Sniffin' Sticks Screening 12 test: Presentation of odours on filter paper improves the recognition rate

To the Editor: Monitoring of olfactory function and diagnosis of olfactory disorders using the pen-based "Sniffin' Sticks test" is problematic during the SARS-CoV-2 pandemic due to hygienic concerns. The aim of this study was to find out whether the results of olfactory testing obtained by presenting odours on a single-use filter paper is identical to performing the test by presenting the odour pens according to the manufacturer's manual.

Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population

BACKGROUND

Treatment of head and neck cancer (HNC) often leads to visible and severe functional impairments. In addition, patients often suffer from a variety of psychosocial problems, significantly associated with a decreased quality of life. We aimed to compare depression, anxiety, fatigue and quality of life (QoL) between HNC patients and a large sample of the general population in Germany and to examine the impact of sociodemographic, behavioral and clinical factors on these symptoms.

METHODS

We assessed data of HNC patients during the aftercare consultation at the Leipzig University Medical Center with a patient reported outcome (PRO) tool named "OncoFunction". Depression, anxiety, fatigue and QoL were assessed using validated outcome measures including the PHQ-9, the GAD-2, and the EORTC QLQ-C30 questionnaire.

RESULTS

A total of 817 HNC patients were included in our study and compared to a sample of 5018 individuals of the general German population. HNC patients showed significantly higher levels of impairment in all dimensions assessed. Examination of association between depression, anxiety, fatigue and QoL and clinical as well as sociodemographic variables showed significant relationships between occupational status, ECOG-state, body mass index and time since diagnosis.

CONCLUSIONS

HNC patients suffer significantly from psychological distress. The used questionnaires are suitable for the use in daily routine practice and can be helpful to increase the detection of depression, anxiety and fatigue and therefore can improve HNC aftercare.

Psychometric properties of an English short version of the Trier Inventory for chronic Stress

Background

Although a variety of instruments are available that capture stress experience, the assessment of chronic stress has been hindered by the lack of economical screening instruments. Recently, an English-language version of the Trier Inventory for Chronic Stress (TICS-EN) consisting of 57 items according to a systemic-requirement-resource model of health in nine subdomains of the chronic stress experience has been introduced.

Methods

We constructed a new 9-item short version of the TICS covering all nine subdomains and evaluated it in two samples (total N = 685). We then used confirmatory factor analysis to check factorial validity.

Results

This version showed a highly satisfactory model fit, was invariant across participant gender, demonstrated a very high correlation with the original TICS (r = .94), and showed a moderate correlation (r = .58) with a measure of perceived stress in the past month.

Conclusions

Therefore, this theoretically driven instrument can be recommended as a short version of the TICS in English language.

Big data analysis techniques to address polypharmacy in patients - a scoping review

Background

Polypharmacy is a key challenge in healthcare especially in older and multimorbid patients. The use of multiple medications increases the potential for drug interactions and for prescription of potentially inappropriate medications. eHealth solutions are increasingly recommended in healthcare, with big data analysis techniques as a major component. In the following we use the term analysis of big data as referring to the computational analysis of large data sets to find patterns, trends, and associations in large data sets collected from a wide range of sources in contrast to using classical statistics programs. It is hypothesized that big data analysis is able to reveal patterns in patient data that would not be identifiable using conventional methods of data analysis. The aim of this review was to evaluate whether there are existing big data analysis techniques that can help to identify patients consuming multiple drugs and to assist in the reduction of polypharmacy in patients.

Methods

A computerized search was conducted in February 2019 and updated in May 2020, using the PubMed, Web of Science and Cochrane Library databases. The search strategy was defined by the principles of a systematic search, using the PICO scheme. All studies evaluating big data analytics about patients consuming multiple drugs were considered. Two researchers assessed all search results independently to identify eligible studies. The data was then extracted into standardized tables.

Results

A total of 327 studies were identified through the database search. After title and abstract screening, 302 items were removed. Only three studies were identified as addressing big data analysis techniques in patients with polypharmacy. One study extracted antipsychotic polypharmacy data, the second introduced a decision support system to evaluate side-effects in patients with polypharmacy and the third evaluated a decision support system to identify polypharmacy-related problems in individuals.

Conclusions

There are few studies to date which have used big data analysis techniques for identification and management of polypharmacy. There may be a need to further explore interdisciplinary collaboration between computer scientists and healthcare professionals, to develop and evaluate big data analysis techniques that can be implemented to manage polypharmacy.

