2014; 252:1955-62. [DOI: 10.1007/s00417-014-2796-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/29/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022] Open
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Abstract
BACKGROUND AND OBJECTIVE Although guidelines for the management of children with type 1 diabetes include recommendations to screen for diabetic peripheral neuropathies (DPN), the research into the diagnostic utility of screening methods has not been systematically reviewed. The goal of this study was to summarize the findings with regard to the diagnostic accuracy of the Semmes-Weinstein monofilament and the Rydel-Seiffer tuning fork in detecting DPN in children and adolescents compared with the gold standard nerve conduction studies. METHODS Based on a PubMed search (conducted on April 26, 2013) and secondary searching, we identified 72 articles for review. We included studies that: (1) assessed DPN with the gold standard nerve conduction studies; (2) used noninvasive screening for DPN (monofilament, tuning fork, or biothesiometer); and (3) were performed in the relevant population (children with diabetes). Five articles met these criteria. Study quality was assessed by using the revised Quality Assessment of Diagnostic Accuracy Studies criteria. Heterogeneous methods precluded a formal meta-analysis of effects. RESULTS Diagnostic accuracies were heterogeneous for the different screening methods. Sensitivities ranged from 1% to 19% for the tuning fork (3 studies); from 61% to 80% for the biothesiometer (2 studies); and from 19% to 73% for the monofilament (2 studies). CONCLUSIONS Data show extremely low diagnostic utility for standard screening methods (tuning fork and 10-g monofilament) but acceptable utilities for biothesiometry and finer (1 g) monofilaments. Data on the diagnostic utility should be used to inform national and international guidelines on diabetes management.
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Affiliation(s)
- Gerrit Hirschfeld
- German Paediatric Pain Centre, Children's Hospital Datteln, Datteln, Germany; and
| | | | | | - Boris Zernikow
- German Paediatric Pain Centre, Children's Hospital Datteln, Datteln, Germany; and
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Hirschfeld G, do Brasil PEAA. A simulation study into the performance of “optimal” diagnostic thresholds in the population:“Large” effect sizes are not enough. J Clin Epidemiol 2014; 67:449-53. [DOI: 10.1016/j.jclinepi.2013.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 07/01/2013] [Accepted: 07/31/2013] [Indexed: 10/25/2022]
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von Brachel R, Hötzel K, Hirschfeld G, Rieger E, Schmidt U, Kosfelder J, Hechler T, Schulte D, Vocks S. Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout. J Med Internet Res 2014; 16:e92. [PMID: 24686856 PMCID: PMC4004149 DOI: 10.2196/jmir.3104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology. OBJECTIVE The aim of the present study was to identify predictors of dropout from this Web program. METHODS A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method. RESULTS The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout. CONCLUSIONS Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
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Affiliation(s)
- Ruth von Brachel
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany.
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Affiliation(s)
- Gerrit Hirschfeld
- German Paediatric Pain Centre, Children’s & Adolescents’ Hospital, Datteln, Witten/Herdecke University, Faculty of Health, School of Medicine, Germany
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Tietze AL, Zernikow B, Otto M, Hirschfeld G, Michel E, Koh M, Blankenburg M. The development and psychometric assessment of a questionnaire to assess sleep and daily troubles in parents of children and young adults with severe psychomotor impairment. Sleep Med 2014; 15:219-27. [DOI: 10.1016/j.sleep.2013.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 09/07/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
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Hirschfeld G, Wager J, Schmidt P, Zernikow B. Minimally Clinically Significant Differences for Adolescents With Chronic Pain—Variability of ROC-Based Cut Points. The Journal of Pain 2014; 15:32-9. [DOI: 10.1016/j.jpain.2013.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 08/01/2013] [Accepted: 09/13/2013] [Indexed: 11/28/2022]
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Wager J, Ruhe A, Hirschfeld G, Wamsler C, Dobe M, Hechler T, Zernikow B. Influence of parental occupation on access to specialised treatment for paediatric chronic pain. Schmerz 2013; 27:305-11. [DOI: 10.1007/s00482-013-1320-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Wager J, Hechler T, Darlington A, Hirschfeld G, Vocks S, Zernikow B. Classifying the severity of paediatric chronic pain - an application of the chronic pain grading. Eur J Pain 2013; 17:1393-402. [DOI: 10.1002/j.1532-2149.2013.00314.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - S. Vocks
- Department of Psychology; Clinical Psychology and Psychotherapy; Osnabrück University; Germany
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Blankenburg M, Tietze AL, Hechler T, Hirschfeld G, Michel E, Koh M, Zernikow B. Snake: the development and validation of a questionnaire on sleep disturbances in children with severe psychomotor impairment. Sleep Med 2013; 14:339-51. [DOI: 10.1016/j.sleep.2012.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 11/30/2022]
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