Effects of oral glycerol on food intake in man.

The amount of food ingested was measured in 12 non-obese volunteers after preloads with glycerol, glycose, and water, administered in a double-blind design. A palatable soup was served in concealed containers and on different plates and the volume, consumed on each occasion, was registered. Administration of 7.5 g glycerol 20 min before the meal reduced the mean energy intake by about 10% compared to both an equicaloric amount of glucose solution or the same volume (30 ml) of water. At the start of the meal 20 min after the preload, the plasma glycerol concentration was about 10 times higher than base-line values. The free fatty acid/glycerol ratios did not correlate to the reduction of energy intake.

Early and late effects of weight loss on lipoprotein metabolism in severe obesity.

In a group of grossly obese patients serum lipoproteins and the intravenous fat tolerance test were analysed before a weight reduction program (n = 98), after 6 weeks (n = 58) and 1 year (n = 15). At one year follow-up the mean weight had fallen from 120 to 105 to 100 kg, respectively. In spite of severe overweight, only a moderate hypertriglyceridaemia (males mean fasting concentration of plasma triglycerides (TG) 2.50 +/- 1.36, females 2.03 +/- 1.94 mmol/l) was found before treatment. After 6 weeks significant reductions were found in VLDL-TG, -cholesterol, LDL-cholesterol and HDL-cholesterol (P less than 0.05 at least). After one year VLDL-TG was still below pretreatment level, LDL-cholesterol had increased above pretreatment level, whereas HDL-cholesterol was significantly higher compared to pretreatment (P less than 0.05). Some previous studies suggest that weight loss may lead to HDL-cholesterol reductions, which would be undesirable. The present study indicates that after sustained weight loss and at a stable lower body weight, HDL-cholesterol levels may increase above pretreatment levels after an initial drop during the catabolic weight reduction phase.

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.

Plasma concentrations of regulatory peptides in obesity following modified sham feeding (MSF) and a liquid test meal.

Plasma concentrations of regulatory peptides were monitored in groups of obese and normal-weight subjects following modified sham feeding and a liquid fatty meal. Following modified sham feeding a significant increase in immunoreactive cholecystokinin (CCK) in plasma was recorded in both groups. In the obese subjects, however, the concentrations following sham feeding were significantly lower than in normal-weight subjects, and the initial part of the response was negative. Basal and modified sham feeding stimulated immunoreactive pancreatic polypeptide (PP) concentrations in plasma did not differ between the groups. After the liquid fatty meal plasma CCK concentrations increased similarly in both groups. In contrast immunoreactive neurotensin and somatostatin concentrations following the meal were lower in the obese group, and a changed concentration-time pattern for somatostatin was observed in the obese group. Postprandial concentrations of PP and immunoreactive gastrin were not different in the groups. The results indicate that the plasma concentration patterns of CCK, somatostatin and NT are disarranged in obesity. The changes may promote rapid propulsion and absorption of ingested food, and facilitate deposition of fat in adipose tissue in obesity and thus may be of pathophysiological importance.

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.

Oral- and pharyngeal-cancer patients' perceived symptoms and health.

The purpose of this study was to describe the perceived eating problems, general symptoms, and general health of a group of oral- and pharyngeal- cancer patients before surgery in order to facilitate nursing care planning. A total of 29 patients (20 men and nine women) participated. Two groups were formed: in group 1, 13 patients participated before and, in group 2, 16 patients participated after the presurgical radiotherapy. Questionnaires were used to collect data. Eating disabilities were evident in both groups. The patients who had had their radiation therapy experienced problems such as bad taste function, mouth dryness, difficulties in chewing, and mouth pain more frequently than those who had not been treated. Only five patients in group 2 ate solid food, compared with 10 in group 1. Shoulder and back pain and feelings of worry and anxiety were perceived as the most frequent general symptoms. Most of the patients perceived their general health as being rather good, but some indicated poor health, several symptoms, poor appetite, and/or severe eating problems. Patients with oral and pharyngeal cancer should be carefully assessed before surgery because of their disparity of symptoms and disabilities so as to identify those who need specific nursing interventions.

Nursing students' experience of care planning activities in clinical education.