Depression, anxiety and quality of life in subjects with atopic eczema in a population-based cross-sectional study in Germany

BACKGROUND

Atopic eczema (AE) may be associated with several mental health problems. In Germany, existing data from selected patient cohorts may lead to misestimation of the problem.

OBJECTIVES

We aimed to cross-sectionally determine associations of AE with depression, anxiety, quality of life (QoL) and social interactions in subjects from the population-based LIFE-Adult-Study.

METHODS

Subjects underwent standardized interviews (medical history) and answered standardized questionnaires [Centre of Epidemiologic studies-Depression scale (CES-D), Generalized Anxiety Disorder (GAD-7), Lubben Social Network Scale (LSNS), Short Form Health Survey (SF-8)]. We compared data from subjects with AE with those from subjects with selected other chronic/disabling diseases (cardiovascular, diabetes, cancer) and adjusted for selected sociodemographic parameters. Multivariate binary logistic regression was used for categorical variables, linear regression for continuous variables.

RESULTS

Out of 9104 adults included (57% female, median age 54 years), 372 (4.1%) had a history of AE. Compared with controls, subjects with AE showed higher scores for depressive symptoms (9.3% vs. 6.3%; P < 0.001) and anxiety (8.4% vs. 5.6%, P < 0.001). Odds ratio (OR) was 1.5 [CI 1.0; 2.3] (P = 0.031) for depression, which was comparable to OR in patients with a history of cancer (OR 1.6 [1-2.3], P = 0.001. OR for anxiety in AE was 1.5 [1.0; 2.2], P < 0.049, which was slightly higher than in diabetes mellitus (OR 1.2) and stroke (OR 1.4). Other than in diabetes and/or stroke, we did not find a significant association between AE and social isolation. QoL scores were lower in AE than in controls (mean 46.9 vs. 48.0, P < 0.001 for physical and 50.6 vs. 52.5, P < 0.001 for mental components).

CONCLUSIONS

Subjects with AE showed higher values for depression and anxiety as well as lower QoL scores compared to controls. With regard to depression, odds in AE and cancer were hardly different. Medical care of AE patients should therefore include mental health evaluation and treatment if indicated.

The association between an anxiety disorder and cancer in medical history

BACKGROUND

Cancer patients can feel depression and anxiety any time after a cancer diagnosis. The Generalized Anxiety Disorder Scale (GAD-7) is an instrument for the assessment of anxiety. The main objective of this work was to compare general anxiety levels between cancer survivors and individuals without a history of cancer in a population-based study (LIFE-ADULT) with 10,000 participants.

METHODS

All participants (18-80 years) completed the GAD-7 and other psychological and medical questionnaires. A score of 10 or greater for GAD-7 (of total 21) indicates a probable generalized anxiety disorder.

RESULTS

954 participants reported a diagnosis of cancer in their medical history. In the multivariate analysis an anxiety disorder was associated with prior cancer diagnosis (OR: 1.8; 95% CI [1.4-2.4]), age -every additional year- (OR: 0.983; [0.976-0.991]), female gender (OR: 1.8; [1.5-2.2]) and low socioeconomic status (OR: 2.0; [1.7-2.5]) all p < 0.001. There were no significant associations between general anxiety and other comorbidities, such as myocardial infarction (OR: 1.0; p = 0.948), stroke (OR: 1.4; p = 0.237) or diabetes (OR: 1.0; p = 0.326). There was also no significant difference in anxiety disorder among cancer survivors regarding the time passed since the initial cancer diagnosis (OR: 1.1; [0.6-1.9], p = 0.804 comparing 5-10 years after a diagnosis of cancer vs. ≤5 years and OR: 0.6; [0.4-1.1], p = 0.107 comparing >10 vs. ≤5 years).

LIMITATIONS

This study has a cross-sectional character, therefore, causal conclusions cannot be drawn.

CONCLUSION

Cancer survivors may require screening for anxiety disorders and long-term professional psychosocial support.

Trapping of transient, heavy pnictogen-centred biradicals

The heavy biradicals [E(μ-NTer)]₂ (E = Sb, Bi) were generated in situ and trapped by a formal [2 + 2] addition reaction with tolan (Ph–CC–Ph).

The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types

BACKGROUND

Depression is a common co-morbidity of cancer that has a detrimental effect on quality of life, treatment adherence and potentially survival. We conducted an epidemiological multi-center study including a population-based random comparison sample and estimated the prevalence of depressive symptoms by cancer site, thereby identifying cancer patients with the highest prevalence of depression.

