Ellen Karine Grov

The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors

Background. Neuroticism is a personality trait expressing nervousness and insecurity. Associations between neuroticism and morbidity in long-term cancer survivors have hardly been explored. The aim of this study was to explore associations between neuroticism and somatic and mental morbidity and lifestyle issues in long-term survivors of testicular cancer (TCSs). Material and methods. All Norwegian TCSs treated between 1980 and 1994 (n = 1 814) were invited to this cross-sectional study. Among them 1 428 (79% response rate) delivered valid data. Neuroticism was self-rated on an abridged version of the Eysenck Personality Inventory. Information was collected by mailed questionnaires. The associations of neuroticism and self-reported variables were tested with multivariate logistic regression analyses. Results. Neuroticism was significantly associated with presence of somatic complaints, reduced physical function, neurotoxic side-effects (tinnitus, hearing impairment, peripheral neuropathy, and Raynauds Phenomenon), self-esteem, concerns about not being able to father children, sexual problems, hazardous alcohol use, daily use of medication, use of sedatives and hypnotics, recent visits to a general practitioner, and seeing a psychologist/ psychiatrist after ended cancer treatment. Poor self-rated health, higher number of negative life events, economical problems and problems getting loans granted showed significant associations with neuroticism. Discussion. Neuroticism in TCSs at long-term follow-up is significantly associated with somatic and mental morbidities, and several aspects of unhealthy lifestyle. High levels of neuroticism should be considered in TCSs expressing multiple complaints and concerns at follow-up consultations. Assessment of neuroticism may be clinically important in order to offer appropriate interventions to prevent and manage morbidity in TCSs.

Activity of daily living problems in older cancer survivors: a population-based controlled study.

The ability to perform activities of daily living (ADL) is a crucial factor for independent functioning and living at home. This population-based cross-sectional study examines ADL problems in older cancer survivors compared with an age-matched cancer-free control group. According to both The Cancer Registry of Norway and self-report, 911 individuals > or =70 years had invasive cancer among the participants of The Health Study of Nord-Trøndelag County (HUNT-2) 1995-7. Three age- and gender-matched cancer-free controls for each cancer survivor were drawn from HUNT-2 (N = 2733). Personal- and Instrumental-ADL (P-ADL and I-ADL) problems were self-rated. P-ADL problems addressed activities such as personal hygiene, dressing and eating, while I-ADL problems concerned household activities, managing finances, shopping and administration of medication. Associations among relevant independent variables and P- and I-ADL problems were examined with both descriptive and multivariate statistics. P-ADL problems were present in 10% of the cancer survivors and 8% of the controls (P = 0.02). Correspondingly, 38% of the cancer survivors had I-ADL problems versus 32% of the controls (P < 0.001). Older cancer survivors with co-morbidity showed significantly higher rates of P-ADL and I-ADL problems compared with controls with co-morbidity (14% versus 9%, P = 0.01, and 47% versus 39%, P = 0.02). Cancer survivors with co-morbidity had significantly more P-ADL and I-ADL problems than survivors without co-morbidity (14% versus 8%, P = 0.01 and 47% versus 32%, P < 0.001). This study showed higher incidence of ADL problems among a population of older cancer survivors compared with cancer-free controls. Somatic co-morbidity further increased the prevalence of both P- and I-ADL problems in the cancer survivors. Primary healthcare providers should pay attention to and assess ADL problems in older cancer survivors.

Rasch analysis of the Beck Depression Inventory-II in stroke survivors: A cross-sectional study

