Hjördis Björvell

Swedish population norms for the GHRI, HI and STAI-state

This paper presents reference values for two questionnaires measuring general health, the General Health Rating Index (GHRI) and the Health Index (HI) and one questionnaire measuring anxiety state, the State Trait Anxiety Inventory (STAI-state). The sample used was randomly selected from a Swedish urban population consisting of 180 individuals (90 men, 90 women), divided into three age groups, 26–45, 46–65 and > 65 years. There was a main effect for age on the total GHRI score. The GHRI score was lower for older than for younger people, which is in agreement with earlier studies. For the HI there were main effects both for gender and age and no interaction was found. Although the sample size is small our result was in agreement to earlier studies and to health statistics in Sweden 1989. The health measures significantly correlated with the scores of anxiety inventory used. The total GHRI scores correlated positively and significantly with the HI scale (r=0.7, p<0.001). The GHRI and HI scales correlated negatively and significantly with the STAI scale (r=−0.4, p<0.001, r=−0.4, p<0.001) respectively. Thus, the better the general health the lower the rated anxiety. The value of health status measures in clinical research is reasonably well established, but their values for clinical care are less clear. The use for health index scores for quality assurance purpose is almost unexplored and could possibly be used for outcome measures in evaluating areas of nursing interventions. The short Health index is one possible outcome measure.

Physical and psychosocial functioning in patients undergoing autologous bone marrow transplantation – a prospective study

The main purpose of this study was to evaluate prospectively physical and psychosocial functioning in patients with malignant blood disorders undergoing autologous bone marrow transplantation (ABMT), and relate the findings to the patients’ coping capacity. Twenty patients participated in the study before ABMT, 14 survivors at the 2–6 month follow-up and 12 at the 8–12 month follow-up. Three standardized questionnaires were used: the EORTC QLQ-C30, the Hospital Anxiety and Depression (HAD) scale and the Sense of Coherence scale. No significant changes over time were found in the scores of the QLQ-C30 and HAD. Impaired social function, fatigue, dyspnea, financial problems and emotional distress were the most frequently reported deficits. Functional limitations were related to less successful coping. The results indicate that the patients in this study perceive their physical and psychosocial functioning as rather good before, as well as up to 1 year after the ABMT, as measured with the instruments used.

Neuropeptides of the autonomic nervous system in Sjögren’s syndrome

OBJECTIVE To assess the activity level of the autonomic nervous system in Sjögren’s syndrome (SS) and to correlate this with stress. METHODS Patients with SS (n=12) and healthy controls (n=10) were analysed for the content of vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) in their stimulated saliva by radioimmunoassays and for stress by the use of a modified Jenkins Activity Survey (JAS). RESULTS The data are expressed as median (interquartile range). Salivary VIP output (pg/min) and NPY output (pg/min) were high in SS compared with healthy controls (30.0 (15.6, 36.6) versus 12.3 (9.2, 24.0), p=0.045, 4.8 (0.6, 24.1) versus 0.7 (0.0, 2.4), p=0.038, respectively). Patients experienced only a little, but not significantly, more stress than the healthy controls (stress index −2.8 (−7.7, 6.9) versus −5.2 (−12.9, 2.7), p>0.05). Stress in general was associated with high salivary VIP concentrations (r=0.41, p=0.05). CONCLUSIONS These findings show that adequately processed saliva (containing aprotinin and EDTA as neuropeptidase inhibitors) contains measurable amounts of marker peptides of the autonomic nervous system. Secondly, VIP concentration but not output may be affected by stress, which may act by decreasing watery salivary flow. In patients with SS, VIP and NPY outputs are increased. This may indicate increased leakage into saliva or efforts to compensate for the diminished salivary flow, or both.

The use and efficacy of coping strategies and coping styles in a Swedish sample.

This paper presents Swedish reference values for the Jalowiec Coping Scale (JCS-60), a questionnaire measuring the use and efficacy of coping strategies. The strategies are grouped in eight coping styles. The sample used was randomly selected from a Swedish urban population. The sample consisted of 268 individuals (135 men and 133 women), divided into three age-groups, 26-40, 41-55 and 56-70 years. There were no significant differences between the three age-groups or between men and women when comparing the total scores for use and efficacy on the JCS-60. No significant differences were found between the genders within each age-group. The most commonly used coping styles were the confrontational, the optimistic and the self-reliant. The least used style was the fatalistic. Men, as compared with women, used the confrontational and self-reliant coping styles more while women used the supportive coping style more than men. The youngest age-group used the emotive coping style more, compared with the other age groups. Cronbachs alpha for the total scores indicates acceptable reliability. The results of this study may be useful as Swedish reference values for comparison with the research results of studies on patients.

Post-traumatic Stress Symptoms in Patients Undergoing Autologous Stem Cell Transplantation

The aim of this explorative study was prospectively to evaluate the presence of post-traumatic stress symptoms (PTSS) in patients with hematological malignant disorders undergoing autologous stem cell transplantation (ASCT). The findings were related to sense of coherence and quality of life aspects. Twenty patients were evaluated with four standardized instruments before undergoing ASCT and then at two follow-ups. The patients participating in the study reported PTSS levels high enough to merit attention. Although PTSS declined over time, the levels were still high compared with other studied populations of cancer patients. Intrusive and avoidant symptoms correlated significantly to anxiety and depression but not to sense of coherence and physical dimensions. The high levels of PTSS and their relation to emotional distress emphasize the importance of psychosocial care for this group of patients.

Coping Strategies, Pain, and Disability in Patients With Hemophilia and Related Disorders.