PATIENTS AND METHODS

We included 4020 adult cancer inpatients and outpatients from five distinct regions across Germany in a proportional stratified random sample based on the nationwide cancer incidence and a comparison group consisting of 5018 participants. Both groups reported depressive symptoms by filling in the Patient Health Questionnaire (PHQ-9). In multivariate analyses adjusted for age and sex, we calculated the odds of being depressed.

RESULTS

Out of 5818 eligible patients, 69% participated (51% women, mean age = 58 years). We estimated that one in four cancer patients (24%) is depressed (PHQ-9 ≥ 10). The odds of being depressed among cancer patients were more than five times higher than in the general population (OR, 5.4; 95% CI, 4.6-6.2). Patients with pancreatic (M = 8.0, SD = 5.0), thyroid (M = 7.8, SD = 6.3) and brain tumours (M = 7.6, SD = 4.9) showed the highest prevalence, whereas patients with prostate cancer (M = 4.3, SD = 3.8) and malignant melanoma (M = 5.3, SD = 4.3) had the lowest levels of depressive symptoms.

CONCLUSION

Our results help clinicians identify cancer patients in need of psychosocial support when navigating in the growing survivor population.

Postoperative Health-Related Quality of Life of Cervical Cancer Patients - A Comparison between the Wertheim-Meigs Operation and Total Mesometrial Resection (TMMR)

Introduction: The present study compares for the first time the standard therapy for cervical cancer in FIGO-stages IB-IIB, radical hysterectomy according to the Wertheim-Meigs operation, with the newly developed, nerve-sparing surgical technique, total mesometrial resection (TMMR) with regard to postoperative, health-related quality of life. Method: In the framework of a multicentre, retrospective cohort study a total of 110 cervical cancer patients were interviewed once by means of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the cervical cancer module (EORTC QLQ-CX24). The influence of the surgical method was investigated by analysis of covariance under control of age and the time elapsed between treatment and interview. Results: An influence of the therapeutic method was demonstrated in the EORTC scales physical function (p = 0.047), role function (p = 0.016), fatigue (p = 0.028), pain (p = 0.018), shortness of breath (p = 0.034), lack of appetite (p = 0.006) and diarrhoea (p = 0.012) in favour of the 74 women treated by TMMR. With regard to cognitive, emotional and social functioning as well as cervical cancer-specific symptoms, no significant differences between the therapy groups were found. Conclusion: The findings presented in this study suggest a superiority of TMMR in comparison to the previously employed radical hysterectomy according to Wertheim-Meigs with regard to the postoperative quality of life, especially in the fields of physical activity and fatigue. This needs to be validated in the course of prospective, multicentre studies. In addition, it must be clarified as to what extent the found effects are, in particular, due to the omission of an additional radiotherapy.

TRIM15 is a focal adhesion protein that regulates focal adhesion disassembly

Focal adhesions are macromolecular complexes that connect the actin cytoskeleton to the extracellular matrix. Dynamic turnover of focal adhesions is crucial for cell migration. Paxillin is a multi-adaptor protein that plays an important role in regulating focal adhesion dynamics. Here, we identify TRIM15, a member of the tripartite motif protein family, as a paxillin-interacting factor and a component of focal adhesions. TRIM15 localizes to focal contacts in a myosin-II-independent manner by an interaction between its coiled-coil domain and the LD2 motif of paxillin. Unlike other focal adhesion proteins, TRIM15 is a stable focal adhesion component with restricted mobility due to its ability to form oligomers. TRIM15-depleted cells display impaired cell migration and reduced focal adhesion disassembly rates, in addition to enlarged focal adhesions. Thus, our studies demonstrate a cellular function for TRIM15 as a regulatory component of focal adhesion turnover and cell migration.

Modified-release prednisone decreases complaints and fatigue compared to standard prednisolone in patients with adrenal insufficiency

Patients with adrenal insufficiency (AI) receive first glucocorticoid replacement dose after waking, resulting in a 3-5 h delay compared to physiological secretion. Impaired quality of life (QoL) and fatigue might be due to this delayed dose scheme. Modified-release glucocorticoid preparations might have therapeutic advantages. Exploratory pilot study including 14 patients with AI was conducted in a single university center. Patients on morning dose prednisolone (5 mg) were included, switched to modified-release prednisone (5 mg) at 10 PM for 3 months, and then switched back on standard prednisolone. 3 standardized questionnaires (GBB-24, MFI, and AddiQoL) investigating complaints and fatigue were completed at baseline, after 3, and 6 months. Data regarding clinical and hormonal parameters were assessed. Modified-release prednisone showed significant improvement in one of 4 scales of GBB-24 and positive trends to better scores in 3 of 4 scales. The global score of discomfort improved significantly. The MFI showed also significant improvement in 3 of 5 scales and positive trend to better scores in 2 scales. Significant changes to better scores were seen in 4 out of 30 items of the AddiQoL. Modified-release prednisone showed decreased complaints and fatigue compared to standard prednisolone indicating importance of glucocorticoid increase in early morning hours before waking.

