Development and psychometric properties of the Joy-of-Life Scale in cognitively intact nursing home patients.

AIM: To develop and psychometrically test the Joy-of-Life Scale. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered inter-related measurement properties. METHODS: Cross-sectional data were collected during 2017-2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home patients who met the inclusion criteria: (i) local authority's decision of long-term nursing home care; (ii) residential time 3 months or longer; (iii) informed consent competency recognised by responsible doctor and nurse; and (iv) capable of being interviewed. RESULTS: Exploratory and confirmative factor analyses clearly suggested a unidimensional solution. Five of the original 18 items showed low reliability and validity; excluding these items revealed an acceptable model fit for the one-dimensional 13-item measurement model. Reliability and construct validity were acceptable, indicating good internal consistency. CONCLUSION: Significant factor loadings, several goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, sense of coherence, nurse-patient interaction and quality of life) supported the psychometric properties of the Joy-of-Life Scale. IMPACT: The 'Joy-of-Life-Nursing-Home' is a national strategy for promoting quality of life, meaning and quality of life among nursing home patients in Norway. Therefore, exploring the essence of the Joy-of-Life phenomenon and developing a measurement scale assessing joy-of-life in this population is important for the further development of care quality in nursing homes.

Life satisfaction in association with self-efficacy and stressor experience in adolescents - self-efficacy as a potential moderator.

AIM: This paper reports associations among socio-demographic variables, stressor experience, self-efficacy and life satisfaction among Norwegian adolescents aged 15-21 years and the potential moderating role of self-efficacy on the association between stressor experience and life satisfaction. METHODS: The cross-sectional school-based survey study involved 1816 upper-secondary school students from Mid-Norway. Data were analysed with independent samples t test, Pearson's product moment correlation and multiple linear regression analysis. RESULTS: Bivariate results showed that boys scored higher than girls on life satisfaction and self-efficacy, whereas girls scored higher than boys on all stressor domains. Multiple linear regression analysis showed that life satisfaction declined weakly with age, whereas stronger family economy and having parents who work full-time associated with higher life satisfaction. Stress with teacher interaction, peer pressure, home life, school attendance, school-leisure conflict and school performance were all negatively associated with life satisfaction, whereas self-efficacy associated positively and strongly with life satisfaction. Self-efficacy moderated the association between both interpersonal and school-related stressors and life satisfaction. CONCLUSION: The results provide support for the unique role of stressor experience and self-efficacy in association with adolescents' life satisfaction as well as self-efficacy as a stress moderator in relation to life satisfaction.

Participants and developers experiences with a chronic pain self-management intervention under development: A qualitative study.

BACKGROUND: Non-pharmacological interventions aim to promote health and self-management for people with chronic pain. OBJECTIVE: The aim of this study was to explore if the participants' experiences with a self-management intervention under development were aligned with the developers' rationale and desired outcome of the intervention. METHODS: This was a qualitative study interviewing both participants and developers of a chronic pain self-management intervention. Seven participants, six females and one male in the age from early thirties to mid-seventies attended the chronic pain self-management intervention developed by the staff at a Healthy Life Centre. The data were analysed by the systematic text condensation method. RESULTS: The analyses showed that the participants evaluated the intervention as valuable. They described using coping techniques to manage their chronic pain better, and the developers stated that the aim with the intervention was to provide the participants with coping techniques. The intervention was built upon the developers' professional knowledge and experience in cognitive techniques, health theories, models for behavioural change, and service user involvement. CONCLUSION: This study found that the chronic pain self-management intervention was in concordance with theory of health promotion and empowerment. The participants experienced the intervention as targeting their resources, capacities, and fulfilling social needs, which aligned with the developers aim with the intervention. The participants found the intervention evocative; they learned new ways to manage their pain through theory/education, movement exercises, homework, and sharing their experiences with each other.

Validation of the Norwegian version of the work-related sense of coherence scale.

