Per-Olow Sjödén

Choice of organic foods is related to perceived consequences for human health and to environmentally friendly behaviour

We designed a questionnaire concerned with attitudes and behaviour towards organic foods, environmentally friendly behaviour (EFB), and perceived consequences of organic food choice in terms of human health, the environment and animal welfare. It was mailed in 1998 to a random nation-wide sample of 2000 Swedish citizens, ages 18-65 years, and 1154 (58%) responded. Self-reported purchase of organic foods was most strongly related to perceived benefit for human health. Performance of EFBs such as refraining from car driving was also a good predictor of purchase frequency. The results indicate that egoistic motives are better predictors of the purchase of organic foods than are altruistic motives.

Attitudes towards organic foods among Swedish consumers

The present study reports demographic differences with respect to Swedish consumers’ attitudes towards organic foods (milk, meat, potatoes, bread), purchase frequency, purchase criteria, perceived availability, and beliefs about organic foods. A random nation‐wide sample of 2,000 respondents, aged 18‐65 years, were mailed a questionnaire and 1,154 (58 per cent) responded. The majority of consumers, and particularly women and young respondents (18‐25 years) reported positive attitudes, but purchase frequency was low. A total of 13 per cent stated that they regularly bought organic milk. Corresponding figures for organic meat, potatoes, and bread were 13, 16, and 8 per cent respectively. The most important purchase criterion was good taste, and the least important was “organically produced”. Approximately half of the respondents were satisfied with the availability of the organic foods. The organic foods were perceived to be more expensive and healthier than conventionally produced alternatives. A major obstacle to the purchase of organic foods was reported to be premium prices. The results suggest that the consumption will not increase as long as important purchase criteria and perceived beliefs about organic foods do not match.

Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients

Late effects of adjuvant treatment on perceived health and quality of life were assessed through a questionnaire mailed to 448 premenopausal and postmenopausal breast cancer patients, free from recurrence 2-10 years after primary therapy. The patients had been randomised to postoperative radiotherapy or adjuvant chemotherapy as adjuncts to primary surgery. The differences between the two treatments were generally small. However, the radiotherapy patients had significantly greater problems with decreased stamina, symptoms related to the operation scar and anxiety. The chemotherapy patients had significantly more problems with smell aversion. Activity level inside and outside the home, anxiousness and depressive symptoms were similar in both groups. The chemotherapy patients scored their overall quality of life higher than the radiotherapy patients.

Effect of Endocrine Treatment on Sexuality in Premenopausal Breast Cancer Patients: A Prospective Randomized Study

PURPOSE To study the sexual effects of the 2-year adjuvant goserelin (Zoladex [Zeneca AB, Södertälje, Sweden]) alone, tamoxifen alone, and Zoladex and tamoxifen in combination (ZT) versus no adjuvant endocrine therapy among premenopausal breast cancer patients with or without chemotherapy in a controlled clinical trial (a European multicenter trial: Zoladex in Premenopausal Breast Cancer Patients). PATIENTS AND METHODS This prospective study examined several aspects of sexuality through the use of self-administered questionnaires, which were completed by patients at seven points of assessment for 3 years after randomization. RESULTS Patients treated with chemotherapy had a higher level of sexual dysfunction than did patients who received no systemic treatment. The addition of endocrine treatment did not alter this result. In contrast, among patients who did not receive chemotherapy, Zoladex and ZT produced a significantly higher level of dysfunction from 1 to 2 years after inclusion, as compared with those who received no endocrine treatment. Tamoxifen alone did not produce side effects. After termination of endocrine treatment, sexual dysfunction began to diminish. Those with chemotherapy had high and frequently increasing levels of dysfunction even after 2 to 3 years of independent of endocrine treatment. Zoladex had a negative effect on sexual fear, which was reduced by the addition of tamoxifen. CONCLUSION Zoladex increased sexual dysfunction during treatment among patients without chemotherapy, but the disturbances of sexual functioning were reversible. The use of adjuvant chemotherapy was associated with continued sexual problems, even at 3 years after randomization.

Predicting anxiety and depression among cancer patients : a clinical model.

The aim of this study was to investigate the possibility of predicting anxiety and depression 6 months after the cancer diagnosis on the basis of measures of anxiety, depression (Hospital Anxiety and Depression, HAD scale), subjective distress (Impact of Event, IES scale) and some aspects of social support in connection with the diagnosis. A further purpose was to attempt identification of individual patients at risk of prolonged psychological distress, and to develop an easily applicable clinical tool for such detection. A consecutive population-based series of 522 newly diagnosed patients with breast, colorectal, gastric and prostate cancer were interviewed in connection with the diagnosis and 6 months later. Anxiety and depression close to the diagnosis explained 39% of the variance in anxiety and depression 6 months later. Patients scoring as doubtful cases/cases for HAD anxiety and/or depression were more than 11 times more likely than non-cases to score as doubtful cases/cases at 6 months. Additional risk factors were having an advanced disease and nobody in addition to the family to rely on in case of difficulties. Levels of anxiety and depression at diagnosis predict a similar status 6 months later. The results also indicate that the HAD scale in combination with a single question about social support may be a suitable screening tool for clinical use.