TRIM protein-mediated regulation of inflammatory and innate immune signaling and its association with antiretroviral activity

Members of the tripartite interaction motif (TRIM) family of E3 ligases are emerging as critical regulators of innate immunity. To identify new regulators, we carried out a screen of 43 human TRIM proteins for the ability to activate NF-κB, AP-1, and interferon, hallmarks of many innate immune signaling pathways. We identified 16 TRIM proteins that induced NF-κB and/or AP-1. We found that one of these, TRIM62, functions in the TRIF branch of the TLR4 signaling pathway. Knockdown of TRIM62 in primary macrophages led to a defect in TRIF-mediated late NF-κB, AP-1, and interferon production after lipopolysaccharide challenge. We also discovered a role for TRIM15 in the RIG-I-mediated interferon pathway upstream of MAVS. Knockdown of TRIM15 limited virus/RIG-I ligand-induced interferon production and enhanced vesicular stomatitis virus replication. In addition, most TRIM proteins previously identified to inhibit murine leukemia virus (MLV) demonstrated an ability to induce NF-κB/AP-1. Interfering with the NF-κB and AP-1 signaling induced by the antiretroviral TRIM1 and TRIM62 proteins rescued MLV release. In contrast, human immunodeficiency virus type 1 (HIV-1) gene expression was increased by TRIM proteins that induce NF-κB. HIV-1 resistance to inflammatory TRIM proteins mapped to the NF-κB sites in the HIV-1 long terminal repeat (LTR) U3 and could be transferred to MLV. Thus, our work identifies new TRIM proteins involved in innate immune signaling and reinforces the striking ability of HIV-1 to exploit innate immune signaling for the purpose of viral replication.

[Mental distress and quality of life in tinnitus patients]

BACKGROUND

Tinnitus is a disease with a high prevalence that is often combined with psychiatric comorbidity. The aim of this study was to identify the dimensions of quality of life in which tinnitus patients are especially affected, and how these affections change during a therapy, including a hyperbaric oxygen therapy.

MATERIAL AND METHODS

120 patients suffering from tinnitus were examined at 3 time points: at the beginning (t1) and the end (t2) of a 2-week hyperbaric oxygen therapy, and 4 weeks later (t3). The following questionnaires were adopted: Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, and the quality of life instrument EORTC QLQ-C30.

RESULTS

Compared with the general population, tinnitus patients were impaired in all areas of quality of life. The greatest differences were found in the scales Social, Cognitive, Emotional and Role Functioning and in the field of financial difficulties with effect sizes of about 1.5. During the therapy, the scores improved, reaching roughly the middle between the initial patients' scores and the values of the general population. The directly assessed subjective improvement due to the therapy was only marginally correlated with the differences in the questionnaires.

CONCLUSION

Since there was no control group without hyperbaric oxygen therapy, the results do not justify conclusions about the effectiveness of this therapy. However, the findings document multiple impairments of the patients (especially psycho-social disturbances) and show hints for supportive offers.

Anxiety and depression in sarcoidosis: the influence of age, gender, affected organs, concomitant diseases and dyspnea

BACKGROUND

Heightened degrees of anxiety and depression are often found in patients suffering from sarcoidosis, but the reasons for that are unclear. Furthermore, age and gender differences of anxiety and depression in sarcoidosis have not been reported with reference to normative data.

OBJECTIVES

The aim was to test age and gender differences of anxiety and depression in a large sample, and to examine the influence of affected organs, concomitant diseases and dyspnea.

METHODS

1197 German patients diagnosed with sarcoidosis were examined, using the Hospital Anxiety and Depression Scale (HADS) and the MRC dyspnea scale.

