M Sullivan

University of Gothenburg, Goeteborg, Västra Götaland, Sweden

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Publications (76)266.45 Total impact

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  • L. Lundell, J. Svedlund, M. Sullivan
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    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.
    Scandinavian Journal of Gastroenterology 07/2009; 31(s221):29-29. · 2.33 Impact Factor
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    Journal de Chirurgie. 02/2008; 145(1):77.
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    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. · 5.22 Impact Factor
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    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. · 5.22 Impact Factor
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    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. · 2.82 Impact Factor
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    ABSTRACT: The primary purpose was to assess personality trait differences between the severely obese seeking treatment and a mainly non-obese reference group. We also investigated gender differences and differences between obese patients and obese not seeking treatment. Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychastenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. Patients from the Swedish Obese Subjects (SOS) intervention study (n=3270, ages 37-57, 71% women) and the SOS reference study (n=1135, 54% women) completed the survey. Data presented in this study were gathered prior to treatment. Significance tests and effects sizes were calculated. Although statistically significant differences were found between obese patients and reference subjects on nearly all personality traits, effect sizes were at most moderate. Of the three scales with moderate effects sizes, differences on Somatic Anxiety and Psychastenia could be traced to items tapping condition-specific symptoms, e.g., problems with sweating and breathing as indicators of Somatic Anxiety. Moderate differences on the Impulsiveness scale (men alone) could not be explained by item composition. Further, the obese patients differed from obese in the reference group, and both obese and reference women reported significantly higher levels on Somatic Anxiety, Muscular Tension and Psychic Anxiety compared to men (effect size: small). Our results provided no evidence of a general obese personality profile, instead considerable heterogeneity in personality traits was observed across our obese samples (treatment seekers vs non-seekers, men vs women) and generally only small differences were noted compared to a reference study population. Further research is needed to investigate if the somewhat elevated levels of Impulsiveness, particularly among male obese patients, is affected by weight loss. When assessing personality traits in diseased groups consideration should be given to possible confounding from, e.g., somatic symptoms.
    International Journal of Obesity 01/2004; 27(12):1534-40. · 5.22 Impact Factor
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    ABSTRACT: 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). Four samples were used: 6863 subjects in the SOS cross-sectional study; 2128 in the SOS intervention study; 1017 nonobese in the SOS reference study; and 3305 obese subjects in the XENDOS study. Psychosocial functioning was measured by OP. Overall mood was measured by MACL. Anxiety and depression symptoms were measured by HAD. Psychometric testing provided strong support for the construct validity of OP. Factor analysis confirmed the homogeneity of the construct and multitrait/multi-item scaling analysis demonstrated strong item-convergent/discriminant validity. Reliability coefficients were high and floor and ceiling effects were small. Psychometric results were cross-validated and replicated in subgroups by gender, age and body mass index (BMI). As expected, large differences in OP were observed between obese and nonobese (P<0.0001). Obese women reported more weight-related psychosocial problems than obese men (P<0.0001). Psychosocial disturbances (OP) among the obese were significantly related to poor mood (MACL; P<0.0001) and anxiety and depression symptoms (HAD; P<0.0001). Change in OP over time was strongly correlated with weight loss (P<0.0001). A distinct dose-response effect between weight reduction and improvements in OP was demonstrated. Scores on psychosocial functioning (OP) and mental well-being (MACL, HAD) in nonobese (BMI<30) surgical patients at 4-y follow-up were equal to scores observed in nonobese reference subjects (NS). OP is a psychometrically valid obesity-specific measure suitable for evaluating HRQL effects of obesity interventions. The negative impact of obesity on psychosocial functioning is considerable and disturbances are connected with poor mental well-being. Weight reduction in the obese is followed by improvements in both psychosocial functioning and mental well-being.
    International Journal of Obesity 05/2003; 27(5):617-30. · 5.22 Impact Factor
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    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.
    Spinal Cord 09/2002; 40(8):408-15. · 1.90 Impact Factor
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    U Larsson, J Karlsson, M Sullivan
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    ABSTRACT: To investigate the impact of overweight and obesity on health-related quality-of-life (HRQL) in the general population in western Sweden. Cross-sectional survey. 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. · 5.22 Impact Factor
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    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.
    Spinal Cord 01/2002; 40(1):23-9. · 1.90 Impact Factor
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    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.
    Digestive Diseases and Sciences 01/2002; 46(12):2673-80. · 2.26 Impact Factor
