Patient-reported quality of life with obesity - development of a new measurement scale. / Pasientrapportert livskvalitet ved fedme ­ utvikling av nytt måleinstrument.

BACKGROUND: Many questionnaires for measuring the quality of life for patients with obesity require comprehensive calculation before they are used. There is a need for questionnaires that permit simple assessment of the responses during a patient consultation. We have developed the questionnaire Patient-Reported Outcomes in Obesity (PROS). The objective of the study was to test the reliability and validity of the questionnaire. MATERIAL AND METHOD: The questionnaire was used to ask patients about the extent to which they perceived their weight or body shape as bothersome. A group of patients with an average body mass index (BMI) of 42 (n = 109) completed the PROS questionnaire and The Impact of Weight Quality of Life questionnaire (IWQOL-Lite) before undergoing obesity surgery. Another group with an average body mass index of 29 (n = 95) completed the PROS questionnaire 1-5 years after having undergone obesity surgery. 67,7 % of the patients were > 40 years and 79 % were women. For the statistical analysis we used Cronbach's alpha, factor analysis, Spearman's rank test and independent t-test. RESULTS: Cronbach's alpha for the total PROS score was 0.90, and the factor analysis showed a significant factor (eigenvalue = 4.7) that explained 58.4 % of the variance. The test-retest correlation was 0.93 (p < 0.001). The correlation coefficients between the PROS score, the total IWQOL-Lite score (rs = -0.91) and body mass index (rs = 0.60) were all significant (p < 0.001). The t-test showed an effect size (difference in standard deviation) between the non-surgery and the surgery groups of 1.9 (95 % CI 1.6-2.5) for the PROS questionnaire and 2.1 (95 % CI 1.7-2.5 for the total IWQOL-Lite score. INTERPRETATION: The PROS questionnaire is a reliable and valid questionnaire for measurement of obesity-specific quality of life.

Associations between health-related quality of life, cardiorespiratory fitness, muscle strength, physical activity and waist circumference in 10-year-old children: the ASK study.

PURPOSE: To examine the associations between cardiorespiratory fitness, muscle strength, physical activity and waist circumference with self-reported health-related quality of life (HRQoL) in children. METHODS: We conducted a cross-sectional analysis that included 1129 school children aged 10 years from 57 schools in Sogn and Fjordane County, Norway. The HRQoL outcome was assessed by the self-reported KIDSCREEN-27 questionnaire, which covers five life domains. Independent variables were cardiorespiratory fitness assessed by the Andersen intermittent field running test, handgrip strength measured by a hand dynamometer, explosive strength in the lower body using a standing broad jump test, physical activity (counts per minute) using an accelerometer and abdominal adiposity measured by waist circumference. Statistical analyses were performed using linear mixed-effect models including school site as a random effect. Age and sex were entered as covariates. RESULTS: Only cardiorespiratory fitness was positively associated with higher scores on all five KIDSCREEN-27 domains (P < 0.047 for all). Explosive strength in the lower body was positively associated with higher autonomy and parents scores (P = 0.018), while physical activity was positively associated with higher physical well-being scores (P = 0.008). CONCLUSIONS: Improving cardiorespiratory fitness might be especially useful for improving HRQoL in children.

Psychometric properties of the Norwegian version of the Kidscreen-27 questionnaire.

BACKGROUND: The Norwegian version of the Kidscreen-27, a measure of generic health-related quality of life, has not yet been validated. Thus, the aim of this study was to investigate the reliability and validity of the Norwegian Kidscreen-27, in 10 year-old children. METHODS: The Kidscreen-27 consists of five domains and was validated in a cross-sectional study of 1085 school children (52.5 % boys). In addition a subsample of 56 children also had repeated measures in order to study test-retest reliability. RESULTS: Cronbach's alpha values ranged from 0.73 to 0.83, while intraclass correlation values over time ranged from 0.71 to 0.81. The domains of physical well-being, psychological well-being and autonomy & parents improved over time (Ps < 0.05), while social support and school environment domains did not. Confirmatory factor analysis showed an acceptable overall model fit: X (2) = 707; df = 310; P <0.001, root mean squared error of approximation = 0.037, the comparative fit index = 0.96 and the Tucker-Lewis index = 0.95. All factor loading were > 0.40. The Kidscreen-27 domains were significantly associated with general life satisfaction as measured with the Cantrils Ladder (Spearman rank correlations ranged from 0.29 to 0.59, Ps < 0.05). CONCLUSION: The Norwegian version of Kidscreen-27 has good reliability and validity.