This paper summarises a research study inquiring into the experiences of nursing students of their practice of individualised care planning as a learning activity. The survey was conducted in the final stage of the students' education and concerned three groups of students in the years 1990, 1992 and 1993 who were asked to evaluate their main clinical placements in surgical, medical and long-term care wards with regard to care planning activities. The answers to the questions showed a pattern that was persistent over the different health care specialties as well as over the years when the investigation was made. Some of the activities, such as oral reporting and writing progress notes, were done many times by all the students. Other activities, such as writing care plans and discharge notes, were trained only a few times or never. There were very small positive differences over the years, and there were overall lower scores from the students' training in long term care wards. Possible factors affecting the result from an educational and theoretical point of view are discussed.

Long-term care of obese individuals in a community-based primary health care program.

A four-year treatment program for severe obesity containing behavioural modification, exercise and nutrition advice was developed at the obesity unit at the Karolinska Hospital. The program made it possible to achieve a sustained weight loss. As far as we know such long-term treatment result has not been reported for this group of patients before. As a consequence of the positive outcome the hospital treatment program was transformed to an out-patient program that could be used in a primary health care setting. The transformation process is emphasized in this presentation but also preliminary results of the weight reduction and the attrition rate in the primary health care setting of the weight reduction program are presented. The evaluation indicates that instructors and participants in the program overall have accepted the program. The mean weight reduction after ten weeks was 6.3 kg. The attrition rate during that time was 2%.

Long-term effects of commonly available weight reducing programmes in Sweden.

A majority of people attempting to lose weight will use methods that do not involve medical expertise or professional organizations. Consumer organizations continually have problems with so-called slimming products which claim results that are scientifically unfounded and impossible. In this study four methods commonly used in Sweden were studied with emphasis on long-term effects. One-hundred and twenty moderately overweight women were allocated to one of five groups and repeatedly interviewed and monitored over a 2-year period. The long-term results with a protein powder preparation and a kelp-lecithin-vitamin capsule were poor. However, results were also poor with the nutritionally adequate recommendations issued by the Stockholm Home Economics consultation service but lacking programme support or follow-up. The weight losing programme of a 'slim club' was found to result in the greatest overall sustained weight loss (2.8 +/- 4.7 kg, mean +/- s.d.). An attempt to define 'compliance' with each programme was made, which showed that the majority of overweight women were not able to adhere to these given programmes for a 2-year period, probably because of unsatisfactory results. We consider it essential to document the long-term outcome of these methods in order to facilitate understanding of the situation of these overweight subjects and to assist consumer organizations in their efforts to prevent the spread of scientifically unsound weight reduction methods.

Hospital staff members are satisfied with their jobs.

Job related satisfaction was evaluated by registered nurses, physicians, nurse assistants and aids at an internal medicine clinic at a university hospital in Sweden. A questionnaire concerning cooperation, work load, support, independence and other work related factors was developed and filled out by 153 individuals. The results mostly show high job satisfaction in all professional groups. Nevertheless, nearly half of the staff wanted to quit their jobs. Those who planned to leave their jobs perceived themselves as less satisfied with such factors as cooperation, job complexity, help received from superiors and sufficient time for care delivery, than did those who did not plan to quit. The differences were most evident in the group of registered nurses. The head nurse appeared to have an important supportive function. In conclusion, the results suggest that a supportive organization might reduce personnel turnover in hospitals.

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.

[Salutogenic model and utilization of the KASAM form (Sense of Coherence) in nursing research--a methodological report]. / Den salutogena modellen och användning av KASAM-formuläret i omvårdnadsforskningen 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.

Living with cancer: perceptions of well-being.

The aims of the study were, first, to provide descriptive data on the perception of psychological well-being one year after surgery in a group of patients treated for gastro-intestinal cancer; secondly, to compare aspects of psychological well-being between the group of patients living with other chronic diseases, and thirdly, to determine whether the perceptions of psychological well-being were related to coping capabilities. Sixty-nine patients with gastro-intestinal cancer and 20 patients with ostomies due to Crohn's disease or ulcerative colitis participated in the study. The most interesting finding in this study was that the cancer patients with a strong sense of coherence perceived their well-being as better than did the patients with a weaker sense of coherence. Other interesting findings were the differences in psychological well-being between younger (< 67 years) and older (> or = 67 years) cancer patients and between the younger cancer patients and non-cancer patients with ostomies. The young perceived their well-being as poorer than that of the old and the cancer patients rated their sense of psychological well-being as poorer than that of the patients with ostomies. It is concluded that nurses should focus their attention not only on the patients' physical well-being but also on their psychological well-being. Specific consideration should be given to the psychological needs of younger cancer patients.