[Show abstract][Hide abstract] ABSTRACT: Background: A growing number of surgical trials include Quality of Life (QOL) variables in overall assessment of outcomes. This is believed to broaden the criteria for choice of treatment and the evaluation of treatment regimens. A number of important questions have to be addressed in patients with gastric carcinoma. How are health-related QOL measures presented in patients referred to hospital? Do these patients suffer from mood disorders? Is the QOL of these patients different from that of the general population and other patient groups of similar demographic origin and referred to hospital because of completely different kinds of surgical diseases? What is the impact of surgical therapy on QOL parameters? Does the type of surgical reconstruction affect important QOL parameters? Patients and methods: We have studied QOL in consecutive patients with carcinoma of the stomach considered amenable to curative major surgical procedures. The QOL evaluation was based on a battery of questionnaires, covering general body symptoms, mood level and functional limitations. In a subsequent series of patients, 64 patients were randomized to have either a total (n = 31), a subtotal (n = 13) gastrectomy or a jejunal S-shaped pouch (n = 20) as a gastric substitute. The patients were rated by one of two psychiatrists who were blind to the patient group affiliation. Assessments were made on three occasions: during the week prior to surgery, 3 months and 12 months after the surgical intervention. Results: Patients with gastric cancer reported more neurasthenic complaints such as reduced sexual interest, insomnia and pure appetite as well as lower mood level than the general population. The gastric cancer group also showed a markedly lower mood level compared with a group of cancer survivors 2–3 years after diagnosis than patients with intermittent claudication. Overall, 25% of the gastric cancer patients reported functional limitations regarded to be clinically significant. For instance patients with intermittent claudication reported more limitations and patients with small cell lung cancer markedly more limitations. Irrespective of type of surgical treatment, the patients postoperatively suffered from alimentary symptoms and functional limitations in everyday life, whereas their mental status and well-being improved considerably after surgery. Patients who underwent subtotal gastrectomy had the best outcome, especially with respect to complaints of diarrhoea. Patients given a gastric substitute after gastrectomy showed no difference from those who had only a total gastrectomy with a straight Roux-en-Y oesophagojejunostomy. Conclusion: It can be concluded that all patients with gastric cancer referred to hospital for surgical treatment show a low level of limitation on average, but exhibit problems in the area of sleep/rest; home management and especially eating disturbances were frequently reported. After gastrectomy, significant unfavourable consequences of the operation could be elucidated but the patients recovered with an improved mental status. A pouch reconstruction of total gastrectomy does not improve QOL when assessed during the first 12 months after the operation, but a subtotal gastrectomy has some advantages which have to be considered when the procedure is clinically feasible.
[Show abstract][Hide abstract] ABSTRACT: To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years.
Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese. Subjects: A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMI>or=34) and women (BMI>or=38) who completed 10 years of the study.
HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years.
HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1- and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6- to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study.
Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.
International Journal of Obesity 08/2007; 31(8):1248-61. DOI:10.1038/sj.ijo.0803573 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The primary purpose was to examine 2-y effects of weight change on personality traits in severely obese subjects treated conventionally or surgically. We also assessed differences between the severely obese patients and a primarily normal-weight reference group.
Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychasthenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. A total of 1380 surgical candidates, 1241 conventionally treated patients and 1135 subjects from the SOS (Swedish Obese Subjects) reference study, representing the general population, completed the KSP. Data presented in this study were gathered twice from the patients (prior to treatment and after 2 y) and once from the reference subjects. Significance tests and effect sizes (ES) were calculated.
At baseline, the obese were characterised as more anxiety prone, impulsive, irritable and less monotony avoiding than the reference group; surgery patients more so than the conventionally treated. At follow-up, it was found that anxiety proneness decreased and Monotony Avoidance increased with increasing weight loss. The conventionally treated were, on average, weight stable and, hence, only a small decrease was noted regarding Somatic Anxiety. The surgery group lost on average 28 kg, and differences between surgically treated and the reference group decreased on all scales except Impulsiveness, which remained unchanged. The largest improvement was in relation to Psychasthenia.
Weight reduction maintained for 2 y was associated with changes on practically all personality traits in proportion to the magnitude of weight loss. In particular, Psychasthenia seemed to be alleviated, while Impulsiveness was unaffected.
