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      Demographic characteristics and quality of life of patients with unexplained complaints: a descriptive study in general practice

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          Abstract

          Objective

          About 13% of GPs’ consultations involve unexplained complaints (UCs). These complaints can progress to chronic conditions like medically unexplained symptoms, chronic functional symptoms or somatoform disorders. Little is known about the demographic characteristics and quality of life of patients with early stage UCs. Our study objective was to describe these characteristics. Additionally we compared them with other patient groups to serve as a frame of reference .

          Methods

          Descriptive study in general practices. Patients with early stage UCs who had not had elaborate diagnostic investigations were included. Demographic characteristics were compared to a Dutch general practice population. Quality of life scores were measured with the RAND-36 and compared to another Dutch general practice population and to depressed patients.

          Results

          Data of 466 patients were available for analysis. Mean age was 44 years and 74% were females, mostly higher educated. Of the patients, 63% presented with unexplained fatigue. On average, quality of life was poor (mean RAND-36 domain scores 37–73), also in comparison with other groups.

          Conclusion

          General practice patients presenting with UCs have a remarkably poor quality of life. Future research should explore how early identification of patients at risk of developing chronicity can take place. Awareness of potential poor quality of life may influence GPs' medical decision making.

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          Most cited references19

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          Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice.

          For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12,000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP.
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            Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS).

            Patients commonly present in primary care with symptoms for which no physical pathology can be found. This study is a review of published research on medically unexplained symptoms (MUPS) in primary care. A literature review and qualitative comparison of information was carried out. Four questions were addressed: what is the prevalence of MUPS; to what extent do MUPS overlap with psychiatric disorder; which psychological processes are important in patients with MUPS; and what interventions are beneficial? Neither somatised mental distress nor somatisation disorders, based on symptom counts, adequately account for most patients seen with MUPS. There is substantial overlap between different symptoms and syndromes, suggesting they have much in common. Patients with MUPS may best be viewed as having complex adaptive systems in which cognitive and physiological processes interact with each other and with their environment. Cognitive behavioural therapy and antidepressant drugs are both effective treatments, but their effects may be greatest when the patient feels empowered by their doctor to tackle their problem.
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              Evaluation of four highly cited energy and fatigue mood measures.

              This paper evaluates four highly cited measures of energy and fatigue moods. Substantial experimental and correlational evidence supports the conclusion that scores from the vitality scale of the SF-36 Health Survey can provide a valid measure of the recalled frequency of month-long feelings of energy and fatigue. Substantial experimental and correlational evidence supports the conclusion that scores from the fatigue and vigor scales of the Profile of Mood States (POMS) can provide reliable and valid measures the intensity of both week-long and "right now" fatigue and energy mood states, respectively. A smaller body of evidence supports the conclusion that scores from the energy scale of the Activation-Deactivation Adjective Checklist (AD-ACL) can provide a valid measure of the "right now" mood of energy; however, the energy scale of the AD-ACL has several limitations compared to the POMS vigor scale. All the measures lacked integration within a compelling theory of the mood of energy-fatigue. It is concluded that progress in understanding of energy and fatigue mood states will be aided by advances in both the psychobiological conceptualization of fatigue and energy mood states and their measurement.
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                Author and article information

                Contributors
                +31-20-5663065 , +31-20-5669186 , h.koch@amc.uva.nl
                Journal
                Qual Life Res
                Quality of Life Research
                Springer Netherlands (Dordrecht )
                0962-9343
                1573-2649
                26 September 2007
                November 2007
                : 16
                : 9
                : 1483-1489
                Affiliations
                [1 ]Department of General Practice, Division of Clinical Methods & Public Health, Academic Medical Center-University of Amsterdam, P. O. Box 22660, 1100 DD Amsterdam, The Netherlands
                [2 ]Department of General Practice, University of Maastricht, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
                [3 ]Horten Centre, University of Zurich, Zurich, Switzerland
                Article
                9252
                10.1007/s11136-007-9252-y
                2039860
                17899448
                0cdcc4f3-735f-40c2-810c-d4afd75b1d04
                © Springer Science+Business Media B.V. 2007
                History
                : 9 February 2007
                : 6 August 2007
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media B.V. 2007

                Public health
                unexplained complaints,family practice,fatigue,descriptive study,quality of life
                Public health
                unexplained complaints, family practice, fatigue, descriptive study, quality of life

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