OBJECTIVE To analyze the use of various coping strategies in homogeneous groups of patients with hemophilia and von Willebrands disease and to investigate the relationship between the state of the disease, the use of coping strategies, and management of the disease. METHODS The coping strategies measured by the Coping Strategies Questionnaire were analyzed in 3 homogeneous groups of 224 patients. Psychosocial well-being (PWB) measured by the Rand 36-item Health Survey 1.0 was used as an indicator of management of the disease. The pain factor consisted of the following variables: pain intensity, use of analgesics, Functional Disability Index, and physical activity level. RESULTS The groups of patients differed significantly only in the use of the catastrophizing strategy (CAT). In all pain groups, distraction was the most commonly used coping strategy. A significant interaction effect of pain factor and age on PWB (P = 0.04) was found. The mediating function of the CAT strategy was confirmed by the series of regression analyses. CONCLUSION The coping strategy profile in hemophilia was found to be similar to those in other chronic pain states. The use of the strategies does not depend on the severity of the disease. We confirmed the role of age and the use of the CAT strategy as, respectively, moderator and mediator in the pattern of relationships between the clinical state of the disease and psychosocial well-being.

Sense of coherence and outcome of anterior low-back fusion A 5- to 13-year follow-up of 85 patients

Eighty-five patients were followed up for more than 5 years after an anterior low-back fusion which was performed for a chronically painful low-back condition. The mean age of the patients at the time of the index operation was 35 years, the mean duration of their symptoms was 8 years, and 50 (59%) had undergone previous low-back surgery. Preoperatively the patients were on average severely disabled according to the Oswestry scale, and the self-rated improvement at the follow-up on average 7.4 years after surgery was significant, the mean index being 24%. In 29 (34%) patients, the Oswestry index was 10% or below, reflecting none or very little discomfort as a result of the surgery. In all age groups, women had better results than men. The best outcome was found in patients with no previous low-back surgery. Half of the patients returned to work. Thirteen patients needed new surgery because of nonunion. The use of transpedicular fixation did not produce better results. The sense of coherence scale assessing the patients successful coping capability had a very good predictive value in the whole series, and this predictive value was especially good in patients between 35 and 50 years of age. Also, the shorter duration of symptoms was an important predictor of a successful outcome, and the end results in patients who had a longer duration of preoperative low-back symptoms tended to be poor.

Den salutogena modellen och användning av KASAM-formuläret i omvårdnadsforskning — en metodredovisning

This paper presents psychometrical properties of the Swedish version of the Sense of Coherence (SOC) scale. The concept sense of coherence is proposed to explain successful coping with stressors and as being a stable trait of the individual. The stronger the SOC, the more successful coping and the more likely one is to have better health and quality of life. The data in this study has been obtained from five groups of healthy individuals and eight patient groups. The scores of the SOC scale did not change over time when studied after two, 12 and 18 months respectively. Weaker sense coherence was correlated to more self-rated anxiety, functional limitations especially those of a psychosocial character, and severe perception of symptoms, and to worse self-rated general health, and less motivation. It is suggested that the SOC scale could be of clinical use in assessing the need for nursing care.

Sense of coherence and outcome of low-back surgery: 5-year follow-up of 80 patients

Eighty adult patients, 33 men and 47 women, mean age 46 years (SD 11.8, range 19–74 years), were evaluated 5 years after lowback surgery. The mean duration of symptoms before operation was 8.7 (SD 7.1) years. The purpose was to evaluate the 5-year outcome of lowback surgery, to find the best predictors for the outcome, and to find out if a correlation exists between the patients sense of coherence and the outcome of low-back surgery. The mean Oswestry pain index for the whole group of patients improved from 3.8 to 2.7 (P<0.001). The greatest improvement in pain was found in the group aged 35–50 years. In those over 50 years old, pain improved significantly more in women than men. Regarding walking ability, the mean Oswestry gait index for the whole group improved from 3.0 to 1.9 (P<0.001), with men over 50 years old achieving the greatest improvement in their walking. The mean Oswestry total index for the whole group was 41% before surgery, reflecting severe disability, and 25% at follow-up, reflecting moderate disability (P<0.001). There was no difference between the mean values for men and women. Patients who had undergone several previous operations fared less well in the Oswestry total index, though their improvement was still significant (P<0.05). The postoperative Oswestry total index values correlated significantly with the sense of coherence (SOC) scale values (r=-0.23, P<0.05). In all patients, the Oswestry total index before the index operation is suggested to be a predictor of the final outcome. In multiple regression analysis, the number of previous operations and the preoperatively recorded Oswestry total index appeared to be the best predictors for outcome of low-back surgery. We also found that the SOC scale correlated significantly with the Oswestry total index and seems to provide a possible explanation of ability to cope with the disability and pain associated with low-back disorders.

The factor structure of coping strategies in hemophilia

The purpose of the present study was to analyze the factor structure of the Coping Strategies Questionnaire (CSQ). In order to find factors that are reproducible across samples and to evaluate their relationship to pain, disability, and depressive mood, the subjects used were a group of 224 patients with congenital coagulation defects. Factor analysis identified 4 factors in the Coping Strategies Questionnaire that could be categorized as Distraction, Pain Control, Reinterpreting Pain Sensations, and Catastrophizing. There were positive correlations between pain and Catastrophizing (p < 0.005) and between disability and Catastrophizing (p < 0.005). There was also a relationship between Catastrophizing and emotional well-being indicating that the lower the feeling of well-being, the greater the use of Catastrophizing strategies. The present results confirm that a 4- to 5-factor solution gives reasonable reproducibility across samples and methods.