Pregnancy in Multiple Sclerosis: A Questionnaire Study

<div><p>Background</p><p>Multiple sclerosis (MS) preferentially affects females at childbearing age. For this reason patients and treating physicians were frequently confronted with questions concerning family planning, pregnancy and birth.</p><p>Objective</p><p>The aim of this study was to evaluate the expertise about pregnancy related topics in multiple sclerosis of neurologists in private practice.</p><p>Methods</p><p>We developed a survey with 16 multiple choice questions about pregnancy related topics and sent it to neurologists in private practice in Berlin, Germany.</p><p>Results</p><p>56 completed questionnaires were sent back. 54% of all questions were answered correctly, 21% of the questions were answered with “I don’t know”. Correct answers were more often given by physicians who treat more than 400 MS patients per year (p = 0.001). Further positive associations were found for assumed relevance of the topic (p = 0.002) and the degree of counseling (p<0.001).</p><p>Conclusion</p><p>To provide a comprehensive counseling, MS patients with desire for children should be counseled by physicians with a lot of experience in MS treatment.</p></div

Percentage of correct and I don’t know-answers in relation to the number of treated MS patients per quarter: Kruskal-Wallis-test.

<p>Percentage of correct and I don’t know-answers in relation to the number of treated MS patients per quarter: Kruskal-Wallis-test.</p

Survey results.

<p>IMT: immunomodulatory therapy.</p

Demographic characteristics.

<p>Demographic characteristics.</p

data_sheet_1.docx

Objective<p>To investigate the illness perception characteristics of Chinese patients with functional gastrointestinal disorders (FGID), and the mediating role between symptoms, psychopathology, and clinical outcomes.</p>Methods<p>Six illness groups from four outpatient departments of a general hospital in China were recruited, including the FGID patient group. The modified and validated Chinese version of the illness perception questionnaire-revised was utilized, which contained three sections: symptom identity, illness representation, and causes. The 12-item short-form health survey was utilized to reflect the physical and mental health-related quality of life (HRQoL). The Toronto alexithymia scale was used to measure the severity of alexithymia. Additional behavioral outcome about the frequency of doctor visits in the past 12 months was measured. Pathway analyses with multiple-group comparisons were conducted to test the mediating role of illness perception.</p>Results<p>Overall, 600 patients were recruited. The illness perceptions of FGID patients were characterized as with broad non-gastrointestinal symptoms (6.8 ± 4.2), a negative illness representation (more chronic course, worse consequences, lower personal and treatment control, lower illness coherence, and heavier emotional distress), and high numbers of psychological and culture-specific attributions. Fit indices of the three hypothesized path models (for physical and mental HRQoL and doctor-visit frequency, respectively) supported the mediating role of illness perceptions. For example, the severity of alexithymia and non-gastrointestinal symptoms had significant negative effect on mental quality of life through both direct (standardized effect: −0.085 and −0.233) and indirect (standardized effect: −0.045 and −0.231) influence via subscales of consequences, emotional representation, and psychological and risk factor attributions. Multi-group confirmatory factor analysis showed similar psychometric properties for FGID patients and the other disease group.</p>Conclusion<p>The management of FGID patients should take into consideration dysfunctional illness perceptions, non-gastrointestinal symptoms, and emotion regulation.</p

Data_Sheet_1_Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study.DOCX

<p>Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.</p><p>Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.</p><p>Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.</p><p>Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.</p

Questionnaire items used for scoring.

<p>Numbers in brackets (%) are frequencies of parents' answers, denominator of n = 1226 in Leicester subsample used for generating the tool, and of n = 140 in MAS-90 subsample. * before/after imputation with values from prior follow-up assessments and baseline.</p><p>Questionnaire items used for scoring.</p

Questionnaire items used as inclusion criteria and outcome definition, comparing original and validation cohort.

<p>Questionnaire items used as inclusion criteria and outcome definition, comparing original and validation cohort.</p

Comparison of study characteristics.

<p>Comparison of study characteristics.</p

Characteristics of families in sample used for external validation, by follow-up status.

<p>ISCED, International Standard classification of Education; BMI, Body mass index; IgE, Immunoglobulin E; 95%-CI, bootstrapped 95% confidence intervals; kU/l, kilo Units per litre.</p><p>Characteristics of families in sample used for external validation, by follow-up status.</p