General Population Reference Group Research Articles

Comparison of internal and external reference populations for occupational cancer surveillance in a cohort drawn from a diverse workforce.

Prior analyses of the Occupational Disease Surveillance System (ODSS) have compared cancer rates using internal referent groups. As an exploratory analysis, we sought to estimate cancer risk using general population reference rates to evaluate the impact that the comparison population has on findings from our surveillance program. A cohort of approximately 2.3 million workers in Ontario, Canada with an accepted lost-time workers' compensation claim were followed for all cancer diagnoses between 1983 and 2018. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for workers in specific occupational groups using (1) all other workers in the ODSS cohort, and (2) the general population of Ontario. SIRs using the general population reference group were generally equal to or modestly lower compared to SIRs using the internal reference group. Within occupation groups, SIRs had a discordant direction of association (increased rate in the internal comparison and decreased in the external comparison) for some cancer sites including urinary, prostate, and colorectal. Findings emphasize the importance of the choice of reference group when evaluating cancer risks in large occupational surveillance cohorts. Importantly, the magnitude of confounding and the healthy worker hire bias may depend on the occupation group and cancer site of interest.

Psychosocial and economic impact of COVID-19 pandemic by sex among migrant populations compared with general Finnish population: a population-based study.

To study sex differences in the psychosocial and economic impact of the restrictive measures during the COVID-19 pandemic in 2020 among the migrant origin and the general population in Finland. Cross-sectional MigCOVID Survey data (10/2020-2/2021; n=3668) were used. FinHealth 2017 Follow-up Study participants constituted the general population reference group (n=3490). Sex differences in self-perceived impact of the restrictive measures during the COVID-19 pandemic in 2020 on the psychosocial and economic situation were examined with multivariate logistic regression, adjusting for sociodemographics and self-rated health. The migrant origin population had higher odds for reporting weakened economic situation (odds ratio (OR) 5.41; 95% confidence interval (CI) 3.96-7.39), increased loneliness (OR 1.75; 95% CI 1.35-2.28), decrease in feelings of hope for the future (OR 1.70; 95% CI 1.33-2.19) and increased sleeping difficulties and nightmares (OR 1.98; 95% CI 1.34-2.92) than the general population. While the psychosocial and economic impact of COVID-19 was higher in women compared with men in the general population, findings were not fully replicated in the migrant origin population. Individuals of migrant origin faced a higher likelihood of experiencing adverse changes in both psychosocial and economic aspects during the pandemic, suggesting increased vulnerability linked to migrant origin. Additional research is required to delve into the intricate connections among gender, migrant origin, and the impact of COVID-19, aiming to enhance comprehensive understanding of the contributing factors. Vulnerabilities of different population groups should be identified and addressed when planning measures to reduce adverse societal impact in future crises.

The association of depressive and anxiety symptoms with the metabolic syndrome and its components among Russian, Somali, and Kurdish origin adults in Finland: A population-based study

ObjectivePositive association of depressive and anxiety symptoms with the metabolic syndrome (MetS) have been reported, however there is little information on these among migrant origin populations. The aim of this study was to examine these associations among diverse migrant origin populations in Finland. MethodsData of 318 Russian, 212 Somali, and 321 Kurdish origin participants in the cross-sectional Finnish Migrant Health and Wellbeing Study (Maamu) aged 30–64 years was used. The general population reference group constituted of 786 Health 2011 Survey participants. Depressive and anxiety symptoms were measured with HSCL-25 subscales. Harmonized definition of MetS was used. ResultsDepressive symptoms were associated with elevated blood pressure in Kurdish origin (30.1%, 95% CI 22.7–38.8 vs. 19.9%, 95%CI 15.4–25.4 for those with and without symptoms respectively); and elevated waist circumference (72.1%, 95%CI 56.9–83.5 vs. 55.0%, 95%CI 50.6–59.4) and triglycerides (30.8%, 95%CI 16.0–51.0 vs. 11.9%, 95%CI 9.3–15.0) in general population. Anxiety symptoms were associated with MetS (47.0%, 95%CI 37.6–56.7 vs. 31.9%, 95%CI 26.7–37.6) and elevated blood pressure (37.2%, 95%CI 28.3–46.9 vs. 18.8%, 95%CI 14.7–23.6), and with elevated triglycerides in Somali origin (33.0%, 95%CI 14.5–59.0 vs. 5.7%, 95%CI 3.3–9.6) and general population (30.2%, 95%CI 16.4–48.8, 12.8%, 95%CI 9.9–16.2). No associations between low HDL-cholesterol and depressive or anxiety symptoms were observed. ConclusionCardiometabolic health should be taken into account in mental health services. Future studies should explore the underlying pathways to the observed differences in strengths of associations of depressive and anxiety symptoms with MetS and its components across diverse migrant origin populations.