International Journal of Obesity 12/2004; 28(11):1485-93. DOI:10.1038/sj.ijo.0802768 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To derive formulae to predict the likely 12-month health-related quality of life outcome following different treatments for intermittent claudication (IC).
A prospective, randomized, controlled study.
One hundred and seventy-one unselected patients with stable IC were sequentially randomized to invasive therapy, supervised physical training or observation. Hierarchical analysis was used to identify significant predictors of outcome.
The strongest outcome predictors were baseline values of the respective outcome variables in all groups. No more than two significant secondary predictors were identified for each outcome variable and no outcome variable was a predictor of any other outcome variable. Resulting prediction equations achieved between 61 and 90% concordance with improvement (75% considered adequate), with best prediction for invasive therapy and poorest for observation. Suggested cutpoints for the various endpoints in the three groups had sensitivities ranging between 65 and 100% and false positive rates between 5 and 50%.
The derived equations adequately predicted improvement on the various outcome variables in invasive therapy and supervised physical training, and may serve as aids in selecting patients likely to benefit most from a particular treatment strategy. The uniqueness of the outcome variables underscores the importance of implementing a comprehensive set of endpoints relevant to the impacts of the condition.
European Journal of Vascular and Endovascular Surgery 02/2004; 27(1):24-32. DOI:10.1016/S1078-5884(03)00352-6 · 3.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The Obesity-related Problems scale (OP) is a self-assessment module developed to measure the impacts of obesity on psychosocial functioning. Our principal aim was to evaluate the construct validity and responsiveness of the OP scale. Our specific aims were to test: (1) the psychometric performance of OP; (2) if OP scores differed by gender and weight category; (3) if OP scores are inversely related to mental well-being; (4) if weight reduction in the obese is accompanied by improvements in psychosocial functioning (OP).
International Journal of Obesity 05/2003; 27(5):617-30. DOI:10.1038/sj.ijo.0802272 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cross-sectional.
In a previous study we found spinal cord lesion (SCL)-related coping factors to be distinctly related to levels of SCL-related psychological outcome. However, we did not control for other potentially confounding variables. In this study we investigated effects of coping strategies on psychological outcome reactions in traumatically spinal cord lesioned persons controlling for sociodemographic, disability-related and social support variables.
The Gothenburg Spinal Injuries Unit in Sweden.
The study sample comprised 255 persons and a subsample of 157 persons. A series of stepwise multiple regression analyses were performed.
SCL-related coping factors clearly predicted psychological outcome even when background variables were controlled. Higher levels of acceptance coping predicted decreased psychological distress and increased positive morale. Elevated social reliance coping predicted heightened distress. Higher levels of social support predicted lower feelings of helplessness. Sociodemographic and disability-related variables were weak predictors of psychological outcome with one exception: higher education predicted less bitterness and brooding.
SCL-related coping remained the most important predictor of psychological outcome even when a wide range of variables was controlled. Thus we conclude that psychosocial interventions aimed at helping individuals develop their coping strategies might be of substantial value in their adjustment to SCL.
[Show abstract][Hide abstract] ABSTRACT: To investigate the impact of overweight and obesity on health-related quality-of-life (HRQL) in the general population in western Sweden.
A total of 5633 men and women aged 16-64 y born in Sweden.
Scale and summary component scores of the SF-36 Health Survey.
Obese men aged 16-34 y rated their HRQL lower than normal-weight men did on all four physical health scales of the SF-36 and on two of the four mental health scales. Obese women in the same age group rated their health worse than normal-weight women on three of the physical health scales. Thus, in younger men and women the analysis indicated a clearer negative association between obesity and physical health than between obesity and mental health. Obese women aged 35-64 y rated their health worse on all scales than normal-weight women did, while obese men in this age group rated their health worse on only two SF-36 subscales-physical functioning and general health perception. The massively obese men and women suffered from a poor level of HRQL.
Not only does the level of obesity affect HRQL, the impact of overweight and obesity also differs by age and sex. The importance of aspects of both physical and mental health should be fully recognised.
International Journal of Obesity 04/2002; 26(3):417-24. DOI:10.1038/sj.ijo.0801919 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cross-sectional.
To investigate relationships between coping and mental well-being with clinical relevance to spinal cord lesion (SCL).