RESULTS

Patients suffering from sarcoidosis were significantly more anxious and depressed than the general population. This effect was especially strong in young age groups. The number of affected organs, the number of concomitant diseases and the degree of dyspnea significantly predicted anxiety and depression scores in univariate analyses. Among the affected organs, muscles, nerves, and bones most significantly contributed to depression. Sleep apnea, restless legs syndrome, and arterial hypertension were associated with anxiety as well as depression. In multivariate analyses including age and gender, however, only dyspnea and the number of concomitant diseases remained predictors of anxiety and depression scores.

CONCLUSIONS

The analysis of mental distress should take into account comparisons with normative values. Young patients deserve special social support. Dyspnea proved to be an important symptom in the prediction of anxiety and depression.

Response shift in the assessment of anxiety, depression and perceived health in urologic cancer patients: an individual perspective

The assessment of quality of life in cancer patients is hampered because patients may change their frames of reference during the course of the disease. The aim of this study was to test individual differences in these response shift effects. Urologic cancer patients (n= 275) were examined during the stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). Furthermore, at T3 they were asked to retrospectively assess their situation at T1 (then-test). The difference between this retrospective assessment and the original assessment at T1 was used to determine the response shift effect (recalibration). Anxiety (Generalized Anxiety Disorder Questionnaire-2), depression (Patient Health Questionnaire-2) and health dissatisfaction (Questionnaire on Life Satisfaction) were obtained at all points in time. The effect sizes of the mean response shift effects (recalibration) ranged between 0.26 and 0.48. Nevertheless, a large proportion of the sample showed no response shift (22-38%) or even negative response shift effects (20-30%). There were significant correlations among the response shift measures of the domains (anxiety, depression and health dissatisfaction) with coefficients between 0.29 and 0.51. The results indicate that response shift should not only be assessed on the mean score level, since it is also a dimension of individual difference.

[Regional and individual factors of stress experience in Germany: results of a representative survey with the perceived stress questionnaire (PSQ)]

AIM

The aim of the present study was to define, besides prevalence data, regional and individual factors of stress experience in a representative sample of the German general population.

METHODS

Regional factors were examined separately by federal state and the size of the political location. Individual factors were defined according to the severity of the stress experience as well as on the basis of central social factors such as family state, profession and earnings. The Perceived Stress Questionnaire (PSQ), a validated, self-evaluation process for recording a subjective representation of frequency estimates of stress experiences was used. Data acquisition was carried out by a market research institute in a multi-topic questionnaire (N=2,552). Households were selected by the random route procedure, target persons were also selected at random.

RESULTS

The prevalence rate for an elevated stress experience was 14.5%, that for a very high stress experience 3.1% of the sample. People without education exhibited the highest rates of stress experience (36.8%), followed by the unemployed (30.6%). Individual and social factors that favour an increased stress experience are a subjectively poor state of health (OR: 3.42) or belonging to the lower social economic status (OR: 1.30). Furthermore, there are indications of regional factors such as size of the location as well as differences between the individual federal states. An east-west comparion did not show any significant differences with regard to stress experiences.

CONCLUSION

In the light of the illness burden associated with chronic stress situations, preventative measures in cases of unemployment or low level of education should be given priority.

CSF glial markers correlate with survival in amyotrophic lateral sclerosis

BACKGROUND

In neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), CSF biomarkers are increasingly studied to evaluate their relevance for differential diagnosis, disease progression, and understanding of pathophysiologic processes.

OBJECTIVE

To identify a biomarker profile of neuronal and glial CSF proteins to discriminate ALS from other motor neuron diseases (MND) and to assess whether baseline levels of CSF measures in ALS are associated with the course of the disease.

METHODS

A total of 122 consecutive subjects with MND were included in this cross-sectional study (ALS, n = 75; lower motor neuron syndrome, n = 39; upper motor neuron diseases, n = 8). Clinical follow-up included 76 patients. We determined baseline levels of protein tau and astroglial S100beta in CSF and microglial sCD14 in CSF and serum in relation to diagnosis, duration of disease, and survival.

RESULTS

CSF tau was significantly elevated in ALS and upper motor neuron diseases as compared to lower motor neuron diseases and controls. CSF S100beta levels were significantly lower in lower motor neuron diseases as compared to other MND. CSF concentrations of S100beta and sCD14 correlated with the survival time in patients with ALS.

CONCLUSIONS

In motor neuron diseases, CSF tau elevation indicates the degeneration of upper motor neurons, while S100 beta and sCD14 may indicate the activation of CNS glial cells. Because S100beta and sCD14 concentrations correlate with survival in amyotrophic lateral sclerosis (ALS), we suppose that the combination of both markers may be useful to obtain prognostic information in patients with ALS.