Anorectal dysfunction in adults with spina bifida and associated socio-emotional factors-a retrospective, cross-sectional cohort study.

Retrospective, cross-sectional study. To investigate prevalence, types, and severity of fecal incontinence (FI) and constipation in adults with spina bifida (SB), in relation to self-perception and help-seeking, and to compare findings to data from a general population reference group. University Medical Center Groningen (UMCG), the Netherlands. The 294 adults with SB registered at UMCG in 2017 were invited to participate. The Groningen Defecation and Fecal Continence Questionnaire was used to assess functional outcomes for FI and constipation using Rome IV criteria. Vaizey (for FI) and Agachan (for constipation) scores were determined. Socio-demographic factors and self-perception of bowel-related problems were recorded through the questionnaire. Data were compared with an age and sex matched reference group. The completed questionnaires of 112 (38%) responding participants were analyzed. FI and constipation were more prevalent in the study group (35% and 45%, respectively) than in the reference group (8.9% and 22%, respectively). In general, in participants with SB aperta (SBA; n = 75), FI was more severe than in participants with SB occulta (SBO; n = 37). However, severity of FI was higher in SBO participants than in the SBA group after the age of 61. Bowel problems in adults with SB were associated with worse self-perception regarding health. In adults with SB, anorectal dysfunction is often present and severe. Older persons with SBO experience more severe FI than in early age. Bowel problems should systematically and more adequately be addressed and controlled throughout adulthood in both the spina bifida groups.

Looking across health and healthcare outcomes for people with intellectual and developmental disabilities and psychiatric disorders: population-based longitudinal study.

Intellectual and developmental disabilities (IDDs) and psychiatric disorders frequently co-occur. Although each has been associated with negative outcomes, their combined effect has rarely been studied. To examine the likelihood of five negative health and healthcare outcomes for adults with IDD and mental health/addiction disorders (MHAs), both separately and together. For each outcome, demographic, clinical and system-level factors were also examined. Linked administrative data-sets were used to identify adults in Ontario, Canada, with IDD and MHA (n = 29 476), IDD-only (n = 35 223) and MHA-only (n = 727 591). Five outcomes (30-day readmission, 30-day repeat ED visit, delayed discharge, long-term care admission and premature mortality) were examined by logistic regression models with generalised estimating equation or survival analyses. For each outcome, crude (disorder groups only) and complete (adding biosocial covariates) models were run using a general population reference group. The IDD and MHA group had the highest proportions across outcomes for both crude and complete models. They had the highest adjusted ratios for readmissions (aOR 1.93, 95%CI 1.88-1.99), repeat ED visit (aOR 2.00, 95%CI 1.98-2.02) and long-term care admission (aHR 12.19, 95%CI 10.84-13.71). For delayed discharge, the IDD and MHA and IDD-only groups had similar results (aOR 2.00 (95%CI 1.90-2.11) and 2.21 (95%CI 2.07-2.36). For premature mortality, the adjusted ratios were similar for all groups. Poorer outcomes for adults with IDD, particularly those with MHA, suggest a need for a comprehensive, system-wide approach spanning health, disability and social support.

The Four-Dimensional Symptom Questionnaire (4DSQ) in the general population: scale structure, reliability, measurement invariance and normative data: a cross-sectional survey.