AIM: The aim of this study was to investigate the psychometric properties of the Norwegian version of the work-related sense of coherence scale, which measures the perceived comprehensibility, manageability, and meaningfulness of an individual's current work situation. METHODS: Factorial validity, convergent and discriminant validity of the factors, as well as scale reliability were tested with confirmatory factor analyses among two samples of employees in higher education institutions ( N = 6951) and nursing homes ( N = 558). Factorial invariance across occupational groups was also investigated. RESULTS: A modified three-factor structure was shown to be valid and reliable in both samples and invariant across occupational groups. However, problems were detected regarding the discriminant validity between the factors comprehensibility and manageability. CONCLUSIONS: The Norwegian version of the work-related sense of coherence scale seems to have good properties. Further development is needed to better distinguish between the comprehensibility and manageability dimensions.

The impact of work culture on quality of care in nursing homes--a review study.

AIM: The main aim of this review study was to identify which factors that characterise the relationship between work culture and quality of care in nursing homes. METHOD: This review study was structured through systematic search methods to identify articles that describe the relationship between work culture and quality of care in nursing homes. The database search yielded 14510 hits. Closer examination showed that 10401 of these hits were duplicates. Of the remaining 4109 articles, only 10 were related to our aim for the study. A qualitative method were used to explain and understand phenomena of work culture and quality if care in nursing homes. FINDINGS: Nine out of 10 articles in this review study emphasise the importance of leadership style and supportive management to increase quality of care in nursing homes. Increased empowerment, participation and influence were important factors for improving quality of care. Significant associations between work culture and quality of care and between empowerment and quality of care were reported. CONCLUSION: Nursing management and leaders must take in consideration that work culture is crucial for improving quality of care in nursing homes, and this study can be used to increase the focus on the work culture among healthcare personnel in nursing homes. Changes are necessary to increase healthcare personnel's job satisfaction, empowerment, autonomy and influence in nursing homes. Giving empowerment to the healthcare personnel working in nursing homes is both an organisational and an interpersonal issue. Being given empowerment and influence over their own work situation, the healthcare workers can be more committed and involved in the goal of obtaining best possible care to the residents.

The relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients.

BACKGROUND: Self-transcendence is considered a developmental process of personal maturity and a vital resource of well-being in later adulthood. Measurement of the associations between self-transcendence and spiritual well-being in cognitively intact nursing home patients has not been previously published. AIMS: The aim of this study was to identify the relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients. METHODS: A cross-sectional design using the self-transcendence scale and the FACIT-Sp spiritual well-being questionnaire was adopted. A sample of 202 cognitively intact nursing home patients in mid-Norway was selected to respond to the questionnaires in 2008 and 2009. Statistical analyses were conducted using lisrel 8.8 (Scientific Software International, Chicago, IL, USA) and structural equation modelling. RESULTS: A hypothesised structural equation model comprising a two-factor construct of self-transcendence and a three-factor construct of spiritual well-being demonstrated significant direct relationships between self-transcendence and spiritual well-being and total effects of self-transcendence on spiritual well-being. IMPLICATIONS FOR PRACTICE: Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might increase spiritual well-being among cognitively intact nursing home patients, which is seen to be of great importance to nursing home patients' overall satisfaction and satisfaction with staff. The two-factor construct of self-transcendence and the three-factor construct of FACIT-Sp allow a more complex examination of the associations between the constructs and prove more specific guidelines for nursing interventions promoting well-being in nursing home patients.

Long-term effects of a nurse-led group and individual patient education programme for patients with chronic inflammatory polyarthritis - a randomised controlled trial.