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    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. · 2.82 Impact Factor
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    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. · 2.82 Impact Factor
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    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. · 6.36 Impact Factor
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    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
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    ABSTRACT: A Swedish and Norwegian study was designed to examine health-related quality of life (HQL) in patients with head and neck cancer (head and neck) at diagnosis and during treatment and rehabilitation. The overall aim was to examine the impact on HQL at diagnosis depending on tumor location, stage, sex, and age (part I) and to describe HQL longitudinally and determine for which patients and during which period HQL deteriorated most (part II). This article presents the results at diagnosis. Patients with head and neck cancer at five hospitals in Sweden and Norway were consecutively requested to participate. They were asked to answer the EORTC QLQ-C30 and QLQ-H&N35 (the European Organization for Research and Treatment of Cancer, Core 30 questionnaire and head and neck cancer module) repeatedly during 1 year. A total of 357 patients (mean age, 63 y; 72% males) were included. Patients with different tumor locations all had their special problems at diagnosis, for example, those with tumors in the larynx with communication, those with oral tumors with pain, and those with pharyngeal tumors with nutrition and pain. The patients with hypopharyngeal cancer reported the worst HQL. Stage appeared to have the strongest impact on HQL. Patients with a more advanced tumor stage reported significantly worse HQL scores for 24 of 32 variables reflecting functioning or problems. The females scored worse than the males for some areas, in particular, emotional functioning. The older patients scored significantly better for emotional and social functioning than patients <65 years but worse for physical functioning and various symptoms. The traditional way of grouping the tumor locations into oral, pharyngeal, laryngeal, and "other" tumors (salivary gland, sinus and nose, and unknown primary) was tested from a HQL point of view and found to be consistent. The chosen questionnaires differentiated between different sites of head and neck cancer at diagnosis. Tumor stage had the most powerful impact on HQL score.
    The Laryngoscope 05/2001; 111(4 Pt 1):669-80. · 1.98 Impact Factor
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    C Taft, J Karlsson, M Sullivan
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    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. · 2.86 Impact Factor
  • Eva Hammerlid, Eva Silander, L Hörnestam, Marianne Sullivan
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    ABSTRACT: To examine health-related quality of life (HRQL) of all head and neck cancer patients from diagnosis until 3 years later and to analyze its dependence on tumor site and other patient characteristics. Two hundred thirty-two patients (mean age 61 years; 70% men) were included and followed with clinical measures and mailed standardized HRQL questionnaires (The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), the EORTC QLQ-Head and Neck Cancer module (QLQ-H&N35), and the Hospital Anxiety and Depression Scale (HADS). After 3 years 66% of the patients were alive and 88% of these completed the study. The HRQL was worse during treatment and returned slowly thereafter to pretreatment values with few exceptions. After 3 years the best improvement was found for mental distress, followed by a significant global quality of life improvement and reduced pain compared with diagnosis. A significant deterioration was found for problems with dry mouth, senses, and teeth, as well as for opening the mouth wide (ie, they seemed to be related to the treatment given). There were few significant improvements between the 1- and 3-year follow-ups. Depression and physical functioning at diagnosis were independent predictors for global quality of life at 3 years. Patients who died during the study had a worse HRQL at diagnosis compared with patients completing the study. Patients with advanced disease (stage III + IV) scored worse than patients with small tumors for most of the HRQL domains. These differences increased over time. Few differences were found relating to gender and age. The pharyngeal cancer group scored worse compared with the other tumor sites, and these patients would probably benefit from a rehabilitation program right from diagnosis, including treatment for malnutrition and pain. The largest HRQL changes for head and neck cancer patients are seen within the first year after diagnosis, with a significant deterioration just after finishing treatment. Thereafter, most of the variables return to pretreatment values. The significant problems with dry mouth, senses, and teeth after treatment are constant over time.
    Head & Neck 02/2001; 23(2):113-25. · 2.83 Impact Factor
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    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. · 5.22 Impact Factor

Publication Stats

6k Citations
266.45 Total Impact Points

Institutions

  • 1990–2009
    • University of Gothenburg
      • • Institute of Medicine
      • • Department of Urology
      Goeteborg, Västra Götaland, Sweden
  • 1990–2003
    • Sahlgrenska University Hospital
      • Department of Cardiology
      Goeteborg, Västra Götaland, Sweden
  • 2002
    • Nordic Africa Institute
      Goeteborg, Västra Götaland, Sweden
  • 1998
    • Chestnut Hill College
      Boston, Massachusetts, United States
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
    • New England Baptist Hospital
      Boston, Massachusetts, United States
  • 1992
    • Newcastle University
      • Institute for Ageing and Health
      Newcastle upon Tyne, ENG, United Kingdom