BackgroundThe Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire measuring distress, depression, anxiety and somatization with separate scales. The 4DSQ has extensively been validated in clinical samples, especially from primary care settings. Information about measurement properties and normative data in the general population was lacking. In a Dutch general population sample we examined the 4DSQ scales’ structure, the scales’ reliability and measurement invariance with respect to gender, age and education, the scales’ score distributions across demographic categories, and normative data.Methods4DSQ data were collected in a representative Dutch Internet panel. Confirmatory factor analysis was used to examine the scales’ structure. Reliability was examined by Cronbach’s alpha, and coefficients omega-total and omega-hierarchical. Differential item functioning (DIF) analysis was used to evaluate measurement invariance across gender, age and education.ResultsThe total response rate was 82.4 % (n = 5273/6399). The depression scale proved to be unidimensional. The other scales were best represented as bifactor models consisting of a large general factor and one or more smaller specific factors. The general factors accounted for more than 95 % of the reliable variance of the scales. Reliability was high (≥0.85) by all estimates. The distress-, depression- and anxiety scales were invariant across gender, age and education. The somatization scale demonstrated some lack of measurement invariance as a result of decreased thresholds for some of the items in young people (16–24 years) and increased thresholds in elderly people (65+ years). The somatization scale was invariant regarding gender and education. The 4DSQ scores varied significantly across demographic categories, but the explained variance was small (<6 %). Normative data were generated for gender and age categories. Approximately 17 % of the participants scored above average on de distress scale, whereas 12 % scored above average on de somatization scale. Percentages of people scoring high enough on depression or anxiety as to suspect the presence of depressive or anxiety disorder were 4.1 and 2.5 respectively.ConclusionsEvidence supports reliability and measurement invariance of the 4DSQ in the general Dutch population. The normative data provided in this study can be used to compare a subject’s 4DSQ scores with a general population reference group.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0533-4) contains supplementary material, which is available to authorized users.

Long-term quality of life after oesophagectomy with gastric conduit interposition for cancer

BackgroundGaining insight in long-term health-related quality of life more than 1year after oesophagectomy will assist clinical decision-making and inform patients about the long-term consequences of surgery. MethodsIn this cross-sectional study, all consecutive patients who underwent oesophageal resection with gastric interposition for cancer at a tertiary referral centre between January 2007 and July 2012 were included. European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 and QLQ-OES18 were sent to all patients alive without recurrence more than 1year after surgery. ResultsThe questionnaires were completed by 92 of 100 patients. Median duration of follow-up after surgery at completing the questionnaire was 36months (range: 12–75). Global quality of life scores were similar to a general population reference group (76±19 versus 78±17; p=0.26). However, patients scored significantly worse compared to the general population reference group on physical-, role-, cognitive- and social functioning (p<0.001). Neoadjuvant therapy and minimally invasive oesophagectomy were associated with significantly better health-related quality of life (HRQL) and symptom scores (p<0.05). ConclusionGlobal HRQL more than 1year after oesophagectomy with gastric tube reconstruction is comparable to the general Dutch background population, while specific functional and symptom scores are significantly worse. Neoadjuvant therapy and minimally invasive surgery are associated with quality of life benefits in long-term survivors.

HIV-related behaviors, social support and health-related quality of life among men who have sex with men and women (MSMW): a cross-sectional study in Chongqing, China.

BackgroundHealth-related quality of life (HRQOL) has become commonly used both as a concept and as a field of research. However, little is known about the HRQOL of men who have sex with men and women (MSMW). The aim of this study was to examine HIV-related behaviors, social support, and HRQOL status and explore its predictors among MSMW.MethodsAn anonymous cross-sectional study was conducted by snowball sampling method in 2013. A total of 563 Chinese MSM completed a structured questionnaire. The HRQOL and social support were measured with the Chinese version of the World Health Organization Quality of Life Scale (WHOQOL-BRFE) and the Social Support Rating Scale (SSRS), respectively.ResultsOf the 563 MSM analyzed, 77 (13.68%) were MSMW who had a higher proportion of in-marriage and preference for an insertive role as compared with the men who have sex with men only (MSMO) (P<0.05). As high as 70.13% of MSMW had no regular sex partners and 72.73% of MSMW reported engaging in unprotected anal sex in the last six months. 36.36% had tested for HIV, while only 12.99% had accepted HIV voluntary counseling and testing (VCT) services. The scores of objective support and subjective support in MSMW were significantly higher than that of MSMO (P<0.05). No statistically significant difference was found in scores of all the four domains of the HRQOL between MSMW and MSMO. When comparing the HRQOL scores of MSMW with the Chinese general population reference group, the scores of MSMW were significantly lower in physical health domain. In a multivariate regression model, age, monthly income, sexual role, VCT acceptability, subjective support were associated with variability in HRQOL.ConclusionsTo improve the HRQOL among MSMW, more attention needs to be paid to those with low social support, low-income, the old and those prefer a receptive role during anal sex populations.

Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis

Background: It is of debate whether or not childhood anxiety disorders (AD) can be captured by one taxonomic construct. This study examined whether perceived arousal (PA), autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis measures can distinguish children with different primary diagnoses of clinical anxiety disorders (AD) from each other, and from a general population reference group (GP). Methods: The study sample consisted of 152 AD children (comparing separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia), aged 8- to 12-years, and 200 same-aged reference children. HPA-axis functioning was measured by a diurnal cortisol profile. ANS functioning was measured by continuous measures of skin conductance level in rest and during a mental arithmetic task and high frequency heart rate variability in rest. PA was assessed by a questionnaire. Results: The AD sample showed lower high frequency heart rate variability during rest, heightened anticipatory PA, higher basal and reactive skin conductance levels and lower basal HPA-axis functioning compared to the GP sample. The existence of three or more clinical disorders, i.e. a high clinical 'load', was associated with lower basal HPA-axis functioning, higher skin conductance level and lower posttest PA. Specific phobia could be discerned from social phobia and separation anxiety disorder on higher skin conductance level. Conclusions: Our findings indicated that children with AD have specific psychophysiological characteristics, which resemble the psychophysiological characteristics of chronic stress. A high clinical 'load' is associated with an altered ANS and HPA-axis functioning. Overall, ANS and HPA-axis functioning relate to AD in general, accept for specific phobia.

Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis.

It is of debate whether or not childhood anxiety disorders (AD) can be captured by one taxonomic construct. This study examined whether perceived arousal (PA), autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis measures can distinguish children with different primary diagnoses of clinical anxiety disorders (AD) from each other, and from a general population reference group (GP). The study sample consisted of 152 AD children (comparing separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia), aged 8- to 12-years, and 200 same-aged reference children. HPA-axis functioning was measured by a diurnal cortisol profile. ANS functioning was measured by continuous measures of skin conductance level in rest and during a mental arithmetic task and high frequency heart rate variability in rest. PA was assessed by a questionnaire. The AD sample showed lower high frequency heart rate variability during rest, heightened anticipatory PA, higher basal and reactive skin conductance levels and lower basal HPA-axis functioning compared to the GP sample. The existence of three or more clinical disorders, i.e. a high clinical 'load', was associated with lower basal HPA-axis functioning, higher skin conductance level and lower posttest PA. Specific phobia could be discerned from social phobia and separation anxiety disorder on higher skin conductance level. Our findings indicated that children with AD have specific psychophysiological characteristics, which resemble the psychophysiological characteristics of chronic stress. A high clinical 'load' is associated with an altered ANS and HPA-axis functioning. Overall, ANS and HPA-axis functioning relate to AD in general, accept for specific phobia.

Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depression Scale in 329 prostate cancer patients before surgery as well as 3, 6 and 12 months after surgery. These results were compared with those of a male German general population reference group. Adjustment to disease was assessed using the Perceived Adjustment to Chronic Illness Scale. Patients reported low levels of PD at all points of assessment similar to population norms of age-matched German men. Persistent PD was seen in about 8% of the patients and 20% had PD at least two of the measurement points. Relevant predictors for PD after surgery were urinary symptoms and baseline PD. Adjustment to disease was highest before surgery and had significantly reduced at 3 and 6 months after surgery. In general, men are resilient to the experience of localised prostate cancer and adjust well psychologically after surgery. However, between 8% and 20% of patients could possibly benefit from mental health support.

The Quality of Life of Medical Students Studying in New Zealand: A Comparison With Nonmedical Students and a General Population Reference Group

Background: Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout. Purpose: The aim of the study was to investigate medical students’ perceptions concerning their quality of life. Methods: Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent group's t tests, confidence intervals, and Cohen's d. Results: The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains. Conclusions: The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the university system.

