Helga Jonsdottir

Predictors for chronic pain‐related health care utilization: a cross‐sectional nationwide study in Iceland

Individuals with chronic pain are among the most frequent users of health care. Still, a significant percentage does not utilize health care for pain. A range of factors predict chronic pain‐related health care utilization.

Smoking addiction in chronic obstructive pulmonary disease Integrating neurobiology and phenomenology through a review of the literature

The aim of this review is to extend professional understanding of the various mechanisms that make smoking cessation difficult for patients with chronic obstructive pulmonary disease (COPD). Smoking in people with COPD is a major challenge for health care today. In spite of significant advances in knowledge about the processes of nicotine addiction, current interventions to support smoking cessation in patients with COPD are less successful than hoped for. A wealth of literature has confirmed that nicotine addiction is a powerful force and that smoking is not simply an unhealthy lifestyle or destructive behavior. However, research based on this realization is still in its infancy. To increase understanding and to develop ways of enhancing smoking cessation in patients with COPD, we review and synthesize knowledge found in neurobiology and phenomenology. We use neurobiology to explain the neurochemical changes that take place in addiction in order to substantiate phenomenological perspectives of smoking in patients with COPD. We relate the smoking experience to the concept of “affordances”—in this context “smoking affordances”—to analyze how smoking affects action possibilities in individuals with COPD. Combining these perspectives helps to illuminate the manifold and unique issues related to smoking addiction in patients with COPD.

Hemispatial neglect following right hemisphere stroke: clinical course and sensitivity of diagnostic tasks

Abstract Background Stroke patients with severe symptoms of hemispatial neglect (HN) are known to experience a weaker recovery than those less affected from the outset. Correct identification of HN is therefore important throughout the course of rehabilitation. Objectives To explore: (i) the course of clinical symptoms in stroke patients with moderate/severe HN from acute setting to home, (ii) changes in sensitivity of diagnostic tasks over time, and (iii) agreement between the researcher’s and patients’ HN assessments. Methods Out of 79 consecutive patients, we included 23 patients with moderate/severe HN following right hemisphere stroke. The Catherine Bergego Scale was used as a benchmark for HN and to measure the congruence between the researcher’s and patients’ HN assessments. Diagnostic tasks included star cancellation, line crossing, line bisection, m-fluff test, figure copying, and clock drawing. Data were collected at t1: sub-acute stroke (days: M ± SD = 10.3 ± 5.25), t2: during rehabilitation (days: M ± SD = 51 ± 8), and t3: following discharge (days: M ± SD = 141.5 ± 47.3). Results (i) 20 out of 23 patients had HN at t3. Associated stroke challenges included paralysis, sensory loss, visual deficits, and extinction. (ii) Combining the star cancellation and figure copying yielded the highest sensitivity at all time points, even in patients with mild HN at t3. (iii) Patients’ HN scores differed from the researcher’s at t1. The difference was insignificant at t3. Conclusions Joint consideration of stroke severity, functional difficulties, and patients’ insight into neglect provides new knowledge to increase clinicians’ recognition of HN. More extensive studies are needed to validate bedside screening with star cancellation and figure copying.

Spatial neglect in stroke patients after discharge from rehabilitation to own home: a mixed method study

Abstract Purpose: To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home. Methods: A mixed method prospective study of 15 patients with neglect after a right hemisphere stroke, <1 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a ‘mixing matrix’ and integrated by ‘following threads’. Finally, a synthesis was written into a vignette. Results: The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants. Conclusion: Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect. Implications for Rehabilitation Findings demonstrate that identification of spatial neglect and the way symptoms of neglect impact on daily life functioning of stroke patients must be carefully pursued by health-care professionals working in stroke rehabilitation. Areas that should receive professional attention in the rehabilitation process include: preparing patients and their family for fluctuations related to neglect in the patient’s own home, locating issues that might impact safety, and identifying unique factors that either enhance or diminish neglect within each patient’s daily life context. The results of this study could be used to develop more wide-ranging assessment strategies to assist health-care professionals in identifying neglect after hospital discharge, for instance by expanding existing ecological assessment tools and including qualitative evaluation of test performance in paper-pencil tests, such as the star cancellation and figure copying.

Reluctance of patients with chronic obstructive pulmonary disease in its early stages and their families to participate in a partnership-based self-management trial: A search for explanation:

Recruitment, the process of accessing, screening, selecting and retaining participants for research remains a challenge. In a randomized controlled trial, partnership-based self-management intervention for patients who have chronic obstructive pulmonary disease (COPD) in its initial stages, and their families, a theoretical framework developed for patients with an advanced COPD and their families was modified and implemented in a primary care context. In contrast to recruitment to the original study where 4% decline participation, in this study 25% of the potential patients declined participation. Although participants were encouraged to bring a family member, only 25% of them did so. The main reason for not being accompanied by a family member was that patients did not want anybody accompany them. Those who had quit smoking were more often accompanied by a family member compared to those who smoked. Reviewing the literature, the most compelling explanations for non-participation are shame and self-blame due to smoking, and that potential participants may not have envisioned any benefits from participating since they might not have realized that they had COPD. An alternative recruitment process needs to embrace the situation that potential participants find themselves in and which takes account of the issues at stake.

Is health related quality of life related to the pattern of chronic pain

Abstract Background/aims When studying chronic pain in the general population, other factors besides prevalence may be equally important to establish the scope of the problem. Health related quality of life (HRQoL) is an important indicator for how chronic pain influences and interferes with the individual’s daily life. The relationships between different characteristics in the nature of pain and HRQoL have been investigated, showing number of pain locations and pain severity to be important. However, little is known about the relationship between pattern of chronic pain (constant/intermittent) and impact on HRQoL. The purpose of this study was to investigate the relationships between the pattern of chronic pain and impact on the individual’s HRQoL in a large nationwide population based sample. Methods A postal questionnaire on pain and HRQoL (SF-36), including information letter was sent to a sample of 4500 individuals, aged 20–70 years, randomly drawn from the Icelandic National Registry. Results Of 4500 questionnaires mailed 1586 were returned and completed (35.2%) Majority of respondents were women (56.5%) and the majority were married or cohabitating (73.7%). The total sample mean age was 46.2 years (women 45.3, men 47.3) and respondents were significantly older than non-respondents. The total prevalence of pain ≥3 months was 47.5% with mean duration of 9.3 years (SD = 9.96). One third (31.9%) of participants with pain ≥3 months reported constant pain and 21.4% daily intermittent. The rest reported frequent pain (27.8%) and periodical pain (18.9%). There was a significant relationship between the pattern of pain and both physical and mental components of HRQoL. Participants experiencing constant pain had the lowest scores on both scales. Conclusions The results of this study show that both physical and mental components of HRQoL among individuals experiencing chronic pain are significantly related to the pattern of pain. Constant and daily pain is associated with poorer HRQoL than intermittent or periodical pain.