BACKGROUND The Beck Depression Inventory-II (BDI-II) is often used to assess depressive symptoms among stroke patients, but more evidence is needed regarding its psychometric properties in this population. The purpose of this study was to assess the BDI-II׳s psychometric properties using a Rasch model application in a sample of patients 6 months after a first clinical stroke. METHODS Data were collected prospectively from patient medical records and from questionnaires (with assistance if needed) as a part of a longitudinal study of poststroke fatigue. Data from the 6-month follow-up were used in this analysis. The sample consisted of 106 patients with first-ever stroke recruited from two Norwegian hospitals between 2007 and 2008. Depressive symptoms were measured with the BDI-II. Rasch analysis was used to assess the BDI-II׳s psychometric properties in this sample. RESULTS Five BDI-II items did not demonstrate acceptable goodness-of-fit to the Rasch model: items 10 (crying), 16 (changes in sleep), 17 (irritability), 18 (changes in appetite), and 21 (loss of interest in sex). If these 5 items were removed, the resulting 16-item version not only had fewer items, it also had better internal scale validity, person-response validity, and person-separation reliability than the original 21-item version in this sample of stroke survivors. LIMITATIONS The study did not include a clinical evaluation of depression. CONCLUSION A 16-item version of the BDI-II, omitting items 10, 16, 17, 18 and 21, may be more appropriate than the original 21-item BDI-II for use as a unidimensional measure of depression in patients following first-ever stroke.

Stuck between a rock and a hard place: the work situation for nurses as leaders in municipal health care

Background The paper aims to present how nursing leaders in the municipal health care perceive the interaction with and support from their superiors and peers. The paper further aims to identify the leaders’ vulnerability and strength at work in the current situation of shortage of manpower and other resources in the health care sector. This is seen through the lens of self-determination theory. Methods Qualitative interviews were conducted with nine nursing leaders in nursing homes and home-care services, which, in part, capture the municipal health care service in a time of reform. Results The nursing leaders are highly independent regarding their role as leaders. They act with strength and power in their position as superiors for their own staff, but they lack support and feel left alone by their leader, the municipal health director. The relation between the nursing leaders and their superiors is characterized by controlling structures and lack of autonomy support. As a consequence, the nursing leaders’ relations with subordinates and particularly peers, contribute to satisfy their needs for competence and relatedness, and, to some extent, autonomy. However, this cannot substitute for the lack of support from the superior level. Conclusion The paper maintains a need to increase the consciousness of the value of horizontal support and interaction with peers and subordinates for the municipal nursing leader. Also, the need for increased focus on “the missing link” upward between the municipal health director and the nursing leader is revealed. The impact of extensive controlling structures and lack of autonomy support from superiors might lead to reduced motivation and well-being.

The Cancer Trajectory — A Model of Phases

The aim of this paper is to present a model of phases in the cancer trajectory. This presentation might be valuable as a visual description of the cancer journey because the track may have several sub-classifications. The model is suggested for clinical and research purposes and might work as a map or navigation guide.

The Experience of Relations in Persons with Dementia: A Systematic Meta-Synthesis

Background: Dementia influences a persons experience of social relationships, as described in several studies. In this systematic meta-synthesis of qualitative studies, we aim to interpret and synthesize the experiences of persons with dementias and their relations with others. Summary: Living with dementia changes life, leading to new social roles and different social statuses. Persons with dementia experience being disconnected and dependent on others, feeling like being a burden, and being a person who is treated in paternalistic ways. Family, friends and others with dementia might play significant roles in their ability to maintain a meaningful life. Key Messages: Three categories emerged from the data, change in life, change in relations, and maintenance of meaningful aspects in life; these categories are intertwined and essential in sustaining a lifeline for persons with dementia. The comprehensive meaning of the material is understood as the expression: Living a meaningful life in relational changes.

Sleep among bereaved caregivers of patients admitted to hospice: a 1-year longitudinal pilot study

Objectives This pilot study aimed to describe the sleep of partners and other family caregivers prior to and in the first year after a hospice patients death. The study also evaluated the feasibility of the study protocol and determined the effect sizes in preparation for a full-scale study. Design The pilot study used a longitudinal, descriptive and comparative design. Setting and participants Participants included primary family caregivers of patients admitted to a hospice in Oslo, Norway. Primary outcome Caregiver sleep was measured subjectively with the Pittsburgh Sleep Quality Index (PSQI) and objectively using wrist actigraphy for 4 nights and 3 days at three different times: during the hospice stay, and at 6 and 12 months after the patients death. Results 16 family caregivers (10 partners and 6 other family members) completed the 1-year study protocol. Overall, sleep quality and quantity were stable over time and at each assessment, approximately half of the sample had poor sleep quality, both by self-report and objective measures. However, the sleep trajectories differed significantly over time, with older caregivers (≥65 years) having significantly longer sleep durations than younger caregivers (<65 years). Furthermore, sleep quality also differed over time depending on the caregivers relationship to the patient, with partner caregivers having significantly worse sleep quality than other family caregivers. Conclusions Caring for a dying family member is known to interfere with sleep, yet little is known about bereaved caregivers. The results of this pilot study demonstrate the feasibility of the longitudinal study protocol and indicate that sleep problems are common for caregivers and continue into the bereavement period, particularly for partner caregivers. The caregivers relationship to the patient may be an important factor to consider in future studies.