Suffering and transition strategies in adult patients attending a chronic pain management programme.

AIMS AND OBJECTIVES: To develop a deeper understanding of suffering and useful transition strategies in patients after participation in a chronic pain management programme. BACKGROUND: Chronic pain is a complex, multifaceted, individual experience. Limitations in patients' ability to perform their usual activities, as well as social isolation, are frequently reported. This condition may include a state of suffering that leads to challenges with transitions, for which support, guidance and achievement of useful strategies are needed. DESIGN: Qualitative study with a descriptive and explorative design from a phenomenological perspective. METHODS: A phenomenological-hermeneutic approach was used to analyse interviews with 12 participants in a group-based cognitive-behavioural therapy management programme. RESULTS: Suffering from chronic pain means handling difficult thoughts and feelings. Expression of these thoughts and feelings through group support and therapeutic writing alleviates suffering. In addition, new perspectives through active involvement in the cognitive-behavioural therapy programme indicate a transition towards adaptation to the chronic pain situation. CONCLUSION: Qualitative analysis of participation in a cognitive-behavioural therapy programme deepens our understanding of both patient suffering and helpful transition strategies towards adaptation. Group participation in the programme appeared to be useful in improving patients' ability to handle challenging experiences with transitions. It is essential that the patients play an active role in adaptive transitions by developing new perspectives and insight. RELEVANCE TO CLINICAL PRACTICE: It is an important activity for nurses or other healthcare workers to assist in the transition process so that the patient can take an active role to achieve alleviation. Focus on transition conditions seems to be helpful because it considers the factors that might facilitate successful transitions towards optimal adaptation.

Poor self-rated health associated with an increased risk of subsequent development of lung cancer.

PURPOSE: Self-rated health has shown to be a strong predictor of mortality and some major chronic diseases. The purpose of this study was to investigate whether poor self-rated health also was related to an increased risk of subsequent development of cancer. METHODS: Information on self-rated health, life-style factors, and other health-related risk factors was ascertained in a cohort of 25,532 persons participating in the Hordaland Health Study in 1997-1999. Information on development of cancer during 10 years of follow-up was obtained from the Norwegian Cancer Registry. The relationship between self-rated health and development of cancer was examined using Cox regression analysis adjusting for smoking and other life-style factors. RESULTS: Respondents reporting a poor health showed a non-significant increased risk of overall cancer. Sub-analysis of the four most common types of cancer showed a statistically significant association between self-rated health and lung cancer. The adjusted hazard ratio was 3.88 (95% CI; 0.99, 15.8) for those rating their health as poor compared to very good (p for trend = 0.038). For the other types of cancer, we found a non-significant elevated risk associated with poor self-rated health. CONCLUSION: Respondents who perceive their health as poor had an increased risk of developing lung cancer also after adjusting for smoking. This suggests that self-rated health reflects a broad range of factors important for development of this cancer type. Nevertheless, due to the explorative analysis of the specific cancer types, these findings need to be repeated before elaborate interpretations can be made.

Sense of coherence among cognitively intact nursing home residents--a five-year longitudinal study.

AIM AND OBJECTIVES: To examine how stable the sense of coherence (SOC) is over a five-year period among residents of nursing homes (NH) who are not cognitively impaired and whether components of social support influence SOC. BACKGROUND: Many studies have investigated the stability of SOC, and the findings have been inconsistent. Social support is a crucial resource in developing SOC. Few researchers have studied the stability of SOC and how various social support dimensions influence changes in SOC among older NH residents who are cognitively intact. DESIGN: The study was prospective and included baseline assessment and five-year follow-up. METHODS: The sample comprised 52 cognitively intact NH residents (Clinical Dementia Rating score ≤0.5). We obtained data through direct interviews using the Social Provisions Scale and Sense of Coherence Scale. RESULTS: SOC increased statistically significantly from baseline to follow-up. The social support subdimension reassurance of worth predicted change in SOC after adjustment for sociodemographic factors. When controlled for baseline SOC, attachment was associated with change in SOC, but reassurance of worth was not. CONCLUSIONS: The study indicates that the change in SOC over time during the 5 years of follow-up and the social support dimension attachment appear to be important components of change in SOC. Nursing personnel should be aware of the residents' individual needs for attachment and the importance of emotional support for personal strength and ability to cope.

The Ostomy Adjustment Scale: translation into Norwegian language with validation and reliability testing.

