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Our objectives were to translate the Quality of Life Scale (QOLS) into German and to evaluate its reliability and validity for the use in patients with fibromyalgia (FMS). Together with German versions of the Fibromyalgia Impact Questionnaire (FIQ), the SF-36, a tender point count (TPC) and other questionnaires, we administered the QOLS to 146 patients with FMS. Patients were asked about the severity of pain today (VAS) and the duration of symptoms. Test-retest reliability was assessed using Spearman's correlations. Internal consistency was evaluated with Cronbach's alpha. Construct validity of the QOLS was evaluated by correlating the QOLS with the FIQ, the SF-36, the Beck Depression Inventory (BDI), and the Symptom Checklist (SCL-90-R) as well as with the pain variables. An exploratory factor analysis (EFA) was also conducted. Mean age was 53.1 years. Means were for pain today 6.8 and for duration of symptoms 11.8 years. Test-retest reliability for the total QOLS was rho = .91. Internal consistency was α = .90. Low-to-moderate correlations were obtained between the QOLS and the total FIQ (rho = -.42), the SF-36 (e.g. physical functioning rho = .37; mental health rho = .56) as well as the pain variables (VAS rho = -.11 ns; TPC rho = -.20). Psychological variables were moderately to substantially correlated with the QOLS (e.g. BDI rho = -.61). An EFA suggested a three-factor solution. The QOLS-G is a reliable and valid instrument for measuring quality of life in German patients with FMS.

This article examines the existence, description, perception, treatment, and outcome of symptoms consistent with autistic disorder in nineteenth-century London, England, based on case histories from the notes of Dr William Howship Dickinson at Great Ormond Street Hospital for Children. Three cases meeting the DSM-IV criteria for autistic disorder are described in detail. Other cases in which autistic traits are described are briefly summarized. The article explores the environment of contemporary medical practice, beliefs about childhood brain disorders, and social practice regarding children with brain disorders, and the impact of these factors on assessment and treatment. It correlates Dickinson's observations with current research on autism, providing information about children with autism before the condition was formally named in 1943.

Objective: To translate the Fibromyalgia Impact Questionnaire (FIQ) into German and to evaluate its reliability and validity for the use of German speaking patients with fibromyalgia (FM)., Methods: We administered the FIQ to 55 patients with FM (15 patients filled out the questionnaire 10 days later) together with German versions of the Stanford Health Assessment Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and a tender point count (TPC). All patients were asked about the severity of pain today (10 cm visual analog scale) and the duration of symptoms. Tenderness thresholds were assessed by dolorimetry at all tender points with a Fisher dolorimeter and laboratory tests were obtained. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FIQ was evaluated by correlating the HAQ and subscales of the SF-36 as well as the TPC and the tenderness thresholds., Results: Mean age of participants was 54.3 years and mean duration of symptoms 9.5 years. Test-retest reliability was between 0.62 and 1 for the physical functioning as well as for the total FIQ and other components. Internal consistency was 0.92 for the overall FIQ. Significant correlations were obtained between the FIQ items, the HAQ, and the SF-36., Conclusion: The German FIQ is a reliable and valid instrument for measuring functional disability and health status in German patients with FM.

Objective: To examine the predictive ability of a wide array of measures of disease severity in explaining Dutch and German patterns of health services utilization during a 2-year period., Methods: Slightly over 200 rheumatoid arthritis (RA) patients, 136 from a Dutch and 98 from a German outpatient clinic, supplied information on symptom and functional status, global health, and emotional and social functioning at baseline. The patients' rheumatologists provided clinical assessments of functional grade and disease activity. A questionnaire mailed twice at 12-month intervals was the source of retrospective information on physician consultations, hospitalization, and referrals for surgery and physical therapy during the previous period. Major determinants of use were studied with multivariate analyses., Results: German patients reported more frequent physician contacts than Dutch patients, but the volume of surgery, hospital admissions, and referrals for physical therapy did not differ between the two countries. In a hierarchical regression, the consultation rate was directly associated with pain quality and global health. Markers of RA progression were related to surgery, and the latter to volume of in-hospital care. Fatigue severity and physical disability predicted referrals for physical therapy. Patient self-management activities were only weakly associated with disease severity variables., Conclusion: The activity and damage components of RA were related to the separate components of total health service utilization. Disease activity was the prime determinant of physician services used, and RA progression the determinant of surgical interventions and hospitalization.

