Immunological and Quality-of-Life Profiles in Women with Breast Cancer: Complementary versus Conventional Care.

BACKGROUND: Previous studies showed that women with breast cancer treated in anthroposophic clinic versus conventional care had increased quality of life (QoL) parameters, fighting spirit, and anxiety coping. We have now analyzed immune and QoL factors in these 2 groups for possible differences during the first 6 months after admission, prompted by anthroposophic studies, including mistletoe extracts, showing beneficial immune system effects. PATIENTS AND METHODS: Fourteen immunological variables, including leukocyte count, lymphocyte count, activated T cells (CD4+ and CD8+), NK cells, B cells, IL1ß, IL6, IL10, and oxytocin, were longitudinally analyzed in both groups (n = 2 × 26). A panel of QoL parameters were analyzed using 3 different instruments. Statistical evaluation included that each patient was its own control. RESULTS: Cytotoxic CD8+ T cell frequency (percent of lymphocytes analyzed by flow-cytometry) significantly decreased over time in the anthroposophic group versus the conventional group (repeated measures ANOVA, p = 0.05). No major differences were observed in other immunological parameters, whereas QoL variables, anxiety decreased and physical symptoms increased/improved significantly in the anthroposophic group (p = 0.04 and p = 0.05, respectively). CONCLUSION: Overall, women with breast cancer in anthroposophic or conventional therapy did not differ in their immune profiles over time, with exception of decreased cytotoxic T cells in the anthroposophic group. Improvement in physical symptoms along with less anxiety in this group may have influenced the brain-immune axis resulting in lower frequency of CD8+ T cells, a feature associated with less aggressive cancer stages. To evaluate whether this observation is associated with good or bad prognosis, further detailed analyses of memory and naïve CD8+ T cells at tumor site and in blood circulation are essential.

Audiometric screening of a population with intellectual disability.

OBJECTIVE: Evaluation of pure-tone audiometry (PTA) in hearing screening of a population with mild to profound intellectual disability (ID). DESIGN: PTA was performed at six frequencies at the screening level 20 dB HL. Referral criteria were threshold levels ≥ 25 dB HL at two or more frequencies for one ear or both. STUDY SAMPLE: 1478 participants aged 7-91 years were included. RESULTS: 1470 (99.5%) people cooperated in screening of which 1325 (90%) could be tested on both ears at all six frequencies. A majority, 987 (66.8%), performed ordinary PTA, 234 (15.8%) conditioned play audiometry, and 249 (16.9%) behavioural observation audiometry. Six hundred and sixty-nine (45%) passed and 809 (55%) failed according to referral criteria. Of those failing, 441 (54.5%) accepted referral to clinical evaluation. CONCLUSIONS: PTA with slight modifications is applicable for screening of a population with mild to profound intellectual disability. The most challenging and time-consuming activity is to introduce the test procedure in a way that reduces anxiety and establishes trust.

Quality of life among the elderly with locomotor disabilities in Sweden and Poland in the 1990s.

PURPOSE: To estimate the proportion of locomotor disabilities in two elderly populations in Sweden and Poland, respectively. To estimate the perceived quality of life (QoL) in the disabled groups in samples from each country using a model developed by Carol Estwing Ferrans. METHODS: The study comprised three parts: an epidemiological screening test for identification of individuals with a locomotor disability, an analysis of background data of importance and home visits with evaluations of quality of life and functional capacity. Home visits were made using the Quality of Life Index, (QLI) of Ferrans and Powers and a functional scale, the Standardized Practical Equipment (SPE). Data were collected for the period 1991-1996. RESULTS: In the population part of the study, with 1,380 respondents (78%) comprising elderly Swedish persons, 288 reported a locomotor disability. This can be compared with 425 among 1,045 respondents (52%) in a Polish elderly group. The tests at the home visits (Sweden, n = 89; Poland, n = 84) showed that both men and women in the Swedish group reported significantly higher scores for the total QLI (max. 30.00) with men reporting 26.68 points compared to 19.73 and women reporting 21.39 points compared to 19.40 and for three of the four subscales. Also, the Polish group scored lower for balance and mobility (SPE). CONCLUSION: The study provides an important view of the life situation measured with the QLI tool and the SPE for elderly persons with locomotor disorders in Sweden and Poland during the mid-1990s. The results are congruent with epidemiological reports on the poor health situation in Poland, particularly during that time. A new investigation among the elderly with locomotor disorders in the two countries today might provide different results.