AIMS AND OBJECTIVES: To investigate the long-term effect of a nurse-led hospital-based patient education programme combining group and individual education for patients with chronic inflammatory polyarthritis. BACKGROUND: Patient education interventions have shown short-term effects, but few studies have investigated whether the effects are sustained for a longer period. DESIGN: Randomised controlled trial. METHODS: Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention group (n = 71) or a waiting list (n = 70). Primary outcomes were as follows: Global Well-Being and the Arthritis Self-Efficacy Other Symptoms Subscale. Secondary outcomes were as follows: patient activation, physical and psychological health status, patients' educational needs and a Disease Activity Score (DAS28-3). RESULTS: The intervention group had a statistically significant higher global well-being than the controls after 12 months, mean change score 8·2 (95% CI, 1·6-14·8; p-value = 0·015), but not in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change score 2·6 (95% CI, -1·8 to 7·1; p-value = 0·245). Within each group, analyses showed a statistically significant improvement in DAS28-3, mean change -0·3 (95% CI, -0·5 to -0·1; p-value = 0·001), in the intervention group from baseline to 12 months, but not in the controls. The controls had a statistically significant deterioration in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change -5·0 (95% CI, -8·6 to -1·3; p-value = 0·008), Arthritis Impact Measurement Scales - 2 Social, mean change 0·3 (95% CI, 0·1-0·5; p-value = 0·008), and Hospital Anxiety and Depression Scale total, mean change 1·4 (95% CI, 0·3-2·5; p-value = 0·013). CONCLUSION: A combination of group and individual patient education has a long-term effect on patients' global well-being. RELEVANCE TO CLINICAL PRACTICE: Nurses should consider whether a combination of group and individual patient education for patients with chronic inflammatory polyarthritis is an alternative in their clinical practice. This combination is less time-consuming for the patients, and it includes the benefit of group learning in addition to focusing on patient's individual educational needs.

Work culture among healthcare personnel in a palliative medicine unit.

OBJECTIVE: Understanding and assessing health care personnel's work culture in palliative care is important, as a conflict between "high tech" and "high touch" is present. Implementing necessary changes in behavior and procedures may imply a profound challenge, because of this conflict. The aim of this study was to explore the work culture at a palliative medicine unit (PMU). METHOD: Healthcare personnel (N = 26) at a PMU in Norway comprising physicians, nurses, physiotherapists, and others filled in a questionnaire about their perception of the work culture at the unit. The Systematizing Person-Group Relations (SPGR) method was used for gathering data and for the analyses. This method applies six different dimensions representing different aspects of a work culture (Synergy, Withdrawal, Opposition, Dependence, Control, and Nurture) and each dimension has two vectors applied. The method seeks to explore which aspects dominate the particular work culture, identifying challenges, limitations, and opportunities. The findings were compared with a reference group of 347 ratings of well-functioning Norwegian organizations, named the "Norwegian Norm." RESULTS: The healthcare personnel working at the PMU had significantly higher scores than the "Norwegian Norm" in both vectors in the "Withdrawal" dimension and significant lower scores in both vectors in the "Synergy," "Control," and "Dependence" dimensions. SIGNIFICANCE OF RESULTS: Healthcare personnel at the PMU have a significantly different perception of their work culture than do staff in "well-functioning organizations" in several dimensions. The low score in the "Synergy" and "Control" dimensions indicate lack of engagement and constructive goal orientation behavior, and not being in a position to change their behavior. The conflict between "high tech" and "high touch" at a PMU seems to be an obstacle when implementing new procedures and alternative courses of action.

Self-transcendence in cognitively intact nursing-home patients: a resource for well-being.