The Gothenburg Spinal Injuries Unit in Sweden.
The study sample comprised 274 persons. From in-depth interviews, literature reviews, and the transactional theory of stress and coping, items reflecting coping and psychological outcome, respectively were generated. Principal components factor analysis, multi-trait analysis, and structural equation modelling were used.
The coping scale comprised three factors: Acceptance (i.e. revaluation of life values); Fighting spirit (i.e. efforts to behave independently); Social reliance (i.e. a tendency towards dependent behaviour). The outcome scale included the factors: Helplessness (i.e. feeling perplexed, out of control and low self-esteem); Intrusion (i.e. bitterness and brooding); Personal growth (i.e. positive outcomes of life crisis). Acceptance showed a positive relation to Personal growth and was inversely related to both Helplessness and Intrusion. Fighting spirit had a weak negative association to Helplessness and a weak positive association to Personal growth. Social reliance was positively related to Helplessness and Intrusion. Only Social reliance showed any association to neurological status. Those lesioned 1-4 years reported more Helplessness, Intrusion, Social reliance, and less Acceptance than those lesioned >or=5 years.
Coping is related to psychological outcome in SCL. Our situational coping measure may be a candidate to assess intervention effects.
[Show abstract][Hide abstract] ABSTRACT: That severe malnutrition affects body function and psychological well-being is well documented. We addressed the question of whether quality of life relates to changes in variables such as food intake, body composition, and gastrointestinal symptomatology after gastrectomy for gastric cancer. Thirty-two patients undergoing gastric resection had their dietary intake, body composition, and specific and general aspects of quality of life determined preoperatively, at 12 months and, in the 15 surviving patients, several years after the operation. The patients lost 10% of their preoperative weight (mainly body fat) during the first year. Food intake did not correlate to changes in body composition or quality of life. Gastrointestinal symptoms adversely related to changes in lean body mass, meal size, and general aspects of quality of life for a long time after the operation. Gastrointestinal symptom control seems important to minimize impairment in quality of life, body composition, and eating after gastrectomy.
[Show abstract][Hide abstract] ABSTRACT: to compare the effectiveness of invasive therapy, supervised physical training and no treatment in terms of health-related quality of life (HRQL) in patients with intermittent claudication (IC).
a prospective, randomised, controlled study.
a total of 253 unselected patients with stable IC were sequentially randomised into 3 balanced treatment groups. At 1 year follow-up data from a battery of generic and disease specific HRQL questionnaires, and global indices of quality of life and physical condition were available in 171 patients.
compared with a non-diseased reference group, claudicants were substantially limited in daily physical functioning, but little affected regarding emotional, cognitive and social functioning, or well-being. Invasive therapy yielded significantly greater improvements in some aspects of physical functioning and walk-related symptoms than training. Training was not superior to invasive therapy on any HRQL dimension and superior to no treatment on only one dimension. Treatment effects, however, were generally small-to-moderate and levels of physical dysfunction in all groups remained higher than reference values.
invasive therapy is more effective than supervised training in alleviating illness-specific symptoms and improving certain aspects of physical functioning - the primary HRQL domains impacted on by IC and the principal goals of its treatment. However, since treatment effect sizes were at most moderate and given that untreated claudicants reported at most small deterioration in HRQL, the level of evidence supporting invasive therapy is modest.
European Journal of Vascular and Endovascular Surgery 09/2001; 22(2):114-23. DOI:10.1053/ejvs.2001.1406 · 3.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: to compare the effect of surgery, exercise and simple observation on maximum exercise power in claudicants. Design: prospective, randomised study.
a total of 264 unselected claudicants were randomised to supervised exercise training, invasive treatment (open surgical or endovascular procedures) or observation. One year treatment outcomes were analysed on an intention to-treat basis.
invasively treated patients showed a significant improvement in maximum walking power, stopping distance, post-ischaemic blood flow and big toe pressure at one year. Patients randomised to physical exercise training or to the control group did not improve in any outcome measure.
invasive treatment increased walking capacity, leg blood pressure and flow. Supervised physical exercise training offered no therapeutic advantage compared to untreated controls.