A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population

Background The 4-item Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report questionnaire that consists of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). Given that PHQ-4, PHQ-2, and GAD-2 have not been validated in the general population, this study aimed to investigate their reliability and validity in a large general population sample and to generate normative data. Methods A nationally representative face-to-face household survey was conducted in Germany in 2006. The survey questionnaire consisted of the PHQ-4, other self-report instruments, and demographic characteristics. Results Of the 5030 participants (response rate = 72.9%), 53.6% were female and mean (SD) age was 48.4 (18.0) years. The sociodemographic characteristics of the study sample closely match those of the total populations in Germany as well as those in the United States. Confirmatory factor analyses showed very good fit indices for a two-factor solution (RMSEA .027; 90% CI .023–.032). All models tested were structurally invariant between different age and gender groups. Construct validity of the PHQ-4, PHQ-2, and GAD-2 was supported by intercorrelations with other self-report scales and with demographic risk factors for depression and anxiety. PHQ-2 and GAD-2 scores of 3 corresponded to percentile ranks of 93.4% and 95.2%, respectively, whereas PHQ-2 and GAD-2 scores of 5 corresponded to percentile ranks of 99.0% and 99.2%, respectively. Limitation A criterion standard diagnostic interview for depression and anxiety was not included. Conclusions Results from this study support the reliability and validity of the PHQ-4, PHQ-2, and GAD-2 as ultra-brief measures of depression and anxiety in the general population. The normative data provided in this study can be used to compare a subject's scale score with those determined from a general population reference group.

Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population

The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available. To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data. Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006. Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years. The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics. Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (alpha = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater. Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.

Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis.

To determine the risk for developing malignant melanoma and neurocutaneous melanocytosis (NCM) in patients with large congenital melanocytic nevi. Follow-up data suitable for calculations were available on 160 patients in the New York University Registry of Large Congenital Melanocytic Nevi who had been free of known melanomas or NCM when entered into the Registry. The cumulative 5-year life-table risks for developing melanoma and NCM were calculated. The relative risk for developing melanoma, using a control general population reference group, was determined. The 160 patients (median age at entry: 14 months) were followed prospectively for an average of 5.5 years. Three extracutaneous melanomas developed: 2 were in the central nervous system (CNS) and 1 was retroperitoneal. The 5-year cumulative life-table risk for developing melanoma was 2.3% (95% confidence interval [CI]:.8-6.6) and the relative risk was 101 (95% CI: 21-296). No melanoma occurred within a large congenital melanocytic nevus. Four patients developed manifest NCM, 2 with CNS melanomas. The 5-year cumulative life-table risk for developing NCM was 2.5% (95% CI:.8-7.2). Ten patients were excluded from the calculations because of preexisting disease on entry into the Registry: 5 with manifest NCM and 5 with melanomas (3 in large congenital melanocytic nevi, 1 in nonnevus skin, and 1 unknown primary). Patients with large congenital melanocytic nevi are at increased risk for developing melanomas. There is also a significant increased risk for developing NCM. The high incidence of CNS involvement may influence decisions concerning treatment of the large congenital melanocytic nevi.

Sample size calculations in studies using the EuroQol 5D.

Health-related quality of life (HRQoL) instruments are increasingly used as outcome variables in clinical trials, leading to a requirement for sample size calculations based on these variables. This paper aims to provide a guide to sample size calculations for use with the EuroQol-5D. The paper focuses on sample sizes required for comparative studies, and uses scores from two reference groups of general population and critically ill patients to determine sample sizes using the three parts of the EQ-5D (descriptive system, visual analogue scale (VAS), and EQ-5D index). The effect on sample sizes of different methods of categorising the three variables are compared, and comparisons are also made between sample sizes using parametric and non-parametric methods. Sample sizes required when the EQ-5D descriptive system is used as a binary variable (problems/no problems) are higher than or equal to those required when each dimension is categorised in three levels of severity (no problems, moderate problems, extreme problems). The use of three categories is appropriate in ill populations, though in more healthy populations two categories should be used. Due to the slight skewness of VAS data, and the equality of results using parametric and non-parametric methods, sample size calculations using the VAS should be based on a parametric approach. Sample sizes were considerably higher for the EQ-5D index when predefined intervals, as opposed to a score frequency based categorisation, were used with the general population reference group. Using the EQ-5D index in ill populations, it is recommended that sample size calculations are based on parametric methods, whilst in healthier populations non-parametric methods should be used.