Cured of Primary Bone Cancer, But at What Cost: A Qualitative Study of Functional Impairment and Lost Opportunities

Purpose. Our study aims to explore how former cancer patients experience physical and psychosocial late effects 3–7 years after they underwent treatment for primary bone sarcoma in the hip/pelvic region. A qualitative, phenomenological, and hermeneutic design was applied. Methods. Sarcoma survivors (n = 10) previously treated at Oslo University Hospital, Norwegian Radium Hospital were selected to participate. In-depth and semistructured interviews were conducted. The interviews were analysed using inductive thematic analysis. Results. The participants reported that the late effects had three core spheres of impact: “their current daily life,” “their future opportunities,” and “their identity.” They expressed negative changes in activity, increased dependence on others, and exclusion from participation in different areas. Their daily life, work, sports activities, and social life were all affected. Several of their experiences are similar to those described by people with functional impairment or disability. Conclusion. Patients cured of bone cancer in the hip/pelvic region pay a significant price in terms of functional impairment, practical challenges, exclusion from important aspects of life, and loss of previous identity. It is important to appreciate this in order to help bone cancer survivors who struggle to reorient their life and build a secure new identity.

Kompetanseutvikling i sykehjem; ansattes perspektiv

Denne artikkelen handler om kompetanseutvikling i sykehjem og baserer seg pa en intervjuundersokelse med ansatte ved to sykehjem. Resultatene viser at de ansatte laerer av hverandre pa uformell basis. Imidlertid tyder studien pa manglende systematikk i kompetanseutviklingen. Det er mange tilbud om kurs, men innholdet samsvarer ikke med de ansattes og sykehjemmets behov slik ansatte ser det. Internundervisningen er ikke tilstrekkelig med tanke pa a na alle ansattes behov. Kunnskapskilder er ikke tilgjengelig, og kommunikasjonskanaler, motivasjon, belonning og medbestemmelse syntes ikke ivaretatt som middel for kompetanseutvikling. De ansatte kjenner ikke til om sykehjemmene har mal og planer for kompetanseutvikling. Det kreves et bredt spekter av tilnaerminger for a skape positiv kompetansekultur og kontinuerlig fokus pa kompetanseutvikling. Denne studien gir grunn for a framheve betydningen av vekt pa utvikling av formelle strukturer for kompetanseutvikling, kartleggig av kompetansebehov, lokale kompetanseplaner og ledelse av kompetanseutviklingsarbeidet.

Self-rated health aspects among persons living with chronic obstructive pulmonary disease

Purpose To describe a cohort of chronic obstructive pulmonary disease (COPD) patients and perform a within-group comparison regarding self-management activation, social provision, and health status. Patients and methods A cross-sectional survey including 116 persons. Results The sample comprised 65 men and 38 women, mean age 69 years. Fourteen percent reported very high impact of COPD on their health; 19% had received pulmonary rehabilitation offers, 39% had been offered self-management education, and 64% had acute hospital admissions due to COPD complications in the past year. Persons with COPD Assessment Test (CAT) scores ≥30 reported significantly poorer self-management activation and significantly lower social provision than those reporting CAT scores <30. Number of COPD years had no significant influence on COPD health care consultations or self-management activation. Conclusion Persons with COPD reported decreasing social provision with increasing COPD years and poorer health status. Although COPD is a progressive disease, health status and self-management activation did not vary with number of COPD years. Those living with a very high COPD impact on health reported significantly lower self-management activation but fewer acute hospital admissions. Practice implications COPD patients’ need for pulmonary rehabilitation, self-management support, and social support should be assessed and appropriate services offered throughout the disease trajectory.