AIM: This article reports an empirical study of self-transcendence in cognitively intact nursing-home patients. The aim was to investigate the interrelationships between self-transcendence and nursing-home patients' physical, social, emotional and functional well-being. BACKGROUND: Finding new and alternative approaches to increase well-being among nursing-home patients is highly warranted. Self-transcendence is considered a developmental process of maturity in adulthood and a vital resource for well-being at the end of life, thus self-transcendence could be a useful approach. DESIGN: Cross-sectional METHOD: The self-transcendence scale and the Functional Assessment of Cancer Therapy General (FACT-G) Quality of Life questionnaire were used. A sample of 202 cognitively intact nursing-home patients in Mid-Norway was selected to respond to the instruments in 2008 and 2009. Analysis was applied by means of LISREL 8·8 Structural Equation Modelling. RESULTS: A two-factor construct of self-transcendence showed that intrapersonal self-transcendence directly affected functional well-being and indirectly influenced physical, emotional and functional well-being. Interpersonal self-transcendence directly affected social and emotional well-being. Additionally important influences were disclosed from functional to emotional and from emotional to physical well-being. CONCLUSION: Finding nursing interventions to enhance both intrapersonal and interpersonal self-transcendence might benefit nursing-home patients' overall well-being. In a holistic perspective of body-mind-spirit, this research generates new-research questions about the pathways between the different dimensions of well-being in nursing-home patients, which is important to holistic nursing practice.

One-year course of fatigue after post-operative radiotherapy in Norwegian breast cancer patients--comparison to general population.

INTRODUCTION: Fatigue after treatment for breast cancer (BC) is common, but poorly understood. We examined the fatigue levels during first year after radiotherapy (RT) according to the extent of RT (local or locoregional), hormonal therapy (HT) and chemotherapy (CT). The impact of comorbidity was also explored. Moreover, we compared fatigue levels in patients with the general population (GenPop) data. MATERIAL AND METHODS: BC patients (n = 250) referred for post-operative RT at St. Olavs Hospital, Trondheim, Norway, were enrolled. Fatigue was measured by the EORTC QLQ-C30-fatigue subscale, ranging from 0 to 100, before RT (baseline), after RT, and at three, six, and 12 months. Clinical and treatment-related factors were recorded at baseline. GenPop data was available from a previous survey (n = 652). Linear mixed models and analysis of covariance were applied. RESULTS: Compliance ranged from 87% to 98%. At baseline, mean value (SD) of fatigue in BC patients was 26.8 (23.4). The level increased during RT (mean change 8.3, 95% CI 5.5-11.1), but declined thereafter and did not differ significantly from pre-treatment levels at subsequent time points. In age-adjusted analyses, locoregional RT accounted for more overall fatigue than local RT (mean difference 6.6, 95% CI 1.2-12.0), but the association was weakened and not statistical significant when adjusting for CT and HT. Similar pattern was seen for CT and HT. The course of fatigue differed significantly by CT (p < 0.001, interaction test). At baseline, fatigue levels were higher in patients with than without CT, but at subsequent time points similar levels were evident, indicating a temporary adverse effect of CT. Comorbidity was significantly associated with increased level of fatigue, independent of other factors (mean difference 8.1, 95% CI 2.2-14.1). BC-patients were not significantly more fatigued than GenPop, except for immediately after ending RT, and then only among those without comorbidity (mean 35.9 vs. 25.8, p < 0.001). CONCLUSION: Comorbidity seems to be a more important determinant for fatigue levels than the cancer treatment.

Self-transcendence and nurse-patient interaction in cognitively intact nursing home patients.

AIMS AND OBJECTIVES: The aim of this study was to test whether nurse-patient interaction affects cognitively intact nursing home patients' interpersonal and intrapersonal self-transcendence, as well as testing the psychometric properties of the Nurse-Patient Interaction Scale (NPIS). BACKGROUND: Self-transcendence is considered a spiritual developmental process of maturity in adulthood, and a vital resource of well-being at the end of life. The concept of self-transcendence has previously been explored in various populations, yet the nurse-patient interactions' potential influence on self-transcendence in nursing home patients has not been published previously. DESIGN AND METHODS: A cross-sectional design employing the Self-Transcendence Scale and the NPIS was adopted. A sample of 202 cognitively well-functioning nursing home patients in Norway was selected. The statistical analyses were carried out using lisrel 8.8 and structural equation modelling. RESULTS: Structural equation modelling-analysis indicates statistical significant effect of nurse-patient interaction on the patients' self-transcendence. Direct influence on the intrapersonal and indirect influence on the interpersonal self-transcendence aspects was disclosed. CONCLUSION: Nurse-patient interaction significantly affected both interpersonal and intrapersonal self-transcendence among cognitively intact nursing home patients. Hence, facilitating caring interventions can be significantly beneficial to older patients' self-transcendence and thereby well-being, both emotional and physical. RELEVANCE TO CLINICAL PRACTICE: Caring behaviour signifies the vital and ultimate qualitative nursing behaviour, which promotes self-transcendence and thereby well-being. These findings are important for clinical nursing that intends to increase patients' well-being.