Swedish mothers and fathers of children with cancer: perceptions of well-being, social life, and quality care.

The overall aim was to describe and compare well-being, social life, and quality care among parents of children with cancer with respect to mothers versus fathers and whether the children were on versus. off treatment. The Life Situation Scale for Parents (LSS-P) was answered by 320 parents, comprising 85 mothers and 71 fathers of children on treatment, and 93 mothers and 71 fathers of children off treatment. The results show that the well-being of parents of children with cancer is affected by their child's situation, and that they experience such things as economic strain and a sense of being dependent on the care provided, especially during the child's treatment phase. Mothers whose children are receiving treatment see their life situation as less satisfying, and report being sadder and having lower self-esteem.

The Swedish version of the Philadelphia Geriatric Center Multilevel Assessment Instrument, by age and gender in an old-age Swedish population, especially related to locomotor disability.

The aim of this study was to explore the pattern of the Swedish version of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI), in respect of age and gender, in a sample of old people with locomotor disability from a population aged 60 years and older in Sweden and compare it with other studies in the same area for the purpose of further validation. The participants (n = 199) were selected from a population (n = 3469), age >or=60 years, in two counties in Sweden and were visited in their own homes. The measure was carried out with two instruments, the Swedish version of PGCMAI, used as an interview, and the Standardized Practical Equipment test consisting of practical tasks. We found that these two instruments distinguished the functional pattern among old men and women where women had deteriorated most with age. This is in agreement with other studies.

Psychometric testing of the Swedish version of the Philadelphia Geriatric Center Multilevel Assessment Instrument.

We examined whether the Swedish adaptation of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) developed by Lawton meets criteria for reliability and validity in an elderly Swedish population with locomotor disability. Data were collected, using the mid-length version of the instrument, from 199 elderly people with locomotor disability in two Swedish counties. Reliability was determined by Cronbach's alpha and construct validity was tested by means of exploratory factor analysis. Comparison was made with the Standardized Practical Equipment (SPE) test. Factor analysis identified eight factors, which were comparable to the original eight domains. There was a logical correlation between the PGCMAI and the SPE test. Further psychometric testing is recommended on other groups of elderly people.

A Five-year Follow-up of Quality of Life in Women with Breast Cancer in Anthroposophic and Conventional Care.

Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after 1 year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group.

Women's perceptions and beliefs about the genesis of their breast cancer.

A person's belief is seen as a set of assumptions, depending on perceptions, and formed with the influence of experiences and social culture. With the aim of understanding the beliefs about the genesis of their illness, 118 (59 + 59) women with different stages of breast cancer were interviewed. Half of the sample had chosen complementary care in an anthroposophical hospital, and the other half was a matched group. Qualitative content analysis was used. Three themes emerged: (1) belief in a link to life lived (71%), (2) heredity as the sole genesis (4%), and (3) rejection of the question (25%). Under beliefs in a link to life lived, external aspects to the patient's own life (eg, diet and lifestyle) were cited, as well as inner aspects such as psychosocial problems and stress. The findings show that women are well informed about medical facts, although their beliefs reveal a holistic approach. The women's beliefs, where inner psychosocial factors are uppermost, point to a reverse of the causal ranking of medical advisors. The difference between the groups was that the matching sample was more likely to reject the influence of possible causes from life lived. In a caring perspective, women's perceptions of the genesis of their illness are in some cases turned to creative health activities that may increase well-being.

Coping in women with breast cancer in complementary and conventional care over 5 years measured by the mental adjustment to cancer scale.

