Ann Langius-Eklöf

Gender Differences in Perceived Health-Related Quality of Life Among Patients with HIV Infection

This article explores how a group of human immunodeficiency virus (HIV)-infected patients perceived their health-related quality of life (HRQOL) in relation to their coping capacity expressed as sense of coherence. The emphasis was on gender differences. The sample consisted of 55 women (29%) and 134 men (71%), receiving outpatient medical care in a hospital. Self-report instruments, the health index, the HIV symptom scale, the well-being scale, the sense of coherence (SOC) scale and the Interview Schedule for Social Interaction were used. Disease status (HIV CDC classification, absolute CD4+ lymphocyte count and HIV/RNA) was also measured, and demographic data were collected. The total sample scored significantly worse self-rated health and weaker SOC than healthy controls. The HIV-infected women were significantly younger than the men (p < 0.0001). The majority of the women (60%) were infected by heterosexual transmission and of the men (58%) by homosexual/bisexual contacts. In the univariate analysis the women scored significantly less positive well-being (p < 0.05), weaker SOC (p < 0.05), and less social support (p < 0.01) than the men despite less advanced disease. Multiple regression analyses revealed that SOC was the strongest predictor of subjective HRQOL in both genders. The results suggest that health professionals who individualize their care of HIV-infected patients should try to be sensitive to the different ways in which men and women express their HRQOL.

Determinants of health-related quality of life in long-term survivors of Hodgkin's lymphoma.

In this study health-related quality of life (HRQL) in long-term survivors of Hodgkins lymphoma (HL) was evaluated and the findings were analyzed using a conceptual model developed by Wilson and Cleary. A better understanding of the relationships between the variables explaining HRQL may improve care and rehabilitation of HL patients. The populations were long-term survivors of HL (n=121) and a control group (n = 236). Participants were approached with one semi-structured interview, an extended version of the Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW) and three standardized questionnaires: Hospital Anxiety and Depression (HAD) scale, Short Form 12 health survey questionnaire (SF-12) and Sense of Coherence (SOC) scale. No differences regarding the mean scores were found between the HL survivors and the controls except for the SF-12, where the patients considered themselves to be in poorer physical health than the controls (p < 0.01). Even though physical health was diminished, patients did not evaluate overall QoL worse compared to the controls. The major determinants of perception of general QoL were self-rated physical and mental health as well as SOC. The HRQL of persons who have survived a median of 14years with HL is similar to that of controls.

Well‐being and sense of coherence during pregnancy

Background.  Our knowledge of how a woman as an individual experiences, evaluates and copes with pregnancy is limited. The concept of ‘sense of coherence’ as described by Antonovsky may be an important factor in how people deal with stressful situations in life. The aim of this study is to describe pregnant womens perception of well‐being during pregnancy and after delivery and to explore its relationship to their sense of coherence.

Individual quality of life in long-term survivors of Hodgkin's lymphoma - a comparative study

This study aimed to use an individual approach in evaluating QoL in long-term survivors of Hodgkins lymphoma (HL) and their view of what impact the disease has had on life using an extended version of the The Schedule for the Evaluation of the Individual quality of life-Direct Weighting (SEIQoL-DW). Adult long-term survivors from HL (n = 121) were compared with a randomly selected sample of the general population in Stockholm (n = 236). The results showed that the most commonly nominated areas (>50% of patients and controls) important in life were family, personal health, work and relations to other people. The HL survivors mentioned leisure and finances less frequently than the controls. However, neither the current status in the different areas nor the QoL index score differed between survivors and controls. Thoughts and worries around disease, fatigue and loss of energy and late effects on skin and mucous membrane were the most commonly reported problems following HL. Sixty-six percent of the survivors reported a change in their view of life and of themselves. Demographic and disease characteristics did not influence the ratings of the chosen areas. In conclusion, long-term survivors of HL seem to have adapted well to the situation of having had a life-threatening disease and undergoing treatment, as measured with SEIQoL-DW. The extended Swedish version with a disease-specific module could be of great value when identifying specific issues that are important for the patient at time of evaluation.

Self-Reported Adherence to Antiretroviral Treatment and Degree of Sense of Coherence in a Group of HIV-Infected Patients

The goal of this study was to explore the relation between self-reported adherence to antiretroviral treatment and degree of sense of coherence in a group of human immunodeficiency virus (HIV)-infected patients. Ninety-nine patients from an outpatient clinic, all undergoing antiretroviral therapy, participated. Questionnaires were answered twice at a 12-month interval. The 29-item Sense of Coherence (SOC) Scale was used for measuring the ability to cope with stressful life situations. Medication adherence was assessed with self-reported measurements. Clinical characteristics and background variables were collected from the medical records. Results from variables measured with the 12-month interval show a significant concordance with disease stage (p < or = 0.0001), and in HIV-RNA copies per milliliter (p < or = 0.0001) and an increase in CD4 cell count/mm3 (p = < 0.0001). Univariate analysis showed significant differences between nonadherent patients (n = 19) and adherent patients (n = 80) at the last measurement (i.e., the nonadherent group had lower CD4 cell count/mm3 [p = 0.004], higher HIV-1 RNA levels [p 50.029], and lower SOC [p = 0.04] than the adherent group). Finally, multiple regression analyses showed that at measurement 2 the SOC predicted nonadherence, the lower SOC the more missed doses (p < or = 0.01). Because SOC seems to play an important role in this group of patients managing their disease, a caring patient-provider relationship should be developed to minimize nonadherent behaviour. For this reason SOC scale might be of great clinical value to identify patients needing the most support for successful treatment.

Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial.

This multicentre, randomized controlled trial hypothesized that daily electronic transmission of body weight to a heart failure (HF) clinic will reduce cardiac hospitalization in patients recently hospitalized with HF.

Intermittent versus indwelling urinary catheterisation in hip surgery patients: A randomised controlled trial with cost-effectiveness analysis

BACKGROUND Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. OBJECTIVES The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness. DESIGN Randomised controlled trial with cost-effectiveness analysis. SETTING The study was carried out at an orthopaedic department at a Swedish University Hospital. METHODS One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. RESULTS Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods. CONCLUSIONS Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.

Validation of an extended version of the SEIQoL-DW in a cohort of Hodgkin lymphoma' survivors.

Individual measures of quality of life (QoL) have been initiated to overcome the possible limitations with standardized measures using predefined domains for evaluation. The Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) uses personal interviews to explore the five most important areas in life, both positive and negative, crucial for QoL. The nominated areas are rated regarding satisfaction and weighted to capture the importance of each selected area. The Swedish version has been extended with a disease-specific module, which evaluates the areas in life influenced by disease. The aim of this study was to validate the disease-specific SEIQoL-DW and furthermore, to evaluate the influence of the importance ratings on the overall index score in a cohort of Hodgkin lymphoma survivors. The results support the construct validity of the disease-specific SEIQoL-DW and indicate that the instrument appears to be a sensitive measure with ability to differentiate between groups with disparate subjective health status. The SEIQoL-DW succeeds to capture both positive and negative areas in life influenced by disease. The present study gave no evidence that the weighting procedure has any impact on the total index. The results support the use of the new extended version including a disease-specific module.

Dizziness: A common, troublesome symptom but often treatable

OBJECTIVE To investigate the prevalence of self-rated dizziness/unsteadiness and health as well as to estimate the proportion of participants with peripheral vestibular disorders. METHODS Altogether, 2547 participants (66%) participated in an epidemiological cross-sectional study, including self-rated questions about dizziness/unsteadiness, concomitant auditory symptoms and self-rated general, psychosocial and mental health. RESULTS The overall prevalence of dizziness was 21% and higher among women (27%) than men (14%) (p< 0.001). Dizziness, provoked by the movement of lying-down (benign paroxysmal positional vertigo), was noted in 5% of the participants with the symptom occurring more often in women than in men (p< 0.001). Twenty-four percent of the men and 21% of the women with dizziness simultaneously experienced a sense of rotation and loss of hearing and tinnitus. Fifteen percent reported falls because of dizziness. Both men and women suffering from dizziness symptoms perceived worse self-rated health generally, psychosocially and mentally than those without symptoms of dizziness (p< 0.001). CONCLUSION Dizziness-related symptoms are common in all age groups and may manifest worse self-rated health. About 50% of the participants had symptoms indicating origin of peripheral vestibular disorders. Self-rated questions seem capable of identifying patients for referral to clinical examinations and subsequently those who can be successfully treated.

Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: psychometric properties

AIM This paper is a report of a study to translate one Swedish and three English instruments into the Persian language, and to estimate their validity and reliability. BACKGROUND The Sense of Coherence Scale, Health Index, Brief Religious Coping Scale and Spiritual Perspective Scale are all well tested instruments for use in nursing research. Since there was no Persian translation of these instruments, they had to be translated and cross-culturally adapted for nursing research in the Iranian culture. METHOD After the translation process, sampling for psychometric tests was done. A sample of healthy Iranian people (n = 375) was selected to response to the instruments in 2006, at baseline and 1 month later. FINDINGS Cronbachs alpha values and intra-class correlations were high (>0·70). Tests of criterion-related validity showed that six of the ten hypotheses were confirmed, and the four rejected hypotheses did not imply a threat to validity. Hierarchical multiple regression analysis showed that sense of coherence was the strongest predictor of well-being (Health Index scores) both at baseline (= 0·52, P < 0·001) and 1 month later (= 0·58, P < 0·001). CONCLUSION There is a sound psychometric basis for using the Iranian versions of these instruments in nursing research with the Iranian population. The Sense of Coherence Scale proved to be as valid and reliable as in Western countries, which supports its cross-cultural applicability.