Funktionelle lidelser og symptomer. Dilemma omkring klassifikation og begreber

Et velkendt og meget hyppigt fænomen i vores sundhedsvæsen er patienter, der går til behandling for eller udredning for somatisk sygdom, uden at en sådan kan påvises. Vi kalder dette fænomen somatisering, medicinsk uforklarede symptomer, funktionelle symptomer eller lidelser, helbredsangst eller hypokondri og meget andet. Der hersker en udtalt begrebsmæssig og terminologisk forvirring på området. I denne artikel gives en kort gennemgang af enkelte, relevante begreber og centrale problemstillinger på området. Desuden beskrives en ny inddeling af tilstande, der præsenterer sig med funktionelle fysiske symptomer, dvs. fysiske symptomer, der ikke kan tilskrives nogen kendt ortodokst defineret somatisk lidelse. Endeligt præsenteres en mere moderne forståelse af somatiseringsbegrebet, og mulige årsagsforklaringer på funktionelle tilstande gennemgås

The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health

BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition according to their FPs and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at index and at three, 12, and 24 months, and health care use was extracted from patient registers. Compared with the 968 patients with well-defined medical conditions, the 81 severe Health anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health anxiety (Whiteley-7 scale). They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health anxiety patients used about 41-78% more health care per year in total, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health anxiety was not explained by comorbid depression, anxiety disorder or well-defined medical condition. Patients with mild Health anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of patients with a well-defined medical condition. CONCLUSIONS/SIGNIFICANCE: Severe Health anxiety was found to be a disturbing and persistent condition. It is costly for the health care system and must be taken seriously, i.e. diagnosed and treated. This study supports the validity of recently introduced new criteria for Health anxiety

Radical polymerization of alkyl 2-cyanoacrylates

Cyanoacrylates (CAs) are well-known fast-setting adhesives, which are sold as liquids in the presence of stabilizers. Rapid anionic polymerization on exposure to surface moisture is responsible for instant adhesion. The more difficult, but synthetically more useful radical polymerization is only possible under acidic conditions. Recommendations on the handling of CAs and the resulting polymers are provided herein. In this review article, after a general description of monomer and polymer properties, radical homo- and copolymerization studies are described, along with an overview of nanoparticle preparations. A summary of our recently reported radical polymerization of CAs, using reversible addition-fragmentation chain transfer (RAFT) polymerization, is provided

The BDS checklist as measure of illness severity:A cross-sectional cohort study in the Danish general population, primary care and specialised setting

Objective The bodily distress syndrome (BDS) checklist has proven to be useful in the diagnostic categorisation and as screening tool for functional somatic disorders (FSD). This study aims to investigate whether the BDS checklist total sum score (0–100) can be used as a measure of physical symptom burden and FSD illness severity.Design Cross-sectional.Setting Danish general population, primary care and specialised clinical setting.Participants A general population cohort (n=9656), a primary care cohort (n=2480) and a cohort of patients with multiorgan BDS from specialised clinical setting (n=492).Outcome measures All data were self-reported. Physical symptoms were measured with the 25-item BDS checklist. Overall self-perceived health was measured with one item from the 36-item Short-Form Health Survey (SF-36). Physical functioning was measured with an aggregate score of four items from the SF-36/SF-12 scales ‘physical functioning’, ‘bodily pain’ and ‘vitality’. Emotional distress was measured with the mental distress subscale (SCL-8) from the Danish version of the Hopkins Symptom Checklist-90. Illness worry was measured with the six-item Whiteley Index.Results For all cohorts, bifactor models established that despite some multidimensionality the total sum score of the BDS checklist adequately reflected physical symptom burden and illness severity. The BDS checklist had acceptable convergent validity with measures of overall health (r=0.25–0.58), physical functioning (r=0.22–0.58), emotional distress (r=0.47–0.62) and illness worry (r=0.36–0.55). Acceptability was good with a low number of missing responses to items (<3%). Internal consistency was high (α ≥0.879). BDS score means varied and reflected symptom burden across cohorts (13.03–46.15). We provide normative data for the Danish general population.Conclusions The BDS checklist total sum score can be used as a measure of symptom burden and FSD illness severity across settings. These findings establish the usefulness of the BDS checklist in clinics and in research, both as a diagnostic screening tool and as an instrument to assess illness severity

Probing nano-scale viscoelastic response in air and in liquid with dynamic atomic force microscopy

We perform a comparative study of dynamic force measurements using an Atomic Force Microscope (AFM) on the same soft polymer blend samples in both air and liquid environments. Our quantitative analysis starts with calibration of the same cantilever in both environments. Intermodulation AFM (ImAFM) is used to measure dynamic force quadratures on the same sample. We validate the accuracy of the reconstructed dynamic force quadratures by numerical simulation of a realistic model of the cantilever in liquid. In spite of the very low quality factor of this resonance, we find excellent agreement between experiment and simulation. A recently developed moving surface model explains the measured force quadrature curves on the soft polymer, in both air and liquid

An Experimental Framework for 5G Wireless System Integration into Industry 4.0 Applications

The fourth industrial revolution, or Industry 4.0 (I4.0), makes use of wireless technologies together with other industrial Internet-of-Things (IIoT) technologies, cyber–physical systems (CPS), and edge computing to enable the optimization and the faster re-configuration of industrial production processes. As I4.0 deployments are ramping up, the practical integration of 5G wireless systems with existing industrial applications is being explored in both Industry and Academia, in order to find optimized strategies and to develop guidelines oriented towards ensuring the success of the industrial wireless digitalization process. This paper explores the challenges arisen from such integration between industrial systems and 5G wireless, and presents a framework applicable to achieve a structured and successful integration. The paper aims at describing the different aspects of the framework such as the application operational flow and its associated tools, developed based on analytical and experimental applied research methodologies. The applicability of the framework is illustrated by addressing the integration of 5G technology into a specific industrial use case: the control of autonomous mobile robots. The results indicate that 5G technology can be used for reliable fleet management control of autonomous mobile robots in industrial scenarios, and that 5G can support the migration of the on-board path planning intelligence to the edge-cloud