European Journal of Vascular and Endovascular Surgery 09/2001; 22(2):107-13. DOI:10.1053/ejvs.2001.1413 · 3.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although research has consistently demonstrated that chronic obstructive pulmonary disease (COPD) impairs health-related quality of life (HRQL), little agreement has been evidenced regarding the factors identified as contributing to impaired HRQL. The aim was to study such factors using well established generic and specific HRQL instruments. The patients (n=68) were stratified by forced expiratory volume in one second (FEV1) to represent a wide range of disease severity. Pulmonary function, blood gases and 6-min walking distance test (6MWD) were assessed. HRQL instruments included: St George's Respiratory Questionnaire (SGRQ), Sickness Impact Profile (SIP), Hospital Anxiety and Depression Scale and Mood Adjective Check List. The strength of the impact of COPD on HRQL was represented along a continuum ranging from lung function, functional status (physical and psychosocial) to wellbeing. Although correlations between FEV1 versus SGRQ total and SIP overall scores (r=-0.42 and -0.32) were stronger than previously reported, multiple regression analyses showed that lung function contributed little to the variance when dyspnoea-related limitation, depression scores and 6MWD were included in the models. These three factors were important to varying degrees along the whole range of HRQL. Physiological, functional and psychosocial consequences of chronic obstructive pulmonary disease are only poorly to moderately related to each other. The present study concludes that a comprehensive assessment of the effects of chronic obstructive pulmonary disease requires a battery of instruments that not only tap the disease-specific effects, but also the overall burden of the disease on everyday functioning and emotional wellbeing.
European Respiratory Journal 08/2001; 18(1):69-76. DOI:10.1183/09031936.01.00044901 · 7.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The primary purpose was to define obesity-related strategies for coping with psychological problems connected with obesity. We also wanted to identify obesity-related distress and explore the effect of coping on distress. Thirdly, we wanted to investigate differences in coping and distress related to choice of surgery or conventional treatment.
Cross-sectional data from patients in the Swedish Obese Subjects (SOS) intervention study.
An obesity-related questionnaire concerning coping and distress was created and evaluated in 2510 patients from the SOS study, using multitrait, exploratory and confirmatory factor analysis procedures.
Three coping factors were defined. Social Trust and Fighting Spirit were problem-focused, whereas Wishful Thinking was emotion-focused. Surgical candidates displayed lower levels of problem-focused and higher levels of emotion-focused coping. We also identified two distress factors: Intrusion and Helplessness. Wishful Thinking was positively related to distress, and Social Trust and Fighting Spirit were inversely related, thus explaining the higher levels of distress reported by the surgical candidates.
In our sample, emotion-focused coping proved maladaptive and was associated with increased distress. Problem-focused coping, however, was adaptive and associated with reduced distress. These findings partly explain psychological morbidity and should be taken into consideration in the treatment of obese people.
British Journal of Clinical Psychology 07/2001; 40(Pt 2):177-88. · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: To evaluate the health-related quality of life (HRQL) of patients with head and neck cancer during and after treatment with radiotherapy, surgery, and chemotherapy. Study Design: Prospective, descriptive study. Methods: All new patients in four institutions in Norway and Sweden were asked to participate. Health-related quality of life was assessed at baseline and at 1, 2, 3, 6, and 12 months after start of treatment by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC head and neck cancer-specific questionnaire. Baseline results are described elsewhere; longitudinal results are presented in the current article. Three hundred fifty-seven patients with cancer in the oral cavity, pharynx, larynx, nose, sinuses, and salivary glands and neck node metastases from unknown primaries filled in the questionnaires at baseline. Results: Seventy-eight percent of the patients who were alive after 12 months filled in all questionnaires (218/280). The general trend was that HRQL deteriorated significantly during treatment, followed by a slow recovery until the 12-month flow-up with few exceptions (senses, dry mouth, and sexuality). Patients who later died reported worse HRQL at each assessment point compared with patients who filled in all six questionnaires, whereas those who dropped out of the study for other reasons were quite similar to patients who filled in all questionnaires. The patients with pharyngeal cancer in general reported worse HRQL compared with the other groups and did not reach pretreatment values in several domains. Stage was also an important factor for HRQL in patients with head and neck cancer. Conclusion: Detailed knowledge about the differences between groups and changes over time may aid us in the communication with patients and in the design of intervention studies focusing on improvement of the support and rehabilitation of patients with head and neck cancer.