Objective: To examine prospective relations between a wide array of measures of social functioning and pain, while controlling for disease duration and activity and functional grade., Methods: As part of a larger study on health care utilization, longitudinal data were collected from 136 Dutch and 98 German outpatients on clinical status and pain. Social data included information on sexual handicap, spouse behavior, loneliness, daily emotional support, and the maintenance of pleasurable life domains. Pain severity was assessed at baseline and 12 months later with standard measures of pain and analyzed with hierarchical regressions., Results: Social measures obtained at baseline were consistently associated with pain at followup. Depression was a moderate correlate of pain in the Dutch and German samples. The regressions revealed that patient reports of negative spouse behavior (such as avoidance and critical remarks) and baseline depression predicted worse pain outcome, and this association remained significant in analyses controlling for baseline pain. The level of formal education was a weak correlate of disability, emotional support, and pain. Daily emotional support and social life domains associated with positive affect had an indirect influence on outcome. The absence of strong rather than weak social ties was the component of the loneliness construct linked to pain. These associations between social prognostic factors and pain severity, however, were mediated by psychological functioning at baseline., Conclusion: The social environment was found to operate on the core health outcome, pain severity, via several pathways. Social functioning may be affected by rheumatoid arthritis (RA) progression, but it also appears to form a determinant of future health outcome. Not only the status of being married but also the quality of the relationship in terms of long-term stress and emotional support may be useful prognostic factors in RA.

Genetic alterations are a common feature of the malignant phenotype. Among other properties, altered genes may be responsible for invasion and metastasis, as well as for resistance to chemotherapeutic agents. Under appropriate circumstances, the products of other altered genes expressed by malignant cells may act as tumor-associated T-cell epitopes, capable of provoking antitumor immune responses. As a novel means of augmenting the immunogenicity of the gene products, unfractionated, sheared genomic DNA from various tumor cell lines (B16F1 melanoma, B16F10 melanoma, MOPC-315 plasmacytoma, C1498 lymphoma, or J558 myeloma), or from non-neoplastic liver cells of tumor-free mice, was transfected into LM cells, a mouse fibroblast cell-line (H-2k) that had been modified previously by retroviral gene transfer to secrete interleukin-2 (IL-2). The IL-2-secreting transfected cell populations were then tested for their immunogenic properties toward B16F1 (H-2b) or C1498 (H-2b) cells in syngeneic C57BL/6 mice. The antitumor responses were specific for the type of tumor from which the DNA was obtained. The survival of C57BL/6 mice injected with a mixture of viable B16F1 cells and IL-2-secreting LM cells transfected with DNA from B16F1 cells was significantly prolonged. In a similar manner, the survival of C57BL/6 mice injected with a mixture of C1498 cells and IL-2-secreting LM cells transfected with DNA from C1498 cells was prolonged as well. The immunity was mediated predominantly by CD8+ and natural killer/lymphokine-activated killer (NK/LAK) cells. These data raise the possibility that a cell line altered previously for cytokine secretion may be readily modified to provide immunologic specificity for the neoplasms of individual cancer patients.

The term "Osteoarthrosis" encompasses a group of joint disorders characterized by pain and restriction of mobility. Currently, considerable confusion prevails with respect to the definition of the disease entity and the classification criteria to be utilized in epidemiologic research. Despite these methodological difficulties, it is discernible from the international rheumatology journals that during the past decade this emerging field of research has become firmly established in several European countries and in North America. Researchers have focused their attention on four major facets of the disease: 1. etiological or risk factors with respect to the initiation and clinical course of disease, 2. the impact of illness on the individual and his family, 3. the statistical estimation of incidence and prevalence rates in the total population or in selected at-risk groups of individuals, 4. health care utilization patterns and their costs and benefits. This survey article aims at providing a critical overview of this emerging field of research, as well as at suggesting to the reader future lines of development useful for public health and health promotion researchers in Germany.