The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers.

PURPOSE To translate and evaluate the Patient-Generated Subjective Global Assessment (PG-SGA) a method for the assessment of nutritional status. METHOD Eighty-seven patients with gastrointestinal and urological tumours completed four sections and the remaining sections were independently completed by a doctor and a dietician. Patients were classified as SGA A (well nourished), SGA B (moderately/suspected of being malnourished) or SGA C (severely malnourished). RESULTS Interobserver agreement was complete in 90% of the cases. More patients with gastrointestinal cancers than with urological cancers were classified as SGA B and C. Mean levels of S-albumin and P-prealbumin differed between the SGA-classes. Multivariate logistic regression analyses showed independent contributions to the overall classification by weight loss in the last 6 months, level of food intake, problems with eating, physical activity and muscle wastage. Survival was significantly higher in SGA A than in SGA B+C, P < 0.001. CONCLUSION The PG-SGA is useful for the assessment of nutritional status. Patients had no problems in answering the questions. The PG-SGA also carried prognostic information.

Short- and long-term anxiety and depression in women recalled after breast cancer screening

The aim was to investigate the psychological consequences of further investigation after breast cancer screening. Study participants include 509 women (61%) recalled due to suspicious findings on screening mammograms, and a matched control group of 285 women (68%) with normal mammograms. Psychological distress was prospectively assessed with the Hospital Anxiety and Depression Scale (HADS). 46% of the women reported borderline or clinically significant anxiety prior to the recall visit. A few days after the visit, anxiety and depression had decreased significantly (P<0.01) in women informed about normal or benign results at the recall clinic, while reported distress remained at relatively high levels in women referred to surgical biopsy. The results demonstrate the adverse short-term effect of a delay in receiving false-positive results, but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women.

Quality of life during chemotherapy in patients with symptomatic advanced colorectal cancer

Background. To increase the knowledge about the palliative effects of chemotherapy in patients with symptomatic advanced colorectal cancer, physician‐ and patient‐rated “quality of life” was studied in a randomized multicenter trial comparing a regimen of methotrexate/5‐fluorouracil (5‐FU) followed by leucovorin rescue (MFL) with a regimen of 5‐FU/leucovorin (FLv).

Self‐esteem, depression and anxiety among Swedish children and adolescents on and off cancer treatment

Self‐esteem, depression and anxiety were investigated in 51 Swedish children and adolescents, 8‐18y, on (n=16) and off (n= 35) cancer treatment. The self‐report measures “I Think I Am” (ITIA), the Childrens Depression Inventory (CDI) and the Revised Childrens Manifest Anxiety Scale (RCMAS) were used. Data were compared with data previously obtained by others for healthy Swedish children. Children and adolescents on treatment showed levels of self‐esteem, depression and anxiety comparable to those of healthy children. However, children and adolescents off treatment reported higher depression and anxiety levels and lower psychological well‐being and physical self‐esteem than have been reported for healthy Swedish children. Seven children (14%) reported a high level of depression, six of whom were off treatment. The findings suggest that the period after treatment termination is characterized by a higher risk of psychosocial problems than is the actual treatment period.

Psychosocial adjustment among women with breast cancer stages I and II: six-year follow-up of consecutive patients.

PURPOSE To evaluate, in a long-term follow-up study of consecutive patients (N = 99), the impact of surgery--breast-conserving treatment (BCT) versus mastectomy (MT)--on psychosocial adjustment among women with breast cancer, pTNM stage I/II. PATIENTS AND METHODS Semistructured interviews were conducted at a median of 6 years (range, 5.8 to 8.1) after primary surgery. Sixty-six women were available for the long-term follow-up study. Twenty-six women had been treated with BCT and 40 with MT. RESULTS No statistically significant differences were found between the two groups concerning psychosocial adjustment, as measured by the Social adjustment Scale (SAS). In general, the levels of maladjustment were lower than at 13 months postoperatively, but 10% still showed maladjustment. Sixty percent of the women were unwilling to show themselves naked, and 22% felt that they had become less attractive because of the surgical treatment. In an explorative part of the interview, 68% of the women complained about how they had been informed of the diagnosis. A tendency toward a significant difference was found in the relation between previous maladjustment and a negative experience at the time of diagnosis (P = .07). CONCLUSION Few data are available on long-term follow-up results with regard to psychosocial adjustment among women after breast cancer surgery. This study provides the important information that there are no differences in patient psychosocial adjustment that can be ascribed to the type of surgery at 6-year follow-up evaluation.