OBJECTIVE: Many patients with cancer, women more often than men, use complementary and alternative medicine (CAM) and care. Our aim was to examine coping over 5 years (November 1995 to January 1999) in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment. The present study is part of a larger study of the outcome of anthroposophic care for women with breast cancer. DESIGN: A nonrandomized controlled trial design was used with individual matching and repeated measurements on six occasions (at admission, 1 month, 3 months, 6 months, 1 year, and 5 years). The matching was based on the following variables: stage of disease at entry, age, treatment during the 3 months before entering the study, and prognosis. SETTING: An anthroposophic hospital and conventional hospitals in Sweden. SUBJECTS: Sixty (60) women treated with anthroposophic medicine and 60 women from an oncology outpatient department participated. Forty-nine (49) women in anthroposophic care and 51 in the outpatient group survived 1 year; 26 women in anthroposophic care and 31 in the outpatient group survived 5 years. INTERVENTION: An anthroposophic care program. OUTCOME MEASURE: Coping was measured using the Mental Adjustment to Cancer scale. Repeat measures of analysis of variance (ANOVA) were used for within-group comparisons, and effect size (ES) was used for between-group comparisons. RESULTS: The women in anthroposophic care showed more passive and anxious coping on admission, but this decreased over time. In the women in anthroposophic care, there were small ES improvements in fighting spirit and passive, anxious coping at 4 of the measured timepoints compared to admission. CONCLUSION: The choice of anthroposophic care could be seen as a possible way to cope with emotional distress in this group of women with breast cancer.

Suffering related to health care: a study of breast cancer patients' experiences.

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.

Evaluation of quality of life/life satisfaction in women with breast cancer in complementary and conventional care.

The aim was to study the perceived quality of life/life satisfaction in a sample of women with breast cancer who were treated in a hospital with alternative/complementary care and the same variables in individually matched patients who received only conventional medical treatment. A non-randomized controlled trial design with repeated measurements was used. Sixty women with breast cancer treated with anthroposophic medicine (ABCW) and 60 with conventional medicine (CBCW) were included and 36 matched pairs took part on all occasions. The quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire (LSQ). The comparisons were calculated as effect sizes (ES). The women in the ABCW group reported small or moderate effects, expressed as ES, on their quality of life/life satisfaction compared to their matched "twins" in the CBCW group at the 1-year follow-up in 15 out of 21 scales/factors. It was concluded that the women who had chosen anthroposophic care increased their perceived quality of life/life satisfaction according to the methodology of the study.

The life situation and functional capacity of the elderly with locomotor disability in Sweden and Poland according to a model by Lawton.

A quadripartite concept, the Good Life for older people, was developed by the American psychologist M. P. Lawton and forms the theoretical framework of this study. Ninety Swedish and 93 Polish subjects, aged > or = 60 years who had reported locomotor disturbances in selected samples from the two countries, took part in the study. Interviews were performed using the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) and functional testing was done using the Standardized Practical Equipment (SPE). The Polish elderly scored lower in most domains of the PGCMAI, which meant a worse life situation according to the Good Life model. On the SPE, scoring was lower in the Polish group, mainly on items related to balance and mobility. There was a logic convergent validity between the PGCMAI and the SPE in the whole group. The somewhat more complicated life situation for the Polish elderly has to be further analysed.

Swedish nursing students' attitudes to and awareness of research and development within nursing.

BACKGROUND: Nurses' attitudes towards research have been illuminated in many studies. However, there is still a need for more knowledge about the attitudes and awareness of undergraduate nursing students. AIMS: To investigate Swedish undergraduate nursing students' attitudes towards and awareness of research and development within nursing, and to illuminate factors that may have an impact on their attitudes and awareness. METHODS: A questionnaire consisting of three parts: demographic data, attitude scale, and research awareness was used. Parametric and nonparametric statistics were used. Two hundred and one students participated in the study and the response rate was 77%. Cronbach's alpha test on the seven factors was between 0.52 and 0.80. RESULTS: Most of the students had positive attitudes towards nursing research. More than half (60%) of the students expected to make use of nursing research sometime in the future and about 25% had never read any of the scientific nursing journals. The majority (77%) of the students were acquainted with at least one Swedish researcher, but few had attended a doctoral dissertation. Students with an interest in some particular development or research area in nursing were significantly more positive and expected to make use of nursing research more frequently. Other variables that were found to have some impact upon attitudes were gender, age and additional academic studies. CONCLUSIONS: Nursing students had an overall positive attitude towards nursing research and their interest in a particular development or research area was the most important variable for their attitudes and expected use of nursing research in the future. Therefore, it would seem to be important to encourage the students' interest in specific development/research areas of nursing during their education. In spite of the nursing students' positive attitudes to nursing research, the study demonstrates the theory-practice gap is still present to some degree.