PURPOSE: The purpose of this study was to adapt the Ostomy Adjustment Scale to a Norwegian version and to assess its construct validity and 2 components of its reliability (internal consistency and test-retest reliability). SUBJECTS AND SETTING: One hundred fifty-eight of 217 patients (73%) with a colostomy, ileostomy, or urostomy participated in the study. Slightly more than half (56%) were men. Their mean age was 64 years (range, 26-91 years). All respondents had undergone ostomy surgery at least 3 months before participation in the study. METHODS: The Ostomy Adjustment Scale was translated into Norwegian according to standard procedures for forward and backward translation. The questionnaire was sent to the participants via regular post. The Cronbach alpha and test-retest were computed to assess reliability. Construct validity was evaluated via correlations between each item and score sums; correlations were used to analyze relationships between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, the Hospital Anxiety & Depression Scale, and the General Self-Efficacy Scale. RESULTS: The Cronbach alpha was 0.93, and test-retest reliability r was 0.69. The average correlation quotient item to sum score was 0.49 (range, 0.31-0.73). Results showed moderate negative correlations between the Ostomy Adjustment Scale and the Hospital Anxiety and Depression Scale (-0.37 and -0.40), and moderate positive correlations between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, and the General Self-Efficacy Scale (0.30-0.45) with the exception of the pain domain in the Short Form 36 (0.28). Regression analysis showed linear associations between the Ostomy Adjustment Scale and sociodemographic and clinical variables with the exception of education. CONCLUSIONS: The Norwegian language version of the Ostomy Adjustment Scale was found to possess construct validity, along with internal consistency and test-retest reliability. The instrument is sensitive for sociodemographic and clinical variables pertinent to persons with urostomies, colostomies, and ileostomies.

Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study.

BACKGROUND: There is little robust evidence relating to changes in health related quality of life (HRQL) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass (RYGB). The aim of the present study was to describe and compare changes in five dimensions of HRQL in morbidly obese subjects. In addition, we wanted to assess the clinical relevance of the changes in HRQL between and within these two groups after one year. We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program (ILI) with morbidly obese subjects. METHODS: A total of 139 morbidly obese patients chose treatment with RYGB (n=76) or ILI (n=63). The ILI comprised four stays (seven weeks) at a specialized rehabilitation center over one year. The daily schedule was divided between physical activity, psychosocially-oriented interventions, and motivational approaches. No special diet or weight-loss drugs were prescribed. The participants completed three HRQL-questionnaires before treatment and 1 year thereafter. Both linear regression and ANCOVA were used to analyze differences between weight loss and treatment for five dimensions of HRQL (physical, mental, emotional, symptoms and symptom distress) controlling for baseline HRQL, age, age of onset of obesity, BMI, and physical activity. Clinical relevance was assessed by effect size (ES) where ES<.49 was considered small, between .50-.79 as moderate, and ES>.80 as large. RESULTS: The adjusted between group mean difference (95% CI) was 8.6 (4.6,12.6) points (ES=.83) for the physical dimension, 5.4 (1.5-9.3) points (ES=.50) for the mental dimension, 25.2 (15.0-35.4) points (ES=1.06) for the emotional dimension, 8.7 (1.8-15.4) points (ES=.37) for the measured symptom distress, and 2.5 for (.6,4.5) fewer symptoms (ES=.56), all in favor of RYGB. Within-group changes in HRQOL in the RYGB group were large for all dimensions of HRQL. Within the ILI group, changes in the emotional dimension, symptom reduction and symptom distress were moderate. Linear regression analyses of weight loss on HRQL change showed a standardized beta-coefficient of -.430 (p<.001) on the physical dimension, -.288 (p=.004) on the mental dimension, -.432 (p<.001) on the emotional dimension, .287 (p=.008) on number of symptoms, and .274 (p=.009) on reduction of symptom pressure. CONCLUSIONS: Morbidly obese participants undergoing RYGB and ILI had improved HRQL after 1 year. The weaker response of ILI on HRQL, compared to RYGB, may be explained by the difference in weight loss following the two treatments. TRIAL REGISTRATION: Clinical Trials.gov number NCT00273104.

Health-related quality of life and post-traumatic stress disorder symptoms in accident and emergency attenders suffering from psychosocial crises: a longitudinal study.