The development of a theory of quality of life following serious illness is currently an important field of endeavour in rehabilitation research. The interpersonal relationships of people and elements of the self-concept appear to be salient factors in causal models of subjective well-being. One such model developed to explain characteristic levels of well-being was used in a longitudinal study of adaptation to a first myocardial infarction. Data were collected from a national sample of male cardiac patients and their spouses on the illness and marital situation as predictors of long-term well-being or ill-being. Analyses of data from the first three waves of the study, which is to extend over 5 years after the onset of illness, are to be discussed in the paper. Marital status, the emotional quality of the spouse relationship and long-standing marital stressors were found to have direct and indirect effects on the two dimensions of the Bradburn Affect Balance Scale. The same is true of continuing problems associated with the heart attack relative to perceptions of having coped effectively with the after effects of illness. Differences in self-esteem and personal competence were suggested as mediators of socio-environmental and illness-related influences. The two-factor conception of well-being developed was found to be a useful framework for investigating positive and negative aspects of psychosocial rehabilitation. The same factors that explain differences between happy and unhappy people in social indicators research also appeared to be determinants of different trajectories of adaptation in the wake of a life-threatening illness. Previous research using theoretical models from stress research has overemphasized psychosocial morbidity and stress management and neglected positive processes of adaptation. The identification of love resources related to positive feeling states and life satisfaction has, therefore, not received the attention it deserves. This is especially the case regarding an overemphasis of the concept of social support as a buffer of stress. Instruments were developed to measure high and low marital intimacy, as well as chronic marital role strains, and these measures appeared to explain different trajectories of adjustment to cardiac disease. The two-factor model appears to be useful for future work on quality of life with chronic illness. The same is true of four marital contexts of rehabilitation that were identified in the study.

Eleven analysts tested contaminated reconstituted (1:10) dry milk powders for penicillin residues using spores of Bacillus stearothermophilus var. calidolacris (Delvotest P method). Three types of responses were noted: positive, negative, and questionable. Prediction equations indicated that 95% of the time, analysts unfamiliar with the technique could detect positive results if penicillin concentrations in samples were 0.010 unit/ml or higher and positive and questionable results if the penicillin concentrations were 0.008 unit/ml. Increasing the reconstitution ratio from 1/11 to 1/4 increased the chances of detecting penicillin in milk powder. Penicillinase added to reconstituted penicillin-contaminated milks in all instances produced negative responses.

As part of a larger study on recovery from myocardial infarction in a national sample of male cardiac patients, data was collected on slightly under 400 men and their wives over a 5-year period. This longitudinal data set was used to investigate the role of patient health cognitions and marital factors on long-term psychological response to the illness. Negative appraisals of threat and loss due to cardiac impairment/disability were found to be the best predictor of anxiety and depression at 3-4 years after hospitalisation. Patient cognitions appeared to be a chief mediator of medically-defined illness. Supportive marital environments were defined by scales measuring intimate attachment and spouse conflict. The latter was found associated with negative health cognitions and elevated anxiety. High intimacy marriages appeared to provide adequate social support, and the level of intimacy between the spouses was inversely related to the level of depressed mood. These findings were suggestive of a buffering effect of the patient's social support system. Other predictors, including the type A pattern, 'vital exhaustion', and social class were investigated as components of a multifactorial model for clinical screening purposes.

Data from the 5-year Oldenburg Longitudinal Study were used for investigating the causes of differences in psychological well-being in a national sample of 1000 cardiac patients. In a subsample of 400 married patients, for whom data from the spouse were available, exogenous influences, cognitive mediators, and two measures of psychological distress were linked up in models explaining/predicting the level of anxiety and depression. A major hypothesis was the salience of the illness-related cognitions of the patient as a determinant of long-term behavior and mood state. Early patient subjective health perceptions, the 'primary appraisal' of threat/harm/loss, were found to be the most important predictors of subsequent psychological well-being at the fourth wave of the study several years later. As an instrument for patient screening and psychosocial intervention, Type A's and other groups of subjects seemed to constitute high-risk patient groups.

Malignant neoplasm should not be viewed as a 'psychogenic' nor as a 'primarily organic' disease but as an interaction of various forces, in which psychosocial factors may play an important role. To understand the increase in neoplastic disease, which has taken place in this century, requires a theoretical framework including social, psychosocial and behavioural dimensions, as well as the endocrine and immunologic mechanisms acting as pathogenic pathways. Recent theoretical developments in health psychology and allied disciplines on coping behaviour and social support should be integrated into biomedical models of the aetiology, pathogenesis and clinical course of malignant neoplasia. Environmental stressors, as well as mediating variables at the cognitive, affective, behavioural and physiological levels of adaptation, are suggested as major components of a model of multidimensional pathology. A growing body of research on the role of psychosocial factors in adjustment to cancer and its treatment has contributed new insights into possible variables and causal mechanisms which may be relevant in the aetiology of the disease. Closeness to parents in childhood and the ability to form close interpersonal relationships in later adult life very possibly influence the ability of the individual to cope effectively with environmental stressors prior to neoplastic disease and with the considerable stresses of being a cancer patient subsequent to diagnosis and treatment. Pathogenic pathways for future investigation include mental health variables, such as self-esteem and sense of control, at the psychological level and immunity surveillance at the biological. An integration and cross-fertilization of current work in the aetiology of and adjustment to cancer is suggested linking psychosomatic and somatopsychic models.