[Show abstract][Hide abstract] ABSTRACT: Standard scoring algorithms were recently made available for aggregating scores from the eight SF-36 subscales in two distinct, higher-order summary scores: Physical Component Summary (PCS) and Mental Component Summary (MCS). Recent studies have suggested, however, that PCS and MCS scores are not independent and may in part be measuring the same constructs. The aims of this paper were to examine and illustrate (1) relationships between SF-36 subscale and PCS, MCS scores, (2) relationships between PCS and MCS scores, and (3) their implications for interpreting research findings. Simulation analyses were conducted to illustrate the contributions of various aspects of the scoring algorithm to potential discrepancies between subscale profile and summary component scores. Using the Swedish SF-36 normative database, correlation and regression analyses were performed to estimate the relationship between the two components, as well as the relative contributions of the subscales to the components. Discrepancies between subscale profile and component scores were identified and explained. Significant correlations (r = -0.74, -0.67) were found between PCS and MCS scores at their respective upper scoring intervals, indicating that the components are not independent. Regression analyses revealed that in these ranges PCS primarily measures aspects of mental health (57% of variance) and MCS measures physical health (65% of variance). Implications of the findings were discussed. It was concluded that the current PCS MCS scoring procedure inaccurately summarizes subscale profile scores and should therefore be revised. Until then, component scores should be interpreted with caution and only in combination with profile scores.
Quality of Life Research 02/2001; 10(5):395-404. DOI:10.1023/A:1012552211996 · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the construct validity of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women.
A total of 4377 middle-aged, obese subjects in the Swedish Obese Subjects (SOS) study.
The total sample was randomly split into two data subsets and psychometric testing was performed separately in each sample. Multitrait/multi-item analysis was conducted to test scaling assumptions and factor analysis was used to test the factor structure. Measures of mental well-being (MACL, HAD) were used for testing criterion-based validity.
The Cognitive Restraint factor was consistently reproduced and scaling analysis demonstrated strong item-scale discriminant validity, while the item-scale convergent validity was unsatisfactory. The internal structure of the Disinhibition scale was weak. Most Disinhibition and Hunger items grouped in one global factor labeled Uncontrolled Eating. A third cluster containing items on Emotional Eating was also identified. The obtained three-factor structure was cross-validated and replicated across subgroups by gender, age and BMI.
The original TFEQ factor structure was not replicated. A short, revised 18-item instrument was constructed, representing the derived factors of Cognitive Restraint, Uncontrolled Eating and Emotional Eating. The most efficient items were used to boost both the convergent and discriminant validity of the scales.
International Journal of Obesity 01/2001; 24(12):1715-25. DOI:10.1038/sj.ijo.0801442 · 5.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Quality of life (QOL) is often considered the primary endpoint in research, clinical medicine, and health promotion when impairments are incurable or insufficiently understood. For spinal cord injured (SCI) persons extended life spans and the need for life-long follow-up make it important to expand the outcome parameters of medical care and health services to include QOL measures. Study design: Review. Objectives: The aim of this study was to evaluate QOL research in SCI persons from the perspective of current criteria for instrument psychometric quality developed by Medical Outcomes Trust (MOT).
Relevant articles were extracted from the Medline, Cinahl, and PsycLit databases for approximately a recent 30-year period (1966 - 1999). The keyword 'spinal cord injuries' was cross-indexed with 'quality of life', 'personal satisfaction' and 'life satisfaction'. A total of 105 articles were identified and 46 met our inclusion criteria: (a) report of original research; (b) evaluation of QOL by self-report questionnaires or scales; and (c) publication in English.
The quality of the research designs varied widely. Most of studies were cross-sectional with limited study populations. The number of instruments or different combinations of instruments nearly equalled the number of studies conducted. Most questionnaires were condition-specific and only used by the developers. The variety of instruments and the diversity of their core content made results difficult to compare, and evaluations and conclusions unpredictable and sometimes contradictory. The low psychometric standard of many instruments used further aggravates the interpretation of results.
To improve future research in special populations such as the SCI, the MOT criteria for review of QOL instruments should be further disseminated and applied to reach desirable consensus of a limited number of standardised generic and condition-specific QOL measures.