AIMS: This paper is a report of a study of health-related quality of life and post-traumatic stress disorder symptoms in patients attending an Accident and Emergency department because of psychosocial crises. BACKGROUND: Psychosocial crises are commonplace globally, but there is little knowledge about patients attending Accident and Emergency departments because of psychosocial crises. METHODS: Data were collected at an Accident and Emergency department in Norway from September 2008 to June 2009. A total of 99 adults participated in the baseline study and 41 of these participated at 2 months follow-up. The Short Form-36 Health Survey and the Post Traumatic Symptom Scale were used to obtain data. FINDINGS: Participants reported significantly lower scores in all health-related quality of life domains at baseline compared with the general Norwegian population. The mental health score was two standard deviations below the norm. Health-related quality of life scores were improved and post-traumatic stress disorder symptoms were reduced after 2 months. High levels of post-traumatic stress disorder symptoms were reported by 78% of the participants at baseline and 59% at follow-up. Participants with high levels of post-traumatic stress disorder symptoms at follow-up also reported low health-related quality of life scores. CONCLUSION: This study suggests a need for an acute psychosocial intervention and an opportunity to receive follow-up support at Accident and Emergency departments.

The effectiveness of an improved multidisciplinary pain management programme: a 6- and 12-month follow-up study.

AIM: This article is a report of a Norwegian-revised study on the effectiveness of a follow-up multidisciplinary management programme for chronic pain to investigate the change processes associated with treatment. BACKGROUND: Substantial evidence supports the use of Cognitive Behavioural Therapy approaches to chronic pain. As relapse is often reported, follow-up sessions should be included. METHODS: A follow-up quasi-experimental design was performed, and a previous control group was used. The study initially included 117 participants, and 104 of the sample completed the 6- and 12-month follow-up programme. The 6-month follow-up consisted of therapeutic dialogue and education combined with physical activity. At the 12-month follow-up, a telephonic consultation was conducted. The data collection period was between September 2006 and January 2008. The statistical and clinical significance were considered. RESULTS: Findings suggest that this follow-up programme can potentially maintain the positive results of the basic programme in terms of reduced pain perception, improved health-related quality of life, and movement towards self-management. CONCLUSION: These results are consistent with the ultimate goal of Cognitive Behavioural Therapy approaches, which is to help patients with chronic pain to cope more effectively and to improve their health-related quality of life and functioning. To maintain treatment improvements and advance nursing, there is a clear need for research that tests the efficacy of follow-up interventions that are designed to prevent drop out and relapse.

Pain in children and adolescents: prevalence, impact on daily life, and parents' perception, a school survey.

BACKGROUND: Pain problems in children and adolescents have increased during the last 20 years and have been identified as an important public health problem. AIMS: The specific aims of the study were to study the prevalence of pain, its association with age, gender, and socio-demographics, its frequency, duration, and type. A further aim is to describe the impact of pain on daily living, perceived triggers of pain, and correspondence between parents' and children's perceptions of pain. DESIGN: A cross-sectional study, with a descriptive, exploratory design. SETTINGS AND PARTICIPANTS: A cluster sample of children and adolescents (age 8-18 years N=1238) and parents (n=828), from 20 randomly selected schools in a region of Norway. METHODS: Data were collected using a structured self-report questionnaire, the Lübeck Pain-Screening Questionnaire (LPQ). The children filled in the questionnaires at school, while the parents completed the questionnaires at home. RESULTS: Sixty per cent of the children and adolescents reported pain within the previous 3 months. Pain increased with age, where girls aged 16-18 years reported the most pain. Total prevalence of chronic pain was 21%. Children reported impact on social life; inability to pursue hobbies, disturbed sleep, absence from school, and inability to meet friends because of pain. The girls reported significantly more frequently disturbed sleep, loss of appetite, and use of medication, compared to the boys. There was little agreement between parents and children regarding pain. CONCLUSIONS: Pain is a common problem and influences the daily lives of children and adolescents. Many parents are unaware of the pain experienced by their children. There is a need for preventive programmes that also involve parents, school nurses, and teachers.

Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch.

BACKGROUND: Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms. METHODS: Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression. RESULTS: The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004). CONCLUSIONS: The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health.

School children's experience of being bullied--and how they envisage their dream day.