Co-morbidity and pain sites in long-term gynecological cancer survivors and women in the general population.

OBJECTIVE: Pain is associated with cancer, cancer treatment, co-morbidity and socioeconomic conditions. The aim of this cross-sectional study was to explore the relationship between co-morbidity and number of pain sites (NPS) in long-term survivors of gynecological cancer and a representative sample of women from the general population. Study population comprised recurrence-free long-term gynecological cancer survivors (n=160) and women selected at random from the general population (n=493) in Mid-Norway. Mean age was 58 and 57 (range 32-75), respectively. Mean follow-up time after treatment for gynecological cancer was 12 years (SD 2.6; range 8-17). METHODS: Co-morbidity was assessed as conditions/diseases over the past 12 months. NPS was recorded using a body outline diagram indicating where the respondents had experienced pain during the past week. Socioeconomic conditions were measured by Socioeconomic Condition Index (SCI). All assessments were self-reported. We tested three models of covariates with NPS as outcome: 1-2/0 (A), 3/0 (B) and 4-7/0 (C) pain sites in forward stepwise logistic regression. Outcome measure was adjusted odds ratio (aOR) with 95% confidence intervals (CI). RESULTS: There were no differences in co-morbidity and NPS between gynecological cancer survivors and women from the general population. After adjustment for SCI, age and BMI, musculoskeletal disorders were the strongest predictor of NPS in all models, whereas migraine/headache, sleeping and psychiatric disorders were significantly associated with NPS in model A/B/C, B/C, and C, respectively. CONCLUSIONS: Gynecological cancer survivors are as healthy, and carry as much co-morbid conditions as women from the general population assessed through associations with NPS.

Socioeconomic conditions and number of pain sites in women.

BACKGROUND: Women in deprived socioeconomic situations run a high pain risk. Although number of pain sites (NPS) is considered highly relevant in pain assessment, little is known regarding the relationship between socioeconomic conditions and NPS. METHODS: The study population comprised 653 women; 160 recurrence-free long-term gynecological cancer survivors, and 493 women selected at random from the general population. Demographic characteristics and co-morbidity over the past 12 months were assessed. Socioeconomic conditions were measured by Socioeconomic Condition Index (SCI), comprising education, employment status, income, ability to pay bills, self-perceived health, and satisfaction with number of close friends. Main outcome measure NPS was recorded using a body outline diagram indicating where the respondents had experienced pain during the past week. Chi-square test and forward stepwise logistic regression were applied. RESULTS AND CONCLUSION: There were only minor differences in SCI scores between women with 0, 1-2 or 3 NPS. Four or more NPS was associated with younger age, higher BMI and low SCI. After adjustment for age, BMI and co-morbidity, we found a strong association between low SCI scores and four or more NPS, indicating that there is a threshold in the NPS count for when socioeconomic determinants are associated to NPS in women.

The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis--a randomised controlled trial.