Ethical values in health care: an Indian-Swedish co-operation.

The aim of this report is to present an example of a multidisciplinary Indian-Swedish co-operation on ethics in health care. It is based on a conference held in Asia Plateau, Panchgani, Maharasthra, India in 1998. The emphasis is on ethical values that are important for consumers of health care and professionals, and also for different cultures in developed and developing countries. The importance of human dignity is stressed. Sixteen recommendations are given in an appendix.

Significant others' experience of suffering when living with women with breast cancer.

This is an inquiry into how significant others experience being close to a woman suffering from breast cancer. In order to find this out, theme interviews were arranged with 17 women and 16 significant others from four different caring cultures in Sweden and Finland. A phenomenological case study methodology was adopted and in the analysis of the data a scientific teamwork model was employed, based on ideas developed at the Vancouver School of Doing Phenomenology. The findings show that the significant others experience deep often unrelieved suffering. They consider themselves prisoners of a situation of uncertainty and powerlessness when standing by the woman. They are torn between their own suffering and their desire to alleviate the woman's suffering. A vicious circle of mutual protection intensifies the suffering of the significant other, while actively sharing the suffering brings relief. The gravity of the situation creates an ethical urge in the significant other to assume responsibility for life in common with the woman.

Evaluation of the life satisfaction questionnaire (LSQ) using structural equation modelling (SEM).

The life satisfaction questionnaire (LSQ) was developed for use in conventional and complementary/anthroposophic care to assess the quality of life/life satisfaction of Swedish women with breast cancer. The first attempt to test the reliability and validity was in a sample of women with breast cancer (n = 362), the second in a random sample of Swedish women (n = 257). A theoretical model with six latent and 34 manifest variables was formulated. The aim of the present study was to perform confirmatory factor analyses using structural equation modelling. The software STREAMS was used. An additional sample of men (n = 263) was randomly selected from the Swedish population register. Confirmatory factor analyses were performed for the combined sample of women and men (n = 520) and for the women with breast cancer. The result of the confirmatory factor analyses showed that the factor structure of the original model was confirmed. The factors were called physical symptoms (PS), sickness impact (SI), quality of everyday activities (QDA), socio-economic situation (SES), quality of family relation (QFA), and quality of close friend relationship (QFR).

The face of suffering among women with breast cancer-being in a field of forces.

Through qualitative interviews, the suffering experiences of women with breast cancer and their significant others were disclosed. Seventeen women with different stages of breast cancer and 16 significant others from 4 different care cultures in Sweden and Finland participated. Five of the women had advanced metastatic breast cancer, and 12 had a localized disease. Mean age was 48 years. As a methodology, a team approach, inspired by the Vancouver School of Doing Phenomenology, was used. The findings elucidate how the suffering experience touched the women's inner existence and values. This can metaphorically be described as a "field of force" and affected everything in the women's lives, including their views of themselves and their relationships. Existential questions were raised about life and death and the meaning of life. In their suffering, the women's dependency upon significant others, as well as healthcare personnel, was prominent. Suffering related to healthcare was a strong theme. Different faces of suffering related to breast cancer may still be unknown by healthcare professionals working in cancer care.

Psychometric testing of the NEECHAM Confusion Scale among patients with hip fracture.

The main aim of this study was to assess the reliability and validity of a Swedish translation of the NEECHAM Confusion Scale among 73 patients having surgery for hip fractures. Cronbach's alpha before and 7 days after surgery were.73 and.82, respectively. Principal-component analyses yielded three factors explaining 69% of the variance of the variables preoperatively and 73.6% of the variance 7 days postoperatively. Four months after discharge vital function, factor II in the NEECHAM scale, significantly predicted the total score on the Ferrans and Powers Quality of Life Index. Items reflecting information processing, behavior, and urinary continence, factor I, also predicted functional capacity, using the Standardized Practical Equipment test, a tool measuring instrumental daily activity. The scale seems to be a reliable and valid instrument for evaluating acute confusional state among patients with hip fracture.