Disease specific quality of life instruments in multiple sclerosis: validation of the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS).

Quality of life (QoL) is discussed as an additional outcome measure in multiple sclerosis (MS). However, few questionnaires assessing disease specific QoL in MS have been published. On the basis of the literature and interviews with clinicians and MS patients, we have developed a disease specific QoL instrument and validated it in a broad range of patients with MS. In this study, a heterogeneous sample of n = 237 MS patients completed the newly developed Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS, in German language) and a battery of already validated questionnaires. They further underwent neurological scoring and objective tests. By these means, we investigated its validity, appropriateness, internal consistency, and retest reliability. Internal consistency and retest coefficients were high and satisfied psychometric standards. Convergent and discriminant validity was supported by direction, magnitude and pattern of correlations with other health measures. HAQUAMS subscales and its total score distinguished between patient groups of varied disease severity, cognitive impairment, and affective symptomatology. No floor or ceiling effects were found in either of the HAQUAMS subscales. The HAQUAMS is a reliable, valid and appropriate instrument for QoL assessment in multiple sclerosis. Data of responsiveness are currently being obtained.

[The maternal and perinatal mortality and morbitity in attendance to Caesarean section in the period from 1956--1976 at the UFK-Jena (author's transl)]. / Die mütterliche und kindliche Mortalität und Morbidität nach Sectio im Zeitraum von 1956--1976 an der Universitäts-Frauenklinik Jena.

In the period from 1956--76 1 468 caesarean sections were accomplished at the UFK-Jena. 44 043 children were delivery during the 21-year period. The number of caesarean sections rose from 1,08% to 1956 to 10,8% in 1976. The fetal indication in 1956 was zero, on the other side it amounts to 34,3% in 1976. First place of the maternal indication in the 21-year period took in the cephalo pelvine disproportion. In the same time the maternal mortality in attendance of caesarean section was 12,3%. Considering the period between 1969--76, the maternal mortality fell to 2%. Maternal morbidity diminished from 1965 and obtained 23% in the period between 1974/1976. The feverish childbed took in the first place of the maternal morbidity (30%). The perinatal mortality fall from 28,57% in the period between 1956/1958 to 3,71% in the period between 1974/1976. The perinatal morbidity we could'nt state certainly. In 8,3% we found perinatal morbidity by acidosis. 5,5% of children, delivered by caesarean section needed medical care. 16,4% of all children were either small for gestational age or immature. The problem of caesarean section as an important method for termination of labor is discussed.