OBJECTIVE: The aim of this study was to investigate the effect of an educational programme for patients with polyarthritis compared to usual care. METHODS: Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention (n=71) or usual care (n=70). The intervention consisted of three group educational sessions followed by one individual educational session. The primary outcomes were a patient's global well-being and arthritis self-efficacy. Secondary outcomes were patient activation, physical and psychological health status, educational needs and disease activity. RESULTS: After four months the intervention group had significantly better global well-being, 95% CI (2.3-14.1), p=0.01, and self-efficacy, 95% CI (0.2-8.1), p=0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group. CONCLUSION: This patient educational programme consisting of group sessions and nurse-delivered individual education has statistically significant benefits for global well-being and maintaining a level of self-efficacy in managing other symptoms in patients with polyarthritis. PRACTICE IMPLICATIONS: This educational programme allows patients to learn from each other in addition to addressing individual educational needs.

Quality of life in children and adolescents surviving cancer.

PURPOSE: To explore subjective and proxy reported QoL (Quality of Life) in children and adolescents surviving cancer three years after diagnosis compared with healthy controls. METHOD: Case-control study including 50 children and adolescents diagnosed with cancer between January 1, 1993 and January 1, 2003 and treated at the Paediatric Department of St. Olav's University Hospital in Trondheim, Norway. Data were collected using The Inventory of Life Quality in Children and Adolescents (ILC) and the KINDL QoL questionnaires (parent and self-reports), as well as by collecting data for any somatic late effects and psychological problems from the medical records of children surviving cancer. RESULTS: Adolescents surviving cancer as a group assessed their QoL as similar to that of their peers. However, adolescents surviving brain tumours or those with late effects reported lower QoL and an increased number of QoL domains perceived as problematic, even many years after diagnosis and treatment. Parents generally report a poorer QoL for their children surviving cancer and a greater number of QoL domains experienced as problematic compared with parent controls. CONCLUSION: To improve the child's total functioning and well-being we conclude that when planning long-term follow-up care, rehabilitation of children and adolescents with cancer, especially for survivors with brain tumours, and with late effects should particularly take into account their subjectively perceived and proxy reported QoL, in addition to their psychological problems and psychosocial functioning.

Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation.

AIMS: This study aimed to evaluate the short- and long-term effects of 4-week inpatient rehabilitation on health-related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio-demographical factors on unaltered or improved HRQL after discharge. METHODS: A total of 111 consecutive cases with mild-to-very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6-month follow-up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George's Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio-demography and co-morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow-up were analysed by paired-sample t-test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge. RESULTS: Health-related quality of life and depression improved between t1 and t2: a change of -3.6 for the SGRQ impact score (p = 0.009), -2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of -4.0 for the SGRQ symptom score (p = 0.012) and a reduction of -0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1-7.8, p = 0.039). CONCLUSION: Short-term benefits on HRQL and depression after rehabilitation relapsed at 6-month follow-up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.

The self-transcendence scale: an investigation of the factor structure among nursing home patients.

PURPOSE: Self-transcendence, the ability to expand personal boundaries in multiple ways, has been found to provide well-being. The purpose of this study was to examine the dimensionality of the Norwegian version of the Self-Transcendence Scale, which comprises 15 items. BACKGROUND: Reed's empirical nursing theory of self-transcendence provided the theoretical framework; self-transcendence includes an interpersonal, intrapersonal, transpersonal, and temporal dimension. DESIGN: Cross-sectional data were obtained from a sample of 202 cognitively intact elderly patients in 44 Norwegian nursing homes. RESULTS: Exploratory factor analysis revealed two and four internally consistent dimensions of self-transcendence, explaining 35.3% (two factors) and 50.7% (four factors) of the variance, respectively. Confirmatory factor analysis indicated that the hypothesized two- and four-factor models fitted better than the one-factor model (cx (2), root mean square error of approximation, standardized root mean square residual, normed fit index, nonnormed fit index, comparative fit index, goodness-of-fit index, and adjusted goodness-of-fit index). CONCLUSIONS: The findings indicate self-transcendence as a multifactorial construct; at present, we conclude that the two-factor model might be the most accurate and reasonable measure of self-transcendence. IMPLICATIONS: This research generates insights in the application of the widely used Self-Transcendence Scale by investigating its psychometric properties by applying a confirmatory factor analysis. It also generates new research-questions on the associations between self-transcendence and well-being.