Bullying may have a number of negative health impacts on children. Previous studies have mainly explored negative health consequences related to being bullied. A different approach is to explore how these phenomena are related to the school child's quality of life (QOL). The role of the school nurse is to promote health and prevent sickness, and school nurses therefore need knowledge of what promotes or threatens QOL in children. No previous research has explored how bullied children envisage their dream day or a day with good QOL. There is a need for more qualitative research on how school children experience being bullied and the kind of help they need from their school, and school nurse, to realize their dream day. The aim of this study was to explore how school children experience bullying in their everyday lives, what constitutes their dream day and what kind of help they need. An explorative qualitative design was chosen, and data were collected through focus group interviews. Data collection was conducted throughout 2007 and during the spring of 2008. The sample consisted of 17 school children, aged 12-13 years, in four different groups. An interview guide was used, and the group responses were audio-taped, transcribed and coded into themes. The data were analysed according to Kvale's three contexts of interpretation within a phenomenological and hermeneutic framework. Four main themes were identified: teasing and fighting, emotional reactions to being left alone or excluded, the need for friends to achieve the dream day and stopping the bullying immediately. The participants said that being bullied made them feel helpless, lonely and excluded. They wanted the bullying to be recognized, assistance from the school staff to stop the bullying, and to be included by their peers.

Associations between general self-efficacy and health-related quality of life among 12-13-year-old school children: a cross-sectional survey.

BACKGROUND: While research on school children's health has mainly focused on risk factors and illness, few studies have examined aspects of health promotion. Thus, this study focuses on health promotional factors including general self-efficacy (GSE) and health-related quality of life (HRQOL). GSE refers to a global confidence in coping ability across a wide range of demanding situations, and is related to health. The purpose of this study was to examine associations between GSE and HRQOL, and associations between HRQOL and socio-demographic characteristics. Knowledge of these associations in healthy school children is currently lacking. METHODS: During 2006 and 2007, 279 school children in the seventh grade across eastern Norway completed a survey assessing their GSE and HRQOL. The children were from schools that had been randomly selected using cluster sampling. T-tests were computed to compare mean subscale values between HRQOL and socio-demographic variables. Single and multiple regression analyses were performed to explore associations among GSE, HRQOL and socio-demographic variables. RESULTS: Regression analyses showed a significant relationship between increasing degrees of GSE and increasing degrees of HRQOL. In analyses adjusted for socio-demographic variables, boys scored higher than girls on self-esteem. School children from single-parent families had lower scores on HRQOL than those from two-parent families, and children who had relocated within the last five years had lower scores on HRQOL than those who had not relocated. CONCLUSION: The strong relationship between GSE and HRQOL indicates that GSE might be a resource for increasing the HRQOL for school children.

Health related quality of life in patients with neuroendocrine tumors compared with the general Norwegian population.

PURPOSE: Health related quality of life (HRQoL) was characterized among patients with neuroendocrine tumor (NET) and compared with the general Norwegian population. METHODS: A cross sectional, comparative design was chosen, and the samples comprised 196 NET patients and 5,258 individuals from the general Norwegian population. We used Chi-square cross tab calculations to evaluate sociodemographic characteristics, T-tests for independent samples and Analysis of Variance (ANOVA) in order to compare HRQoL (SF-36) scores across a range of background variables. Furthermore, T-tests were used to analyze differences in HRQoL scores between the samples. RESULTS: NET patients demonstrated significantly lower on all HRQoL subscales when compared with the general population with the lowest values on general health, physical limitation and vitality. Individuals above 70 years reported lower scores on physical functioning and physical limitations compared with those who were younger. Individuals with higher levels of education reported increased physical functioning compared with those with less education and full-time or part-time workers described higher physical functioning and less physical limitations compared with those who were retired. CONCLUSIONS: All SF-36 HRQoL scores were significantly lower among the NET patients when compared with the general population. Assistance from health personnel to NET patients should focus on those domains.

Coping with ageing and failing health: a qualitative study among elderly living alone.

The purpose of this study was to gain a more comprehensive understanding of how the elderly cope with being sick, unhealthy and living alone. Qualitative research interviews using a hermeneutic approach was undertaken to explore how the patients experienced coping with their daily life. Twenty patients with an average age of 82 years having different injuries and diseases were interviewed. The interviews were audiotaped, transcribed and analysed in a hermeneutical tradition of the hermeneutic circle: part-whole, pre-understanding-understanding, and primary, secondary and basic themes. Findings showed that even if physical constraints put limits on their level of activity, the elderly were able to adapt and carry out different activities that did not require any physical strength. The main coping strategy was to accept the situation, but the acceptance was often coloured by a resigned and passive acceptance. If the elderly tend to be passive and resigned, it can be necessary for the community nurses to have a more active problem-solving approach to these patients, in order to help them creating a daily rhythm with which they can feel comfortable.

Predictors for health-related quality of life in patients accepted for bariatric surgery.

