The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization

BACKGROUND: The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire that has been developed in primary care to distinguish non-specific general distress from depression, anxiety and somatization. The purpose of this paper is to evaluate its criterion and construct validity. METHODS: Data from 10 different primary care studies have been used. Criterion validity was assessed by comparing the 4DSQ scores with clinical diagnoses, the GPs' diagnosis of any psychosocial problem for Distress, standardised psychiatric diagnoses for Depression and Anxiety, and GPs' suspicion of somatization for Somatization. ROC analyses and logistic regression analyses were used to examine the associations. Construct validity was evaluated by investigating the inter-correlations between the scales, the factorial structure, the associations with other symptom questionnaires, and the associations with stress, personality and social functioning. The factorial structure of the 4DSQ was assessed through confirmatory factor analysis (CFA). The associations with other questionnaires were assessed with Pearson correlations and regression analyses. RESULTS: Regarding criterion validity, the Distress scale was associated with any psychosocial diagnosis (area under the ROC curve [AUC] 0.79), the Depression scale was associated with major depression (AUC = 0.83), the Anxiety scale was associated with anxiety disorder (AUC = 0.66), and the Somatization scale was associated with the GPs' suspicion of somatization (AUC = 0.65). Regarding the construct validity, the 4DSQ scales appeared to have considerable inter-correlations (r = 0.35-0.71). However, 30–40% of the variance of each scale was unique for that scale. CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92. The 4DSQ scales correlated with most other questionnaires measuring corresponding constructs. However, the 4DSQ Distress scale appeared to correlate with some other depression scales more than the 4DSQ Depression scale. Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave. CONCLUSION: The 4DSQ seems to be a valid self-report questionnaire to measure distress, depression, anxiety and somatization in primary care patients. The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems

Donald J. Louks Korean War collection [DIGITAL CONTENT]

This collection contains an oral history interview with Donald J. Louks from December 17, 2009, as well as photographs related to his military service

Clinical approach to non-resolving pneumonia: a survey of Wisconsin primary care clinicians

Background/significance: Little has been reported regarding the approach of primary care clinicians to ambulatory, non-responsive pneumonia (ANRP), variously defined as pneumonia which has not improved with 3-10 days of antibiotic therapy. Anecdotal experience suggests that changes in antibiotic prescription may occur without diagnostic testing for uncovered etiologic agents such as fungi (estimated 1-7% of pneumonia in Wisconsin). Purpose: To determine the stated approach to this clinical problem by primary care clinicians. Methods: A survey containing an algorhythmic, scenario based clinical case of ANRP was sent electronically to the 103 eligible members of the Wisconsin Research and Education Network Survey Group of Wisconsin area primary care clinicians. Respondents were presented with potential diagnostic and therapeutic responses to the case scenario which was constructed from recent consensus guidelines. Results: Surveys were returned from 53/103 members of which 44 were completed (61% male, 30% rural, mean 20 years practice, 13 counties). X-rays were “ordered” by 39 (89%) at initial presentation, and all 39 ordered antibiotics (70% azithromycin). After 4 days of no response, 25/39 (64%) did additional diagnostic testing, 26/39 (67%) changed antibiotics (5 without further testing); after 11 days of no response 3/39 (59%) ordered CT, 16 (41%) bronchoscopy and 28 (72%) either CT or bronchoscopy. Five clinicians (11%) did not order initial X-rays (3/5 started antibiotics), nor did they order further testing after 4 days of no response. Overall, 29/44 (66%) had done no sputum or antigen testing for bacteria by 4 days, and 24/44 (55%) had done no specific testing for fungi by 11 days of ANRP. Conclusion: When presented with an ANRP scenario, a majority of regional primary care clinicians both change antibiotics and do further testing after 4 days of no response, but do not test for fungi by 11 days. These findings highlight the need for practice guidelines based on research outcomes and expert experience to establish pathways for optimal treatment of ANRP. Studies are underway to determine what is done in actual practice

Second generation gasification combined-cycle power plants for US utilities--Detailed performance and cost estimates

Studies of integrated coal gasification combined-cycle power plants carried out by four US manufactures and process firms are summarised and their results compared on an equivalent basis. The results of these studies indicate that integrated gasification combined-cycle power plants based on the oxygen-blown Texaco entrained flow gasifier and employing current technology gas turbines have the potential for providing substantial performance improvements over conventional coal-fired steam stations with flue gas desulphurisation.

Measuring biodiversity and sustainable management in forests and agricultural landscapes

Most of the world's biodiversity will continue to exist outside protected areas and there are also managed lands within many protected areas. In the assessment of millennium targets, there is therefore a need for indicators to measure biodiversity and suitability of habitats for biodiversity both across the whole landscape/seascape and in specific managed habitats. The two predominant land uses in many inhabited areas are forestry and agriculture and these are examined. Many national-level criteria and indicator systems already exist that attempt to assess biodiversity in forests and the impacts of forest management, but there is generally less experience in measuring these values in agricultural landscapes. Existing systems are reviewed, both for their usefulness in providing indicators and to assess the extent to which they have been applied. This preliminary gap analysis is used in the development of a set of indicators suitable for measuring progress towards the conservation of biodiversity in managed forests and agriculture. The paper concludes with a draft set of indicators for discussion, with suggestions including proportion of land under sustainable management, amount of produce from such land, area of natural or high quality semi-natural land within landscapes under sustainable management and key indicator species