Early effects of contemporary breast radiation on health-related quality of life - predictors of radiotherapy-related fatigue.

BACKGROUND AND PURPOSE: The aim of this study was to report on early effects of contemporary radiotherapy (RT) on health-related quality of life (HRQOL) and explore treatment-related contributors to the development of fatigue during RT in breast cancer (BC) patients. MATERIAL AND METHODS: Consecutive BC patients (n = 248) referred for postoperative RT at St. Olavs University Hospital in Trondheim, Norway were enrolled from February 2007 to October 2008. Clinical- and treatment data were recorded, and HRQOL were assessed before starting (baseline) and immediately after ending RT using the "EORTC QLQ-C30" and the breast module "EORTC QLQ-BR23". Change scores from baseline were calculated. Predictors of increased fatigue during RT were explored with multiple regression analysis adjusted for relevant confounders. RESULTS: The global QOL- and all functional scales remained stable, except for "future perspective" which improved significantly during RT. Breast symptoms and fatigue increased significantly during RT. Groups with elevated baseline fatigue remained more stable during RT than those with lower levels at baseline. The body volume receiving 40 Gy or more (V40) was a significant predictor of increased fatigue during RT adjusted for chemotherapy, comorbidity and age (p = 0.035). CONCLUSION: Contemporary RT has limited early effects on HRQOL. V40 is a significant predictor of RT-related fatigue.

Psychosocial health in children and adolescents surviving cancer.

AIM: To explore psychosocial health in children and adolescents surviving cancer three years after diagnosis compared with healthy controls, as assessed by adolescents themselves, their parents and teacher. MATERIAL AND METHODS: Case-control study included 50 children and adolescents diagnosed with cancer between 1 January 1993 and 1 January 2003 and treated at the Paediatric Department St. Olav's University Hospital, Trondheim, Norway. Data were collected using the Strengths and Difficulties Questionnaire (self-report, parent report and teacher report), as well as the Achenbach System of Empirically Based Assessment questionnaire (teacher report). RESULTS: Children surviving cancer had more emotional symptoms, higher total problem scores and poorer academic performance than their peers. Emotional problems were consistently reported by parents, teachers and adolescents themselves, in particular in children with brain tumours and among survivors with late effects. CONCLUSION: Our study shows that children surviving cancer are at higher risk for emotional problems when compared with their friends, even after several years following diagnosis and treatment. We conclude that when planning long-term follow-up care, rehabilitation of children and adolescents with cancer, especially for survivors with brain tumours and late effects, should particularly take into account their psychological problems and psychosocial functioning.

Ferrans and Powers' Quality of life index applied in urinary incontinence research--a pilot study.

BACKGROUND: The aim of this study was to explore the usefulness of applying a global, evaluation-based quality of life (QoL) questionnaire in assessing the impact of urinary incontinence (UI) on women's lives. METHODS: The study population comprised long-term gynaecological cancer survivors (n=160) and controls from the general population (n=493). The presence of UI was assessed by the question 'Do you leak urine?' while UI perceived as a problem was assessed on a five-point scale from 'No problem' to 'A very large problem'. QoL was measured by Ferrans & Powers' QoL index (QLI), generic version II. RESULTS: UI was distributed equally among women with a history of gynaecological cancer and among women from the general population (34%). UI has a negative impact on overall QLI as well as a wide range of items. Approximately 20% of the incontinent women defined UI as no problem, with QLI scores similar to continent women. Only 5% experienced UI as a large/very large problem; with exceptionally low QLI scores. The psychometric testing of QLI (acceptability, internal consistency reliability and known-group validity) supports the use of QLI in UI-studies. CONCLUSIONS: The Ferrans & Powers' QLI is considered an acceptable tool for UI research, but further psychometric testing is required.