BACKGROUND: The relationship among musculoskeletal pain, depression, and health-related quality of life in patients with severe obesity who are accepted for bariatric surgery should be explored further. METHODS: In this cross-sectional study, we measured the health-related quality of life using the generic questionnaire "Short-Form 36 Health Status Survey." Multiple regression analysis was used to explore associations between the predictors (musculoskeletal pain and depression) and the physical cumulative summary (PCS) and mental cumulative summary (MCS). Age, gender, body mass index, and the number of co-morbidities were entered as covariates. RESULTS: The study subjects included 28 women and 23 men, with a mean age of 37.7 years and a mean body mass index of 51.9 kg/m(2). The PCS and MCS scores were very poor compared with the age- and gender-adjusted population norm (P <.001). The presence of musculoskeletal pain was associated with a score that was 10.97 points lower on the PCS (P <.001) and 7.05 points lower on the MCS (P = .031). The presence of depression was associated with a score that was 20.89 points lower on the MCS (P <.001); no significant association was found between depression and the PCS. CONCLUSION: The results of this study have shown that musculoskeletal pain was strongly associated with lower scores on the PCS and MCS, and depression was strongly associated with a lower score on the MCS.

Patient-reported fatigue in patients with rheumatoid arthritis who commence biologic therapy: a longitudinal study.

AIMS AND OBJECTIVES: To examine changes in patient-reported fatigue, over a twelve month period, in rheumatoid arthritis patients who commence biologic treatment, and to identify possible predictors for such changes. BACKGROUND: Fatigue is a burdensome symptom for patients with rheumatoid arthritis. Despite biologics being effective in reducing disease activity, patients still report fatigue. DESIGN: A longitudinal observational study. METHODS: A total of 48 patients were enrolled in the study. Fatigue was measured by the Fatigue Severity Scale. Independent samples T-tests were used to test gender differences, and paired samples T-tests were used to measure differences between repeated measures. Bivariate and multiple regression analyses were used to examine potential predictors for changes in fatigue, such as age, sex, Disease Activity Score 28, pain and physical and emotional well-being. RESULTS: Forty-seven patients completed the study. From baseline to 12-month follow-up, fatigue decreased significantly in both women and men. Analyses of predictors were performed step-wise, and the final model included sex and physical well-being. The results from this final step showed that female sex was the only significant predictor for changes in fatigue. CONCLUSION: Patients commencing biologic therapy reported a significant reduction in fatigue. Female sex was a significant predictor of changes in fatigue. RELEVANCE TO CLINICAL PRACTICE: Despite improvements in pharmacological treatment, patients with rheumatoid arthritis still report fatigue. This is a multifaceted health problem encompassing personal and emotional factors in addition to the clinical factors directly connected to the disease.

Sense of coherence as a resource in relation to health-related quality of life among mentally intact nursing home residents - a questionnaire study.

BACKGROUND: Sense of coherence (SOC) is a strong determinant of positive health and successful coping. For older people living in the community or staying in a hospital, SOC has been shown to be associated with health-related quality of life (HRQOL). Studies focusing on this aspect among nursing home (NH) residents have been limited. This study investigated the relationship between SOC and HRQOL among older people living in NHs in Bergen, Norway. METHODS: Based on the salutogenic theoretical framework, we used a descriptive correlation design using personal interviews. We collected data from 227 mentally intact NH residents for 14 months in 2004-2005. The residents' HRQOL and coping ability were measured using the SF-36 Health Survey and the Sense of Coherence Scale (SOC-13), respectively. We analyzed possible relationships between the SOC-13 variables and SF-36 subdimensions, controlling for age, sex, marital status, education and comorbidity, and investigated interactions between the SOC and demographic variables by using multiple regression. RESULTS: SOC scores were significantly correlated with all SF-36 subscales: the strongest with mental health (r = 0.61) and the weakest with bodily pain (r = 0.28). These did not change substantially after adjusting for the associations with demographic variables and comorbidity. SOC-13 did not interact significantly with the other covariates. CONCLUSION: These findings suggest that more coping resources improve HRQOL. This may indicate the importance of strengthening the residents' SOC to improve the perceived HRQOL. Such knowledge may help the international community in developing nursing regimens to improve HRQOL for older people living in NHs.

Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway.

AIM: To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. METHODS: The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65-102 years with at least six months' residence and a representative population sample of 1137 Norwegian citizens aged 65-102 years. All nursing home residents had a Clinical Dementia Rating Scale score > or =0.5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. RESULTS: After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23.2 and mean general population 62.9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. CONCLUSIONS: The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. RELEVANCE TO CLINICAL PRACTICE: This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health-related quality of life.