[Life satisfaction and subjective importance of life domains in schizophrenia patients: the role of partnership and parenthood]

OBJECTIVE

The aim is to analyze determinants of subjective quality of life in schizophrenia patients.

METHODS

Life satisfaction and subjective importance of life domains were assessed in 107 patients (FLZ (M)) and compared with the general population (n = 2974).

RESULTS

Schizophrenia patients experience lower levels of life satisfaction as well as less meaningfulness in all life domains. According to the range-of-affect hypothesis, patients with low importance ratings judged their life satisfaction more homogenously. While the presence of a partnership increases life satisfaction, parenthood has only indirect influences on satisfaction.

CONCLUSION

Psychiatrists should not only explore life satisfaction, but also the importance of different life domains and the patient's family relations. Supporting beneficial family relations can increase the quality of life in schizophrenia patients.

Anxiety and depression in cancer patients compared with the general population

The objective of this study was to compare the prevalence of anxiety and depression in cancer patients with the prevalence found in the general population, using the Hospital Anxiety and Depression Scale (HADS). Participants were 1529 cancer patients treated between 2002 and 2004 in Germany and 2037 persons from the German general population. In the cancer patients, the risk of psychiatric distress was nearly twice that of the general population. While for older age groups (61 years and above) there were only small differences between cancer patients and the general population, the differences in both scales were high for young persons. There were differences between the HADS mean scores of the patients with different tumour localisations, with high values for brain cancer and low scores for prostate cancer. The influence of the tumour stage on anxiety and depression was weak. However, depression scores of patients with a survival time less than 1 year were elevated. The results show that large sample sizes are necessary to evaluate the psychological situation of cancer patients, and that age and gender differences must be taken into account when several samples are compared.

[Pain and pain-related behavior during orthopedic rehabilitation]

BACKGROUND

Problems concerning the sustainability of medical rehabilitation are well known. Persistent avoidance behavior might be a potential cause. The present study is designed to determine the relationship between pain and pain-related behavior (resignation, distraction, avoidance) during the rehabilitation process. In addition, the impact of gender, age, level of chronicity, and location of ailments are investigated.

METHODS

Pain (German pain perception scale, SES) and pain-related behavior (German pain control questionnaire, FSR) were measured in 309 orthopedic rehabilitation patients.

RESULTS

Affective pain, resignation and distraction are more pronounced in women than in men. Participants with highly increased levels of chronicity have more affective and sensory pain and higher values of avoidance and resignation. During the rehabilitation process, there was a decrease in affective pain, sensory pain and resignation. The difference values correlate significantly.

CONCLUSION

Rehabilitation is effective for pain reduction. However, only limited changes in pain-related behavior were detected.

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of ⩾13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

Membrane Fusion

Membrane fusion of enveloped viruses with cellular membranes is mediated by viral glycoproteins, which are activated by proteolytic cleavage and/or interaction with cellular receptors. Fusion entails extensive conformational changes of the fusion protein that initially anchors to cellular membranes thus bridging two bilayers. Further refolding into a hairpin-like structure pulls viral and cellular membranes into close proximity to permit lipid bilayer fusion. Refolding provides the energy for fusion, which follows several defined lipidic intermediate states occurring concomitantly with refolding. Although different classes of fusion proteins use different structural motifs, the principle of repositioning both membrane anchors, the transmembrane and the fusion peptide region, at the same end of an elongated hairpin structure generated by receptor binding is maintained in all known viral fusion protein structures, suggesting that they follow similar principles to achieve lipid bilayer fusion.

Fatigue assessment questionnaire: standardization of a cancer-specific instrument based on the general population

OBJECTIVES

Fatigue has become a major issue of concern in the care of cancer patients, as it has been shown to compromise their quality of life in a significant and lasting way. However, there is a lack of economic and specific measures. The Fatigue Assessment Questionnaire (FAQ) has been developed based on thorough interviews and tested on a large mixed sample of cancer patients. The purposes of this paper are to test the psychometric properties of the FAQ and to provide norms for the German population.

METHODS

The FAQ was administered to a representative sample of the German population (1,340 female and 1,101 male participants) along with standardized scales of depression, mood and life satisfaction.

RESULTS

We could confirm that fatigue is multidimensional and can be measured by the scales of physical, affective and cognitive fatigue with good reliability and validity. The dependency of fatigue on sex and age makes it useful to have standard fatigue scores for oncological research as provided in this paper.

CONCLUSION

The FAQ is a promising, differentiated, yet economic instrument for further use in oncological research.